Implants don’t matter… metal doesn’t matter
There has been little to no meaningful advancement over the last 20 years
Stryker recognizes that and spun off its implant business but kept the robot. Globus Medical and Medtronic do, as well. It’s why they are all hitching their wagons to ‘enabling technology’ and robotics. I’ll argue that the robots although expensive has no meaningfully impact on patient outcome, especially in deformity.
Below are my deformity cases for this week…
Both were completed successfully. The one on the left was walking the halls several hours after surgery and went home postop day 2, require no blood.
The one on the right the surgery took a little longer. She was walking the halls the next morning after surgery. However, we did navigate through intraoperative neuromonitoring changes before completing case. And is scheduled to go home postop day 3.
What made all of this possible had nothing to do with metal or the surgeon… it had to do with a host of other factors that have meaningfully improved our results last 20 to 25 years.
The first being IONM. Neuromonitoring existed for more than 25 years but the incorporation of MEP‘s and subsequent improvements in technique have allowed for improved capacity to recognize issues and improve safety for high risk surgeries.
The second being TXA. To this date, I don’t understand how it works or why it works so well.
Like Ozempic, we might need to put it in the drinking water. TXA in combination with other techniques to decrease blood loss has changed the way we approach much of spinal deformity.
The third is ERAS and improving postop protocols. Gone are the days where we have patients lying in bed for a week at a time. we mobilize our patients faster. We utilize less and less narcotic. This has a huge role to play in how they recover in the post office setting.
The last being improvements in our understanding of spinal alignment. This one likely is more controversial of its global impact on outcomes.
As a lover of all things, technology related, it is amazing how the lowest cost and lowest tech changes have made the biggest impact on outcomes.
#OrthopedicSurgery #Neurosurgery #SpineSurgery #EnablingTechnologies