What's New in Spine Surgery

Innovation and New Technologies in Spine Surgery, Circa 2020: A Fifty-Year Review

Spine surgery (lumbar, cervical, deformity, and entire spine) has increased in volume and improved in outcomes over the past 50 years because of innovations in surgical techniques and introduction of new technologies to improve patient care. Innovation is described as a process to add value or create change in an enterprise's economic or social potential. This mini review will assess two of three assessments of innovation in spine surgery: scientific publications and patents issued. The review of both scientific publications and issued patents is a unique assessment. The third assessment of innovation: regulatory clearances of medical devices and equipment for spine surgery and their evolution over time, will also be discussed.

Osteoconductive bone graft extenders in posterolateral thoracolumbar spinal fusion: a systematic review

STUDY DESIGN

A systematic review.

OBJECTIVE

To evaluate the efficacy, safety, and outcomes of osteoconductive bone graft extenders (BGEs) compared with iliac crest bone graft (ICBG) in posterolateral thoracolumbar spinal fusion.

SUMMARY OF BACKGROUND DATA

ICBG is the current "gold standard" for achieving spinal arthrodesis. However, morbidity associated with its harvesting has led to the increased use of BGEs.

METHODS

An electronic literature search was conducted through April 2011 using MEDLINE, EMBASE, CENTRAL, and Cochrane Library. Risk of bias and methodological assessment was performed using the Cochrane Risk of Bias Tool. Higgins I(2) test was used to assess for heterogeneity. Pooled weighted relative risk (RR) ratios were calculated to compare fusion and adverse event rates. Weighted standardized mean differences were calculated to compare functional outcome and pain scores.

RESULTS

Thirteen studies were included representing a total of 768 patients. Overall study quality was low (mean Cochrane Risk of Bias score, 4.8 out of 12; range, 3-6). Fusion rates were comparable between the BGE and ICBG groups (RR, 0.96; 95% confidence interval [CI], 0.89-1.03; P = 0.28). Higgins I(2) test (58%) suggested substantial heterogeneity in the pooling of studies. The pooled rate of donor site pain in the ICBG group was 11.2% (95% CI, 7.4%-15.1%). Reported adverse events, excluding donor site pain, were significantly lower in the BGE group (RR, 0.42; 95% CI, 0.28-0.64; P < 0.0001). Functional outcomes were not significantly different between the 2 groups.

CONCLUSION

Osteoconductive BGEs combined with local spine autograft and/or bone marrow aspirate have comparable fusion rates, similar functional outcomes, lower complication rates, and a lower risk of donor site pain than ICBG. Caution should be taken in interpreting these findings, given the low quality of the studies and the heterogeneity in the results. Randomized controlled studies using blinded assessments are required to help elucidate more conclusive evidence.

Adult spine deformity

Adult spinal deformity may occur as the result of a number of conditions and patients may present with a heterogeneous group of symptoms. Multiple etiologies may cause spinal deformity; however, symptoms are associated with progressive and asymmetric degeneration of the spinal elements potentially leading to neural element compression. Symptoms and clinical presentation vary and may be related to progressive deformity, axial back pain, and/or neurologic symptoms. Spinal deformity is becoming more common as adults 55-64 years of age are the fastest growing proportion of the U.S. population. As the percentage of elderly in the United States accelerates, more patients are expected to present with painful spinal conditions, potentially requiring spinal surgery. The decision between operative and nonoperative treatment for adult spinal deformity is based on the severity and type of the patient's symptoms as well as the magnitude and risk of potential interventions.