Emerging Technologies in Spine Surgery

Emerging technologies have invaded all fields of medicine but few surgical disciplines have experienced the rapid technological transformation seen in spine surgery. The last two decades have seen rich advances in robotic surgery, computer assisted intraoperative navigation, immersive technologies, data driven decision systems and artificial intelligence. These advances have completely influenced how surgeons diagnose, plan and perform surgeries, and record clinical outcomes. Spine surgery is no longer dependent on a surgeon’s innate clinical and surgical skills but is being positively influenced by a high degree digital precision and computational intelligence. Such rapid changes naturally present great opportunities for the future but also raise important concerns about accessibility, medical ethics, training and the future role of a spine surgeon. Intraoperative navigation is the most widely adopted technology, which has become well validated in high-level studies and is almost indispensable in challenging deformity correction surgeries, revision spine surgery and complex tumor resections. Recent advances make it possible to integrate navigation seamlessly with 3D imaging and augmented reality overlays that make the workflow very efficient. Similarly, robotic surgeries have also transformed from being an inspirational idea to a clinically useful adjuvant. In minimally invasive surgeries too, modern robots have documented improved precisions and enhanced reproducibility, thereby improving overall safety. Transformational advances in minimally invasive techniques, innovative approaches, endoscopic techniques etc., have also found a permanent place in the armamentarium of the spine surgeons due to decreased post-operative pain, early mobilization and higher patient satisfaction. Immersive technologies like augmented and virtual reality and surgical simulation are entering the field of training in spine surgery and transforming the way surgical training was performed for many decades. The recent entry of big data analysis and AI powered algorithms are creating a revolution in automated radiographic diagnosis and calculations, classifying deformities, assisting surgical planning and predicting outcomes. The future impact of AI will not be limited to the surgical room but will extend to diagnosis, electronic medical record analysis, outcome predictions and research methodologies. There is no doubt that the penetration of modern technology will only be deeper and stronger. For a developing country like India, these technologies offer both opportunities and challenges. We have to answer the broader question – Is every one of these technologies valuable to the patient? What are the cost– benefit ratio implications at a practical level? In a country like India, accessibility and equal application across all socio-economic population layers will be a challenge and a significant barrier. A solution that is not affordable or available to all patients is not a real solution. Bridging the gap will not only require more technological innovation but also policy support from the Government, development of cost-effective population specific indigenous solutions and widespread collaborative training initiatives. The challenge will be to make these innovations cost effective and applicable to various practice settings – from high volume tertiary specialized centers to district level hospitals. There will also be a need for constant and rigorous documentation, robust evidence generation; ethical oversight and continuous training to ensure that technology is used safely and effectively. While we embrace these advances, we should ensure that technology remains a valuable adjunct to increase our capabilities in patient care without eroding the human side of clinical medicine. Technology may enhance precision, but it cannot replace a good surgeon-patient relationship that is built on empathy and compassion, clinical judgments that are built on experience and a practice built on ethical integrity. Ultimately, the future of spine surgery will not only depend on technology but more on the integrity and wisdom of the surgeon who is using them. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.