"Spinal deformity surgery today is safer than ever before," Munish Gupta, MD, told Becker's Spine Review, following the fourth edition release of "The Textbook of Spinal Surgery," which he and his colleague Keith Bridwell, MD, edited.
"Preoperative optimizations have improved and we've learned more about the importance of bone density," said Dr. Gupta, who practices at St. Louis-based Washington University School of Medicine.
"The population is getting older and living longer. They don't want to live with a deformity because they get disabled. Now we can really change their life in terms of improving their ability to function and decrease their pain. Surgeries are being performed more often and there are more surgeons who can take care of these patients, so the number of cases is growing."
"We're now doing prehab — physical therapy and conditioning — so patients can tolerate procedures and recover better," Dr. Gupta said. "We have improvements in techniques such as anterior or lateral approaches to release the spine so we can make the spine limber and correct it."
Advancements in deformity care and techniques
Postoperative care is also improving, according to Dr. Gupta, with anesthesiologists learning how to take care of patients both intraoperatively and postoperatively. However, he signals the need to proceed with caution, especially in older patients, where there is still a significant complication rate.
Drs. Gupta and Bridwell's book, "The Textbook of Spinal Surgery," looks at degenerative spine disorders, spinal deformities, tumors, fractures and infections and features an ebook component, which can be used as a reference as well as for learning.
One primary area of revision for the textbook is severe deformity corrections, due to the development of osteotomy techniques in spine.
It also dives into advancements in minimally invasive surgery and early onset scoliosis, which is defined as curvature of the spine in children from birth to 5 years of age.
"We focused on how to tackle that because you don't want to fuse the spine when patients are so young. You must have a way to let the spine grow," said Dr. Gupta, who has more than 27 years of experience treating spinal deformities. "There are new techniques like implanting rods with a magnetic motor, so you don't have to make an incision every 6 months to do the lengthening."
Putting spine in perspective
When reviewing a topic on spine, the literature has the capacity to be overwhelming because it is often incomplete or confusing due to the wide variation in viewpoints, said Dr. Gupta, who has three children studying medicine — one in each of urology, ophthalmology and orthopedics.
"This book puts things in perspective and also gives the historical and complete perspective on topics. Trainees — especially residents and fellows — need to learn all that because if you don't have the basics, then reading what's current does not put everything in perspective."
Developing technologies such as bone grafting and biologics for spinal fusion are also covered in the book, which features more than 4,000 illustrations for visual context.
Techniques have also improved in terms of bone fusion, with bone morphogenetic proteins far more prominent now than 20 years ago, according to Dr. Gupta.
"However, older patients don't fuse their spine as well as younger patients, so we have several adjunct products that can extend the bone graft material," he said. "We have lots of products on the market now that are helpful in achieving fusion, rather than using the patient's own bone. I think BMP has improved the fusion rate in adult deformity."
It's unclear whether any of his children will one day pick up "The Textbook of Spinal Surgery," but Dr. Gupta highlights the importance of medical students paving their own path.
"I try not to pressurize them into going one way or the other," he said. "It's a long life so you have to do what you truly enjoy because you're going to do it for a really long time."
"You're also more likely to be really good at it if you enjoy it."