New Technology in Spine
By Jaideep Chunduri, MD
Spine surgery has been performed for decades. The first documented spinal fusion procedure occurred in 1912 and was successfully used to treat tuberculosis of the spine. Much has changed since 1912 in how surgery is performed. This includes everything from the diagnosis of a spinal problem, performance of the surgical procedure, and completion of the rehabilitation process. This involves changes in anesthesia and post-operative care, instrumentation used in the spine, bone grafting options, amount of muscle stripping, and post-operative physical therapy.
Four of the more recent advances in spinal surgery are the use of bone graft substitutes to avoid the need to take one’s own bone from the iliac crest (hip), the attempt to move away from fusion of the spine, minimally invasive spinal surgery, and continuous intra-operative nerve monitoring.
Bone graft substitutes have been available for a while and include cadaver bone (allograft), demineralized bone matrix, and various matrix devices which allow for bone to grow within a scaffold. The reason for the bone graft substitutes is to substitute the potential complications of taking one’s own bone from the iliac crest. One of the more powerful agents that has come to the forefront is a substance called BMP (bone morphogenic protein) which is a natural protein found in the bone. The substance is genetically engineered and magnified multiple times and allows bone cells to be “called” to the site of the fusion in an attempt for fusion. These substances (Medtronic’s Infuse, Stryker OP-1) have shown some promise in various applications and can allow for a solid spinal fusion although not FDA approved for every indication. Another substance which has shown promise is a product by Nuvasive Spine called Osteocel. This product uses a combination of allograft bone which is specially processed to an ideal size and mesenchymal stem cells which have a propensity to form bone.
Neurologic monitoring of the nerves allows for a continuous check of signals of the spinal cord and nerves in the arms and legs during the surgical procedure. The purpose is for safe decompression of the spinal cord, placement of instrumentation around the nerves, adequate positioning of the patient, and overall patient safety.
Minimally invasive surgery allows for a surgical procedure to be done through small incisions with the use of intra-operative X-ray, less muscle stripping, less blood loss, and a theoretical faster recovery time. The procedures are usually performed through small tubes or retractors and can be used for microdiscectomies, decompressions, and spinal fusions.
Dynamic stabilization or surgery performed with a motion sparing device has become the new buzz word in spinal surgery. This avoids the need for a spinal fusion where 2 or 3 bones are made into one bone. Dynamic stabilization can include the Total Disc Replacement, Facet Arthroplasty (joint replacement of the facet joint), Flexible Rods, and Disc Distraction devices. Much of these technologies are still under FDA investigation but show promise for the future. Currently several lumbar and cervical Total Disc Replacements are FDA approved and available for use in patients with the proper indications.
Please contact us if you have any questions with regards to newer technologies which are available.