On the Horizon of Spinal Surgery

Minimally Invasive Approaches

Minimally invasive spine fusion surgery may be improved by new imaging systems that are in development. These systems provide computerized three-dimensional images, which increase the accuracy of identifying anatomic structures.

Currently there are systems available that can present the surgeon with three dimensional imaging (CT images) intra-operatively. Such systems are not widespread and the images are at present not as clear as a regular CT scan, but can certainly be useful especially for evaluation of the position of the hardware such as pedicle screws.

Robotic surgery is another technology that is on the horizon. It should increase the accuracy of minimally invasive spine surgery techniques and make them highly reproducible. The marriage of robotic technology with three-dimensional image guidance should allow for more advances and improvements in spine surgery.

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Motion Preservation Approaches

Additional developments in spine surgery will very likely be distinguished not only by advanced minimally invasive fusion techniques, such as imaging and robotics systems, but by new philosophies of treating spine disorders. For example, artificial discs have introduced a new field of spine surgery known as non-fusion or motion preservation techniques.

Artificial discs may have the potential advantage of maintaining most of the motion in the spine segment that is treated, rather than eliminating it as a fusion does. This may restore the spine more closely to normal function, and lessen the long-term detrimental effects of fusion surgery on discs at adjacent levels of the spine. The discogenic pain associated with pseudoarthrosis (failure of the bone to fuse) would also not be an issue with an artificial disc.

Other motion sparing technologies are in the process of being developed and some are under going clinical FDA trials. At present the artificial cervical disc is being tested in clinical trials across the country. These discs may provide stability in the cervical spine after removing the disc, with the advantage of maintaining motion. The other potential advantage would be that it may spare the next level from degenerating. None of the claims above are proven, and that is why they are considered investigational. In addition to artificial discs, developments in other motion sparing technologies are underway.

Written by Ali Araghi, DO