Minimally invasive spine in 2028: 5 predictions

Minimally invasive spine techniques have been the focus of recent medtech innovations, and more growth is expected in the motion preservation aspects.

Five spine surgeons discuss what the near future of minimally invasive techniques will look like. 

Question: What will motion-preserving spine surgery look like in 3 years?

Tan Chen, MD. Geisinger Musculoskeletal Institute (Danville, Pa.): Cervical and lumbar disc arthroplasty has grown in popularity in the past decade with a multitude of high-quality studies demonstrating non-inferior outcomes compared to fusion in the appropriately selected patient. However, there seems to be significant resistance to widespread adoption of the technology, and I suspect the technical degree of bony carpentry required, coupled with disadvantageous reimbursement rates may play a role. Motion sparring technology continues to evolve, and I’m particularly excited about the upcoming implants that are able to address the anterior disc and the posterior facet complexes simultaneously (ie: changing all 3 wheels of the tricycle vs replacing just the front wheel) through a single minimally invasive posterior incision. 

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: We will find new ways to restore motion to degenerated segments. We have seen a new interest in hybrid constructs and more interesting data, although not as rigorous as we all would like, but I think it will bear out.  That being said, certain techniques that involve truly destabilizing a segment with no thought to what happens when it fails will likely not be time-tested or outcome-supported. We all should think carefully about how close one should get to the bleeding edge without falling off in terms of technique. 

Mohammed Faraz Khan, MD. New Jersey Brain and Spine (Paramus): I think in the next three years, we’ll keep seeing motion-preserving surgery gain ground, especially in the cervical spine where the evidence is decent and the implants are getting better. Lumbar is still going to be more selective, it’s a harder problem to solve, both biomechanically and from a payer standpoint. So while we’ll see better tools and more data supporting these techniques, I don’t think we’re heading for a dramatic change just yet.

Jeremy Smith, MD. Hoag Orthopedic Institute (Irvine, Calif.): Over the next three years, motion preservation spine surgery is likely to see significant growth and refinement, driven by advances in implant design, biomaterials, and surgical techniques. Cervical disc arthroplasty is expected to expand in indications as long-term data continues to validate its durability and reduction in adjacent segment degeneration compared to fusion. We may see the increased use of disc arthroplasty in hybrid fusion constructs.

In the lumbar spine, newer-generation total disc replacements and facet joint arthroplasty devices are emerging, with early results suggesting improved biomechanics and patient satisfaction. Minimally invasive approaches will become more common, aided by navigation, robotics, and patient-specific planning. At the same time, biologics and surface coatings designed to improve osseointegration and reduce wear will extend the lifespan of motion-preserving devices. As payers and guidelines begin to reflect this growing evidence base, motion preservation is poised to transition from a niche option to a more mainstream strategy in appropriately selected patients, with an emphasis on preserving natural kinematics, minimizing reoperations and optimizing quality of life.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho):Claims to efficiency driven and augmented precision spinal implantations will result from increased robotic use during surgery in prospective modeling for spine surgery. This indeed may be the case especially concerning complex patient populations and more tenuous areas such as the skull base and the markedly larger patient.

The persistent concerns about cost containment and over indications, corresponding and adjacent level failure, reduced motion and revision will remain pertinent, especially regarding the overall economic status of healthcare and daily scrutiny attached to all procedures.

The post Minimally invasive spine in 2028: 5 predictions appeared first on Becker’s Hospital Review | Healthcare News & Analysis.