4 Trends in Outpatient Minimally Invasive Spinal Stablization

At the 20th Annual Ambulatory Surgery Centers Conference in Chicago on Oct. 24, Jeffrey Nees, MD, a neurosurgeon with Laser Spine Institute, talked about trends for outpatient minimally invasive stabilization surgery.

A subset of patients require fusion surgery for spinal stabilization, Dr. Nees said, and minimally invasive approaches can give these patients the relief they need with less post operative pain and quicker recoveries.

Patient desires are driving much of the push toward less invasive surgery. Patients are increasingly educated about their care and are looking for newer ways to achieve fusion results, he said. Much of the medical community is also on board and realizing open surgeries aren’t doing much good. Reimbursements are also shrinking, which is an incentive for physicians to find ways to achieve the same care outcomes at lower costs, he said.

Dr. Nees discussed lumbar and cervical spine device trends, as well as biologicals and neuronavigation.  

1. Cervical spine. MIS procedures include anterior cervical discectomy with fusion and cervical total disc arthroplasty. Cervical procedures have graft innovations, such as PEEK-OPTIMA by Invibio Biomaterials, ceramic and bio-absorbables.

2. Lumbar spine. Lumbar spine MIS procedures include transforaminal lumbar interbody fusion, extreme lateral or direct lateral interbody fusion, axial lumbar interbody fusion, anterior lumbar interbody fusion and lumbar total disc arthroplasty. Use of the coflex device is becoming more popular. Also, the future of the AxiaLIF is uncertain due to controversy and lessened use of rhBMP-2.

3. Neuronavigation. Previously, neuronavigation systems required preoperative registration of landmarks, which could change once the patient moved from pre-op to the operating room. However, newer systems register intraoperatively and offer true navigation-only fixation placement.

4. Biologicals. Bone expanders, both biological and inorganic, are becoming more commonly used in MIS. Also, amniotic and bone-derived stem cells will become more popular tools for stimulating spinal healing.

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