From the advancement of robotics and advanced imaging systems to innovations in motion-preservation technologies, eight surgeons discuss key trends in minimally invasive spine care.
Note: Responses are lightly edited for style and clarity.
Daniel Lieberman, MD, Phoenix Spine & Joint: Over the last five years we've seen real energy pulling away from deformity correction and multilevel fusion surgery, and the entire field of spine surgery moving into much more focused interventions based on structure. I think the next horizon is focused interventions based on symptoms. What patients really are concerned about is their pain. Our surgery centers offer endoscopic dorsal rhizotomy, so ultra-minimally invasive surgeries that eliminate pain are really the next horizon. It's almost like we're going to see spine surgery absorb and move into more of a pain management approach, rather than a structural correction approach.
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.
K. Samer Shamieh, MD. Avala (Covington, La.): There are two major categories of possible advancement in minimally invasive spine surgery. Strides in disc and cartilage regeneration in the facet joints seem to be a hot topic these days. But the next big advancement is joint and replacement surgery, which has exploded with the aging population. I would like to see facet joint replacement become a real option for surgeons. Advancement in the quality of lumbar disc replacement is going to be the next great step, as joint replacement is the future of spine surgery.
John Liu, MD. USC Spine Center (Los Angeles): Minimally invasive surgery has come a long way since I started practice in 1999. However, there currently are still very few cervical MIS options for decompression and fusions that are reliable and consistent. I would like to see the use of robotics or advanced imaging and navigational systems to help us tackle these cases to provide more options and quality of life for patients.
Robert Eastlack, MD. Scripps Health (San Diego): We are in an exciting era of spine surgery, in which there have been vast improvements in both our implants and their application toward the benefit of our patients. As we strive for still further refinements in the accuracy and safety of surgery for our patients, as well as looking to avoid the dramatic occupational exposure we as surgeons likely suffer at the hands of ionizing radiation, robotics married with computerized navigation will surely be a keystone for our future practice. It is imperative that we guide the development of these technologies, such that they can be properly validated to do what we need in an effective and reasonably efficient manner.
Additionally, we must evaluate and iterate its application toward good stewardship of our health economy, keeping in mind that the cost of technology should follow a downward trend with time. Another interesting serendipitous benefit of these augmentative tools has been a subjective diminishment in surgeon fatigue realized by early adopters. Should this outcome be legitimized, application of these technologies could very well result in higher productivity, and perhaps even greater career longevity. In the end, I believe robotics will revolutionize much of what we do in spine surgery, and there will be a time in the not-too-distant future, that they will be incredibly effective extensions of the surgeon, making us better, faster and more productive.
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 in spine. Since MIS results in less pain and quicker recovery, it will drive more spine procedures out of hospitals and into the ASC setting.
Brian Gantwerker, MD. Craniospinal Center of Los Angeles: The increasing minimization of surgical techniques and the development of great expandable devices piques my interest. I am finding myself using expandable cages more and more as they really help avoid making more "flat back" patients. It is reassuring when instead of doing five-level fusions, you can focus on one level, correlate with the patient's symptoms and films, do a great job and give them lasting relief.
Srdjan Mirkovic, MD. Northshore Orthopaedic & Spine Institute (Chicago): I see two big minimally invasive spine surgery innovations in spine care. First, robots have advanced in spine surgery. Robotic and free-hand spine surgical procedures are proving to insert screws with great precision and accuracy for surgeons. Secondly, we are managing pain much better through more aggressive, nonoperative steroid injection protocols.