Four spine surgeons outline what technologies they see making the next big breakthrough in the field.
Question: What technologies do you see making waves in the spine field?
Peter Derman, MD. Texas Back Institute (Plano): I hope that we will look back 10 years from now and think that the surgery we were doing in 2020 was archaic. In the future, I think that far fewer fusions will be performed as disc replacement and other motion preserving technologies continue to improve. I am also excited about endoscopic spine surgery, which is becoming an increasingly large part of my practice. It is a true paradigm shift in the field, which allows surgeons to access and address spinal pathology without the morbidity associated with traditional techniques. In many cases, it allows me to perform an ultra-minimally invasive decompression when a fusion might otherwise have been necessary. Patients are comfortably home within hours of surgery and often only take Tylenol for postoperative pain control in the days after the procedure.
Stephen Hochschuler, MD. Texas Back Institute (Plano): It's my belief that we will see many changes in spinal care delivery. Just as there has been a convergence of cardiovascular surgery and interventional cardiology, I believe spine will see an acceleration of the convergence of spine interventionalists with spine surgeons. The spine world has already accepted that interventionalists (physical medicine and rehabilitation physicians, anesthesiologist/dolorologists and interventional radiologists) utilize dorsal column stimulators. In addition, interdiscal injections, minimally invasive rhizotomies, facet and epidural injections are all accepted by the spine world.
More recently, Boston Scientific acquiring Vertiflex has opened interspinous, mini-open surgery to this group. Despite some criticism from the surgical world, this is happening and I believe will progress. Elsewhere, I believe regenerative spinal medicine, new image guidance technologies, motion preservation technologies, informatics and artificial intelligence, as well as population health applications for spine are all on the horizon.
Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): There will be continued drive toward minimally invasive procedures, especially for the lumbar spine. There are a lot of new technologies coming out to increase precision of the surgical procedure and implant placement through navigation, robotic technologies and augmented reality. Less invasive procedures with the same or better outcome than traditional open techniques are already being done routinely, but not widely adopted. We now have more scientific evidence showing the benefits of MIS procedures in spine. We also have better technologies to shorten the learning curve, minimize complications and lower radiation exposure to the patient and surgeon. All of this will help with wider adoption of MIS surgery in spine. Since MIS surgery results in less pain and quicker recovery, it will drive more spine procedures out of hospitals and into the ASC setting.
Ara Deukmedjian, MD. Deuk Spine Institute (Melbourne, Fla.): The most significant innovation in spine care in the last decade is our ability to cure chronic back or neck pain. In the past, curing CBNP wasn't possible as we did not possess a complete understanding of the exact causation of pain in the back or neck in every patient. With advanced diagnostic testing, physicians can now pinpoint the source of each patient's pain in their back or neck and within hours of their initial office visit. Although each patient does have a unique combination of pain sources, almost like a fingerprint, the actual pain generators — joints, disc, ligaments and muscles — are now well understood. There are specific treatment strategies that completely cure pain at its source and without pills, ongoing injections or extended courses of therapy. One of these advanced therapies is an endoscope and medical laser used to repair painful bulging, herniated or degenerated discs in the neck or back.