Recent Advances in Spine Surgery- Pros and Cons

Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 50-53 | Arvind Janardhan Vatkar, Sumedha Shinde, Sachin Kale, Pramod Bhor


Authors: Arvind Janardhan Vatkar [1], Sumedha Shinde [2], Sachin Kale [3], Pramod Bhor [4]

[1] Consultant Orthopedic Spine Surgeon, Fortis Hiranandani Hospital, Vashi, Navi Mumbai- 400703, India,
[2] Assistant Professor, Sir JJ Blood Center, Byculla, Mumbai, Maharashtra 400008, India,
[3] Department of Orthopedics, D Y Patil Hospital and medical college, Ayyappa Temple Road, Dr D Y Patil
Vidyanagar, Sector 5, Nerul, Navi Mumbai, Maharashtra 400706, India,
[4] Director of Department of Orthopaedics, Fortis Hiranandani Hospital, Vashi, Navi Mumbai- 400703, India.

Address of Correspondence
Dr. Arvind Vatkar Janardhan,
Department of Orthopaedics, Fortis Hiranandani hospital, Juhu Nagar, Sector 10A, Vashi, Navi Mumbai,
Maharashtra 400703, India.


Recent innovations in spine surgery, such as minimally invasive spine surgery, endoscopic spine surgery, robotic spine surgery, virtual reality, artificial intelligence, and biomaterials, have resulted in significant gains, although more work need to be done. Minimally invasive and endoscopic spine operations provide the advantages of minimum tissue stress and early recovery, but they have a high learning curve. Robotic spine surgery and virtual reality can improve precision and planning, although they are expensive and may be restricted in availability. Artificial intelligence and biomaterials show promise for personalised therapy, but their long-term implications are still being investigated. To make educated judgments for their patients, surgeons must consider the benefits and drawbacks of various technologies.
Keywords: Minimally invasive spine surgery, Artificial intelligence, Robotic spine surgery, Endoscopic spine surgery, Virtual reality, Biomaterials


1. Móga K, Ferencz A, Haidegger T. What is next in computer-assisted spine surgery? Advances in image-guided robotics and extended reality. Robotics 2022;12:1.
2. Zhou S, Zhou F, Sun Y, Chen X, Diao Y, Zhao Y, et al. The application of artificial intelligence in spine surgery. Front Surg 2022;9:885599.
3. Choi JY, Park SM, Kim HJ, Yeom JS. Recent updates on minimally invasive spine surgery: Techniques, technologies, and indications. Asian Spine J 2022;16:1013-21.
4. Sharma A, Shakya A, Singh V, Deepak P, Mangale N, Jaiswal A, et al. Incidence of dural tears in open versus minimally invasive spine surgery: A Single-center prospective study. Asian Spine J 2022;16:463-70.
5. Wang X, Borgman B, Vertuani S, Nilsson J. A systematic literature review of time to return to work and narcotic use after lumbar spinal fusion using minimal invasive and open surgery techniques. BMC Health Serv Res 2017;17:446.
6. Thongtrangan I, Le H, Park J, Kim DH. Minimally invasive spinal surgery: A historical perspective. Neurosurg Focus 2004;16:E13.
7. Tieber F, Lewandrowski KU. Technology advancements in spinal endoscopy for staged management of painful spine conditions. J Spine Surg 2020;6:S19-28.
8. Park SM, Park J, Jang HS, Heo YW, Han H, Kim HJ, et al. Biportal endoscopic versus microscopic lumbar decompressive laminectomy in patients with spinal stenosis: A randomized controlled trial. Spine J 2020;20:156-65.
9. Kang MS, You KH, Han SY, Park SM, Choi JY, Park HJ. Percutaneous full-endoscopic versus biportal endoscopic posterior cervical foraminotomy for unilateral cervical foraminal disc disease. Clin Orthop Surg 2022;14:539-47.
10. Fiani B, Siddiqi I, Reardon T, Sarhadi K, Newhouse A, Gilliland B, et al. Thoracic endoscopic spine surgery: A comprehensive review. Int J Spine Surg 2020;14:762-71.
11. Naros G, Machetanz K, Grimm F, Roser F, Gharabaghi A, Tatagiba M. Framed and non-framed robotics in neurosurgery: A 10-year single-center experience. Int J Med Robot 2021;17:e2282.
12. Grimm F, Naros G, Gutenberg A, Keric N, Giese A, Gharabaghi A. Blurring the boundaries between frame-based and frameless stereotaxy: Feasibility study for brain biopsies performed with the use of a head-mounted robot. J Neurosurg 2015;123:737-42.
13. Fatima N, Massaad E, Hadzipasic M, Shankar GM, Shin JH. Safety and accuracy of robot-assisted placement of pedicle screws compared to conventional free-hand technique: A systematic review and meta-analysis. Spine J 2021;21:181-92.
14. Han X, Tian W, Liu Y, Liu B, He D, Sun Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: A prospective randomized controlled trial. J Neurosurg Spine 2019;??? ;1-8.
15. Keric N, Doenitz C, Haj A, Rachwal-Czyzewicz I, Renovanz M, Wesp DM, et al. Evaluation of robot-guided minimally invasive implantation of 2067 pedicle screws. Neurosurg Focus 2017;42:E11.
16. Park J, Ham DW, Kwon BT, Park SM, Kim HJ, Yeom JS. Minimally invasive spine surgery: Techniques, technologies, and indications. Asian Spine J 2020;14:694-701.
17. Yu Y, Li ZZ, Nishimura Y. Editorial: Endoscopic spine surgery. Front Surg 2022;9:1127851.
18. Hasan S, Miller A, Higginbotham D, Saleh ES, McCarty S. Virtual and augmented reality in spine surgery: An era of immersive healthcare. Cureus 2023;15:e43964.
19. Gasco J, Patel A, Ortega-Barnett J, Branch D, Desai S, Kuo YF, et al. Virtual reality spine surgery simulation: An empirical study of its usefulness. Neurol Res 2014;36:968-73.
20. Ma L, Fan Z, Ning G, Zhang X, Liao H. 3D Visualization and augmented reality for orthopedics. Adv Exp Med Biol 2018;1093:193-205.
21. Hasan LK, Haratian A, Kim M, Bolia IK, Weber AE, Petrigliano FA. Virtual reality in orthopedic surgery training. Adv Med Educ Pract 2021;12:1295-301.
22. Saeed SA, Masters RM. Disparities in health care and the digital divide. Curr Psychiatry Rep 2021;23:61.
23. Browd SR, Park C, Donoho DA. Potential applications of artificial intelligence and machine learning in spine surgery across the continuum of care. Int J Spine Surg 2023;17:S26-33.
24. Broida SE, Schrum ML, Yoon E, Sweeney AP, Dhruv NN, Gombolay MC, et al. Improving surgical triage in spine clinic: Predicting likelihood of surgery using machine learning. World Neurosurg 2022;163:e192-8.
25. Wilson B, Gaonkar B, Yoo B, Salehi B, Attiah M, Villaroman D, et al. Predicting spinal surgery candidacy from imaging data using machine learning. Neurosurgery 2021;89:116-21.
26. Xie N, Wilson PJ, Reddy R. Use of machine learning to model surgical decision-making in lumbar spine surgery. Eur Spine J 2022;31:2000-6.
27. Peng L, Zhang G, Zuo H, Lan L, Zhou X. Surgical design optimization of proximal junctional kyphosis. J Healthc Eng 2020;2020:8886599.
28. Garcia-Canadilla P, Isabel-Roquero A, Aurensanz-Clemente E, Valls-Esteve A, Miguel FA, Ormazabal D, et al. Machine learning-based systems for the anticipation of adverse events after pediatric cardiac surgery. Front Pediatr 2022;10:930913.
29. Iqbal FM, Joshi M, Fox R, Koutsoukou T, Sharma A, Wright M, et al. Outcomes of vital sign monitoring of an acute surgical cohort with wearable sensors and digital alerting systems: A pragmatically designed cohort study and propensity-matched analysis. Front Bioeng Biotechnol 2022;10:895973.
30. Boaro A, Leung J, Reeder HT, Siddi F, Mezzalira E, Liu G, et al. Smartphone GPS signatures of patients undergoing spine surgery correlate with mobility and current gold standard outcome measures. J Neurosurg Spine 2021;35:796-806.
31. Lyman S, Hidaka C, Fields K, Islam W, Mayman D. Monitoring patient recovery after THA or TKA using mobile technology. HSS J 2020;16:358-65.
32. Shi LY, Wang A, Zang FZ, Wang JX, Pan XW, Chen HJ. Tantalum-coated pedicle screws enhance implant integration. Colloids Surf B Biointerfaces 2017;160:22-32.
33. Takayanagi A, Siddiqi I, Ghanchi H, Lischalk J, Vrionis F, Ratliff J, et al. Radiolucent carbon fiber-reinforced implants for treatment of spinal tumors-clinical, radiographic, and dosimetric considerations. World Neurosurg 2021;152:61-70.
34. Lv ZT, Xu Y, Cao B, Dai J, Zhang SY, Huang JM, et al. Titanium-coated PEEK versus uncoated PEEK cages in lumbar interbody fusion: A systematic review and meta-analysis of randomized controlled trial. Clin Spine Surg 2023;36:198-209.
35. Singhatanadgige W, Tangchitcharoen N, Kerr SJ, Tanasansomboon T, Yingsakmongkol W, Kotheeranurak V, et al. A comparison of polyetheretherketone and titanium-coated polyetheretherketone in minimally invasive transforaminal lumbar interbody fusion: A randomized clinical trial. World Neurosurg 2022;168:e471-9.
36. Feng JT, Yang XG, Wang F, He X, Hu YC. Efficacy and safety of bone substitutes in lumbar spinal fusion: A systematic review and network meta-analysis of randomized controlled trials. Eur Spine J 2020;29:1261-76.
37. Iunes EA, Barletta EA, Barba Belsuzarri TA, Onishi FJ, Cavalheiro S, Joaquim AF. Correlation between different interbody grafts and pseudarthrosis after anterior cervical discectomy and fusion compared with control group: Systematic review. World Neurosurg 2020;134:272-9.
38. Ament JD, Vokshoor A, Yee R, Johnson JP. A systematic review and meta-analysis of silicon nitride and biomaterial modulus as it relates to subsidence risk in spinal fusion surgery. N Am Spine Soc J 2022;12:100168.
39. Fiani B, Jarrah R, Shields J, Sekhon M. Enhanced biomaterials: Systematic review of alternatives to supplement spine fusion including silicon nitride, bioactive glass, amino peptide bone graft, and tantalum. Neurosurg Focus 2021;50:E10.
40. Cottrill E, Premananthan C, Pennington Z, Ehresman J, Theodore N, Sciubba DM, et al. Radiographic and clinical outcomes of silicate-substituted calcium phosphate (SiCaP) bone grafts in spinal fusion: Systematic review and meta-analysis. J Clin Neurosci 2020;81:353-66.
41. Choi UY, Kim KT, Kim KG, Lim SH, Kim YJ, Sohn S, et al. Safety and tolerability of stromal vascular fraction combined with β-Tricalcium phosphate in posterior lumbar interbody fusion: Phase I clinical trial. Cells 2020;9:??? .
42. Kwon BT, Kim HJ, Lee S, Park SM, Ham DW, Park HJ, et al. Feasibility and safety of a CaO-SiO2-P2O5-B2O3 bioactive glass ceramic spacer in posterior lumbar interbody fusion compared with polyetheretherketone cage: A prospective randomized controlled trial. Acta Neurochir 2023;165:135-44.

How to Cite this article: Vatkar AJ, Shinde S, Kale S, Bhor P. Recent Advances in Spine Surgery- Pros and Cons. Journal of Clinical Orthopaedics 2023;8(2):50-53.

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