Roger Hartl, MD, professor of neurological surgery and director of spine surgery at Weill Cornell Medicine in New York City, as well as director of the Weill Cornell Medicine Center for Comprehensive Spine Care, discusses the key trends in spine technology to consider in the future.
Question: What emerging technology or technique will have the biggest impact on the field over the next five years?
Dr. Roger Hartl: We are seeing an emergence of surgical navigation (including robotics but this is a subset of overall navigation and still in its early stages), surgical planning and simulation, and virtual reality technology that will significantly change the way that we will plan, perform and assess spinal surgery for all types of pathologies. Deformity is a clear and obvious target, but this will expand into degenerative and revision surgery, tumors etc.
Biologics are starting to enter the surgical arena, but we are still at the beginning. We need better data that biologics really have an impact on disc regeneration and repair. Many groups are working on this and we will likely have much more and better evidence soon. Also, the advantages of tissue engineering (in addition to just injecting cells) have not been taken advantage of. So far, we just use cells but a combination with tissue engineered materials and strategies for annular repair and disc regeneration may have an additional positive impact.
Q: Where are the biggest opportunities for innovation in spinal biologics? What are you working on right now and what is the potential to impact care?
RH: In my opinion annular repair is the most obvious target for biologics. It's an obvious and huge clinical problem and our patient clearly understand this. For example, many of my patients will ask: "After you have removed the herniated disc, what will you use to seal the hole in the disc?" We have made significant improvements in developing compounds that have the ability to quickly and effectively seal the annular defect that is created by a disc herniation and/or by the surgical discectomy. Combining this with cellular therapy results in a greater ability to achieve short-and long-term annular sealing and repair. Animal data are promising, and we need to translate these results in order to move them into the clinical arena.
A few groups, including ours, are working on total biological disc replacement that will eventually replace cervical disc arthroplasty and maybe even offer new options in the lumbar spine. This is very exciting and will require the combination of biologics, tissue engineering, but possibly also the combined use of other technologies such as resorbables.
Q: What technologies or techniques do you think will become less common or fade over the next few years?
RH: The combination of MIS, biologics for disc repair, regeneration and replacement, better surgical planning (navigation/robotics) and a better understanding of the pathophysiology will result in a reduced need for fusion surgery. This will take some time but will surely happen. As surgeons, we can decide to be at the forefront of research and innovation or have insurance carriers and governmental decision-makers take the lead.
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