By Evan Sheha, MD
In recent years, there have been a number of advances in how we approach spine treatment, driven by a greater understanding of spine challenges and the advent of new technologies that help improve patient outcomes. These innovations deliver safe, effective results and faster recoveries for patients post-surgery.
At HSS, we’re firm believers that surgery may not be the first nor best option for many patients. Any surgery involves certain risks. We have many non-surgical options to help patients get better and relieve their back issues. For instance, a combination of physical therapy and meds could be the right course. Spinal injections are another option. Time and a targeted exercise regimen could be a third path to follow.
But for the patients who need it, spine surgery can be an ideal treatment option. Here are three innovations to improve spine surgery practice: augmented reality (AR), robotics and minimally invasive techniques.
Augmented Reality: X-ray Vision
Augmented reality (AR) is a technology that superimposes digital elements on a user’s view of the real world, creating an interactive 3D experience.
This same AR technology is now being used in spine surgery. Surgeons use AR to visualize the anatomy of a patient’s spine in 3D during surgery and then track progress in real-time with a transparent display headset fitted with AR eyeglasses. The headset lets surgeons superimpose a patient’s CT scan or x-ray over the surgical site to guide the surgeon during the procedure. The headset projects 3D navigation data onto the surgeon’s retina to see and review data simultaneously without having to shift their focus back and forth from the surgical site to a remote screen. Surgeons can course-correct as needed during procedures.
Enhanced visualization with AR enables ultraprecise alignment and positioning of spinal implants during surgery, with less cutting and movement of muscles and tissues to see a patient’s entire spine. Smaller incisions mean faster patient recoveries and improved outcomes. We can be more precise surgically while reducing a medical team’s exposure to radiation by exporting CT scans and x-rays onto the surgical field.
Robotics: A Helping Hand
We’re currently using robotics at HSS as an added navigation capability. Robotics can help surgeons accurately insert pedicle screws during spinal fusion to anchor and help encourage bone growth during the fusion process. The robot does not take the surgeon’s place but rather provides a helping hand and this assistance helps surgeons avoid nerve roots, the spinal cord or spinal canal when placing the screws. In addition, with robotics, we have less need for fluoroscopy, which means reduced x-ray exposure for patients and OR staff.
While this innovation is being used primarily for navigation purposes, we’re on the cusp of broader uses of robotics in the future, perhaps to safely decompress the spine.
Minimally Invasive Techniques
During standard open spine surgery, a surgeon makes a large incision in the back and then cuts the spinal muscles to pull them away to better visualize the spine.
Minimally invasive techniques utilize smaller incisions and result in less soft tissue damage through use of tubular retractors or endoscopic technology to minimize the trauma of surgery. Thanks to innovations including robotics, navigation and augmented reality technologies, we have become less reliant on making large incisions to perform safe and accurate surgeries.
Smaller incisions mean less soft tissue damage during surgery, reduced blood loss, less pain for the patient, and less need for pain medications. Minimally invasive surgeries can include laminectomies, spinal fusions, and discectomies, among other procedures. Minimally invasive techniques translate into shorter hospital stays after surgery, faster patient recoveries, and less rehabilitation.
Spine surgery will never be welcome news for many patients. But if surgery is warranted, innovations like AR, robotics, and minimally invasive techniques are helping improve results and overall patient experiences. At HSS, we are singularly focused on using the latest technologies and expertise to get our patients back to doing what they enjoy most.
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Evan Sheha, MD, is an assistant attending orthopedic surgeon at HSS Orthopedics at Stamford Health, specializing in spine surgery.
