The Future of Spine Surgery

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Perspectives and trends to look out for in 2020

Recently, we had the great honor of again collaborating with AO Spine to share our collective insights on the spine industry in this article published last month by Spinal Surgery News. The story highlights some of the most prominent trends seen today, along with a fascinating interview with one of the leading orthopaedic surgeons in the world on the essence of being a spine surgeon. Read the article here:

Trend 1: Aging Population Leads to Increase in Spinal Fusion

The percentage of the European population over the age of 65 equaled 19.7% in 2018, indicating a 2.6% increase over 2008; an even more dramatic increase is expected to occur by 2100.1 Data confirms that older patients are increasingly meeting the indications for spinal fusion.2,3 Older patients are more likely to have suboptimal bone quality and may require stronger forms of fixation.2,4

Current limitations are mainly reported in the areas of fixation, alignment and extension.3-9 For example, 95% of surgeons have reported to have seen a lateral-mass screw pull out or loosen.3 Market research has also shown limited satisfaction in the ability to achieve alignment targets or to extend constructs with current instrumentation.3

Today, DePuy Synthes addresses this fast-growing segment with a new solution, the SYMPHONY™ Occipito-Cervico-Thoracic System, which helps streamline procedures and create efficiencies for the surgeon and operating staff who are treating patients with complex cervical spine disorders. You can read about the launch of the new DePuy Synthes Spine SYMPHONY OCT System to learn more, then follow our global account on LinkedIn to stay up-to-date on our ongoing news.

Trend 2: “Enabling Tech” Is All the Buzz

Intraoperative image-guided spinal navigation was by far the most talked about technology at EUROSPINE 2019. The utilization of image guidance (IG) is becoming increasingly widespread and can be invaluable to surgeons during spine surgery procedures.22 Minimally invasive spine (MIS) surgery can result in a decrease in visualization, however using computer-assisted navigation technologies enables greater visualization through smaller MIS incisions as compared to open surgical procedures.23

DePuy Synthes is proud of our longstanding strategic collaboration and co-marketing and distribution agreement with Brainlab, a company that offers an industry-leading suite of technologies including navigation, imaging, robotics and software planning tools. As part of this agreement, our companies collaborate on the marketing and promotion of integrated systems. This strategic collaboration allows us to offer an end-to-end navigation solution including intra-operative services and professional education that provides customers with seamless access to Brainlab’s enabling technology in combination with DePuy Synthes offerings.

This collaboration also furthers the DePuy Synthes aim of building a connected digital environment in which technologies that enhance surgical performance, professional education and monitoring, as well as help guide patients to full recovery are connected—pre-, intra- and post-operatively—across the continuum of care.

Trend 3: Surgical Procedures Are Improving

Annually, 266 million patients worldwide are diagnosed with lower back pain due to lumbar degenerative disease.10 Surgeons performed more than 62,000 transforaminal lumbar interbody fusion (TLIF) procedures in Europe in 2018.11 The average cost of TLIF in some European regions extends to over Euro 10,000.12

Minimally invasive surgery (MIS) for spinal fusion is growing for the treatment of lumbar degenerative disease due to lower morbidity (i.e., blood loss, surgical complications, wound infections, or hospital length-of-stay), and lower total hospital direct costs compared to open TLIF.13-16 However, MIS TLIF is a common procedure that can be complex,17 variable in length,18 and requires multiple instruments/instrument passes.19

Market indicators show a clear need to increase efficiency in MIS TLIF by reducing unnecessary instrumentation and redundant tray use. High instrument variability, as well as unnecessary surgical instrument sterilization, packaging, transport, unwrapping and reorganization, drive up costs and carry implications for patient safety.20

Given this burden, opportunities exist for improvement in MIS TLIF procedures. DePuy Synthes invests in minimally-invasive (MIS) spine solutions to reduce variability and inefficiency in spine surgery and deliver consistent outcomes. The UNLEASH™ MIS TLIF Solution helps streamline and improve the three main stages of MIS TLIF: discectomy, cage and screw placement. Learn more in this case report authored by Dr. Avelino Parajón.

Looking Ahead

In conclusion, therapies and procedures that reduce time and costs and provide optimized outcomes are expected to increase as innovative technologies continue to shape the space. Intelligent orthopedics—a combination of traditional techniques and high-end technology—will be the future of the spine industry.



1 Eurostat (Web Page) Population structure and ageing. Updated July 2019. Available online at: Accessed: August 1, 2019.
2 Salzmann SN, Derman PB, Lampe LP, Kueper J, Pan TJ et al. (2018) Cervical Spinal Fusion: 16-Year Trends in Epidemiology, Indications, and In-Hospital Outcomes by Surgical Approach. World Neurosurg 113 e280-e295.
3 DePuy Synthes SYMPHONY™ OCT System Internal Data on File - ADAPTIV 103584004. Unpublished.
4 Reitman CA, Nguyen L, Fogel GR (2004) Biomechanical evaluation of relationship of screw pullout strength, insertional torque, and bone mineral density in the cervical spine. J Spinal Disord Tech 17 (4): 306-311.
5 Coe JD, Vaccaro AR, Dailey AT, Skolasky RL, Jr., Sasso RC et al. (2013) Lateral mass screw fixation in the cervical spine: a systematic literature review. J Bone Joint Surg Am 95 (23): 2136-2143.
6 Iyer S, Nemani VM, Nguyen J, Elysee J, Burapachaisri A et al. (2016) Impact of Cervical Sagittal Alignment Parameters on Neck Disability. Spine (Phila Pa 1976) 41 (5): 371-377.
7 Tang JA, Scheer JK, Smith JS, Deviren V, Bess S et al. (2012) The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery 71 (3): 662-669; discussion 669.
8 Jacob C, Annoni E, Haas JS, Braun S, Winking M et al. (2016) Burden of disease of reoperations in instrumental spinal surgeries in Germany. Eur Spine J 25 (3): 807-813.
9 Koerner JD, Kepler CK, Albert TJ (2015) Revision surgery for failed cervical spine reconstruction: review article. HSS J 11 (1): 2-8.
10 Ravindra VM, Senglaub SS, Rattani A, Dewan MC, Hartl R et al. (2018). Global Spine Journal 1-11.
11 Millennium Research Group (2013). RPEU20SP13, 1-525.Millennium Research Group I: Toronto.
12 Vertuani S, Nilsson J, Borgman B, Buseghin G, Leonard C et al. (2015). Value Health 18 (6): 810-816.
13 Singh K, Nandyala SV, Marquez-Lara A, Fineberg SJ, Oglesby M et al. (2014). Spine J 14 (8): 1694-1701.
14 Sulaiman WA, Singh M (2014). Ochsner J 14 (1): 32-37.
15 Niesche M, Juratli TA, Sitoci K-H, Neidel J, Daubner D, Schackert G, Leimert M. (2014). Clin Neurol Neurosurg 124 (2014): 25-31.
16 Pelton MA, Phillips FM, Singh K (2012). Spine (Phila Pa 1976) 37 (22): 1914-1919.
17 Epstein NE (2017). Surg Neurol Int 8 61.
18 Serban D, Calina N, Tender G (2017). Biomed Res Int 2017, 7236970.
19 Lavelle WF, Ordway NR, Araghi A, Buckley RA, Fayyazi AH (2017). J Neurosurg Spine 26 (4): 454-458.
20 Farrokhi FR, Gunther M, Williams B, Blackmore CC (2015). J Healthc Qual 37 (5): 277-286.
21 Accessed: November 8, 2019.
22 Kochanski RB, Lombardi JM, Laratta JL, Lehman RA, O'Toole JE. Neurosurgery. 2019 Jun 1;84(6):1179-1189. doi: 10.1093/neuros/nyy630.
23 Virk S, Qureshi S (2019). J Spine Surg. 2019 Jun; 5(Suppl 1): S25–S30. doi: 10.21037/jss.2019.04.23.