21th (R)Evolution in Orthopedics: Spine Surgery

Surgical spine procedures have progressively evolved during the last decades, concurrently to a global aging of the population with a high functional demand.
So far, intervertebral fusion, mostly via a posterior approach using pedicle screws is the most common procedure. In order to prevent postoperative complications such as proximal junctional failures, non-fusion techniques (dynamic stabilization, disc arthroplasty) have also been developed.
More recently, minimal invasive procedures have been reported with similar results than conventional procedures but with a decreased muscular operative trauma. These techniques remains challenging according to various parameters such as the necessary learning curve or an increased exposition to radiation. Intra-operative navigation systems and CT-scans are therefore a precious help in order to obtain satisfactory results and to train younger surgeons.
Conversely, «maximal invasive surgery» have also been developed in the management of degenerative spine conditions with the aim to restore sagittal alignment which is known to be a critical clinical parameter. In order to obtain the desired correction, patient-specific rods have been recently introduced on the market, and various cemented screws have been developed for optimization of the fixation strength in patients with poor bone stock.
Spine surgery is currently undergoing a rapid evolution due to technical and technological recent developments, tending to obtain the most «adequate-invasive surgery» procedures.