Technological developments in spine are occurring at an ever increasing rate, but what does this mean for patients? To date, most new technologies have involved reducing the postoperative pain and speeding recovery, and lately, technologies to preserve motion in the spine (as opposed to a fusion).
None of these technologies, however, change what we as surgeons can treat. Indications for spine surgery for pain are still limited to decompressing a nerve root or stabilizing a painful motion segment. Spinal conditions that include an anatomical defect that causes nerve root pinching or a painful motion segment may be amenable to surgical correction. Patients that have back pain that cannot be attributed to either of these problems still do not have a surgical option.
Often, new technology represents more of a marketing tool for physicians than a true advancement in patient outcomes.
Surgical success is mostly determined by first having an accurate preoperative diagnosis, not by what technology is used to do the surgery. Even the best technology will not be useful if what is operated on is not what was causing your pain.
Spine surgery is like any other field of medicine in that it is really more of an art than a science. Practicing spine surgery involves trying to improve ones techniques for accurately diagnosing patients’ problems, and then improving ones surgical technique. To some extent, all this focus on new technology can be a distraction. Often, new technology represents more of a marketing tool for physicians than a true advancement in patient outcomes.
This is not to say new technologies are not helping. Patients in particular need to temper their enthusiasm and be realistic about what can and cannot be accomplished. Truly useful technologies often take years to be verified. There are multiple technologies that were once thought to be the next best thing for back pain but are no longer used. Technologies such as chemonucleosis, percutaneous discectomies, laparascopic lumbar fusions, and to some extent, intradiscal electrothermocoagulation (IDET). At one time or another all of these technologies had seemed to hold the promise of a significant advancement in treating low back pain but have now been largely or completely abandoned.
Just as in the rest of life, with back surgery there are no simple answers, and relying on new technologies alone to improve outcomes is probably not going to be all that reliable. The judicial use of newer technologies combined with rigorous scientific study holds the promise of eventually improving overall patient outcomes. In my opinion, an accurate preoperative diagnosis trumps any of the new spine technologies, and always will.