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

Bibliometric Patent Review of Minimally Invasive Spine Surgery

STUDY DESIGN

This study analyzes patents associated with minimally invasive spine surgery (MISS) found on the Lens open online platform.

OBJECTIVE

The goal of this research was to provide an overview of the most referenced patents in the field of MISS and to uncover patterns in the evolution and categorization of these patents.

SUMMARY OF BACKGROUND DATA

MISS has rapidly progressed, with a core focus on minimizing surgical damage, preserving the natural anatomy, and enabling swift recovery, all while achieving outcomes that rival traditional open surgery. While prior studies have primarily concentrated on MISS outcomes, the analysis of MISS patents has been limited.

METHODS

To conduct this study, we used the Lens platform to search for patents that included the terms "minimally invasive" and "spine" in their titles, abstracts, or claims. We then categorized these patents and identified the top 100 with the most forward citations. We further classified these patents into 4 categories: Spinal Stabilization Systems, Joint Implants or Procedures, Screw Delivery System or Method, and Access and Surgical Pathway Formation.

RESULTS

Five hundred two MISS patents were identified initially, and 276 were retained following a screening process. Among the top 100 patents, the majority had active legal status. The largest category within the top 100 patents was Access and Surgical Pathway Formation, closely followed by Spinal Stabilization Systems and Joint Implants or Procedures. The smallest category was Screw Delivery System or Method. Notably, the majority of the top 100 patents had priority years falling between 2000 and 2009, indicating a moderate positive correlation between patent rank and priority year.

CONCLUSIONS

Thus far, patents related to Access and Surgical Pathway Formation have laid the foundation for subsequent innovations in Spinal Stabilization Systems and Screw Technology. This study serves as a valuable resource for guiding future innovations in this rapidly evolving field.

Innovative technologies in thoracolumbar and lumbar spine surgery failing to reach standard of care: state-of-art review

PURPOSE

To evaluate previously popular technologies in the field of spine surgery, and to better understand their advantages and limitations to the current standards of care. Spine surgery is an ever-evolving field that serves to resolve various spinal pathologies in patients of all ages. While there are established treatments for various conditions, such as lumbar spinal stenosis, idiopathic scoliosis, and degenerative lumbar disease, there is always further research and development in these areas to produce innovative technologies that can lead to better outcomes. As this process progresses, we must remind ourselves of previously tried and tested inventions and their outcomes that have fallen short of becoming a standard to ensure we are able to learn lessons from the past.

METHODS

A thorough literature review was conducted with the aim of compiling literature of previously utilized technologies in spine surgery. Biomedical databases were utilized to gather relevant articles including PubMed, MEDLINE, and EMBASE. Emphasis was placed on gathering articles with technologies or therapeutics aimed at treating common spinal pathologies including lumbar spinal stenosis (LSS), adolescent idiopathic scoliosis (AIS), and other degenerative lumbar spine diseases. The keywords used were: "failed technologies", "historical technologies", "spine surgery", "spinal stenosis", "adolescent idiopathic scoliosis", and "degenerative lumbar spine disease". A total of 47 articles were gathered after initial review.

RESULTS

Different technologies pertaining to spine surgery were identified and critically evaluated. Some of these technologies included X-STOP, Vertiflex, Vertebral Body Stapling, and Dynesys. These technologies were evaluated for their strengths and limitations across their spinal pathology applications. While each type of technology had their benefits, the data tended to be mixed with various limitations across studies.

CONCLUSION

These technologies have been trialed in the field of spine surgery across various spinal pathologies, but still prove of limited efficacy and shortcomings to the current standards of care.

Patent bibliometrics in spinal deformity: the first bibliometric analysis of spinal deformity's technological literature

PURPOSE

Bibliometric analyses have gained popularity for studying scientific literature, but their application to evaluate technological literature (patents) remains unexplored. We conducted a bibliometric analysis on the top 100 most-cited patents in scoliosis surgery.

METHODS

Multiple databases were queried using The Lens to identify the top 100 scoliosis surgery patents, which were selected based on forward patent citations. These patents were then categorized into 8 groups based on technological descriptors and assessed based on various factors including earliest priority date, year issued, and expiration status.

RESULTS

The top 100 most-cited patents included technology underlying anterolateral tethering and distraction systems (n = 11), posterior tethering and distraction systems (n = 23), posterior segmental bone anchor and rod engagement systems (n = 29), interbody devices (n = 10), biological and electrophysiological agents for scoliosis treatment and/or improved arthrodesis (n = 8), intraoperative arthroplasty devices (n = 5), orthotic devices (n = 12), and implantable devices for non-invasive, postoperative alterations of skeletal alignment (n = 2). Seventy-five patents were expired, 21 are still active, and 4 were listed as inactive. The late 1970s and early 2000s saw increased numbers of patent filings. Demonstrated trends showed no meaningful correlation between patent rank and earliest priority date (linear trendline y = 0.2648x - 477.27; R2 = 0.0114), while a very strong correlation was found between patent rank and citations per year (power trendline y = 118.82x--0.83; R2 = 0.8983).

CONCLUSION

Patent bibliometric analyses in the field of spinal deformity surgery provide a means to assess past advancements, better understand what it takes to make a difference in the field, and to potentially facilitate the development of innovative technologies in the future. The method described is a reliable and reproducible technique for evaluating technological literature in our field.

LEVEL OF EVIDENCE: 3

Should We Hire Our Current Fellow? Hiring Trends and Preferences in Spine Surgery

OBJECTIVE

To provide insight into hiring trends/preferences in Academic Orthopaedic Spine Surgery after fellowship training.

METHODS

Fellowship directors (FDs) listed by the North American Spine Society were surveyed regarding new faculty hiring preferences. Surveys were analyzed/stratified by response using the Kruskal-Wallis with Dunn multiple comparisons test, the Fisher exact test, and the Mann-Whitney U test for univariate comparisons.

RESULTS

Thirty-two of 52 (61.5%) FDs responded. 32.3% of graduated fellows pursued academic medicine, which was preferred by FDs (3.59 ± 0.67; 1 to 5 scale). From 2015 to 2020, of the 2.25 ± 1.46 faculty members hired per program, 45.8% were former residents/fellows. Top listed hiring qualities were "strong recommendation from a trusted colleague" (84.4%), "prior personal experience, as a resident/fellow" (78.1%), and "amicable personality" (53.1%). Twelve (38%) answered "no", six (19%) "yes", and 14 (44%) "other", regarding if hiring former residents/fellows benefits the field of spine surgery. "Other" answers endorsing in-house hiring most commonly mentioned consistency/stability (28.6%) while those opposed most commonly mentioned lack of diversity of training/novel techniques (42.9%). When considering programmatic size, while the stated perception of FDs regarding in-house hiring at larger (>2 fellows) versus smaller (1 to 2 fellows) programs was equivalent, the mean percentage of in-house hires at larger programs (67.8% ± 35.8%) was significantly greater than that of smaller programs (33.3% ± 44.8%, P = 0.04).

CONCLUSIONS

In-house hiring in spine surgery appears to occur more commonly than perceived by program leadership, particularly at larger fellowship programs. Further study of hiring preferences and their impact on the field of spine surgery is warranted.

STUDY DESIGN

Prospective Survey Study.

Systematic review of the top 10 ranked spine articles in the last 10 years [2011-2021]

Background

Spine-related research continues to evolve rapidly and in the paradigm of increasing data, evidence-based practice becomes imperative. Citation-based rankings are thus critical in allowing clinicians to quickly ascertain the importance and value of a study. The purpose of this article is to report on the 10 most cited articles in the field of spine surgery over the last 10 years to provide an insight into the direction of research and clinical endeavors.

Methods

Google Scholar was searched (1st April 2021) using an algorithm that sorts all cited spine surgery publications based on the number of citations per year. The top 10 most cited articles were identified. Information including journal, publication title, published year, subspecialty, and purpose of the study were compiled.

Results

The top 10 publications ranged from 471 to 66 citations, with yearly citations ranging from 67 to 14. Eight articles directly related to lumbar fusion, 2 related to 3D Printing in spinal surgery, and one article on robotic surgery. There were 4 retrospective studies, 1 randomized controlled trial (RCT), and 2 systematic reviews. 3 of the papers related to decision making in surgery, 4 on outcomes of surgery, and 3 on innovations in surgery. The journal that appeared most frequently in the top 10 list was the Journal of Spine Surgery.

Discussion

Novel surgical approaches or management strategies are almost always a manifestation of advancements in clinical and basic science research. Algorithm-based identification of highly cited articles provides an effective and prompt avenue for evidence-based medicine. Our ranking found a predominance of publications related to lumbar spinal fusion. Several articles in the top 10 provide an in-depth discussion on novel surgical techniques and technologies that define the current epoch of innovations in spine surgery.