Becker's Spine Review

11 SPINE 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 market- ing around new technologies can sometimes get in front of the science, re- sulting in less than optimal outcomes for patients and significant steps backward for the technology. Here are four spine technologies that surgeons argue promised more than they delivered: 1. Robotics Robotics has been a buzz word in spine surgery for more than a decade, but cur- rent robotic systems on the market fall short of what robotic systems in other spe- cialties such as general surgery, gynecol- ogy and urology can achieve. "I believe the robot promised more than it delivered in spine surgery," said Alok Sharan, MD, of NJ Spine and Well- ness in East Brunswick, N.J. "In other fields of medicine ... there have been tremendous advancements in the use of robotic surgery. Initially, the spine com- munity 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 adoption in robotic spine surgery." 2. Laser spine surgery Many physicians believe laser spine sur- gery did not live up to the hype for treating spinal stenosis or herniated and ruptured spinal discs. A 2019 study published in the Journal of the American Academy of Or- thopaedic Surgeons found the risk associ- ated 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 preci- sion in our ability to address spinal prob- lems in the vast majority of the cases, it has failed to do this safely," said Ehsan Jazini, MD, of Reston-based Virginia Spine Insti- tute. "Laser technology poses a risk due to the thermal collateral damage it imposes on the surrounding structures. Although laser technology has been used success- fully in many industries, it has failed to live up to its hype for spine surgery and has little utility in our field. With the advance- ment in motion-preserving techniques, robotics and ultrasonic technologies, we can more effectively address structural spine conditions while preserving mo- tion, which laser technology can't suc- cessfully address." 3. PEEK rods Polyetheretherketone rods, touted by many device companies, were introduced in the mid-2000s as an alternative to ti- tanium rods for posterior instrumented lumbar spinal fusion and aimed to reduce the risk of adjacent segment disease. However, clinical trials demonstrated that it failed to alleviate the adjacent level fail- ure phenomena that many surgeons saw over time. "The 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 persis- tence," said Christian Zimmerman, MD, of Saint Alphonsus Medical Group and SAHS Neuroscience 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 evolution of forward-thinking spi- nal care remedied this issue with eventual phase-outs by most corporations." 4. Interspinous and interlaminar devices Intervertebral distraction devices, which became popular around three years ago, have largely failed to live up to their hype, according to many surgeons. The devices were considered innovative technologies designed to treat spinal stenosis and were initially seen as less invasive options to spinal fusion or laminectomy. "However, the results of these techniques in practice have not always delivered on the promise of addressing symptoms of neurogenic pain," said Michael Goldsmith, MD, of the Centers for Advanced Ortho- paedics 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 process fractures from these devices and have taken out at least one. I sincerely hope these devices will be retooled or re- moved from circulation altogether." n Dr. Robert Watkins performs lumbar discectomy on Las Vegas hockey player By Carly Behm Robert Watkins IV, MD, operated on Las Vegas Golden Knights captain Mark Stone, the team said May 19. Dr. Watkins performed a lumbar discectomy at Cedars Sinai Marina del Rey Hospital in Los Angeles. Mr. Stone is expected to recover in time for the 2022-23 NHL season. Mr. Stone is the second Golden Knights player to undergo spine surgery in recent months. In November, center Jack Eichel had an artificial disc re- placement. n

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