Becker's Spine Review

15 Executive Briefing SPONSORED BY S urgeons are accustomed, in various degrees, to identifying a plan of action for their surgeries. However, there has never been a way to never been a way to three-dimensionally represent the plan in the OR, until now. Becker's Spine Review spoke with Christopher Kleck, M.D., an orthopedic spine surgeon and co-director of the spine fellowship program at the University of Colorado Hospital in Aurora to discuss this new link between preoperative planning and intraoperative confirmation. Dr. Kleck went on to describe his experience using UNiD™ adaptive spine intelligence technology by Medtronic. Question: How did you originally perceive the usefulness of preoperative planning in your practice? Dr. Christopher Kleck (CK): I have always been a big believer in preoperative planning and systematically used it in my practice, though I was aware of its shortcomings, in particular, the inability to directly implement the plan in surgery. This is how spine surgery uniquely became known as an art. I took pride in my ability as an artist, to select and manipulate implants and change my strategy on-the-fly, as many surgeons do. Although being medically trained, surgeons are also very scientific in their methodologies. I knew there was room to bridge this planning gap and improve my practice. Q: What was your reaction to introducing patient-specific implants, like the UNiD™ rod, to spine surgery? CK: For this type of technology to be effective in spine surgery, it needs to be holistic. Offering a patient-specific implant, even with a surgical planning component, was not sufficient for my practice. In my opinion, to be truly powerful, there must be a scientific methodology driving the entire process. For instance, a manufacturer could produce a custom rod, but it may not be the ideal rod for the patient or the surgical strategy. Further, designing a patient-specific implant preoperatively does not necessarily provide insight into the efficacy of that implant postoperatively versus a standard one. Q: What was the tipping point when you began to believe in preoperative planning, predictive modeling, and "trusting" the UNiD™ rods? CK: We had an early case example where we planned a fairly large thoracic spine correction in a young patient. An initial comparison between the 3-D printed model of the patient's spine compared to the patient-specific rods had me questioning whether I could achieve the correction I originally planned. I kept the rods on hand as I began moving through the case. Near the end of the case, I positioned the rods against the patient's spine and was surprised to see how close I was to achieving my original plan. After a few adjustments to the patient, I was able to implant the patient-specific rod. Q: Do you think there is a benefit in applying preoperative planning and predictive analytics to degenerative cases? CK: After experiencing success in my complex cases, I started implementing UNiD™ adaptive spine intelligence into my degenerative cases, including minimally invasive applications. When I think of deformity, it is all about achieving the desired alignment. It turns out the same is true of degenerative surgery. I know adjacent level disease is significantly increased when certain alignment parameters are not met, even in short- construct cases 1 . So, as spinal surgeons, we are either dealing directly with deformity or, if we choose to ignore it, we are at risk of creating deformity. The UNiD™ rods I am implanting today in my degenerative cases have a significantly higher lordosis than I was previously applying with traditional rods 2 . In my mind, the ultimate goal for the industry should be to end revision surgery. Q: I understand the predictive analytics component includes data from pre and postoperative analysis. Have you found these procedural analyses to be directly helpful and how? CK: Prior to my first 50 or 60 cases, I really was not looking closely enough at a patient's thoracic kyphosis when I was planning. However, by reviewing the thorough postoperative analysis provided by the UNiD™ Hub software interface system, I saw some junctional failures in my cases that I thought were probably due to the patient being hypokyphotic in the thoracic spine. This prompted me to make an immediate strategic change when forming my next preoperative surgical plans for patients, whom I began to see were really hypokyphotic, based on the preoperative analytics at our fingertips. I believe the analytical services are key elements in helping surgeons improve their planning strategy. More than just outcomes — Predictive analytics provide support through the surgical continuum The rise of value-based care is placing additional economic pressure on surgeons to deliver the highest standard of treatment for less cost. Medtronic is focusing its efforts on integrating predictive analytics into a system that actively drives preoperative planning, intraoperative confirmation, and postoperative analysis. Becker's Spine Review had the opportunity to interview Chief Scientific Officer Thomas Mosnier to better understand how his team of biomedical Moving from art to science brings new possibilities to spine surgery

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