Innovative Technology

Computer navigation in spine surgery is a technology that helps surgeons place screws, rods, and other implants with greater accuracy and safety. Before or during the operation, special imaging such as CT scans or 3D X-rays are used to create a detailed map of the patient’s spine. Navigation systems then track the position of the surgeon’s instruments in real time, almost like a GPS for surgery. This allows the surgeon to see exactly where an implant will go on a screen before making a move, which is especially helpful in complex or delicate areas of the spine, or when typical landmarks are not clear due to prior surgery.

The biggest benefit of computer navigation is precision. Studies have shown that it helps reduce the chance of misplaced screws or other hardware, which can lower the risk of nerve injury, bleeding, or the need for additional surgery. It also decreases the amount of X-ray exposure for both patients and the operating team, since fewer images are needed during the procedure. Lastly, the efficiency it creates during surgery can result in hours less time under anesthesia. Typically, these benefits far outweigh the downsides of navigation, including cost, set-up time in the operating room, and loss of accuracy during surgery.

Computer navigation has become an important tool in modern spine surgery. It gives surgeons more confidence in difficult cases and helps patients by improving safety and outcomes. Looking ahead, new technologies like robotics, virtual reality, and artificial intelligence are being added to navigation systems, making spine surgery even more precise in the future.

Augmented reality (AR) refers to, at its most basic level, the “overlay” of artificial imaging or data onto the user’s normal vison or reality. AR navigation is one of the newest technologies being used in spine surgery. Unlike traditional computer navigation, which shows images on a separate screen, AR projects important information directly into the surgeon’s field of view. Using special headsets or glasses, the surgeon can see a 3D model of the patient’s spine overlaid onto the actual surgical site. This means the surgeon doesn’t need to look away from the patient to check a monitor—they can see the anatomy, surgical tools, and planned implant pathways all in one view.

The main advantage of AR navigation is that it improves accuracy while keeping the surgeon’s focus on the patient. By combining real-time imaging with direct visualization, AR helps surgeons place screws and other implants more precisely, which reduces the chance of complications. Like traditional navigation, it also limits the need for repeated X-rays, lowering radiation exposure for both patients and staff. AR is especially helpful in cases where anatomy is complex or distorted, such as scoliosis, revision surgery, or tumors.

There are still some challenges with AR navigation. The technology is new, so equipment costs are high and not every hospital has access to it. Surgeons also need training to get comfortable with the headsets and software. Some systems may feel bulky or take extra time to set up, though these issues are improving as the technology advances.
Overall, AR navigation is an exciting step forward in spine surgery. By giving surgeons a “see-through” view of the spine, it blends the safety of computer guidance with the natural feel of looking directly at the patient. As the technology becomes more widely available, it has the potential to make spine surgery safer, faster, and even more precise.

Patient-specific implants are a newer option in spine surgery that are custom-designed to fit an individual patient’s anatomy. Instead of using standard, off-the-shelf implants, surgeons can now work with 3D imaging and advanced manufacturing (often 3D printing) to create implants that match the exact shape, size, and alignment of a patient’s spine. These implants can be tailored to address unique problems such as deformity, bone loss, or unusual anatomy that may not be well-suited for standard devices.

Dr. Colman uses several types of patient specific spinal implants, including:

• Custom contoured spinal rods to fit the individual shape and stiffness requirements of each patient
• 3D-printed interbody spacers which can be used in front of spine (ALIF), side of spine (LLIF), and back of spine (TLIF) applications
• Larger, custom-made prosthetic implants for reconstruction of spinal and pelvic tumors

The main advantage of patient-specific implants is that they provide a more precise fit. This can lead to better stability, improved alignment, and in some cases faster healing or fusion of the spine. Custom implants may also reduce the need for adjustments during surgery, which can shorten operative time and improve accuracy. For patients with complex conditions—such as severe scoliosis, spinal tumors, or revision surgery after multiple prior operations—patient-specific implants can offer solutions that standard implants simply can’t match. More recently, 3D-printing has allowed the ability to choose specific biomaterials, densities, porosities, and micro-surface-structure for a given implant.

There are, however, some limitations. Designing and producing a custom implant takes time, so it may not be practical for urgent surgeries. These implants are also more expensive and not yet available in every hospital or for every patient. Because the technology is relatively new, long-term research is still being collected to fully understand the benefits compared with traditional implants.

Even with these challenges, patient-specific implants represent a major step forward in personalized spine care. By tailoring the treatment to each individual’s anatomy, surgeons can offer safer, more effective, and more reliable results—especially in the most difficult cases. As 3D printing and design technology continue to advance, custom implants are likely to become an increasingly common part of modern spine surgery.

Another important area of progress in spine surgery is the use of new biomaterials and biologics. These are special materials and substances designed to improve healing, strengthen implants, and increase the chances of a successful spinal fusion.

Modern biomaterials include advanced metals, ceramics, and polymers that are stronger, lighter, and more compatible with the body than older designs. For example, newer titanium alloys and porous metals are shaped to encourage bone to grow directly into the implant, creating a more secure and long-lasting connection. Some implants are even 3D printed to match the structure of real bone, improving stability and fusion rates.

Biologics are one of the fastest-growing areas in spine surgery. These are special materials that help the body heal, stimulate bone growth, and improve the success of spinal fusion procedures. Traditionally, surgeons relied on a patient’s own bone (often taken from the hip or spine) to promote fusion. While this remains the “gold standard,” biologics now give surgeons additional tools that can reduce the need for harvesting bone and improve healing, especially in patients with risk factors for poor fusion.

There are several main classes of biologics used in spine surgery, each with a different mechanism of action:

• Autograft: This is bone taken from the patient’s own body, usually the hip or nearby spine. It contains living bone cells and natural growth factors, making it highly effective at stimulating fusion. The downside is that it requires an extra incision and can cause pain at the donor site.
• Allograft: Donor bone taken from a bone bank. It provides a natural scaffold for new bone to grow but has fewer living cells and growth factors compared to autograft.
• Demineralized Bone Matrix (DBM): Processed donor bone in which the mineral content is removed, leaving behind proteins that encourage bone formation. DBM is moldable and can be combined with other grafts or carriers.
• Bone Morphogenetic Proteins (BMPs): These are powerful, lab-made growth factors that directly stimulate the body to form new bone. They can be very effective, particularly in challenging cases, but must be used carefully because they can sometimes cause excessive bone growth or swelling.
• Cell-based grafts and stem cell–enhanced biologics: These products contain live cells that have the potential to turn into bone-forming cells. They provide both a scaffold and active biologic stimulation, though research is ongoing to better understand their long-term effectiveness.
• Synthetic bone substitutes: Materials such as calcium phosphate or bioactive glass, which act as a scaffold to support new bone growth. They do not have living cells but can be combined with biologics or the patient’s bone marrow to increase their effectiveness.

By choosing the right biologic—or often a combination—surgeons can create the best possible environment for bone fusion. The goal is to provide a stable spine while reducing pain and lowering the risk of complications or the need for repeat surgery.

There are still considerations. Some biologics are expensive, and not every product is right for every patient. Surgeons weigh factors such as bone quality, age, smoking history, and whether the surgery is a first-time operation or a revision.

Overall, biologics have transformed the field of spine surgery. By enhancing the body’s natural healing process, they give patients a better chance of achieving a solid fusion and long-lasting improvement in pain and function.

Big data, machine learning, and artificial intelligence (AI) are changing how doctors approach spine surgery. In the past, most surgical decisions were based on a surgeon’s training, experience, and studies involving smaller groups of patients. Today, technology allows doctors to analyze information from thousands of surgeries worldwide—what’s known as “big data.” By looking at these large datasets, patterns can be identified that help predict which treatments are most likely to work for specific patients.

Machine learning is a type of AI that allows computers to “learn” from this data. For example, by studying past cases, machine learning algorithms can predict which patients are more likely to benefit from surgery, who might be at higher risk for complications, or what kind of implant might work best in a given situation. This helps surgeons personalize care and make more informed choices before, during, and after surgery.

Artificial intelligence is also being integrated into surgical planning and navigation systems. AI can help generate 3D models of the spine, assist with implant placement, and even alert the surgeon in real time if something looks unusual. Beyond the operating room, AI tools are being used to monitor recovery, track patient-reported outcomes, and guide rehabilitation by comparing an individual’s progress to thousands of other patients.

Dr. Colman utilizes these data technologies in his research, contribution to national registries of data, and even in his day-to-day practice to predict outcomes and select the best treatment for any individual patient.

There are challenges, of course. These technologies require large amounts of high-quality data, and protecting patient privacy is critically important. AI tools are also only as good as the data they are trained on—if the data is incomplete or biased, the predictions may not be accurate. Surgeons continue to play the central role, using AI as a tool rather than a replacement for their judgment and expertise.

Overall, big data, machine learning, and AI are opening the door to a more personalized and precise future in spine surgery. By combining a surgeon’s skill with the power of advanced analytics, patients can expect safer operations, more predictable outcomes, and better long-term results.