The Future of Spinal Medicine
The trajectory of medicine over the last 30 years gives some indication as to where the speciality medicine will be in the next 30 years. The change will be exponential and will focus on an increasingly less invasive model that will ultimately not involve any invasion of the bodily compartments. The other area of spinal medicine that will see a marked development of technology will involve the development of increasingly sophisticated diagnostic tools that will both be able to identify the disease process earlier, more accurately and on a smaller scale. Conjoined to this technology will be the development of more portable diagnostic imaging devices that the individual physician can wear and that will allow the simultaneous visualization of all of the structures of the body using a complex alogorhytm to analyse the feedback data from the input of a combination of ultrasound, infrared and x radiation. One of the main concerns of the current use of radiation is the increased risk of cancer wihich will be mitigated with the addition of these other modalities. The portability of these devices/goggles will allow the easy addition of advanced technology to parts of that are currently unable to purchase the heavy cumbersome tools of today
The current use of metallic hardware such as pedicle screws and verterbral interbody devices will see a drastic reduction as the degenerative process is diagnosed earlier in the cascade and therapeutic tools such as stem cell therapy employed thus minimizing any further degeneration and therefore the need for corrective surgery involving the insertion of metallic hardware. An increased understanding of the connection between a diseased disc and its altered magnetic configuration will lead to the creation of high intensity smaller magnets that will be used therapeutically to address the imbalance without the need for any bodily invasion. Compared to 30 years ago the MRI now allows the identification of abnormal and painful disc. These machines are however large and cumbersome and not easily transported to poorer parts of the world. The next 30 years will see the creation of much smaller diagnostic magnetic units that in conjunction with the previouslymentioned diagnostic googles will drastically change the landscape of spinal diagnosing.
The continued improvement in fibreopitics and video technology will lead to the production of portable scopes that when inserted through mm long incisions will illuminate the spine and its surrounding structures. These tools will allow the placement of genetically engineered tissue that will be used to replace degenerated material if the symptoms of the patient are either diagnosed late or fail to respond to more conservative treatments such as stem cell therapy. Spine surgery will benefit from the extensive work that has been done in other areas of medicine such as tracheal replacement in which silicon shaped tracheas are coated with several layers of the patients cells. This technology with slight modifications to accommodate the different pressure profiles in the spine will allow the removal and replacement of intervertebral discs that will possess the same biomechanical profiles as the natural ones. This would be a significant advancement over the insertion of artificial discs which have unfortunately proven to be unsophisticated enough in their replication of the normal human disc.
Portability and energy conservation will become some of the main driving forces for the development of innovative solutions particularly for the populations of poorer countries where energy generation is limited and many areas are still off the grid. The development of self sustaining mobile surgical units that are constructed with high performing solar panels will allow the placements of these units in areas off the grid and thus allow the provision of technology advanced spine care to impoverished populations. Another obvious use for these units would be in the immediate provision of advanced health care units to disaster areas around the world that have been cut off from their power supply. They would be constructed with light fibrecarbon materials which would allow helicopters to easily drop them into disaster areas.
There have been some advances over the last 20 years in the indentification of human DNA with some facilities being able to accurately link and map specific ares of the genome to various disease processes. This task is complex but further research will eventually lead to an exact correlation between spinal degeneration and specific genes. The relevance of this is that it will allow the development of therapeutic models that can with pin point accuracy modify the gene /s that are causing of significantly involved in the steps leading to the disease process.
The use of magnetic forces and directed fields is most commonly employed in the diagnostic sector and most notably with the MRI and CT units. However the next 30 years will see the emergence of therapeutic tools that will employ high density low weight magnets to treat a variety of spinal diseases. The theory behind this lies in the simple fact that everything in the universe has a magnetic field that can be manipulated and the human body is no exception. The magnetic changes that occur when a bodily structure changes from a normal to an abnormal diseased state can be reversed with the targeted application of high intensity magnetic forces applied with devices that do not physically invade the body. The principles underlying this technology have been known for centuries in eastern cultures that refer to magnetic field as meridians and use acupuncture to correct abnormal flows of chi.
Thirty years from today the treatment of spinal disease will be and look as radically different as the landscape today looks compared to the treatment options of the 1970s. The trend has and will continue to be the development of increasingly less invasive options that will be supported by the improved understanding of human disease using the energy/wave concepts of theoretical physics.