Insights from Dr. Peter Derman, Dr. Richard Guyer, Dr. Scott Blumenthal, Spine Surgeons at Texas Back Institute.
One of the most powerful forces shaping spinal care is demographics. Since many countries, including the US, are experiencing an aging population, our roles as spine surgeons are greatly impacted. This shift from traumatic spine injuries in younger populations to non-traumatic injuries in older adults is evident in our examination rooms every day.
A key study found that patients over the age of 65 in the US experienced a 22% increase in non-traumatic spinal cord injuries (2013-18). European studies have identified similar concerns, with an aging population creating strain on medical care resources to address degenerative diseases.
As surgeons with spinal care medical center Texas Back Institute, our team has pioneered advances that have helped humanitarian causes around the globe, as well as aging and younger populations with traumatic and non-traumatic surgery care modalities. Here are three key care innovations that will help meet the demand of a growing, changing – and aging – world.
Key spine health innovation: Artificial disc replacement
Artificial disc replacement was a pioneering procedure in the early 2000’s, and Dr. Scott Blumenthal had the distinction of performing the first US procedure in March 2000, and also working in close cooperation with the nation’s Federal Drug Administration for testing and efficacy. The practice now has data from over 5,000 patient surgeries, and innovations in this arena make artificial disc replacement a much less risky solution with greater positive outcomes. For patients that have suffered through chronic conditions or a need for additional surgery, ADR can be a lifechanger.
In brief, there are two areas in the spine where discs tend to wear out, herniate, rupture, and basically degenerate. Those are in the cervical or the neck, and the lumbar, which is the low back.
We started with the lumbar region 25 years ago and then moved to the cervical region which we’ve been doing for about 23 years. The initial couple years were all under FDA trials, but since 2004, with the FDA approval of the first lumbar disc, it’s now pretty much available for anybody who would otherwise qualify. Previously, these patients were typically viewed as suitable only for fusion procedures.
Key spine health innovation: The rise of minimally invasive surgery for spine procedures
The ability to see within the spine and address internal problems without the need for large open incisions has long been an aspiration of spine care specialists. Relatively recent technological advancements have made this dream a reality. Recent innovation has launched the “ultra minimally invasive” spine surgery. This technique involves inserting a narrow camera through a tiny opening in the skin, enabling the magnification and projection of images onto a high-definition screen in the operating room.
According to Dr. Peter Derman, a specialist in endoscopic, ultra-minimally invasive spine surgery, “This procedure is performed via a very small, sub-centimeter incision through which a narrow camera is inserted. This minimizes disruption of the muscle and other important stabilizing structures.”
This approach gives the surgeon the ability to view the spine and surgical area on a high-definition monitor throughout the surgery. Patients often experience immediate relief of their sciatica-type symptoms and are comfortably home within hours of surgery.”
Endoscopic surgery is an effective technique for taking pressure off nerves in the spine. Pressure on nerves causes pain to radiate down the arms or the legs. The beauty of minimally invasive surgery is that it allows the surgeon to take pressure off nerves without doing damage to other tissues around the site of the problem.
Surgeons can now use a narrow camera to scope the injury and correct it without opening the entire spine, like knee and neck injuries. Once the surgeon identifies the damaged nerve and employs the scope and micro-instruments to correct it, the tube can then be removed, and the patient has a very small incision that is closed with a small stitch under the skin.
Key spine health innovation: The use of robotics and 3D printing technology for spine surgery
Spine diagnostic and surgical technologies are advancing rapidly. The benefits of harnessing the latest technology such as 3D printing, robotics and imaging tools such as magnetic resonance (MRI) and computed tomography (CT) scans and using them to formulate state-of-the-art patient treatment.
In our spine surgery practice, we have seen rapid advances in surgical technology that have fundamentally improved patient outcomes. State-of-the-art technology can increase the efficiency and success of other surgical challenges such as pre-operative planning, diagnosis and the surgical procedure itself.
3D-enhanced imaging is most useful in diagnosing and treating complex deformity. It helps the surgeon understand what the challenges will be in a surgery. Due to the changes in the vertebral bodies and the connecting joints that occur when the spine begins to twist and turn in deformities, it is helpful for the surgeon to see these in a 3D printed model beforehand. With advancement in intraoperative navigation along with robotics, planning for successful correction is made easier for the surgeon.
Three-dimensional printing has been utilized in a variety of ways in the setting of spinal surgery. One use is to print 3D models of the spine before surgery so that the surgeon can manipulate and examine these before the procedure to get a better understanding of the issue. This is most helpful when the spinal anatomy is particularly distorted by the issue (e.g., severe scoliosis).”
Future innovations: A forecast
As spinal surgeons committed to the care of our patients, we are optimistic that new technologies will continue to enhance positive patient care.
Soon, multi-arm robotics will replace single-armed robotics in assisting the surgeon in placing hardware.
As technology advances, we will see robotic assisted decompressions which are among the most common procedures in spine surgery. Finally, navigation along with AR (augmented reality) will allow more accurate placement of implants and artificial discs in the future.”
The medical profession is experiencing a revolution in spine care. A variety of ‘enabling technologies are being used to allow surgeons to perform spinal surgeries more safely and less invasively. These include 3D navigation, robotics, augmented reality and endoscopic spine surgery. While helpful in their current form, these technologies will continue to improve over time, becoming even more powerful.”
What advances in spine care will occur in the next 25 years?
If the past is any indication, these changes in patient care will only accelerate as the population ages and non-traumatic injuries and disease increase. No one knows when the next artificial disc replacement procedure or technology-enhanced diagnostic tool will be discovered, but there is one thing patients can count on. When it occurs, committed, caring and innovative spinal surgeons will be an important part of their discovery and implementation for patient care.
About the authors:
For information on Dr. Scott Blumenthal, click here (https://texasback.com/physician/scott-l-blumenthal/)
For information on Dr. Peter Derman, click here (https://texasback.com/physician/peter-derman/)
For information on Dr. Richard Guyer, click here (https://texasback.com/physician/richard-d-guyer/)
Image: From left to right, Dr. Peter Derman, Dr. Richard Guyer, Dr. Scott Blumenthal
