与Lehman教授在北京会面
The most exciting innovations in spine today & tomorrow don't include implants: Key thoughts from Dr. Ronald Lehman
内固定技术并不会是今后脊柱外科领域最令人兴奋的进展之一—Ronald Lehman
Ronald Lehman, MD, director of degenerative, minimally invasive and robotic surgery at NewYork-Presbyterian Och Spine Hospital in New York City discusses the big trends and opportunities in the spine arena.
Ronald Lehman作为一位医学博士和纽约长老会脊柱医院退变·微创·机器人辅助外科部门的负责人介绍了现今脊柱外科领域的风向与机遇
Question: What emerging technology or technique do you think will have the biggest impact on the spine field five years from now?
问：您认为在未来的五年内哪些科技或技术能够在脊柱领域产生最大的影响力？
Dr. Ronald Lehman: The biggest impact on the field of spine surgery over the next two to five years will be the increased utilization of robotic assistance, navigation guidance and surgical synergy. This is an exciting time for the field of spine surgery, as many of our industry partners are actively pursing the use of 'assist technologies' to help make spine surgery: 1) safer, 2) more efficient, 3) more accurate, and 4) more reproducible for all spine surgeons.
Dr. Ronald Lehman:在未来2-5年内，更多的机器人辅助技术、导航技术和外科优势协同会脊柱领域产生巨大的影响力。这对于脊柱外科来说是一个风生水起的时代，很多学者和机构都致力于开发相关辅助技术使得脊柱外科手术：1）更安全，2）更有效率，3）更加精准，和4）对于所有脊柱外科医生有更高的可重复率。
脊柱外科领域部分最新技术
Additionally, robotic assistance and navigation are currently being combined into one system, thereby allowing the surgeon and their team to have the best of both worlds. Also, planning software and enabling technologies are actively assisting surgeons to carefully plan their cases preoperatively. Some of these planning tools are incorporated into the robotics platform, thereby allowing true 'surgical synergy' to allow the surgeon and team to begin with planning, culminating with accurate execution in the operating room.
机器人辅助脊柱手术规划系统
另外，机器人辅助技术和导航技术目前正在整合成为一个系统。因此能够使得脊柱外科医师和团队在两个领域都有更好的体验。而且软件的设计和技术的推动可以积极地辅助外科医师在术前更仔细的规划。一些规划工具已经和机器人平台相结合，这样可以让外科医师及团队进行规划，在手术室里更加精准的操作，做到真正的外科优势协同。
朝阳骨科开展机器人辅助脊柱畸形手术
This allows us to perform more minimally invasive spine surgery with more accuracy, and with better techniques, so that we can execute a fusion, decompression of interbody fusion in much the same fashion as standard, traditional open techniques; but with smaller incisions.
这可以使得我们利用更高级的技术在微创脊柱手术中做到更加精确，甚至可以做到用比传统开放手术更小的切口做和开放手术一样的融合，椎间融合减压。
朝阳骨科自主创新的PE-TLIF技术
实现了“微创置钉减压融合”的突破
朝阳脊柱团队参与研发
世界首台光磁一体脊柱手术导航系统
朝阳骨科脊柱团队开展显微微创脊柱手术
Another exciting concept is that as these technologies evolve, there will be an increased ability for these systems that utilize segmentation and alignment registration to begin to perform additional aspects of the surgery in addition to pedicle screw placement. This will really allow our field to evolve, similar to other surgical specialties that have been using this technology for over a decade.
另外一个令人欣喜的是随着这些技术不断发展，这些系统会有更大的潜力去分割和标准化除了椎弓根钉置入以外的手术其他方面。这会真正使得我们的领域就像其他已经利用这样技术的外科领域一样得到进化。
Furthermore, there is a growing understanding of using predictive modeling, risk stratification and artificial intelligence to predict which patients will have good outcomes after surgical intervention. By understanding and mitigating risk factors, we can better optimize and predict patient-reported outcome measures, therefore allowing us to have better dialogue and understanding to tell patients what the 'real' risks are for various surgeries.
还有越来越多的人选择用预测模型，危险分级和人工智能去预测哪些患者在手术干预之后会有更好的预后。充分了解并降低风险因素，使我们能更好地利用患者自我报告结局估量结果。在与患者沟通的时候才能告诉他们不同的手术方案真正的风险都是什么。
Q:What do you think will fade or disappear from the spine field over the next few years?
问：您认为在未来几年哪些技术会逐渐退出舞台呢？
RL: It is always difficult to predict if anything will fade or disappear, but there continues to be better adoption of more minimally invasive techniques, less muscle and tissue dissection and faster return to work and activities. Now that we are truly beginning to understand that we have to restore lordosis in the lumbar spine, even with one-and two-level surgeries, we hope that we can prevent the need for performing three column osteotomies (pedicle subtraction osteotomies).
Dr. Ronald Lehman：真的很难说哪些技术会逐渐退出舞台，但是会有越来越多的人选择使用更加微创的方案，更少的肌肉与软组织的分离，使得患者更快返回工作岗位和日常活动。现在我们意识到即使在单节段或是双节段腰椎手术中都要恢复腰椎前凸的重要性。我们希望减少需要进行三柱截骨（PSO）的手术。
Q: Where do you see the biggest room for innovation in spine? What do you need to provide better care that doesn't currently exist?
问：您认为脊柱创新发展的最大空间是什么？您对哪些尚不存在的技术更加关心？
RL:The biggest room for innovation will be in coordinating preoperative planning, reproducibly executing the plan intraoperatively and understanding in 'real-time' if we achieved our surgical goals. This will allow us to make everything more objective, so that we are relatively certain before leaving the operating theatre that we achieved all of our goals for each individual patient. As previously stated, the next several years will be an exciting time for innovation in our field as our understanding of patient-specific risk factors, assessing and executing surgical goals and being able to standardize this approach across the world continues to improve the care for our patients.
Dr. Ronald Lehman：在脊柱领域有创新发展的最大发展空间的是在我们完成手术目标时协调术前规划，术中有效的操作和实时情况之前的关系。这样会使得我们做任何事情都更加客观。这样当我们完成针对个体病人的手术目标之后，离开手术室的时候能够更加笃定。就像之前提到的一样，未来的几年对我们的领域来说会是一个生机勃勃的时代。我们会通过了解患者特定风险因素，分析和完成手术目标，并能够完成全球标准化，来达到我们不断提高患者医疗质量的目标。
可谓是英雄所见略同呀。
脊柱外科手术的未来发展趋势，就是各种先进数字技术、大数据技术、精准微创技术的开发、应用和推广。相信我们可以通过努力，在不远的将来为广大患者提供更安全、更精准和更有效的治疗手段。
原文链接：
https://www.beckersspine.com/spine/item/44745-the-most-exciting-innovations-in-spine-today-tomorrow-don-t-include-implants-key-thoughts-from-dr-ronald-lehman.html?origin=spinee&utm_source=spinee
感谢张瀚文同学翻译本文部分内容。
本文来源：海涌医生
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