Minimally invasive spine surgery has been available for several years, but the trend has just begun picking up steam across the country. Many surgeons who learned traditional open surgery are content with those procedures, but more spine fellows are seeking to learn minimally invasive techniques and will begin incorporating them into their practices at a faster rate than ever before.
1. Complex procedures are now minimally invasive.
Simple procedures, such as discectomies, were among the first to transition into a minimally invasive approach, and now surgeons are performing minimally invasive fusion procedures on a regular basis. However, more recent technological development has allowed even more complex procedures, such as scoliosis correction, to fall under the minimally invasive umbrella.
2. Outpatient spinal fusions are more common.
As more surgeons are learning minimally invasive techniques and the technology develops for fusion procedures, more of those cases could be performed in the ambulatory surgery center setting. Anterior cervical discectomies and fusions are performed regularly in some ASCs, and additional procedures could make the transition in the future.
3. Artificial disc technology in limbo.
Motion preservation has been a trend in orthopedics for years, and disc replacement technology was designed as a step up from fusions in the field. However, attempts at lumbar disc replacements are largely considered failures and recent studies question whether cervical disc replacements reduce the risk of adjacent segment disease.
4. Biologics and disc regeneration. Moving forward with motion preservation, surgeons and scientists have set their sights on biological solutions and disc regeneration. Early technologies are still in the beginning stages and clinical trials, but this area shows the most promise in combating some of the highest pain and cost generators in the country.
5. Lateral approach is gaining steam.
More procedures are looking for a lateral approach to the spine, and device companies are developing new lateral systems to meet these needs. Initial minimally invasive procedures approached the spine anteriorally or posteriorally, but there have been some proven benefits to the lateral approach when possible.
6. Intraoperative neuromonitoring and neurophysiology.
Along with minimally invasive instrumentation and implants, a new need for advances in neuromonitoring and neurophysiology has emerged. Surgeons want to perform these procedures safely for their patients, and an extra person gauging the quality of the procedure can really make a difference.
7. Computer navigation could have a place going forward.
Computer assistance and robotic guidance for orthopedics and spine have been a contentious issue for the past few years; the equipment is expensive and surgeons question whether it actually improves the procedure enough to warrant that cost. However, there is a market for this technology and future iterations could make an impact on spine care.
8. Physician-owned ambulatory surgery centers are more common in spine.
There is an opportunity for more spine surgeons to become investors in ambulatory surgery centers if they can move their cases into the outpatient setting. Spine practices in unsaturated markets are able to open their centers and have more control over their cases.
Source: www.beckersasc.com; Laura Miller; March 5, 2013.