At the last NASS and SAS meetings, we got to see a whole new crop of artificial discs. Most were knock-off of current designs, but there were some very cool innovations. I even got to see some prototypes that world-leading developers were still in the development process with... very cool stuff.
Like with so many other spine surgeries, there are many compromises that must be made. With posterior decompressions, we've talked about open microscopic surgery vs endoscopic surgery. The various techniques trade-off the amount of collateral damage caused by the surgery, the surgeon's ability to visualize the surgical field, the ability to access the surgical field (tool size, angles, etc.. ) There are huge advantages and disadvantages for all of each type of surgery. A surgeon once told me that "an endoscope is a poor surgeon's microscope." I did not understand this until years later when I had seen so many endoscopic and microscopic surgeries. The trade-offs are significant. (Having said this, I do believe that in many cases, the advantages of endoscopic spine surgery outweight the disadvantages... with certain indications... that's what I'd choose for myself.)
As we see the new crop of total disc replacements, we'll come to understand a new set of trade-offs. Over the years, we've seen the features of the current design change as the access techniqies improved. Early on, the plates were smaller to allow easier implantation. As the understanding of the devices developed, access techniques improved, materials manufacturing capabilities improved., the plates became larger. As long as I've been speaking to the surgeons about devices and techniques, they have been clammoring for better shapes and sizes to cater for different shape and sized spaces... extra deep... extra wide.
Now we are going to see plate size and shape dictated by access technique. The designs I've seen for straight lateral and posterior access were necessarily smaller and more slender shapes than current discs. This allows implantation through access techniques that are much more limited that the current techniuqes. I'm lucky enough to be able to spend time touring the exhibit halls with many of the most experienced ADR surgeons in the world and discuss these issues. What is going to keep this device in place? Will it move around? What will keep it from subsiding?
This new device and approach are very exciting. There are a lot of incredible people working on the challenges of alternate approaches for total disc replacement. I believe that the advances we'll see in the years to come will have us laughing at the antique discs we are implanting today. I'm really looking forward to SAS next month in Berlin. I can't wait to hear what Pimenta has to say.
All the best,
Mark
PS, Tim, I hope you don't mind... I moved your post to it's own thread... thanks for sharing this.
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