The Growing Trend of Lateral Spine Surgery: Q&A With Dr. Scott Spann of Pantheon Spinal Featured
Written by Carrie Pallardy | Wednesday, 21 August 2013 09:30
Scott Spann, MD, board-certified orthopedic spine surgeon and the founder of Austin-based device company Pantheon Spinal, discusses the emergence of the lateral approach as a trend in the field and why he thinks the trend will continue to grow.
Q: Why is the lateral approach a growing trend in spine surgery?
Dr. Scott Spann: Interestingly enough, this is the only segment of the spine market that is growing on a percentage basis. The other areas are stagnating or losing market share and major device companies are responding to this.
Lateral surgery and implants have anatomic advantages. Whenever spine surgeons did prior approaches, such as ALIF or TLIF we had to disturb some of the major natural ligaments and stabilizers. When you go in laterally, you preserve these structures. It is practically an avascular plane. You do not have to violate as much tissue. You can spread the musculature, rather than violating.
The beauty of lateral implants, over ALIF or TLIF implants, is that we can buttress them on the outer edges of the cortical ring around the vertebral body. All other implants have been placed in the middle cancellous region of the vertebral body, where they are much more likely to subside. Because of the large graft window unique to the lateral implants, direct contact with the most vascular region of the vertebral body, the ability to achieve fusion is even further enhanced. With the lateral approach overall structural and biological integrity is maximized.
Q: What does this trend mean for the future of spine surgery?
SS: The lateral approach is still gaining ground. There have been some anatomic restrictions, such as L5/S1 access. This is the most common level of pathology, but how do you get there through the lateral approach? That question sparked the genesis of Pantheon Spinal and the Epiphany. These will open the door to eliminating some of the rate limiting aspects of the lateral approach.
There is a learning curve, as with any novel approach. You have to reach a certain level of comfort to perform a new approach regularly. The lateral approach may take longer to adapt than almost any other advancement we have seen over the past 30 years.
Each use of the lateral approach has its own anatomical challenges, particularly with deformities. A lot of this is overcome simply by repetition and paying attention to technique and protocols. This style of approach mandates a much greater skill and precision level than almost any other approach to fusion.
Once you have met the learning curve and become comfortable with the approach, you can see that is has so many other applications. This approach gives more than any almost any other approach we have had access to previously.
Q: How are surgeons responding to this trend?
SS: Surgeons are always going to perform whatever is best done in their hands. I do think as the comfort level grows and the techniques become more readily taught, in areas such as residency and fellowship, it will become more mainstream.
Surgeons will respond to the advantages of the lateral approach. It is not the least bit unusual for people to go home on postoperative day one. Patients are walking the halls the evening of surgery. As far as functionality, it is an incredibly rapid alternative from the patient’s perspective. The patient will be able to note the rapidity of their