Emerging Technologies in Spinal Surgery

Abstract

In 2002, the feasibility of percutaneous pedicle screw fixation was first reported.1 This novel implant technology consisted of a screw extender allowing remote access to the screw head in conjunction with a unique “sextant” based rod delivery mechanism. In many ways, this new percutaneous screw-rod technology and technique heralded the onset of minimally invasive spinal fusion surgery. As with any new technology or technique, the value is dependent on the relative efficacy compared to existing standards. Usage and subsequent effectiveness of the percutaneous screw-rod technology was quickly established for single level minimally invasive posterior lumbar interbody fusion and transforaminal lumbar interbody fusion.2-4 Success with short segment degenerative conditions led to the expansion of percutaneous screw-rod usage to more complex spinal conditions involving trauma, oncology, and deformity necessitating longer segment constructs. To date, there is no question that minimally invasive fusion surgery incorporating percutaneous screw-rod technology has had a significant and lasting impact. Beyond percutaneous screw-rod technology, many advancements in spinal surgery have depended on technological innovations to improve surgical efficiency, safety, and outcomes. Another example is spinal navigation, which has unquestionably improved accuracy of pedicle screw placement.5 Subsequent development of newer instruments and software refinement has resulted in the application of navigation to other aspects of surgery, including osteotomy, cage placement, and drilling with potential benefits in reducing complications and improving outcomes. Similarly, robotics in spine surgery was introduced more than 10 yr ago, but only recently has the technology matured to a point that widespread use is becoming feasible. Other recent innovations include continuing development of expandable cage technology, novel osteobiologics, surface technology, radiation reduction technology, and augmented and virtual reality. Although the clinical value of many of these technologies has not been firmly established, they are promising and likely will positively enhance spinal surgery. The purpose of this supplement is to highlight the current and future technological advancements impacting spinal surgery. Funding Publication of this supplement was funded by Globus and Medtronic. Disclosures Outside of publication in this supplement, the authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.