Zoher Ghogawala, MD, FAANS
Charles A. Fager Chairman, Department of Neurosurgery, Lahey Hospital and Medical Center
Professor, Tufts University School of Medicine
Neurosurgeons have long been at the forefront of discovery in understanding spinal pathology and treating disorders of the spine. Innovations in medicine, imaging, anesthesia and surgery have already radically changed our ability to diagnose and treat patients suffering from spine problems, yet innovation continues to push the frontier, offering an even brighter future for patients. We asked five surgeons recognized for their spine expertise to gaze into the future. Here’s what they see!
Michael Y. Wang, MD, FAANS, University of Miami
Major evolution will be seen for minimally invasive spine surgery (MIS), such as Endoscopic surgery (operating through a very small incision using a specialized camera). Soon, endoscopes will easily interface with other technologies including localization through image guidance (think GPS systems), electrophysiology and near-field electron microscopy. Advances in the endoscopes themselves will involve stereoscopic visualization along with larger working channels, allowing manipulation of tools/instruments in multiple planes. Finally, specialized delivery of molecular soft tissue management systems will create new treatment options that will increase utilization of endoscopic techniques for spinal surgery.
Praveen V. Mummaneni, MD, FAANS, University of California, San Francisco
Advances in computer technology will impact the quality and safety of spine surgery. Specifically, Robotic surgery will increasingly be used for placement of pedicle screws. Merging navigation with robotics increase the safety and efficacy in treating more complex cases including spinal deformity while decreasing tissue trauma and blood loss. However, a surgeon’s experience, understanding of spinal disease, and the connection with the patient cannot be reproduced by a robot.
Charles L. Branch, Jr., MD, FAANS, Wake Forest University
Merging Video Microscopy with 3D imaging will:
- Improve surgeon ergonomics for minimally invasive surgery (MIS);
- Enhance the education platform students; and
- Augment operative team cohesion.
Currently, using the microscope with tubular portal access or MIS midline approaches obligates the surgeon to adopt a less favorable posture because of the required microscopic line of exposure. Development of video microscopic technology provides high-resolution imaging of the operative field even through an MIS portal. It also frees the surgeon to maintain good posture and ergonomic advantage. The ultra-high definition 3D images create an almost lifelike educational platform for everyone in the operating room and for streaming beyond. This technology realizes another step toward realistic simulation capability, which will dramatically advance surgical skill development, especially in the MIS spine arena.
K. Daniel Riew, MD, Columbia University
Artificial discs will continue to improve in design and insertion. This will mean that cervical arthroplasty will become more widely adopted. Many of the patients that currently are treated with fusions will maintain more physiological spine function. As we live longer and remain more active, this will be increasingly important.
Steve D. Glassman, MD, University of Louisville
Innovations will dramatically impact adult spinal deformity correction. At present, our evaluation of adult patients suffering from curvature of the spine (medically known as deformity) is based on static alignment, which is how our bones line up when we are in just one position. We talk about the sagittal balance of our spines, but we only measure sagittal alignment. An improved understanding of spinal balance requires that we evaluate how the bones of the spine are positioned when in motion. Biomechanical technologic advancements in force plate and motion sensing technology are bringing us closer to this capability. Better quantification of balance should translate into improved risk stratification and more reliable outcomes for surgical patients.
Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #SpineMonth.