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31 DEVICES & IMPLANTS The future of spine technology: 13 surgeon predictions By Laura Dyrda S pine technology is always evolving to provide better value-based care options. Here are 13 spine surgeon predictions: John Finkenberg, MD. Sharp Healthcare (San Diego): e most important trend for 2018 will be seen as the creation of instru- mentation and procedures that blur the lines between minimally invasive spine and mini- mal-access surgery. 2018 will bring on a new tax code, which may positively affect many professional businesses. Tax ceilings and op- portunities to buy digital radiograph equip- ment with advantageous depreciation rules should be considered. Richard Chua, MD. Northwest NeuroSpe- cialists (Tucson, Ariz.): I believe there will be continued growth in the application of mini- mally invasive spine surgical techniques, in- cluding improvements in implant technology, biologics, instrumentation and biomechan- ical considerations. In addition, the move toward outpatient spine surgical services may continue to grow as reimbursement and pay- ers demand more efficiency, reduced cost and better resource utilization. Kern Singh, MD. Co-Director of the Min- imally Invasive Spine Institute at Midwest Orthopaedics at Rush (Chicago): 2018 will be the year of the robot in spine surgery. Al- most every major spine company will have re- leased their next-generation robot. Look for robots to do more than just help place pedicle screws. Navigation, surgical assistance and even help with the surgical decompressions are on the horizon. Mick Perez-Cruet, MD. Director of min- imally invasive spine surgery and spine program at Oakland University William Beaumont (Rochester, Mich.): e most important spine technology trend for 2018 will be the further development of minimal- ly invasive spine surgery and stem cell-based biologics. e best opportunity for spine sur- geons will be to bring cases into outpatient spine surgery centers in which they hold an equity stake. Michael Musacchio, MD. NorthShore Uni- versity HealthSystem's Neurological Insti- tute (Evanston, Ill.): Technology is the game changer for spine surgeons and their patients, especially 3D capabilities. A paradigm shi is in play; 3D navigation has improved accuracy and safety of screw placement and the overall procedure. It has further advanced minimal- ly invasive techniques and it reduces, if not eliminates, redo surgeries for screw misplace- ment. Robotics has better enabled the inte- gration of 3D navigation through soware to aid in deformity correction. Deformity correction technologies include preoperative planning soware, intraoperative assist de- vices, rod benders and more. Brian Gill, MD. Nebraska Spine Hosptial (Omaha): I am interested in seeing how 3D technology/printing capabilities will translate into implant design and function; whether this technology translates into quantifiable better outcomes remains to be seen. Andrew Hecht, MD. Chief of Spine Surgery at Mount Sinai Hospital and Health System (New York City): e most important tech- nology trends in 2018 are continuing to find the appropriate carriers and doses for the use of BMP-2 (Infuse) to minimize complications and yet harness its effective capabilities. In addition, spine surgeons continue to explore the appropriate indications for minimally in- vasive fusions for degenerative, trauma and deformity applications. Lastly, spine surgeons continue to define the appropriate indications for cervical disc replacement and how to minimize heterotopic ossification aer total disc replacement. Jocelyn Idema, DO. Advanced Ortho- paedics and Rehabilitation (Washington, Pa.): ere is recent data with regard to lumbar disc replacement and a five-year fol- low-through that has shown highly favorable patient outcomes and reduction in overall healthcare costs due to a significantly de- creased revision rate for adjacent-level pa- thology. As more insurance companies and hospital systems begin to align and recognize these significant changes in spine surgery, there will be more opportunities in the near future for improved quality of care. Other innovative technologies, such as im- proved navigation systems, robotics and the various implant techniques, will continue to positively impact the spine industry in the future. It is important to note although these technologies continue to change and im- prove, the spine industry must also balance the cost-effectiveness and value of these tech- nologies, always striving for the best patient outcome and experience for the patient. Todd Lansford, MD. South Carolina Sports Medicine & Orthopaedic Center (North Charleston): e most important trend in spine technology would be the continued integration of biplanar fluoro to navigation. I say this especially because the use of robot- ics is an expanding field; advances in imaging will increase the speed for robot procedures. Once navigation improves in speed and ease, robots will be used more frequently. e sec- ond trend I see is use of titanium/tritanium implants. is has shown superiority over PEEK and will gain in use throughout the year. omas Schuler, MD. Founder of Virginia Spine Institute (Reston): e top two areas affecting spine surgery are artificial intelli- gence and arthroplasty. Both of these shi the paradigm of decision making and treatment options. Artificial intelligence applied to ro- botic surgery simplifies surgeries, decreasing complication rates while enabling smaller, less invasive operations. ese preserve more natural passive and active stabilizers of the spine, minimizing adjacent segment disease. Arthroplasty is achieving a similar outcome by protecting adjacent segments. Regenera- tive medicine is impacting nonoperative care and providing a new option for mild adjacent segment pathology. Paul Slosar, MD. President of SpineCare Medical Group (Daly City, Calif.): e focus is now on surface technologies for fusion im- plants. e most sophisticated and advanced surface has a unique titanium nano-technol- ogy to stimulate the host bone to grow rap- idly, promoting early osseous-integration. is should lower surgeons' dependence on expensive or inflammatory biologics. e porous implants may be better than smooth surfaces, but still lag behind in terms of stim- ulating a cellular response. William Tally, MD. Athens (Ga.) Orthope- dic Clinic: e biggest technical change will be the continued rise of minimally invasive spine and the correlated transfer of spine pro- cedures into an ambulatory surgery center setting. Christian Zimmerman, MD. Saint Alphon- sus Medical Group (Boise, Idaho): Ad- vancements in onsite hardware creation may be a thing of the extreme future, but online custom-made hardware may realize a place in the implant market. n