Four spine surgeons talk about which spinal technologies they see the most potential for positively impacting patient care.
Jeffrey Goldstein, MD, Director of Spine Service, NYU Langone Medical Center’s Hospital for Joint Diseases:
Positive impact in patient care will be seen in technologies which focus on restoring function. This will include implants that seek to restore normal sagittal alignment, such as hyperlordotic interbody cages. Fusion devices that enhance or program bony integration with nanotechnology will enhance patient outcomes. However, motion preservation devices, such as artificial disc replacements, need to demonstrate through level one data that they can fulfill their promise in the long term. We now have good five-year plus data demonstrating their benefits.
Fusion devices that enhance or program bony integration with nanotechnology will enhance patient outcomes.
Jeffrey Wang, MD, UCLA Spine Center:
These days, spinal technologies are a bit stunted due to the environment. However, I am excited about new biological treatments that may come out in the next five years. As for technologies that are available now, I find dynamic MRI studies very interesting. I think we are learning more about spinal stability and spinal pathologies with dynamic MRI studies. We have done a great deal of research in this area, and I find it fascinating. These dynamic studies are revealing more pathologies in the spine and allowing us a better understanding of the biomechanics of the spine. This is translating into understanding the disease processes of the spine, which may allow us to find better treatments for our patients..
Vincent Arlet, MD, Orthopedic Spine Surgeon, KneeFootAnkle Center of Kirkland (Wash.):
Technologies that provide a better understanding of the overall balance of the patient and what he needs to be improved will provide improved care, and technology that can provide prophylaxis of spine diseases at their very onset.
Nick Shamie, MD, Neurosurgeon, UCLA Spine Surgery:
Compared to 10 years ago, we have seen a significant retraction of new technology introduction in the spine surgery arena. Decreased funding for research and development and more rigorous approval processes are the main contributors to this retraction. Regenerative technologies for treatment of spinal disc degeneration show great promise but we are several years away before they are introduced in spinal surgeons’ armamentarium. Less invasive surgical techniques are slowly evolving and are being applied to daily clinical practices.
The challenge will be to educate the surgeons in proper utilization of these technologies; stretching the indications for many of these new technologies has led to sub-optimal results for our patients.
I have always believed that the excitement of utilizing novel minimally invasive surgeries should not lead to minimal treatment for our patients; and sometimes more extensive surgery is indicated to improve the patient’s spinal health.
Spinal arthroplasty has been proven in numerous clinical trials to be equal or superior to fusions in treatment of lumbar and cervical disc disease and neural compression. Many new technologies are based on predicate devices and don’t truly change the immediate outcome for our patients. SI fusion and interspinous devices are new technologies that have shown great promise.
We have seen an explosion of various implants as interspinous spacers and fusion devices. X-Stop and coflex are FDA approved. The growing epidemic of lumbar spinal stenosis in an elderly population will create an increased need for the utilization of these implants. These technologies help us treat LSS minimally invasively and without the need for general anesthesia, which in some cases is not possible in this patient population.
The SI fusion technologies treat a condition that remains under diagnosed due to lack of good understanding of causes for sacroiliac pain. Furthermore, open techniques for fusion cause significant morbidity and minimally invasive fusion techniques have created a renewed interest in treatment of sacroiliitis.