The future of spine surgery – perspectives and trends to look out for in 2020

The spine industry is a large, growing and vibrant market, demonstrated in significant technological advances for spine surgery and events like EUROSPINE 2019. Jordy Winters, EMEA Spine Lead, DePuy Synthes, shares his thoughts on the current trends in spinal surgery. Additionally, Maarten Spruit, Chairman of AOTK Spine discusses his experience and achievements in the field of spine surgery

 

Trend 1: Aging population leads to an increase in spinal fusion

The percentage of the European population over the age of 65 equaled 19.7 per cent in 2018, indicating a 2.6 per cent increase since 2008; an even more dramatic increase is expected to occur by 2100 [1]. Data confirms that older patients are increasingly meeting the indications for spinal fusion [2,3]. Older patients are more likely to have suboptimal bone quality and may require stronger forms of fixation [2,4].

Current limitations are mainly reported in the areas of fixation, alignment and extension [3-9]. For example, 95 per cent of surgeons have reported to have seen a lateral-mass screw pull out or loosen [3]. Market research has also shown limited satisfaction in the ability to achieve alignment targets or to extend constructs with current instrumentation [3].

 

Trend 2: ‘Enabling tech’ is all the buzz

Intraoperative image-guided spinal navigation was by far the most talked about technology at EUROSPINE 2019. The utilisation of image guidance (IG) is becoming increasingly widespread and can be invaluable to surgeons during spine surgery procedures [22]. Minimally invasive spine (MIS) surgery can result in a decrease in visualisation, however using computer-assisted navigation technologies enables greater visualisation through smaller MIS incisions as compared to open surgical procedures [23].

DePuy Synthes is proud of its longstanding strategic collaboration and co-marketing and distribution agreement with Brainlab, a company that offers an industry-leading suite of technologies including navigation, imaging, robotics and software planning tools.

As part of this agreement, our companies collaborate on the marketing and promotion of integrated systems. This strategic collaboration allows us to offer an end-to-end navigation solution including intra-operative services and professional education that provides customers with seamless access to Brainlab’s enabling technology in combination with DePuy Synthes offerings.

This collaboration also furthers our aim of building a connected digital environment in which technologies that enhance surgical performance, professional education and monitoring, as well as help guide patients to full recovery are connected – pre-, intra- and post-operatively – across the continuum of care.

 

Trend 3: Surgical procedures are improving

Annually, 266 million patients worldwide are diagnosed with lower back pain due to lumbar degenerative disease [10]. Surgeons performed more than 62,000 transforaminal lumbar interbody fusion (TLIF) procedures in Europe in 2018 [11]. The average cost of TLIF in some European regions extends to more than €10,000 [12].

Minimally invasive surgery (MIS) for spinal fusion is growing for the treatment of lumbar degenerative disease due to lower morbidity (i.e., blood loss, surgical complications, wound infections, or hospital length-of-stay), and lower total hospital direct costs compared to open TLIF [13-16]. However, MIS TLIF is a common procedure that can be complex [17], variable in length [18], and requires multiple instruments/instrument passes [19].

Market indicators show a clear need to increase efficiency in MIS TLIF by reducing unnecessary instrumentation and redundant tray use. High instrument variability, as well as unnecessary surgical instrument sterilization, packaging, transport, unwrapping and reorganisation, drive up costs and carry implications for patient safety [20].

Given this burden, opportunities exist for improvement in MIS TLIF procedures. Our company invests in minimally-invasive (MIS) spine solutions to reduce variability and inefficiency in spine surgery and deliver consistent outcomes. The UNLEASH™ MIS TLIF Solution helps streamline and improve the three main stages of MIS TLIF: discectomy, cage and screw placement.

 

Looking ahead

In conclusion, therapies and procedures that reduce time and costs and provide optimised outcomes are expected to increase as innovative technologies continue to shape the space. Intelligent orthopaedics – a combination of traditional techniques and high-end technology – will be the future of the spine industry.

 

Meeting Maarten Spruit

The Chairman of AO Technical Commission for Spine discusses his experience and achievements in the field of spinal surgery. Maarten is an orthopaedic spinal surgeon at Sint Maarten’s clinic in the Netherlands

 

SSN: As a specialist in spine surgery, could you tell us more about your experience and training background in this field?

MS: I am a spine surgeon and during my orthopaedic training in Nijmegen (Maartenskliniek & Radboudumc) Leiden University, I undertook a fellowship in paediatric orthopaedics. That was my first introduction to spine surgery – for adolescent Idiopathic Scoliosis.

During my further training I became focused on spine surgery and I was fortunate to have had a great mentor in my clinic, who almost personally trained me and helped me become more experienced in spine surgery.

In the following years, you soon become aware that as you progress from a trainee resident to a spine specialist, you then become a mentor yourself. So these days I am a mentor for a lot of my colleagues, and I help to train them in spine surgery.

In my current practice, it’s mainly degenerative as well as deformity I work on, and it’s not only paediatric deformity but also adult spinal deformity. You can do a lot of surgical procedures that will improve the quality of the lives of our patients, so that’s the main driver. However, in degenerative spine you really have to decide carefully when to perform surgery and when not to perform surgery.

 

SSN: What’s the best part of your job?

MS: There is not a single highlight in my career. There have been many highlights, from when I finished my thesis in 2005, to becoming head of the orthopaedic department.

As the chairman of the AO Technical Commission for Spine, I do this work with a lot of pleasure. It takes up a great deal of my time, but as my wife says: “When you come home, you’re always full of energy.” So for me, this is a very positive thing in my career and certainly a more recent highlight.

Being part of the technical commission means that I am part of the AO. It’s not just the technical commission, it’s the complete foundation. And before I was in the Technical Commission, I was part of the faculty for years. In the technical commission, we constantly try to identify clinical needs and gaps that we hopefully solve with technical innovation. That is our core business.

I’m Dutch, so I can be quite direct and I want to encourage people, show commitment and get things done, otherwise I wouldn’t be part of the group.

 

SSN: … And the worst?

MS: The worst part of my job is when you run into complications during surgery. Even as a senior spine surgeon that’s still the most devastating thing that happens and the things that keep me awake at night. When you have serious complications, you should not run away from it, you should deal with them and you should treat the patients.

 

SSN: What are your thoughts on the key trends looking to the future of spinal surgery?

MS: Well, it’s obvious to me that there is a huge trend towards less invasive and minimally invasive spine surgery. And you know within the work that we do, for us, the focus has been quite a lot on minimally invasive surgery and guidance. But it’s clear that you cannot do everything with minimally invasive surgery. So we do need instrumentation for open surgery, as well.

 

SSN: Away from the clinic and operating theatre, what do you do to relax?

MS: Working in spine surgery can be physically demanding, so I like to keep fit. Together with my wife we go running, mountain biking and to the gym.

I feel it is important to get out of the hospital once in a while, and do something else which can or cannot be work-related. That’s why I always tremendously enjoy going on trips for the technical commission. It adds to new experiences in life and being able to travel and see the world is also a very relaxing and necessary experience.

 

References:

1. Eurostat (Web Page) Population structure and ageing. Updated July 2019. Available online at: https://ec.europa.eu/eurostat/statisticsexplained/index.php/Population_structure_and_ageing#The_share_of_elderly_people_continues_to_increase. Accessed: August 1, 2019.
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