Becker's Spine Review

9 SPINE SURGEONS 9 spine surgeons discuss their favorite MIS technology By Mackenzie Garrity H ere are nine spine surgeons discuss their favorite minimally invasive spine technology. Neel Anand, MD, professor of orthopedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles Minimally invasive Oblique Lateral Interbody Fusion (OLIF). I believe it is the workhorse of minimally invasive surgical correction of sco- liosis and it has made a complex surgery that much safer and effective for patients. Ali Araghi, DO, director of spine at Phoe- nix-based e CORE Institute XLIF with or without plating is my favorite technique, as it allows me to correct sagittal and coronal plane segmental spinal deformi- ties and decompress the canal via indirect re- duction, all through a small incision with min- imal morbidity in well selected cases. I find this technique to be even more muscle sparing than an MIS decompression and TLIF with a larger foot print of interbody support. Carlos Arias, MD, spine surgeon at Del Rio Hospital Universitario in Ecuador My favorite is a minimally invasive retractor named Maxcess from NuVasive. It allows me to perform posterior and lateral approaches in cervical, thoracic and lumbar spine. Vincent Arlet, MD, chief of orthopedic spine surgery at Philadelphia-based Uni- versity of Pennsylvania Anterior Interbody fusion 5/1 or lateral ante- psoas anterior interbody fusion [is my favor- ite MIS technology]. Bobby Bhatti, MD, president and founder of Atlanta Spine One thing we do a lot of and we do well is lateral. It's a powerful tool and restores sagit- tal balance, and I believe that's where things are heading at this point. ere is also a lot of new technology coming out for it. We are in the design processes of a new lateral cage that expands and does a ventral column re- construction at the same time without cutting or spreading the fibers. Because the retractors have improved we can use the retractors better. Randolph Bishop, MD, medical director of Neurological & Spine Institute in Savan- nah, Ga. My favorite minimally invasive technology is the spinal endoscope. Using the visualiza- tion provided with the endoscope and tools deployed through the working channel, a surgeon can remove compressive lumbar disc pathology, open the neural foramina, per- form facet rhizotomy, and/or fuse the spine with or without instrumentation. All this can be done with minimal anesthesia, minimal collateral tissue damage, and result in faster return to pre-morbid functional ability. Egon DoppenBerg, MD, and Erinn Zach- arias, PhD, Good Samaritan Hospital, Downers Grove, Ill. Spine navigation systems continue to innovate and facilitate MIS. One example is the placement of pedicle screws, which aim to improve accura- cy and reduce radiation exposure over traditional MIS freehand techniques. However, these navi- gation systems have not resulted in superior clin- ical outcomes, lacking evidence of reduced rates of neurological injury, vascular injury or reopera- tion. A demonstrated clinical advantage must be established and appropriate patient selection and procedural complexity should be considered be- fore widespread adoption of navigation systems as a whole over freehand techniques. Jeffrey A. Goldstein, MD, chief of spine ser- vice, education and director of spine fellow- ship NYU Langone Health in New York City Robot-assisted spine surgery helps bring MIS to the next level. Robotics allow us to complete MIS surgery with less radiation exposure to the surgeon, patient and OR team. In addition, robots facilitate spine surgery with less so tis- sue disruption and potentially improved pre- cision, accuracy and patient outcomes. I look forward to seeing how robots can improve our ability to safely perform more difficult revi- sions or deformity procedures. Richard Kube, MD, founder of Prairie Spine in Peoria, Ill. My practice is mostly minimally invasive so there are a variety of things that I use. One of the more recent technologies is DTRAX. We see a lot of patients with nonunions and this device allows us to do the procedures almost percutaneously, and we have seen success with getting these procedures to fuse. Patients experience less blood loss and shorter recov- ery times while surgeons do not have any tissue stripping and are able to perform the surgeries in an outpatient setting. n Why spinal implant surface technology makes a difference: 2 key thoughts from Dr. Raphael Rey Roybal By Shayna Korol R aphael Rey Roybal, MD, is an orthopedic surgeon at Cha- tham Orthopaedic Associates in Savannah, Ga. Here are his thoughts on implant ma- terial and achieving successful fusion in spine surgery. Question: How do you see implant selection, particularly the surface technology of the implant, impact- ing patient care? Dr. Rapheal Roybal: Basic science is clearly showing that certain materials and surface topography favorably im- pact bone growth and fusion. When arthrodesis is the goal of surgery, an implant with the appropriate material and surface architecture provides the best chance of biomechanical success — fusion. In effect, the implant acts as a biomaterial. Q: Where do you see the biggest opportunities for continued growth and development in implant mate- rials and nanotechnology for spine surgery? RR: Implants acting as a biomaterial influence the cellular reaction and re- sponse of bone-growing cells. As sci- ence better understands these cellu- lar interactions, and the influences of biomaterials and surfacing on these interactions, devices may effectively release this healing potential. Hopefully, this will provide a more economical and safer mechanism of increasing the rate of successful ar- throdesis while overcoming patient variables that make it more challeng- ing such as age, poorer bone quality, chronic disease and the like. n

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