Spinal Care: The Past, the Present and the Future with Kate Windard
How integral is medical technology to spinal care?
Medical technology has now become an integral part of spinal care, with pre-operative and inter-operate planning, choice of materials and surgical approaches all enabling enhanced surgical care and improved clinical outcomes for patients.
Without evolving medical technology, positive patient outcomes over the past 20 years would have been severely stunted. Patients would likely still be struggling with lengthy duration of stays, increased blood loss and increased post-operative rehabilitation times, all combining to add to a greater burden on the NHS and UK employment due to increased return to work times.
The impact of using innovative spine technologies and solutions to provide better clinical outcomes and create a better patient experience is exemplified with a lateral approach to spine surgery. The lateral procedure is performed through the side of the body and is designed to treat a range of spinal pathologies. It does not require an anterior (front) or posterior (back) exposure, and thereby does not present the same risks of vascular and/or neural injury as traditional approaches.
The lateral procedure has continued to evolved and has opened the door to lateral single-position surgery, which can reduce the number of times a patient has to be repositioned during surgery.
What are the long-term patient benefits to high quality spinal care?
The developments of new surgical approaches and greater understanding of the spine have meant that patients are no longer prescribed long periods of bed rest, instead they are encouraged to be mobile as long as possible. With Musculoskeletal multi-disciplinary teams, patients go through all conservative non-surgical options before being considered for surgery, with a small percentage of patients undergoing surgery.
Surgical approaches have been greatly enhanced through smaller, more minimally-invasive incisions, which in turn means shorter operating times, reduced blood loss and shorter length of stay for the patients. The future of spine surgery remains focused on minimally-invasive approaches.
Intraoperative planning also ensures clinicians are achieving their surgical goals in sagittal alignment and therefore reducing the potential for failed back surgery and shorter segments of the spine being fused—all enabling patients to stay mobile and flexible for longer periods.
The NHS turns 70 this year. How has spinal surgery changed in that time?
There have been enormous leaps and bounds in spine surgery over the past 70 years, from the full length of spine fusion constructs and hooks and wires for deformity corrections to seeing changes in advances in new materials, evolving from stainless steel to Titanium and cobalt chrome. 3D printing, growth rods for deformity and custom designed rods to fit patient anatomy continue to improve surgical outcomes for patients and keeping patients mobile for longer.
What changes and trends can we expect to see with the future of spinal surgery?
There will be greater developments in growth rod systems for pediatric deformity as new technologies are developed to battle early onset scoliosis and other maladies.
Enhanced pre- , mid- and post-operative planning ensure surgeons are achieving their surgical goals and spinal corrections/fixations are shorter which keeps patients mobile for longer periods. It is all about “GIRFT” or Getting It Right First Time and creating a win-win experience for both the surgeon and the patient.
Patient-led apps are also playing a more important role in the process, potentially giving clinicians more accurate patient data, such as pain scores and a disability index to help identify the best non-surgical and surgical approaches.
Navigation has already started to be utilized within some hospitals but will be more widely adopted. Another focus is finding novel ways to continue to make the OR more intuitive and safer for surgeons, staff and patients.
Finally, partnerships between the NHS and Industry for clinical studies continue to grow, as has the acknowledgement of the importance of surgical training and education and the speed at which products and technology evolve.
Kate Windard is a Spine & Reimbursement Specialist with Nuvasive