Becker's ASC Review

61 ORTHOPEDICS 4 spine technologies that promised more than they delivered By Alan Condon I nnovation moves at a rapid pace in spine surgery, but hype and marketing around new technologies can sometimes get in front of the science, resulting in less than optimal outcomes for patients and signifi- cant steps backward for the technology. Here are four spine technologies that sur- geons argue promised more than they de- livered: 1. Robotics Robotics has been a buzz word in spine sur- gery for more than a decade, but current robotic systems on the market fall short of what robotic systems in other specialties such as general surgery, gynecology and urology can achieve. "I believe the robot promised more than it delivered in spine surgery," said Alok Sharan, MD, of NJ Spine and Wellness in East Brunswick, N.J. "In other fields of medicine ... there have been tremendous advancements in the use of robotic surgery. Initially, the spine community thought the same successes in those fields would apply to spine surgery. Due to a variety of reasons (capital costs, workflow issues, etc.), we have not seen a tremendous leap in adop- tion in robotic spine surgery." 2. Laser spine surgery Many physicians believe laser spine sur- gery did not live up to the hype for treat- ing spinal stenosis or herniated and rup- tured spinal discs. A 2019 study published in the Journal of the American Academy of Orthopaedic Surgeons found the risk asso- ciated with laser spine surgery outweighed the benefits, suggesting that lasers added potential thermal-based complications and could burn a patient's nerves, tissue and cartilage. "While laser technology promises precision in our ability to address spinal problems in the vast majority of the cases, it has failed to do this safely," said Ehsan Jazini, MD, of Reston-based Virginia Spine Institute. "Laser technology poses a risk due to the thermal collateral damage it imposes on the surrounding structures. Although la- ser technology has been used successfully in many industries, it has failed to live up to its hype for spine surgery and has little utility in our field. With the advancement in motion-preserving techniques, robotics and ultrasonic technologies, we can more effectively address structural spine condi- tions while preserving motion, which laser technology can't successfully address." 3. PEEK rods Polyetheretherketone rods, touted by many device companies, were introduced in the mid-2000s as an alternative to titanium rods for posterior instrumented lumbar spinal fusion and aimed to reduce the risk of adjacent segment disease. However, clin- ical trials demonstrated that it failed to al- leviate the adjacent level failure phenomena that many surgeons saw over time. "e five-year run (or so it seemed) saw mitigation of pain issues because of less- ened surgical intervention but saw returns for the additional surgeries years later for related symptoms of failure or persistence," said Christian Zimmerman, MD, of Saint Alphonsus Medical Group and SAHS Neu- roscience Institute in Boise, Idaho. "Al- though the fracture rate of the rods was rare, this also became a concern in the older populace. As interest waned, the healthcare industry, applicable economics and the evo- lution of forward-thinking spinal care rem- edied this issue with eventual phase-outs by most corporations." 4. Interspinous and interlaminar devices Intervertebral distraction devices, which be- came popular around three years ago, have largely failed to live up to their hype, accord- ing to many surgeons. e devices were con- sidered innovative technologies designed to treat spinal stenosis and were initially seen as less invasive options to spinal fusion or lami- nectomy. "However, the results of these techniques in practice have not always delivered on the promise of addressing symptoms of neuro- genic pain," said Michael Goldsmith, MD, of the Centers for Advanced Orthopaedics in Bethesda, Md. "Spine surgeons — and the healthcare industry in general — can learn that we must still abide by the basic principles of decompression, and stabilization when necessary, to achieve our patients' goals." "A slew of these devices were put into pa- tients with the promise of relief from spinal stenosis," according to Brian Gantwerker, MD, of the Craniospinal Center of Los An- geles. "I have [had] at least two spinous pro- cess fractures from these devices and have taken out at least one. I sincerely hope these devices will be retooled or removed from cir- culation altogether." n Indiana court rules injured patient can sue physician group By Patsy Newitt T he Indiana Supreme Court agreed to allow a patient who was injured during physical therapy to pursue her complaint against an orthopedic physician group, The Indiana Lawyer reported March 25. Darci Wilson sued her orthopedic physician group, Athletico, and her physi- cian therapist, Christopher Lingle, alleging that treatments reinjured her knee and required her to have more surgery. The ruling reversed a lower court summary judgment in favor of Athletico and Mr. Lingle. The lower court also ruled that the physician group could not be held liable for Mr. Lingle's actions without evidence of employment or contractual rela- tions. But the Supreme Court found the physician group was not entitled to the summary judgment. n

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