Amanda Wilde (Host): As technological innovations advance the practice of medicine, we're focusing today on technology in spine surgery with Dr. Timothy Chryssikos, Spine Surgeon at the University of Maryland Medical Center. Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System.

I'm Amanda Wilde. Dr. Chryssikos, welcome and thank you for being here.

Timothy Chryssikos, MD: Thank you, Amanda.

Host: Before we talk about the future of spine surgery, let's talk about the context. Can you provide some history about spine surgery, a brief overview maybe of how, um, spine surgery has evolved over the years to where we are in the present?

Timothy Chryssikos, MD: Yeah, absolutely. I completed medical school here at the University of Maryland and then, did my neurosurgery residency also here at the University of Maryland. So I was, you know, it was during this time, realized that I was going to be a spine surgeon and had outstanding, mentors here among others, Dr. Charlie Santor really inspired this passion and was able to get a, you know, outstanding training. And, after that I decided to pursue a fellowship. I went to California, was there last year at UC San Francisco and my fellowship was focused on minimally invasive spine surgery as well as and the other part was focused on complex spine surgery.

 So for instance, things like scoliosis, spinal deformity, spine oncology, that is surgery for spine tumors, among other things. So you know, as an individual, I've been exposed to and had a chance to experience some changes in, in the field. Everything from, how we place our hardware, the evolution of the hardware that we place, and then also, increasingly newer tools that we use to plan our surgeries and then of course, be able to carry them out efficiently in the operating room.

Amanda Wilde (Host): And then you said you trained in minimally invasive techniques, would you say the current technologies are making that even more possible?

Timothy Chryssikos, MD: Yes, absolutely. So, for instance, during my training here as a resident, we had a very strong foundational training where our surgery is largely guided by our understanding of the patient's anatomy and then also, becoming familiar with how to use x rays during surgery. And then one of the main things I learned during my fellowship was how to use computer navigation. So for instance, we're now able in the operating room to use, computer navigation software. So we can see in real time precisely where our hardware is going is, which is a really great supplement to our knowledge we have in anatomy. And, what this has allowed us to do is a couple of things. Number one, it allows us to take less x-rays during surgery, for instance, minimizing exposure to staff in the operating room. But it also allows us to take, and to make smaller incisions and to have less tissue disruption for us to be able to carry out these operations.

Host: And does that change also recovery time for patients and outcomes in general?

Timothy Chryssikos, MD: In general, yes, we believe it does, and there's certainly plenty of literature to support that. So, for instance, if I'm doing, say a patient has a herniated lumbar disc, I'm able to do that surgery through an 18 millimeter incision. Oftentimes the disc we're pulling out is bigger than the incision itself, and those patients do very well. It's one of, among the surgeries we do, the satisfaction is very high and those patients, we're able to send home from the hospital the very same day.

Host: Now is this with a robot? Is this robotic surgery we're talking about?

Timothy Chryssikos, MD: So, there's a couple of things and points of difference. So, whatwe use for if we're using standard navigation, what we do is, we use an intraoperative CT scanner, which we now have at the University of Maryland, and we can place our hardware using that scan and computer software, but what we also have available is a robot specifically dedicated for spine surgery for the placement of spinal hardware, and there is a connection because, when we use the robot, we also have available to us that same or similar computer navigation.

So minimally invasive surgery can be done with conventional navigation, which is where the surgeon is primarily the one, who is directing where the instruments are directed and then using the software to help guide that. And then we also have, as I mentioned, have a robot, which, has a robotic arm, which we can preplan where we're going to place our hardware, and then we can actually direct the robotic arm to be perfectly in line with that trajectory. So as of now, the main thing that navigation and our robot is used for is for the placement of spinal hardware. But in the future, certainly, industry is working and, and we're keeping a close eye on other advances that these technologies can be used for.

Host: Yeah, I mean, it's astounding how quickly robotics and artificial intelligence are really changing some of medical fields. Do you see AI, artificial intelligence, impacting your field of spine surgery in the future?

Timothy Chryssikos, MD: I do. And I think one of the real big advantages that AI is going to lend to our specialty is, in particular is in the planning of surgeries and in the counseling of patients as well. So for instance, we have a tremendous amount of data at our disposal. Whenever we're evaluating a patient for spine surgery, for instance, we're able to quantify how severe the patient's symptoms are.

We're able to look at, for instance, in the case of cervical spinal stenosis and cervical myelopathy. In the future, our plan is to be able to look at the patient's MRI and to be able to take the data from that. For instance, how severe is the stenosis? Do they have any, any indications that their spinal cord has already sustained a bruise, things like that, and then in addition to be able to look at CT scans and x-rays and to be able to take all of this data and put it together and have assistance from AI to tell us, well, you know, with the experience we've had in this data, you've put into the system, you know, what surgical recommendations might be offered, using AI assistance and for patients, what can we tell them?

Well, based on AI, we can tell you that the recovery or the expected recovery might look something like this. And that's really critical to have a tool like that because, you know, above all, we want our patients to be very well informed before heading into surgery and to be able to make that decision together with us collaboratively.

Host: So AI may actually play a role in patient safety as well.

Timothy Chryssikos, MD: I certainly think that is going to be the case. For instance, if we know that we'd like to propose or offer a certain surgery to a patient, we based on past experience, other patients who've undergone that same surgery, what kind of complication profile have patients had with that before for instance? Our goal is to do surgeries, first of all, minimally invasively if possible, to do them as safely as possible, and to minimize complications as much as we possibly can. In some cases, the surgeries are larger. And in that case, AI helps us make a decision with our patients, about what the best treatment and what their goals, especially what their goals for the operation are.

Host: Now the integration of these technologies such as AI and robotic surgery, are they going to impact surgical training for surgeons like yourself? And does it change the skill set required for spine surgeons?

Timothy Chryssikos, MD: That's a fantastic question. So, I've had the benefit in my training to have been exposed to and in all the different varieties of spine surgery that we currently have, both conventional larger open surgeries that in which we're often relying on the patient's anatomy, our tactile feel, our experience, use of x-rays, as well as, again, more recently, I've been trained, to do minimally invasive surgery and to use technological advances. So I, for, as far as surgeon training in the future, I do think it's very important to have exposure to and familiarity with both. So with every new technology, potentially comes a new set of problems. When you're using the new technologies, you always ever need to ask, is what you're seeing on the screen, does that make sense?

And so here, you know, we always have to have that background knowledge of, you know, does this make sense based on the anatomy? Does this feel right? So I think, you know, certainly for our residents, we're training them in all the different methods so that they have a really well rounded complement because, even though we're using these new technologies, it's still 100 percent the surgeon that's doing the surgery.

Correct. So supervising everything, making sure plans make sense, making sure when placing hardware that things look right, that they feel right. And then always, of course, verifying as well, you know, after we place our hardware with x-rays, for instance. So I think, you know, moving forward, we've got a fantastic array of spine surgeons here.

 You know, faculty that are training the next generation of surgeons, each of whom is instilling in trainees, how to do surgery using conventional methods as well as giving them familiarity and using the newer technologies. And then above all, using these, one another to be able to check and to verify.

Host: Checks and balances and combining the personal with the technological advances in a way that really impacts the teaching, training, and the patient care that you give.

Timothy Chryssikos, MD: That's correct. Yeah, these new technologies, it's not just push a button and autopilot. That's not what this is all about. You know, the surgeon needs to have a complete understanding of spinal anatomy and spinal pathology and know how to use these technologies.

Host: Right. Well, Dr. Chryssikos, thank you for this insight into spinal surgery and the impact of technology and sort of spotlighting what we can look forward to also in the future.

Timothy Chryssikos, MD: Great. Thanks, Amanda.

Amanda Wilde (Host): That was Dr. Timothy Chryssikos, Spine Surgeon at the University of Maryland Medical Center. For more shows just like this one, go to umms.org/podcast or YouTube. Thank you for listening to Live Greater, a Health and Wellness podcast, brought to you by the University of Maryland Medical System.

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