Rajesh Arakal, MD, of Plano-based Texas Back Institute, has become an expert with spinal navigation technology and said he sees artificial intelligence as a potential game changer in the space.
He closed 2024 by completing his 1,000th case with Stryker's Airo spine imaging technology in December, an achievement nine years in the making.
When TBI made the purchase nine years ago, surgeons were looking to solve challenges with radiation exposure and workflows, he told Becker's. The Airo system has helped improve surgical precision and uses an intraoperative CT scan to support physicians.
As with any new spine technologies, Dr. Arakal said there was an initial learning curve using it.
"Early on, we started really very conservatively with smaller type procedures, and we wouldn't use it universally," he said. "Now for almost any instrumented case, we are using this because it's so much more superior to the older techniques or freehand methods."
Dr. Arakal came from a training program that performed freehand spine surgeries without relying too much on technologies. However that sometimes led to cases where freehand techniques weren't enough.
"There are occasionally procedures where the anatomy was difficult and the pedicle was really difficult, and that would take a long time to correct or change," he said. "It created a huge problem for consistency. If you're trying to be efficient, those efficiencies would be undercut if you have a stumbling block. What we're finding is with these technologies, things can be much more reproducible. Even in the cases where there's difficult anatomy, we can reliably get the screw in that really tight space, or not have an error which would require us to reposition or correct during surgery."
In his practice, spinal navigation technology helped him cut down surgical times for instrumented cases by almost two thirds, benefitting the surgeon and patients.
Thinking about the next generation of spine innovation, Dr. Arakal said he thinks AI will play an integral role, especially with its concept of "continually learning."
"The concept of continual learning may allow for better capabilities of real time navigation," he said. "Some of the issues that we have are if the marker gets dislodged. It's a very archaic system of relying on a single marker, and I think in the future if there is better capability to flag inaccuracies, it may allow for earlier assessments if things need to be readjusted. Or if it needs to be recalibrated. If something is off, the machine learning can readjust and then keep it accurate again, which would be the holy grail for all of these navigation pieces."
AI also has the potential to improve precision in different types of spine care and help surgeons think on their feet.
"We're now using it to know where the bony landmarks are in revision cases," he said. "We're using it in trauma cases to assess how well we reduce a burst fracture, for example. We're making real time surgical decisions about how much surgery we do based on the navigation feed. The other part of it is in some infectious cases it would be really hard to know where things are. So we are now doing it in thoracic cases because we can count multiple levels. We have much larger capabilities to count intraoperatively and reassess and make sure that those treatments are being placed at the right level."
And at Texas Back Institute, leaders are keeping their eyes on the latest innovations.
"We are continually trying to keep pace, and we are always kind of looking at whatever technologies there are," Dr. Arakal said. "In 2025, I know all of these companies will probably have newer renditions or newer options. A lot of these are expensive endeavors and investments. But in these kinds of cases where there is a huge impact, a lot of the hospitals are able to retrieve those economic costs in savings based on efficiencies of time and getting more procedures done in the same amount of time. So they are making it up in efficiency."