Introduction. The growth of minimally invasive lumbar spine surgery

Paul M. ArnoldDepartment of Neurological Surgery, Carle Neuroscience Institute, Urbana, Illinois;

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Dean ChouDepartment of Neurological Surgery, Columbia University, New York, New York;

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Cara L. SedneyDepartment of Neurosurgery, West Virginia University, Morgantown, West Virginia;

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Xu SunDepartment of Orthopedics, Nanjing Drum Tower Hospital, Nanjing University Medical School, Jiangsu, China;

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Timothy F. WithamDepartment of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland; and

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Robert F. HearyDivision of Neurosurgery, Hackensack Meridian, Mountainside Medical Center, Montclair, New Jersey

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INTRODUCTION

The first 2 decades of the new century have seen an explosion of new technology and surgical techniques in spine surgery, not the least of which has occurred in minimally invasive spine surgery (MIS). What was once the province of a few surgeons has become mainstream, with residents being trained in these procedures in every residency program. Originally used for lumbar discectomy, MIS techniques are now being adapted to resect intradural tumors and treat fractures in patients with polytrauma. In several centers, patients are undergoing outpatient transforaminal lumbar interbody fusion surgery. Even the field of spinal deformity—itself a beneficiary of recent intense interest and study—has also benefited from this revolution. Patients are leaving the hospital sooner, experiencing less postoperative pain, and returning to work sooner. These advances have also led to lower healthcare costs, something that is on the minds of all healthcare practitioners.

The current issue of Neurosurgical Focus highlights several novel techniques that will be of interest to the practicing spine surgeon. The rise of MIS techniques has paralleled advances in our understanding of spinal biomechanics and spinal alignment, which has subsequently been fueled by new knowledge in the measurement of spinal and spinopelvic parameters. Future advances are likely to include artificial intelligence and machine learning, wherein the surgeon will be able to input data into an algorithm and arrive at an appropriate construct, much like a pilot produces a flight plan before takeoff. The patient will be able to see the projected construct in the office in three dimensions. The proposed construct will help guide the surgeon intraoperatively, and it is likely that custom, pre-bent rods can be produced and delivered to the surgeon before skin incision. Of course, robotics, augmented reality, and navigation technology will allow the surgeon to accurately place screws, rods, and interbody devices. This is the future of spine surgery in the very near term. We hope these articles will highlight the challenges and innovative technologies that are rapidly becoming available.

Disclosures

Dr. Chou reports receiving royalties from Globus and being a consultant for Globus and Orthofix. Dr. Sedney reports receiving grants from NIH outside the submitted work. Dr. Witham reports stock ownership, travel expenses, and being a medical advisory board member of Augmedics, Inc., outside the submitted work.

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Illustration from Chan et al. (E2). © Andrew K. Chan, published with permission.

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