The future of spine surgery: New horizons in the treatment of spinal disorders

Abstract

Background and Methods:As with any evolving surgical discipline, it is difficult to predict the future of the practice and science of spine surgery. In the last decade, there have been dramatic developments in both the techniques as well as the tools employed in the delivery of better outcomes to patients undergoing such surgery. In this article, we explore four specific areas in spine surgery: namely the role of minimally invasive spine surgery; motion preservation; robotic-aided surgery and neuro-navigation; and the use of biological substances to reduce the number of traditional and revision spine surgeries.Results:Minimally invasive spine surgery has flourished in the last decade with an increasing amount of surgeries being performed for a wide variety of degenerative, traumatic, and neoplastic processes. Particular progress in the development of a direct lateral approach as well as improvement of tubular retractors has been achieved. Improvements in motion preservation techniques have led to a significant number of patients achieving arthroplasty where fusion was the only option previously. Important caveats to the indications for arthroplasty are discussed. Both robotics and neuro-navigation have become further refined as tools to assist in spine surgery and have been demonstrated to increase accuracy in spinal instrumentation placement. There has much debate and refinement in the use of biologically active agents to aid and augment function in spine surgery. Biological agents targeted to the intervertebral disc space could increase function and halt degeneration in this anatomical region.Conclusions:Great improvements have been achieved in developing better techniques and tools in spine surgery. It is envisaged that progress in the four focus areas discussed will lead to better outcomes and reduced burdens on the future of both our patients and the health care system.

The Evolution of Minimally Invasive Spine Tumor Resection and Stabilization: From K-Wires to Navigated One-Step Screws

“…MIS surgery compromises the surgeon’s ability to comprehend the anatomical structures by direct sight, and relies significantly on either 2D fluoroscopy or 3D navigation. The 3D imaging combined with intraoperative navigation provides better visualization of the anatomy and therefore improves surgeon’s orientation during surgery and ameliorates screws localization and placement [ 24 , 25 , 26 ]. In the current series, the use of fluoroscopy was abandoned in favor of intraoperative 3D imaging and navigation.…”

Clinical and Radiologic Outcomes of Minimally Invasive Surgery Transforaminal Lumbar Interbody Fusion with Computer Navigation

“…7 Since introducing the tubular retractor system (METRx™, Medtronic, Memphis, TN, USA) by Foley and Smith in the late 1990s, an increasing trend in using minimally invasive techniques has been seen regarding the treatment of spinal pathologies. 8 It has also been noted in studies by Goldstein, 2014;Wong, 2014;and Kahn, 2015 that patients who underwent MIS-TLIF have improved outcome measures, such as reduced blood loss, decreased complication rates, and shorter length of hospital stay. [9][10][11] Despite the numerous advantages of MIS, the rates of fusion and operative time are similar between MIS TLIF and open TLIF.…”