Spinal fusion has long been an answer for several conditions, including degenerative disk disease, spinal stenosis, fractured vertebra, among others. Essentially, the procedure welds together two or more vertebrae into one solid bone, and has proven to be effective in relieving painful motion or to restore stability to the spine.
The next decade will be filled with significant market growth for spinal fusion with projections forecasting a $9-billion industry by 2023 and $12.5 billion by 2027.
Here are five reasons why.
Over the past several years, the clinical experience treating spine issues has accelerated. There is a greater understanding of the dynamics and alignment of the spine, from the head to the pelvis. Previously, people with lumbar stenosis would have a decompression if they didn’t have obvious instability. Now, some are developing terrible back pain because they are out of balance.
With more in-depth studies and expanded focus, we can ensure proper spinal alignment so they are not suffering long term.
Spine surgery is typically recommended only when the source of pain can be identified. Diagnostic imaging (X-rays, CT scans and MRIs) has allowed us to accurately find these sources and consider spinal fusion much earlier in a person’s treatment. We are much more proactive.
Advancements in instrumentation, hardware and fusion techniques have also made it more routine for surgeons to insert the hardware. It’s an easier decision thanks to improvements in technology, imaging and minimally invasive ways — like robotic surgery — which have made it much easier and safer.
Robotic surgery has impacted almost all areas of health care. Its benefits shouldn’t be understated. People are recovering quicker with less blood loss, postoperative pain and lower risk for infections. Robotics doesn’t add complexity to spinal procedures. Instead it involves significantly less trauma. So, we might now operate on a patient that we would not have 15 years ago.
From a clinician’s perspective, especially with spinal fusions, robotics makes the procedure and decision to do it easier. During the minimally invasive procedure, surgeons make a 1-to 2-inch incision and use the instruments to move muscles to reach the spine. The implants are placed through these small incisions.
One would think as the population ages, more people will need a spinal fusion due to the conditions related to the aging process. This isn’t entirely true. People are living longer and healthier. The activity level for someone who is 75 is much greater than it has ever been. In fact, functionality for individuals in their 60s, 70s and 80s is an all-time high. Eighty is now the new 70. People are still working, traveling, bowling, playing tennis. So, we consider surgery for them as well. Somebody who is 70 and has surgery can continue living their active lifestyle for several more years.
We are trying to look at the population that requires spine surgery and treating them a little more completely, looking at all parameters including stability and alignment regardless of age.
While most spinal fusions deal with degenerative spine disease, fusions for tumor removal are becoming much more aggressive. We have better techniques and better technology to resect spinal pathologies. And when we do that, we have to then reconstruct, whereas in the past we were limited in the reconstruction.
Mark Eisenberg, MD, is a neurosurgeon specializing in spinal and skull base disorders. He is director of the Northwell Institute for Neurology and Neurosurgery's Skull Base Center and an associate professor of neurosurgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.