As enabling technologies become more widely adopted in spine surgery, there is a concern that the next generation of surgeons may rely too heavily on these innovations to guide them through procedures.
Four spine surgeons reflected on what the advancement of enabling technologies means for the future of the specialty and why developing a complete understanding of the anatomy will remain critical in spine care.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.
Next week's question: Why has the pace of spine surgery migration to ASCs not kept up with that of joint replacement in recent years?
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Editor's note: Responses were lightly edited for clarity and length.
Question: Is there a danger of the next generation of spine surgeons becoming too dependent on enabling technologies?
Wesley Bronson, MD. Mount Sinai Health System (New York City): Enabling technologies, including robotics and navigation platforms, have allowed spine surgeons to enhance the safety and efficiency of spine surgery. As more surgeons incorporate these modalities into their practice, residents and fellows will similarly be exposed to them in their training. It certainly is the case that resident and fellow education has the potential to be compromised by overreliance on these tools.
If educators focus too much on these technologies without teaching the fundamentals of spine surgery, new spine surgeons entering practice may lack the ability to perform surgery without them. It is the responsibility of both residents and fellows as well those training them to always focus on the basics, even if certain technologies are being used for the case. The thought "what would I do if the navigation wasn't working today?" should always be present.
Ehsan Jazini, MD. Virginia Spine Institute (Reston): The next generation of spine surgeons must be able to do every aspect of spine surgery without the assistance of enabling technology. The most important skill set for a spine surgeon is being able to deal with option A, B and C. And that means that the surgeon continues to refine and improve upon what option A is by using enabling technologies such as robotics and augmented reality to improve the precision of surgery, do more minimally invasive surgery to help patients recover faster with fewer complication but also always have option B and C in the back pocket.
Tibor Boco, MD. NorthShore Neurological Institute (Arlington Heights, Ill.): One of the most important components of training to become a competent spine surgeon is to develop an appreciation of the anatomy and how it extends in the 3D space beyond direct visualization. This skill is essential to accomplish adequate decompression and effective instrumentation. Enabling technologies, such as image guidance and robotics, are great adjuncts in our operative armamentarium but should not replace a thorough understanding of the anatomy.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: A discussion I frequently have with both my reps and those who train residents is there is a genuine concern of the overreliance on tech. Surgeons of a certain vintage who trained on anatomic techniques were slow to adopt them. The next generation seemed more comfortable but were also trained in the backup plan of mapping hardware placement using landmarks and aided by fluoroscopy "just in case." The following generation I hope can still do this.
My concern is that instead of verifying and then proceeding, some will just charge ahead, assuming the navigation or technology is spot on. It's more concerning when you think about who exactly is liable when the technology is "off." I hope the next set of surgeons can see its shortcomings and that the need for anatomical knowledge is paramount.