Becker's Spine Review

15 THOUGHT LEADERSHIP guidance to make incisions and exposure more precise. Additionally, I believe sensor technologies to measure intrinsic strain on surgical hardware will also reduce hardware failure in the future and building this sensing technology up will enable smarter surgery. Luke Macyszyn, MD. DISC Sports & Spine Center (Newport Beach, Calif.): I would focus on tools and platforms that allow us to better collect, monitor and analyze patient outcomes aer spinal surgery in a more rigorous and systematic manner. I feel like this is critical for spinal innovation so that we are developing tools, implants and methodologies that lead ultimately to improved patient outcomes and quality of life versus just another "me too" implant or procedure. However, without a rigorous analysis and monitoring of these outcomes, this research is simply not possible. In the future, all physicians, researchers and companies developing in the field of spinal medicine would have access to these tools and share a common platform that has been validated in these patients so that we can all speak and communicate using a common language. is would allow us to recommend certain treatments or management strategies that are more concretely based on objective data versus one's singular experience. Edward Perry III, MD. Swi Institute (Reno, Nev.): I would fund research to develop a cost-effective way for patient bone marrow or stem cell autogra harvesting and preparation methods to actually improve thoracolumbar fusion rates beyond our current technology. Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): Unfortunately, no big research project can be done for $5 million nowadays. One reasonable project that I would recommend would be clinical research or safety and efficacy of various bone gra products used for spinal fusions. A lot of the bone gra products currently on the market have not been tested in-vivo and only rely on animal and laboratory testing for their FDA approval. Having "real world" human data for these bone gra materials will help spine surgeons and hospitals choose the best products for their patients. William Taylor, MD. University of California San Diego: Artificial intelligence and its application for navigation, predicting outcomes and operative planning would be first on the list. Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): As a multidecade seasoned spinal surgeon, the most devastating course of events of a spinal cord injury are resounding, lasting and challenging beyond comprehension for patient and family. While the lauded research continues to be central to injury and recovery, personally, the most impactful path in curbing these circumstances is awareness and the life changes associated with its outcomes. Furthermore, my focus would be intensive education at the high school/college-level age groups, liken to the inkFirst [injury prevention] program of the past. n Robotics will be 'standard of care' in joint replacements by 2030: 3 surgeon insights By Carly Behm R obotics in total joint surgery has grown in 2022. By the next decade, surgeons predict continued growth, along with the further integration of artificial intelligence and augmented reality. Editor's note: Responses were lightly edited for clarity. Question: Looking to 2030 and beyond, how will orthopedic surgeons be able to use robots for total joints? James Abbott, MD. Best Surgery & Therapies (Cincinnati): The robotic platforms will only get faster at registration of the joint position and recognizing deformity, determining alignment and intraoperative planning. The planning will move faster with AI algorithms that can plan and balance the knee instantaneously. Ideally, these AI algorithms will be based on outcomes data on patients that have had robotic surgery and developed to optimize the kinematics specific to the knee design utilized. The next difference will be on how we remove the bone. Currently we use saws and burrs, but that could be replaced with computer- controlled micro machines to remove the bone and prep for implants accurately and cause less pulling and tugging on the soft tissues. Still, current implant designs require enough exposure to accurately place the implant once the bone prep is complete. It would be great if the systems eventually evolve to an open-source platform that can be loaded with software specific to the implant, but given our current fragmentation of the industry, that will be decades away. Anthony Melillo, MD. Bay Oaks Orthopaedics & Sports Medicine (Houston): I have used the Stryker Mako Robot to perform my partial and total knee replacements and total hip replacements (including revisions) for over seven years. I was hesitant at first since it was a new concept. But I can now say that I will never do another joint replacement without this technology. I have now corrected wildly deformed knees and hips [and] arthritic joints successfully and confidently using this platform. The computer-based program and pre-op CT scan allows me to realistically correct the deformities in advance of my surgery. I can see the obstacles and plan for the correction of them pre-op and have corrective measures ready at the time of surgery. Bottom line, robotics in total joints, especially by 2030, will be the standard of care. Think about having the ability to place an acetabular cup in the exact place that maximizes hip movements in an individual taking into account lumbar motion, hip motion, etc. Vivek Mohan, MD. OC Irvine (Calif.) Medical Center and OC Anaheim (Calif.) Medical Center: The robotic footprint will grow and continue to grow rapidly. However, the economy of scale and the deployment of vast resources to get these robots in operating rooms around the world will eventually halt. At that point alternative technologies such as augmented reality and ocular base technology will take over. n

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