Becker's Spine Review

25 S pine technology has made big advancements in the last decade, and the pandemic accelerated the move to more precise, less invasive care. Twenty innovations in spine: Artificial intelligence. Medtronic CEO Geoff Martha predicted artificial intelligence and machine learning would be the next frontier in medtech in late 2020, and despite the pandemic many companies and surgeons have continued to explore AI applications in spine. AI-guided surgery could make procedures more precise, eliminate reoperations and lower the overall cost of care. ere are also AI applications in radiology and imaging that can assist surgeons in identifying issues more efficiently. Augmented reality. Augmented reality technology took the spine field by storm in 2020 aer the first procedures using Augmedics' Xvision took place at Johns Hopkins in Baltimore. e Xvision spine system includes a headset for real-time spinal anatomy projection, allowing for 3D visualization of the spinal anatomy during surgery. It is designed to appear as if the surgeon has X-ray vision into the patient's anatomy to navigate instruments and implants while looking directly at the patient instead of a screen. Since last year, many other surgeons have begun to use the technology, and Augmedics has grown as well. e company raised $36 million in series C funding in March. Awake spinal fusion. e early adopters of awake spinal fusion techniques are seeing interest among fellow surgeons grow amid the COVID-19 pandemic. ese spinal fusions are performed without general anesthesia, so the patient is awake throughout the procedure and can begin recovery more quickly than patients who undergo traditional fusions. e procedure can be performed in ASCs and typically lowers the overall cost for an episode of care. Big data. Surgeons have more data at their fingertips than ever before, and in the coming years they'll be able to use it for better patient outcomes. ey can also use data about cases to standardize care processes among surgical groups, identify gaps in care and make sure care is delivered efficiently. Surgeons who aren't already intimately familiar with their cost data will soon have access to much more information as healthcare organizations ramp up value-based care efforts. Disc regeneration. Spine surgeons and scientists are teaming up at academic medical centers across the U.S. to develop solutions for disc regeneration. While it is still in the very early stages, over the next decade technology is expected to advance to the point where surgeons could repair annular tears biologically and reverse disc degeneration. If proven effective, disc regeneration techniques would disrupt the spine field and prevent nagging pain from getting to the point where patients need surgery. Enabling technologies. In the early 2000s, the spine field experienced a renaissance of innovation in spinal devices and implants to make procedures less invasive. However, in the last few years, true innovation has shied from the implant to technologies that make surgery more efficient, personalized and precise. Enabling technologies include robotic systems integrated with imaging pre-planning devices, neuromonitoring and computer navigation, which allow surgeons to control every aspect of surgery and lower radiation exposure. Endoscopic spine surgery. e endoscopic spine surgery technique has been popular overseas for years and now is gaining steam in the U.S. While the technique has many benefits as a less-invasive procedure for decompressions, among other surgeries, it comes with a learning curve. However, as more spine cases move into the outpatient setting and an emphasis is placed on value-based care, more surgeons are seeing the value of an endoscopic approach and training on the technology. Early career surgeons are championing the technique as well aer learning it during fellowships and at professional meetings. Imaging. e imaging systems used in spine surgery have much more advanced applications than the traditional MRI and CT scan. Specialized systems such as NuVasive's Pulse platform integrates images with data on alignment, neuromonitoring and navigation capabilities. Imaging is also becoming 3D with many new applications. GE Healthcare gained FDA clearance for the OEC 3D surgical imaging system for spine and joint replacement in March to make planning for complex and routine surgeries easier. Intraoperative imaging and guidance systems are also advantageous because surgeons know screws are placed correctly before the patients leave the operating room. Infection control. Surgeons are taking steps to reduce surgical site infections during spine procedures by taking several measures, from improving air flow and disinfectant efforts to using vancomycin powder on the surgical site. ey can also use Surgx, a sterile antimicrobial gel applied to the surgical wound to protect against infections for up to five days. Multilevel disc replacements. Artificial disc replacement technology has evolved in the last decade to fit better into the patient's natural anatomy than spinal fusions. Patients typically have better range of motion aer disc replacement procedures, and studies show superior outcomes as well. Zimmer Biomet's Mobi-C was the first disc to receive two-level FDA clearance in 2013, and NuVasive's Simplify Disc was the second, cleared April 6. Centennial Spine's prodisc L is also cleared for two-level lumbar disc replacements. e demand for motion-preserving techniques is growing, and there is room for continued innovation in disc replacements to prevent adjacent segment disease. Nonopioid pain management. e opioid crisis in the U.S. sparked a need for new methods of dealing with patients' pain, especially during and aer surgery. Many surgeons are turning to nonopioid solutions, such as physical therapy, spinal cord stimulation or interventional pain injections to aid patients with back pain. When patients do need surgery, they can use long-acting local anesthetics like Pacira's Exparel intraoperatively to lower pain for the first 24 to 48 hours aer surgery. e local anesthetics control pain so patients can move sooner aer surgery, and have spurred the migration of spine surgeries with traditionally long hospital stays to outpatient ASCs. 20 cutting-edge spine innovations | 2021 Sponsored by: continued on page 26

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