From the rise of robots to the use of big data and a move away from hospital-owned practices, changes in the field of spine surgery will be very evident by 2030, six spine surgeons predict.
Note: Responses are lightly edited for style and clarity.
Question: What will spine surgery look like in 2030?
Oren Gottfried, MD. Duke Health (Raleigh, N.C.): I am hopeful that advances and validation of predictive analytic tools and use of big data will allow spine surgeons to precisely focus care on the right patient at the right time and with the right surgery. Also, there will be improved standardization of all spine surgeries to reduce variability in cost and quality, thereby maximizing value. There will be greater enforcement on only practicing evidence-based guideline concordant care. Further, more patients who need or will only benefit from conservative treatment would see and be managed by primary care teams, physical therapy, chiropractors and other clinicians, reducing unnecessary and costly visits to spine surgeons. Surgeons will be incentivized to only provide low-cost, high quality care.
Additionally, there will be more successful efforts and algorithms to achieve better optimization of physical and mental health before surgery, and we'll do better to improve outcomes to populations who have not previously benefited from spine surgery, or have had poorer outcomes. As spine surgeries will have improved and more predictable outcomes and procedures become even less invasive, we will see a reduction in patients' time off work and quicker recoveries. There will likely be fewer spine Centers of Excellence destinations, and patients may have to travel out of state more often to these locations providing the best outcomes at the lowest cost. We will push the limits of outpatient surgery by better methods of postop pain control and even less invasive surgeries. Finally in this prediction, patients and spine surgeons will have access to significant and specific outcome and quality data when making decisions on surgery.
Ronald Lehman, Jr. MD. Columbia Orthopedic Surgery (New York City): Spine in 2030 will look very different than it does currently. One of the fascinating things about the current advancements in spine surgery is that we are moving toward spine 'solutions' and not just using and placing 'widgets.' The advancement in technology is rapidly changing the landscape for us and we are truly embarking on surgical synergy. We now have very advanced ability to:
1. Plan surgical strategy with advanced planning platforms.
2. Safely, reliably and expeditiously place implants.
3. Using machine learning and artificial intelligence to 'predict' the correction and define the goals for our surgery.
4. We have the ability to appreciate if we have achieved the desired goals of the surgery intraoperatively.
5. We will advance incorporating EMR and long-term follow up with patient-specific monitoring after they leave the hospital.
It is an exciting time for spine surgery, and we will truly have a more comprehensive approach to the patients in terms of planning, execution and patient-reported outcomes. Using data and predictive analytics will allow us to tell each patient what their 'expected' results will be before they consider a spine surgery, and also perhaps who best to perform the surgery as all of our metrics, as surgeons, will be available as well.
Chris Summa, MD. Sutter Health (Sacramento, Calif.): Spine Surgery in 2030 will be utilizing refined technologies and philosophies that have begun entering mainstream practice over the last 10 years. Between motion preservation, minimally invasive procedures and comprehensive image guidance systems, patient outcomes will be notably improved. Spinal arthroplasty will continue to be shown to have less adjacent level degenerative changes and updated devices will allow improved visualization of neural elements following implantation that we do not currently have.
Surgical procedures will be more efficient with smaller exposures and less collateral damage, shortened anesthetic/operative times. As a result, hospital stays will be shortened and an increasing number of these procedures will be performed outpatient. [Enhanced recovery after surgery] protocols will facilitate quicker recoveries for patients and a more rapid return to their desired level of activity. Lastly, image guidance systems will become more encompassing, involving and integrating many different aspects of the more complex surgical planning and procedures into a relatively simple, straightforward process that allows for greater reproducibility and safety.
Thomas Schuler, MD. Virginia Spine Institute (Reston, Va.): Fortunately, we are living in the 'bio-century.' This means great advances have, and will continue to come from the rapidly evolving field of genomics. Stem cell therapy will enable us to heal injured tissues without surgery in many cases. We are already seeing great strides using concentrated bone marrow aspirate to stabilize degenerative discs and ligaments. This is standard care in the equine world today. The medical world is lagging. The same was true in the 1990s when the idea for a threaded anterior lumbar interbody cage was 'borrowed' from equine veterinary medicine. Now anterior interbody cages are essential.
Motion-preserving surgeries will become standard in 2030 as insurance companies finally accept that this is not experimental. This will be especially true for multilevel pathology. Minimally invasive technology will advance with multigenerational improvement in robotics, image guidance and augmented reality. Patients will get better improvements with fewer iatrogenic problems and fusion disease because of all these advancements.
Domagoj Coric, MD. Carolina Neurosurgery & Spine Associates (Charlotte, N.C.): Spine surgery in 2030 will be permeated by intraoperative navigation and the rise of the robots. Spinal navigation will become the standard of care, as misplaced instrumentation and subsequent return to the operating room for revision become viewed as 'never' events. Robot-assisted surgery will be widely adopted and expand to routinely involve decompression as well as interbody device placement. Precise ultrasonic bone-cutting instruments will make rudimentary cutting tools such as osteotomes and rongeurs obsolete.
Spinal arthroplasty will be more pervasive, including the first FDA approvals for posterior lumbar arthroplasty devices as well as hybrid fusion/total disc replacement indications for cervical and lumbar indications. Population healthcare delivery and spine bundles for outpatient cases ([anterior cervical discectomy and fusion], cervical total disc replacement, discectomy, decompression, etc.) and one- and two-level degeneration fusion cases will be the norm.
Thomas Loftus, MD. Austin (Texas) Neurosurgical Institute: I would expect spine surgery to involve more technology integration. Robot-assisted surgery in the spine still has significant limitations, but I would expect with time these will be improved upon. From a practice standpoint, I hope there will be a swing back toward more private practice offices and away from hospital-owned practices. The dynamic flexibility and patient-focused care of private practices are being eroded currently, but I expect the pendulum will swing back over time. Whether the government will succeed in trying to take over its citizens' healthcare completely remains to be seen. I expect more encroachment on individual choices in their healthcare, but I hope there will still be a rigorous defense of free will for patients in their healthcare options.