Framework for Adoption of Enabling Technologies for Improved Outcomes in Spine Surgery

Sathish Muthu^{1

2

3}, Swaminathan Ramasubramanian⁴, Madhan Jeyaraman⁵, Roger Hartl⁶, Javad Tavakoli⁷, Samuel K Cho⁸, Laura Scaramuzzo⁹, Hardeep Singh¹⁰, Philip K Louie¹¹, Andreas K Demetriades¹², Patrick C Hsieh¹³, Stipe Ćorluka^{14

15}, Yabin Wu¹⁶, Xiaolong Chen¹⁷, Hai V Le¹⁸, Gianluca Vadala^{19

20}, Waeel Hamouda^{21

22}, Zorica Buser^{23

24}, Jeffrey C Wang¹³, Hans-Jorg Meisel²⁵, Tim Yoon²⁶, Amit Jain²⁷; AO Spine Knowledge Forum Degenerative²⁸

Affiliations

¹ Department of Orthopaedics, Government Medical College, Karur, India.
² Department of Spine Surgery, Orthopaedic Research Group, Coimbatore, India.
³ Department of Biotechnology, Karpagam Academy of Higher Education, Coimbatore, India.
⁴ Department of Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai, India.
⁵ Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, India.
⁶ Department of Neurosurgery Spine, Weill Cornell Medicine, New York, NY, USA.
⁷ Department of Biomedical Engineering, School of Engineering, RMIT University, Melbourne, VIC, Australia.
⁸ Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁹ Department of Spine Surgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.
¹⁰ Department of Orthopaedic Surgery, The Brain and Spine Institute, University of Connecticut Health Center, Farmington, CT, USA.
¹¹ Center for Neurosciences and Spine, Virginia Mason Medical Center, Seattle, WA, USA.
¹² Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Royal Infirmary of Edinburgh, Scotland, UK.
¹³ USC Spine Centre, Department of Neurological Surgery and Orthopaedics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁴ Spinal surgery Division, Department of Traumatology, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia.
¹⁵ Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia.
¹⁶ Research Department, AO Spine, AO Foundation, Davos, Switzerland.
¹⁷ Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China.
¹⁸ Department of Orthopaedic Spine Surgery, UC Davis Medical Center, Sacramento, CA, USA.
¹⁹ Reaserch Unit of Orthopaedic and Trauma Surgery, Depaertimental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
²⁰ Operative Reaserch Unit of Orthopaedic and Traumatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
²¹ Department of Neurosurgery, Kasr Alainy Faculty of Medicine, Research, and Teaching Hospitals, Cairo University, Cairo, Egypt.
²² Department of Neurosurgery, Security Forces Hospital Dammam, Dammam, Saudi Arabia.
²³ NY Orthopedics, Gerling Institute, Brooklyn, NY, USA.
²⁴ Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA.
²⁵ Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany.
²⁶ Department of Orthopaedics, Emory University, GA, Atlanta, USA.
²⁷ Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
²⁸ AO Network Clinical Research, AO Spine, AO Foundation, Davos, Switzerland.

PMID: 39977347
PMCID: PMC11843566
DOI: 10.1177/21925682251323277

Review

Framework for Adoption of Enabling Technologies for Improved Outcomes in Spine Surgery

Sathish Muthu et al. Global Spine J. 2025 Jul.

. 2025 Jul;15(6):2977-2985.

doi: 10.1177/21925682251323277. Epub 2025 Feb 20.

Authors

Affiliations

¹ Department of Orthopaedics, Government Medical College, Karur, India.
² Department of Spine Surgery, Orthopaedic Research Group, Coimbatore, India.
³ Department of Biotechnology, Karpagam Academy of Higher Education, Coimbatore, India.
⁴ Department of Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai, India.
⁵ Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, India.
⁶ Department of Neurosurgery Spine, Weill Cornell Medicine, New York, NY, USA.
⁷ Department of Biomedical Engineering, School of Engineering, RMIT University, Melbourne, VIC, Australia.
⁸ Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁹ Department of Spine Surgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.
¹⁰ Department of Orthopaedic Surgery, The Brain and Spine Institute, University of Connecticut Health Center, Farmington, CT, USA.
¹¹ Center for Neurosciences and Spine, Virginia Mason Medical Center, Seattle, WA, USA.
¹² Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Royal Infirmary of Edinburgh, Scotland, UK.
¹³ USC Spine Centre, Department of Neurological Surgery and Orthopaedics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁴ Spinal surgery Division, Department of Traumatology, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia.
¹⁵ Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia.
¹⁶ Research Department, AO Spine, AO Foundation, Davos, Switzerland.
¹⁷ Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China.
¹⁸ Department of Orthopaedic Spine Surgery, UC Davis Medical Center, Sacramento, CA, USA.
¹⁹ Reaserch Unit of Orthopaedic and Trauma Surgery, Depaertimental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
²⁰ Operative Reaserch Unit of Orthopaedic and Traumatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
²¹ Department of Neurosurgery, Kasr Alainy Faculty of Medicine, Research, and Teaching Hospitals, Cairo University, Cairo, Egypt.
²² Department of Neurosurgery, Security Forces Hospital Dammam, Dammam, Saudi Arabia.
²³ NY Orthopedics, Gerling Institute, Brooklyn, NY, USA.
²⁴ Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA.
²⁵ Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany.
²⁶ Department of Orthopaedics, Emory University, GA, Atlanta, USA.
²⁷ Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
²⁸ AO Network Clinical Research, AO Spine, AO Foundation, Davos, Switzerland.

PMID: 39977347
PMCID: PMC11843566
DOI: 10.1177/21925682251323277

Abstract

Study DesignNarrative Review.ObjectivesWe aim to investigate the integration and impact of enabling technologies, such as augmented reality, virtual reality, mixed reality, navigation, robotics, and artificial intelligence within the domain of spinal surgery.MethodsWe made a literature review for articles that examined the progression of adoption from initial to subsequent adopters. We also analysed the key determinants that influence adopting these technologies into clinical settings. These include cost-effectiveness, ease of integration, patient acceptance, learning curves, and availability of training resources. Based on the available data a suggestion has been made on the adoption framework for clinical utility.ResultsThese technological advancements have the potential to transform surgical practice, offering improved precision and efficiency. The journey toward widespread adoption presents challenges, which include the financial implications, the necessity for specialized training, and the complexities associated with integration. To navigate these hurdles, the study proposes recommendations aimed at improving cost efficiency, streamlining technology integration, investing in professional development, and nurturing a culture of innovation and research.ConclusionsA framework has been established for the evaluation and integration of state-of-the-art technologies in spinal surgery, thereby maximizing their potential impact on surgical outcomes and patient welfare.

Keywords: artificial intelligence; augmented reality; digitalization; mixed reality; robotics; spine surgery; surgical outcomes; technology integration; virtual reality.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

**Figure 1.**
Factors determining the adoption of technology in spine surgery and recommended strategies on managing them.

**Figure 2.**
Recommendation for technological upgrade based on institutional setup. 3D, three-dimensional; CT, computerized tomography.

See this image and copyright information in PMC

References

1. Foley D, Hardacker P, McCarthy M. Emerging technologies within spine surgery. Life. 2023;13(10):2028. doi: 10.3390/life13102028 - DOI - PMC - PubMed
1. Cornwall GB, Davis A, Walsh WR, Mobbs RJ, Vaccaro A. Innovation and new technologies in spine surgery, circa 2020: a fifty-year review. Front Surg. 2020;7:575318. doi: 10.3389/fsurg.2020.575318 - DOI - PMC - PubMed
1. Godzik J, Farber SH, Urakov T, et al. “Disruptive technology” in spine surgery and education: virtual and augmented reality. Operative Neurosurgery. 2021;21(Supplement_1):S85. doi: 10.1093/ons/opab114 - DOI - PubMed
1. Yuk FJ, Maragkos GA, Sato K, Steinberger J. Current innovation in virtual and augmented reality in spine surgery. Ann Transl Med. 2021;9(1):94. doi: 10.21037/atm-20-1132 - DOI - PMC - PubMed
1. Liu A, Jin Y, Cottrill E, et al. Clinical accuracy and initial experience with augmented reality-assisted pedicle screw placement: the first 205 screws. J Neurosurg Spine. 2022;36(3):351-357. doi: 10.3171/2021.2.SPINE202097 - DOI - PubMed

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Framework for Adoption of Enabling Technologies for Improved Outcomes in Spine Surgery

Affiliations

Framework for Adoption of Enabling Technologies for Improved Outcomes in Spine Surgery

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources