Personalization will be a key factor when it comes to the future of spine implants, some surgeons say.
Six spine surgeons discuss what's next for spinal implant technology.
Note: Responses were lightly edited for clarity.
Question: What does the future of personalized spine implants look like?
Michael Gallizzi, MD. The Steadman Clinic (Vail, Colo.): Custom total knees have paved the way for personalized orthopedic implants, demonstrating some value of tailored solutions for the overall continuum of care, OR time, sterile processing, number of trays, etc.
Patient-specific spine implants are following a similar trajectory, but their adoption will be slower due to the complexity of spine surgery and the need for more comprehensive clinical evidence.
Currently, tumors, severe deformities, sacral pathologies are leading areas for these custom implants, but with the high cost of manufacturing, applications in the adult degenerative space are more limited and less likely to have a dramatic improvement in outcomes.
As the technology advances and clinical data accumulates, patient-specific spine implants are likely to gain wider acceptance, mirroring the success of custom total knees. However, the spine market's unique challenges and regulatory landscape may influence the pace of adoption.
Morgan Lorio, MD, of Advanced Orthopaedics and Pain Management (Orlando, Fla.) and ISASS president (2024-2025): The future of personalized spine implants is poised to revolutionize spinal surgery through the cutting-edge technology of 3D-printed titanium spinal interbody fusion cages. These implants, precisely tailored to each patient's unique anatomical and mechanical needs, will deliver unparalleled patient outcomes by promoting robust bone growth and providing exceptional bio-support for spinal fusion procedures. Leveraging titanium's superior biocompatibility, strength, and corrosion resistance, these custom implants will ensure optimal osseointegration and long-term success.
The true game-changer is the meticulous design flexibility of 3D printing, allowing for varied pore sizes and shapes that enhance osteoinduction and osteoconduction. This creates an ideal environment for bone growth, facilitating the migration, attachment, and differentiation of bone-forming cells while supporting vascularization and nutrient diffusion. Ultimately, adjunctive bone grafts will be eliminated, costs reduced and surgical procedures streamlined. Surgeons can anticipate a new era where these state-of-the-art implants not only meet but exceed the demands of complex spinal surgeries, delivering unmatched precision and patient care.
Lali Sekhon, MD, PhD. Spine Surgeon at Reno (Nev.) Orthopedic Center: It has a future but mostly for congenital anomalies. The price point is a big issue with a fourfold cost. It's never really taken off in orthopedics and they are generally five years ahead of spine.
Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): With the currently available inventory of various implant sizes, expandable spacers and ability to preplan and then execute an instrumented spine surgery using robotic/navigation systems there is already a great ability to customize the implants to each patient's anatomy. Getting a personalized implant specifically manufactured for a particular patient is still cumbersome, time-consuming, and more expensive. I think it will remain a "niche" sector with a low volume of production targeted for occasional patients with very unusual anatomy.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: There are many challenges to standard implants in spine surgery. We know that problems like subsidence occur due to imperfect fit of implants. Also importantly, achieving the perfect alignment may not be possible with standard implants. These are big opportunities for personalized implants. However, highly personalized implants have their own challenges. Designing implants to fit perfectly to a patient's spine means that the surgeon has to be able to fit that implant perfectly during surgery. This is not always possible given the constraints of exposure, nerves, and the patient's anatomy. We will need to continue to think about how personalized implants can be designed in a way that anticipates surgical constraints and enables us to maximize the benefits at the same time.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Sooner than later the entire rewrite of implant surgery will be personalized, of course providing cost and reimbursement. Three-dimensional design and onsite fabrication will emerge as state-of-the-art applications emerge. Formulating differences in bone structure. And angulation coupled with immediate OR creation of product is in the pipeline. The future is now.