Spine tech's future in 4 insights

Spinal Tech

Spine navigation, robotics and endoscopic tools are three areas that have seen significant growth within the specialty.

Four spine surgeons spoke with Becker's about what the next generations of these technologies will look like.

Spine navigation and robotics

Frank Phillips, MD. Rush University Medical Center (Chicago): In 2025, navigation techniques will increase in sophistication and likely involve a combination of augmented reality and robotic technologies. More complex surgeries such as multilevel decompressions and osteotomies will be performed with augmented reality technologies. We will also see the ability to create segmented CT scans from routine pre-operative MRI studies eliminating CTs from the process. Machine learning technologies will further facilitate our ability to navigate without the need for advanced imaging. Enabling technologies will likely evolve to include superimposed real time bone and soft tissue images (such as nerves or blood vessels) visualized with 3D augmented reality. 

Jason Lowenstein, MD. Morristown (N.J.) Medical Center: I think incorporating all aspects of spine surgery within the robotic platform is going to be the evolution. Over time there may be the opportunity to have the surgeon not be directly on top of the patient, but utilizing the robot from a short distance. That's probably where robotics will go over time. It's been a big jump just using robotics the way we're using them now, and I think it's going to take time for spine surgeons to feel comfortable using it effectively and making it a win in the operating room. 

Endoscopic spine surgery

Ezriel Kornel, MD. Somers Orthopaedic Surgery and Sports Medicine Group (Carmel, N.Y.): I believe we'll see a significant increase in endoscopic spine surgery. Surgeons are already exploring endoscopic approaches for more complex procedures, such as laminectomies and cervical surgeries. Future advancements will likely include a broader range of equipment specifically designed for endoscopic use, enabling procedures to be performed through small, "stab-wound" incisions.

As the technology evolves, we’ll also see the development of more specialized tools and techniques that allow surgeons to address various areas of the spine with greater precision and efficiency.

Daniel Park, MD. Michigan Orthopedic Surgeons (Royal Oak): I believe endoscopic spine surgery won't be uniportal versus biportal. There will be certain situations where uniportal will be preferred such as in thoracic cases and certain situations where biportal shines such as cases where more bony work needs to be performed. The next generation will be the endoscopic evolution where the entire platform will progress to more ergonomic friendly instruments and higher resolution visualization. The biggest hurdle, however, will be industry support and the financial constraints. The capital cost of some endoscopic systems is too great and the disposable cost of doing the cases cuts into the margin of the case. As cases migrate into the surgery center and surgeons need to be cost conscious, the ability of endoscopic companies to deliver innovation while minimizing costs will be the lynchpin in the greater adoption of this skill set. Furthermore, I strongly feel the traditional spine companies will need to join hands with these endoscopic companies to provide more ways to provide innovation as endoscopic spine surgery expands from just laminectomy and discectomy to fusions. 

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