From OT Europe

19th EFORT Congress in Barcelona: Relying on innovation to address complex spine deformities

EFORT

The first and major aim of innovation is to actively influence the decision-making of any physician via new possibilities to overcome the limitations of current practice, but to what extent should new technologies replace well-established surgical procedures? How can the best outcome for patients be guaranteed when introducing a new treatment for conditions that have formerly proven results?

During our upcoming congress in Barcelona, innovation and new technologies are included as the main theme. Dr. Janez Mohar from Valdoltra Orthopaedic Hospital in Ankaran, Slovenia has developed the scientific program for a symposium entitled, “CAS and Other Innovative Techniques for Complex Spine Deformity Correction,” which will focus on the status of the most important, ground-breaking advancements in complex spine reconstructive surgery.

The session will outline sophisticated and complex recent techniques like robotics, computer-assisted surgery, 3-D printing, patient-specific treatments, advanced implant technologies and new minimally invasive surgical techniques. Moreover, the benefits of modern technology in spine surgery, such as the faster execution of treatments through seamless integration of processes, enhanced patient safety through repeatability and reproducibility of surgical procedures, and the user-friendliness of the new techniques, will be discussed.

Barcelona banner

Spine deformity surgery has always been considered a high-risk procedure in which even a minor change in optimal accuracy implies serious clinical consequences. Use of computer-patient models as the basis for multiple computer-assisted techniques, as well as for treatment planning and guidance, has recently emerged to aid in the best patient handling possible. The symposium will feature the latest news in this field, presented by key opinion leaders who either elaborated on or improved some of these techniques. A special emphasis on personalized surgical solutions will be presented in two presentations in particular, one on precontured, patient-specific rods; and the other on a pedicle-screw insertion technique guided by patient-specific 3-D printed templates. As an alternative to this technique, results of pedicle screw insertion with the use of robotic assistance will also be shown. Last, but not least, the experience with a new and revolutionary technique of minimally invasive, non-fusion procedure vertebral body tethering in scoliotic patients will complete the session program and provide a challenge toward the current concepts in early idiopathic scoliosis.

CAS and Other Innovative Techniques for Complex Spine Deformity Correction
Wednesday 30 May 2018

Introduction & Conclusions
Janez Mohar (Slovenia)
Enric Cáceres Palou (Spain)

  • Robotic Guided Spine Deformity Surgery - Beyond Screw Guidance – Yair Barzilay (Israel)
  • How to Improve the Pedicle Screw Accuracy in Scoliotic Curves and Reduce the Amount of Radiation – Claudio Lamartina (Italy)
  • Patient Specific Implants; One Size Does Not Fit All – Evalina Burger (United States)
  • A State of the Art Minimally-Invasive Non-Fusion Surgery for Scoliosis: Vertebral Body Tethering (VBT) – Ahmet Alanay (Turkey)

Main theme banner 

Analysis of the advantages and disadvantages of all these surgical techniques will involve participants in the discussion and give them a glimpse of the future state-of-the-art in spine deformity operative treatment.

Computer-assisted surgery (CAS) and minimally-invasive surgery (MIS) complement each other yet, more often, MIS procedures are supported by computer-guided techniques. Both procedures present several advantages in correction of spine misalignment or instability. For instance, CAS procedures alleviate the surgeon’s workload as his/her performance is more standardized. When performing CAS, the OR time is reduced and the preoperative planning is proportionally increased. Moreover, MIS spares the tissue from approach-related collateral damage because these procedures allow surgeons to address the pathology through a direct, usually muscle splitting/sparing approach.

The main objective is accelerated recovery and rehabilitation of the patient. If we consider that this diminishes the rate of perioperative comorbidities, MIS can be considered a safer technique in comparison to standard, open procedures. Furthermore, in the specific case of CAS and MIS, innovation changes the practitioner’s medical behavior, as once the results using these techniques reach a plateau, it’s extremely unlikely to go back to free-hand techniques and classic approaches. Indeed, there is a common consensus among spine deformity surgeons that in severe and dysplastic scoliotic curves, pedicle screws should be inserted under navigation guidance. Statistically, spine operations with CAS are safer. Unfortunately, complete avoidance of complications is not possible, even with the most sophisticated guidance system, but CAS offers a possibility to reduce this rate by improving the accuracy of the surgeon’s performance.

The presentations from well-known orthopaedic surgeons will give an overview of all these advantages but also raise the interest on any possible limitation. In fact, in view of the surgical indication for spine deformity treatment, computer-assisted surgery seems not to have limitations. A high degree of severity in spine deformity can paradoxically better justify the use of CAS as computer guidance considerably eliminates the variable of the surgeon’s pure skill from the equation. In the case of considerable comorbidities, there are even more reasons to use MIS target-access approaches to maximize the accuracy of implant positioning.

However, as with any novel technique, numerous studies proving the good outcome of these procedures need to be published before benefits and indications of CAS usage in a specific type of spinal operation is standardized. Of course, we must be aware of the hype factor behind every “product of the innovation” but, generally speaking, if CAS would not have provided at least a minimal clinical improvement in spine deformity treatment, it would already have been discarded. On the contrary, CAS has been on the market for at least 20 years which in the medical modern age is significant.

Additionally, it is important to consider that there might be economic reasons that prevent CAS techniques to be used worldwide, but most hospitals in the developed world can nowadays afford a good navigation system and that is the first step into a computer-assisted surgery dimension. In the specific case of spine deformity surgeries, tertiary referral medical centers host most of these procedures and therefore hospitals must stay in touch with new advances if they want to be competitive with their peers.

The symposium entitled “CAS and other innovative techniques for complex spine deformity correction” is part of the core scientific programme of the 19th EFORT Congress and is open to fully registered attendees. Guidelines and fees to sign-up will be available on our registration platform as of January 2018. Visit our 2018 congress website on a regular basis.

EFORT

The first and major aim of innovation is to actively influence the decision-making of any physician via new possibilities to overcome the limitations of current practice, but to what extent should new technologies replace well-established surgical procedures? How can the best outcome for patients be guaranteed when introducing a new treatment for conditions that have formerly proven results?

During our upcoming congress in Barcelona, innovation and new technologies are included as the main theme. Dr. Janez Mohar from Valdoltra Orthopaedic Hospital in Ankaran, Slovenia has developed the scientific program for a symposium entitled, “CAS and Other Innovative Techniques for Complex Spine Deformity Correction,” which will focus on the status of the most important, ground-breaking advancements in complex spine reconstructive surgery.

The session will outline sophisticated and complex recent techniques like robotics, computer-assisted surgery, 3-D printing, patient-specific treatments, advanced implant technologies and new minimally invasive surgical techniques. Moreover, the benefits of modern technology in spine surgery, such as the faster execution of treatments through seamless integration of processes, enhanced patient safety through repeatability and reproducibility of surgical procedures, and the user-friendliness of the new techniques, will be discussed.

Barcelona banner

Spine deformity surgery has always been considered a high-risk procedure in which even a minor change in optimal accuracy implies serious clinical consequences. Use of computer-patient models as the basis for multiple computer-assisted techniques, as well as for treatment planning and guidance, has recently emerged to aid in the best patient handling possible. The symposium will feature the latest news in this field, presented by key opinion leaders who either elaborated on or improved some of these techniques. A special emphasis on personalized surgical solutions will be presented in two presentations in particular, one on precontured, patient-specific rods; and the other on a pedicle-screw insertion technique guided by patient-specific 3-D printed templates. As an alternative to this technique, results of pedicle screw insertion with the use of robotic assistance will also be shown. Last, but not least, the experience with a new and revolutionary technique of minimally invasive, non-fusion procedure vertebral body tethering in scoliotic patients will complete the session program and provide a challenge toward the current concepts in early idiopathic scoliosis.

CAS and Other Innovative Techniques for Complex Spine Deformity Correction
Wednesday 30 May 2018

Introduction & Conclusions
Janez Mohar (Slovenia)
Enric Cáceres Palou (Spain)

  • Robotic Guided Spine Deformity Surgery - Beyond Screw Guidance – Yair Barzilay (Israel)
  • How to Improve the Pedicle Screw Accuracy in Scoliotic Curves and Reduce the Amount of Radiation – Claudio Lamartina (Italy)
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  • Patient Specific Implants; One Size Does Not Fit All – Evalina Burger (United States)
  • A State of the Art Minimally-Invasive Non-Fusion Surgery for Scoliosis: Vertebral Body Tethering (VBT) – Ahmet Alanay (Turkey)

Main theme banner 

Analysis of the advantages and disadvantages of all these surgical techniques will involve participants in the discussion and give them a glimpse of the future state-of-the-art in spine deformity operative treatment.

Computer-assisted surgery (CAS) and minimally-invasive surgery (MIS) complement each other yet, more often, MIS procedures are supported by computer-guided techniques. Both procedures present several advantages in correction of spine misalignment or instability. For instance, CAS procedures alleviate the surgeon’s workload as his/her performance is more standardized. When performing CAS, the OR time is reduced and the preoperative planning is proportionally increased. Moreover, MIS spares the tissue from approach-related collateral damage because these procedures allow surgeons to address the pathology through a direct, usually muscle splitting/sparing approach.

The main objective is accelerated recovery and rehabilitation of the patient. If we consider that this diminishes the rate of perioperative comorbidities, MIS can be considered a safer technique in comparison to standard, open procedures. Furthermore, in the specific case of CAS and MIS, innovation changes the practitioner’s medical behavior, as once the results using these techniques reach a plateau, it’s extremely unlikely to go back to free-hand techniques and classic approaches. Indeed, there is a common consensus among spine deformity surgeons that in severe and dysplastic scoliotic curves, pedicle screws should be inserted under navigation guidance. Statistically, spine operations with CAS are safer. Unfortunately, complete avoidance of complications is not possible, even with the most sophisticated guidance system, but CAS offers a possibility to reduce this rate by improving the accuracy of the surgeon’s performance.

The presentations from well-known orthopaedic surgeons will give an overview of all these advantages but also raise the interest on any possible limitation. In fact, in view of the surgical indication for spine deformity treatment, computer-assisted surgery seems not to have limitations. A high degree of severity in spine deformity can paradoxically better justify the use of CAS as computer guidance considerably eliminates the variable of the surgeon’s pure skill from the equation. In the case of considerable comorbidities, there are even more reasons to use MIS target-access approaches to maximize the accuracy of implant positioning.

However, as with any novel technique, numerous studies proving the good outcome of these procedures need to be published before benefits and indications of CAS usage in a specific type of spinal operation is standardized. Of course, we must be aware of the hype factor behind every “product of the innovation” but, generally speaking, if CAS would not have provided at least a minimal clinical improvement in spine deformity treatment, it would already have been discarded. On the contrary, CAS has been on the market for at least 20 years which in the medical modern age is significant.

PAGE BREAK

Additionally, it is important to consider that there might be economic reasons that prevent CAS techniques to be used worldwide, but most hospitals in the developed world can nowadays afford a good navigation system and that is the first step into a computer-assisted surgery dimension. In the specific case of spine deformity surgeries, tertiary referral medical centers host most of these procedures and therefore hospitals must stay in touch with new advances if they want to be competitive with their peers.

The symposium entitled “CAS and other innovative techniques for complex spine deformity correction” is part of the core scientific programme of the 19th EFORT Congress and is open to fully registered attendees. Guidelines and fees to sign-up will be available on our registration platform as of January 2018. Visit our 2018 congress website on a regular basis.