Technological developments in spine surgery are occurring at an ever-increasing rate, but what does this mean for you?
To date, most new technologies have focused on goals such as developing less invasive approaches, reducing postoperative pain and speeding recovery, preserving motion in the spine, and enhancing the fusion process.
Newer technologies that seem to be here to stay include:
- Cervical artificial disc replacement for treatment of cervical disc pathology is standing the test of time (with 4 to 7 years of clinical results reported in the US) and emerging as a mainstay alternative to Anterior Cervical Discectomy and Fusion (ACDF). More recently, one cervical artificial disc technology has even been approved for 2-level procedures as well.1
- Fusion outcomes are improving over time, with improving fusion rates and less postoperative pain and complications. Areas of improvement include less invasive approaches, more bone graft options, and innovations in cages/implants.
- Minimally invasive sacroiliac joint fusion is gaining more widespread adoption.
With newer, less invasive fusion approaches now available, SI joint fusion is a more commonly offered treatment option for those with pain caused by sacroiliac joint dysfunction.2
- Vertebral augmentation for a painful fractured vertebra has been around for awhile and patients now have many options to choose from, including options for vertebroplasty and kyphoplasty. Prior to these innovations, a patient with an osteoporosis compression fracture would pretty much only have nonsurgical treatment options, but vertebral augmentation has now become a mainstay option that offers certain patients a relatively reliable path to pain relief.
Limitations of technology
None of these technologies, however, change two important fundamentals for patients to keep in mind:
- The importance of getting an accurate preoperative diagnosis, which is surprisingly difficult when it comes to identifying the cause of many types of back and neck pain. Even the best technology will not be useful if what is operated on is not what was causing your pain.
- Choosing a surgeon who has expertise in your specific pathology (diagnosis) and treatment. Take your time in selecting a surgeon—don't rush into a decision about surgery. Many people get a second or third opinion before making a decision, and surgeons are used to this so don't be concerned about consulting with more than one surgeon.
Spine surgery is like any other field of medicine in that it is part art and part science. Practicing spine surgery involves trying to improve techniques for accurately diagnosing patients’ problems, and then improving surgical technique. To some extent, all this focus on new technology can be a distraction. Sometimes, new technology may even be more of a marketing tool for physicians than a true advancement in patient outcomes.
Just as in the rest of life, with spine surgery there are no simple answers, and relying on new technologies alone to improve outcomes is probably not a good idea. The combination of judicial use of newer technologies combined with rigorous scientific study and the surgeon's skills and expertise holds the promise of providing an increased probability of good outcomes.