Spinal cord injury care has yet to receive the focused attention it deserves from the government

In the realm of spinal cord injury (SCI) care, recent advancements in enabling technologies are revolutionising treatment, rehabilitation, and long-term care. These innovations are all set to redefine the quality of life for SCI patients. The International Spine and Spinal Injuries Conference (ISSICON) 2024, organised recently in New Delhi by Sri Balaji Action Medical Institute and the Spinal Cord Society, highlighted this potential by bringing together over 600 participants, including national and international experts, all focused on advancing SCI care.

Experts discussed the transformative role of technologies like the role of Exoscope, Robotic surgery, Neurorehabilitation tools, and Artificial Intelligence (AI). It is evident that these enabling technologies are going to be the game changer in SCI care. Unlike in previous decades, where survival was the primary focus, today’s innovations allow for the enhancement of function, mobility, and independence, shifting our approach from survival to empowerment and functionality. Visibility and precision are paramount in spinal microsurgeries. The ability to maintain a clear view of the surgical area with magnification is crucial, as it allows surgeons to operate with accuracy while providing adequate illumination.

Traditionally, microscopes have been the gold standard in such complex procedures, offering the depth of field and lighting necessary to navigate intricate anatomical structures. However, the limitations of traditional microscopes—primarily the fixed head position required for prolonged periods—often lead to neck and back strain for surgeons. Unlike traditional microscopes, exoscopes are equipped with high-definition cameras and 3D viewing screens, allowing surgeons to view a magnified 3D image on a large screen rather than through an eyepiece. This shift not only alleviates physical strain but also enhances ergonomic comfort, which can be transformative for procedures requiring extended focus.

The exoscope’s ability to provide improved illumination and 3D visualisation allows for sustained precision, minimising fatigue and supporting a higher level of surgical performance over prolonged periods. Moreover, it offers seamless integration with digital systems, assisting with documentation and enabling real-time collaboration with other specialists. Remote access to the exoscope’s 3D feed allows for consultations with experts outside the operating room, which is particularly valuable in teaching hospitals and cases that require multidisciplinary input. By reducing the physical toll on surgeons and offering digital connectivity, the horoscope is paving the way for better, more collaborative care in spinal surgery.

The inclusion of AI in spinal surgery is another game-changer, with the potential to reshape the field by allowing for data-driven insights and more precise treatment planning. Through AI, vast amounts of patient data can be analysed to identify optimal surgical approaches and predict complications.

Such AI insights combined with robotic precision could minimise human error and variability in outcomes, enhancing both surgical efficiency and patient safety. Currently, robotic systems are already being used in spinal procedures, aiding in the precise placement of screws, rods, and other implants. With AI-driven data analytics, robotic assistance could reach new levels of effectiveness. AI systems could improve preoperative planning based on large datasets, enabling more accurate hardware placements and efficient decision-making. This technology can analyse past surgeries to predict potential complications and suggest the most effective treatment paths, offering a personalised, data-backed approach to surgical care. Furthermore, AI-driven analytics have the potential to predict patient outcomes based on prior cases, guiding surgeons on probable recovery trajectories and aiding patient consultations. ISSICON 2024’s workshops reflected this commitment to enabling technologies by providing participants with hands-on experience in emerging techniques, such as robotic and navigation-assisted spine surgery and robotic-assisted rehabilitation.

The conference was aligned with the World Health Organisation’s Rehabilitation 2030 initiative, reinforcing a global commitment to improving access to advanced rehabilitation services, particularly in underserved areas. To ensure the longevity of these innovations, ISSICON 2024 is developing eight position statements, created through pre-conference deliberations and expert discussions, to serve as guidelines for SCI care. The Spinal Cord Society has been advocating for a National Spinal Care Program that addresses the rising needs in spinal injury care and back pain management.

(Dr H S Chhabra is president of the Spinal Cord Society, director of Spine & Rehabilitation Services at the Sri Balaji Action Medical Institute, and Chairman of the ISSICON 2024 Organizing Committee; views are personal)