Innovations in Spine Surgery: AI Personalized Implants for Fusions

Back pain is one of the most common reasons that people seek a physician’s care. Depending on the cause and severity, there are several pain relief treatments available ranging from conservative to surgical. When appropriate, conservative treatments can include anti-inflammatory medications, physical therapy and/or injections.

One surgical option for back and/or leg pain is a spinal fusion. Spinal fusions aim to reduce pain or restore stability by fusing together multiple vertebrae into a single bone.

Dr. Mark Lapp, orthopedic spine surgeon, joins us in a Q&A to explain a new innovation in spinal fusions.

What are AI-designed personalized devices for minimally invasive surgery (MIS) lumbar fusion?
In the past, we would use implants (called “cages” for spinal fusions) that were off the shelf. The implants would be manufactured in different sizes, all of them with standardized surfaces, and so we would choose the length that most closely matched the patient’s spine structure. It’s been this way for about twenty years. What’s new now is that some implant companies are using AI to design personalized implants for each patient taking into account anatomical variation.

How are the implants personalized?
I start by obtaining a CT scan of a patient’s spine and send it to the company who uses AI to custom create a 3D image of an implant designed to a patient’s exact specifications. Instead of a straight implant, it will have curves to match spine curvature and the anatomical variations in a patient’s vertebral body. I will then receive three different images to review, which vary slightly by size to account for all possible situations in the operating room. After I approve them, the company uses 3D printers to manufacture the implants.

Is the surgery itself different?
No. However, the implant is perfectly matched to the appropriate surgical technique. I let the company know whether I will be performing a minimally invasive technique or a more traditional open surgery. The implant is then tailored to that approach so it can be inserted smoothly.

What are the benefits for patients?
Since the implant is custom designed for each patient’s exact spinal shape and anatomical variation, there is an increased contact area and load distribution to potentially increase the fusion rate. The goal of the cage is to fuse the vertebrae together to allow the bone to grow through it. If the cage has a better fit to the bone itself, it will weld together better. This leads to a reduction in the need for revision surgery.

Tell us about your experience using these implants.
I’ve been using customized implants for two years now with excellent results. While this is now increasing in popularity across the nation, I currently have more experience than anyone else in New England. The AI designed cage should fit into the spine like a puzzle piece – so it’s important to place it exactly where it was engineered to be.

What’s next in the field of spine surgery?
The future of spine surgery is utilizing technology to improve patient outcomes. Specifically, technologies such as AI, custom-made implants, navigation and robotics have helped make surgeries safer and more effective.