Research.

Our award-winning research has been recognized nationally and internationally for advancing patient knowledge about innovations in spinal surgeries and procedures.

Why Our Research Matters.

Patients who suffer from spinal conditions have numerous options to choose from when considering medical intervention. At the National Spine Health Foundation, we empower patients with knowledge so they have the tools to make the best informed choices. We aim to discover which treatments work, and to advocate for greater access to these life-changing treatments. We utilize clinical outcomes data to gather the latest cutting-edge research, publish our findings in peer-reviewed medical and scientific journals, and present that information at national and international conferences. Through our Research Institute, we help cultivate the next generation of spinal experts in research and medicine.

Our research can help clarify a patient’s options when confronted with a need for treatment so that patients, along with their qualified doctors, can develop the optimal treatment plan specific to their situation. Our publications help drive our advocacy efforts to make spinal healthcare available to all who need it.

The National Spine Health Foundation is a 501(c)(3) nonprofit organization that thrives, thanks in large part to our generous donors. Your donation helps us pursue, educate about and create access to spinal treatments that will allow people to get back to their daily lives, free from spinal pain.

Research that Saves Lives.

We advance research that patients can trust and that gives patients real answers for their spine health. We critically evaluate treatment options from a patient perspective, independent of outside interests. Our award winning research is nationally and internationally recognized, and is sought after by patients and their physicians to inform treatment plans for serious spinal conditions and medical researchers seeking to develop innovative new therapies.

Your contribution helps us bring real hope and real solutions to all who are suffering.

Spine-Talks

The NSHF’s Spine-Talks platform offers patients free and accessible videos from world-class experts that explain advances in spinal treatments and surgeries, in language that anyone can understand.

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Raising Public Awareness

Thanks to our advocacy and research, in 2021, the United States Congress named October “Spine Health Awareness Month” to help the public become better informed about their spinal health, wellness and treatment options.

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Sharing and Collaborating with Spinal Professionals

The Foundation’s research has been featured at many of the leading conferences in the field of spine treatment, including the American Academy of Orthopedic Surgery (AAOS), Lumbar Spine Research Society (LSRS), and North American Spine Society (NASS), among many others.

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Although patients can choose from numerous medical interventions to fix their spine-related pain and discomfort, many promising treatments are considered “experimental,” making them unlikely to be approved by insurance. At the NSHF, we work tirelessly with our medical and industry partners to get life-changing spinal procedures more readily available and accessible. Often, although the Food and Drug Administration (FDA) has approved a treatment, insurers will deem it experimental and therefore not provide coverage. We want to make sure that patients have access to the most up-to-date options for treating their spinal conditions.

Areas of Impact.

Our research covers numerous avenues for repairing damaged spines, including surgical and non-surgical procedures.

Robotic-Guided Spine Surgery

Many of the Foundation’s spine health research partners utilize navigation and various robotic-guidance platforms for surgery planning and hardware implantation, demonstrating greater accuracy than traditional surgery or fluoroscopic-guided (live x-ray) techniques. Robotic-guided surgery provides surgeons the ability to create an extremely detailed preoperative plan, enabling them to prepare for the entire procedure before ever making an incision.

Robotic-guidance enables more precise screw implantation and fewer complications for patients than the traditional freehand techniques. Robotic-guided surgery allows for a more minimally invasive procedure with less radiation exposure to the patient and surgical team, and enables greater accuracy of hardware placement which can result in quicker recovery times for patients. The NSHF is currently gathering outcomes data on patients who have undergone robotic-guided surgery, with the hope that minimally invasive surgery can be more widely available to patients.

Artificial Disc Replacement

Artificial disc replacement (ADR) was developed as an alternative to fusion surgeries as a method to preserve some motion and reduce stress on adjacent discs. ADR has the goal of simulating normal disc function while increasing mobility and alleviating pain. There are a variety of artificial discs currently on the market.

The Foundation is investigating discs composed of a combination of materials, including ceramic, titanium, polyurethane, and polyether ether ketone (PEEK). These available artificial discs have a “moveable” core, which allows for flexion and rotation once implanted. This means that the discs more closely mimic the patient’s native (natural) discs, thereby easing the post-surgery recovery time and allowing patients to move more naturally. Along with industry partners, the NSHF is helping identify the benefits of artificial discs and track the recovery progress of patients with them. Our current research surveys outcomes from patients who have undergone hybrid cervical spine surgeries which are a combination of disc replacement and fusion. This partial motion-preserving procedure is beneficial to patients who have a multi-level disc problem.

Augmented Reality

One of the key research goals for the Foundation is to identify effective, minimally invasive surgeries for relieving spinal pain and other spinal conditions. “Minimally invasive” means that the surgeon performs the smallest operation possible with the least disruption of tissues. One new advancement in minimally invasive surgery is called “Augmented Reality.” Think of it as a virtual reality headset: through this technique, surgeons can perform spinal procedures while looking at a patient’s spine as if with X-ray vision!

The NSHF is currently gathering data on Augmented Reality-Assisted spine surgery, which has shown great promise in early trials. Our work on Augmented Reality surgical procedures seeks to show a reduction in the post-operative time patients spend in the hospital and the length of the overall patient recovery.

Enhanced Surgical Recovery (ESR)

The Foundation also takes great interest in improving patient recovery times after surgery. We sponsor research that identifies the methods that can be used to reduce patient recovery windows, and outline recovery plans that will lead to decreased usage of opioid-based pain medicines. Much of this research centers on a multi-step process called ESR (Enhanced Surgical Recovery), a patient-centered technique that involves the collaboration of surgeons, doctors, anesthetists, and other medical staff to best prepare the patient for their procedure. The main goal of ESR is to minimize the length of stay in the hospital which means they can more readily return to their daily activities. The Foundation’s early studies point to great promise for the utilization of ESR protocols for spine patients.

One important NSHF-backed study surveyed patients undergoing surgery for Adult Spinal Deformity (ASD). This study found that those who recovered with the ESR protocol consumed fewer post-operative opioids, had urinary catheters removed earlier, and regained mobility faster.

A similar study surveyed the three-month utilization of opioids after spine surgery. Researchers assessed the pain relief needs of patients based on opioid usage. Understanding the use of opioids after spine surgery can help identify the best pain management for patients.

Spine Health Research Highlights.

The NSHF has helped produce some of the most cited scholarship on spinal health and spinal procedures on a range of topics. Below you will find some of our exciting recent research breakthroughs. By donating to the Foundation, you can be a part of taking this research even further.

Feasibility and Workflow Using Robotic Guidance to Achieve MIS Facet Fusion

Minimally invasive spine surgery reduces tissue dissection and retraction, which can decrease blood loss, blood transfusion, complications, and pain. One of the key challenges with a minimally invasive approach is achieving consistent posterior fusion. A minimally invasive surgical approach accomplished without sacrificing the quality of the posterior fusion has the potential to decrease both short- and long-term complications compared to the traditional open techniques. Innovations in navigated and robotic-assisted spine surgery continue to address this need. The feasibility and workflow of achieving posterior facet fusion using robotic guidance is outlined in this article.

Source: Good CR, Orosz LD, Lehman RA, Gum JL, Fox D, Lieberman IH. (2022) ‘Minimally Invasive Posterior Facet Decortication and Fusion Using Navigated Robotic Guidance: Feasibility and Workflow Optimization’, Neurospine, 19(3), pp. 773–779. doi: 10.14245/ns.2244190.095.

The Role of Robot-Assisted MIS Spinal Deformity Surgery

Advances in minimally invasive spine surgery have been in large part due to the navigated and robotic technologies that allow many traditionally open surgeries to be performed in a less invasive fashion, including spinal deformity surgery. In any spine surgery requiring deformity correction, extensive preoperative planning is required to prepare for the amount of correction that is needed often in all planes, as well as the size, strength, and alignment of implants, decompression, and fusion to achieve the corrective goal. Preoperative planning software allows for optimization of implant size and trajectory, as well as strategic planning of alignment
correction. The benefits of preoperative planning include: reduced risk of surgical complications and revision surgery, less intraoperative radiation exposure, a decrease in proximal facet joint violations, and the “single-pass” drilling of the pilot hole which may provide stronger bone purchase. These benefits support the role of robot-assisted minimally invasive spine surgery for many spinal deformity pathologies.

Source: Orosz LD, Thomson AE, Good CR.(2022). Technical Advances in Minimally Invasive SpineSurgery. SpringerLink,The Role of Robot-AssistedMIS Spinal Deformity Surgery (pp. 311-320). DOI: 10.1007/978-981-19-0175-1_28

 

Novel Artificial Intelligence Algorithm: An Accurate and Independent Measure of Spinopelvic Parameters

The analysis of sagittal alignment by measuring spinopelvic parameters has been widely adopted among spine surgeons globally, and sagittal imbalance is a well-documented cause of poor quality of life. These measurements are time-consuming but necessary to make, which creates a growing need for an automated analysis tool that measures spinopelvic parameters with speed, precision, and reproducibility without relying on user input. This study introduces and evaluates an algorithm based on artificial intelligence (AI) that fully automatically measures spinopelvic parameters. This application allows users to accurately obtain critical spinopelvic measurements automatically, which can be applied to clinical practice. This solution can assist physicians by saving time in routine work and by avoiding error-prone manual measurements.

Source: Orosz LD, Bhatt FR, Jazini E, Dreischarf M, Grover P, Grigorian JN, Roy R, Schuler TC,Good CR, Haines CM.Novel artificial intelligence algorithm: an accurate and independent measure of spinopelvic parameters. Journal of Neurosurgery.July 2022. https://doi.org/10.3171/2022.5.SPINE22109

 

Augmented Reality-Assisted Spine Surgery: An Early Experience Demonstrating Safety and Accuracy with 218 Screws

Minimally invasive spine surgery has many advantages, but screw placement can be complex, particularly when anatomy is distorted by spinal deformity or previous spine surgery. Screw guidance techniques such as navigation and robotics are tools to guide screw placement and optimize minimally invasive options to achieve fusion. NSHF is dedicated to supporting research on the latest surgical techniques, particularly those that expand minimally invasive options for patients. This study sought to determine the safety and accuracy of a novel technology, augmented reality navigation, for spinal fusion patients. The results of one spine center’s early experience with augmented reality-assisted spine surgery demonstrated it as an effective, safe, and accurate navigation tool for screw placement.

Source: Bhatt FR, Orosz LD, Tewari A, Boyd D, Roy R, Good CR, Schuler TC, Haines CM, Jazini E. Augmented Reality-Assisted Spine Surgery: An Early Experience Demonstrating Safety and Accuracy with 218 Screws. Global Spine Journal. January 2022. doi:10.1177/21925682211069321

Robotic-guidance Allows for Accurate S2AI Placement Without Complications

There are many patients with complex spinal anatomy that require fixation from the spine to the pelvis as part of their fusion surgery. Instrumentation with S2-alar-iliac (S2AI) screws is one type of pelvic fixation, and multiple methods are available for the placement of these screws. This study aimed to evaluate complication rates, revision surgery rates, and accuracy grading for 118 robotic-guided S2AI screws. In this study, there were no medical or surgical complications related to the S2AI screws. There were also no revision surgeries performed as a result of the S2AI screws, although 17% underwent elective removal of S2AI screws after fusion was achieved due to hardware-related pain. Finally, all robotic-guided S2AI screws had the highest grade of accuracy (no breach). In summary, the robotic-guided technique for S2AI screw placement is a reliable method to achieving pelvic fixation with low complication and revision rates. In addition, a high degree of accuracy can be achieved without relying on visible and tactile landmarks needed for the freehand technique or the additional radiation associated with fluoroscopic-guidance.

 

Source: Good CR, Orosz LD, Thomson AE, Schuler TC, Haines CM, Bhatt FR, Boyd D, Grossman KM, Roy R, Jazini E.Robotic-guidance allows for accurate S2AI placement without complications. J Robotic Surg. 2021 Dec 1. doi: 10.1007/s11701-021-01345-x

 

Robotic-Guided Surgery Study

The Foundation was part of this multi-center study, including contributions from 11 researchers, that compared two different methods of performing spinal fusion: one with robotic guidance and one without. The robotic system operates by pre-planning an entire spinal procedure based on a pre-surgical CT scan of the patient’s spine. With fluoroscopic-assisted surgery, a surgeon uses a live x-ray to visualize the spine. While both the robotic and the fluoroscopic methods are minimally invasive, the robotic method involves much less radiation exposure to the patient and the operating room staff during the surgical procedure.

From a pool of 485 patients – 374 robotic-guided patients and 111 fluoroscopic patients – researchers identified several benefits of the robotic-guided system over the fluoroscopic approach. Robotic-guidance led to fewer surgical complications, a lower likelihood of revision surgery, and a reduction in exposure to radiation throughout the procedure. Robotic surgical assistance thus shows great promise in reducing surgical risks for patients, and potential postoperative benefits.

Source: Good C, Orosz L, Schroerlucke S, et al. Complications and Revision Rates in Minimally Invasive Robotic-Guided Versus Fluoroscopic-Guided Spinal Fusions: The MIS ReFRESH Prospective Comparative Study.” Spine. 2021; 46(23), 1661-1668. doi: 10.1097/BRS.0000000000004048

Enhanced Surgical Recovery After Lumbar Fusion

Researchers from the NSHF were involved in the publication of a paper entitled “Adoption of Enhanced Surgical Recovery (ESR) Protocol for Lumbar Fusion Decreases In-Hospital Postoperative Opioid Consumption.” This paper found that, in a study of patients that underwent lumbar fusion surgeries, those who recovered using an Enhanced Surgical Recovery protocol reported lower postoperative pain, moved more quickly post-procedure, and used less pain-relieving opioids after their operation.

This research was presented at numerous meetings of spinal professionals, including the 2020 North American Spine Society (NASS) and the 2019 Lumbar Spine Research Society (LSRS).

Source: Jazini E, Thomson A, Sabet E, et al. “Adoption of Enhanced Surgical Recovery (ESR) Protocol for Lumbar Fusion Decreases In-Hospital Postoperative Opioid Consumption.” Global Spine Journal. May 2021; 1-6. https://doi.org/10.1177%2F21925682211015652

Newer in Robotic Generations Improves Screw Placement Accuracy

This research article shows the growing improvements made to robotic surgical platforms, which could minimize the chance of error during a spinal procedure. A study of two groups of 70 patients found that a new generation of robotic surgical guidance not only had lower incidences of abandoning screw placements in the spine, but also placed screws in the spine more accurately. The conclusion reached by the authors points to the ongoing advancements in robotic surgical technology can further reduce surgical complications.

Source: Schroerlucke S, Harris E N, Roy R. “P109. Improvements in screw placement and accuracy with newer generation robotic-assisted minimally invasive instrumented lumbar fusions.” The Spine Journal. September 2020; 20(9), S198-S199. https://doi.org/10.1016/j.spinee.2020.05.507

2022 Conference Schedule

Research and outcomes are important to the National Spine Health Foundation. NSHF’s research efforts were presented at the following meetings in 2022.

March 10-12, Maui, HI. www.spineintervention.org/event…

  • Poster Presentation
    • Intradiscal Injection of Autologous Bone Marrow Aspirate Concentrate Improves Low Back Pain at One Year

March 22-26, Chicago, IL. www.aaos.org/annual…

  • Poster Presentation
    • Intradiscal Injection of Autologous Bone Marrow Aspirate Concentrate Improves Low Back Pain at One Year

April 6-9, Miami, FL. www.srs.org/imast2022

    • Podium presentation
      • Augmented Reality-Assisted Spine Surgery: An Early Experience Demonstrating Safety and Accuracy with 218 Screws

April 7-8, Chicago, IL.  www.lsrs.org/lsrs…

    • Poster presentation
      • Opioid Utilization After Elective Spine Surgery: How Many Pills Are Leftover?

April 6, virtual. https://spinecanada.org/

    • Poster presentations:
      • Robotic Guidance Allows for Accurate S2AI Screw Placement without Complications
      • Robotic-Guided Thoracolumbar Fusion Experience: A Multi-Surgeon, Single-Center Study of 628 Patients and 3,874 Robotic-Guided Screws from 2012 to 2020
      • Comparison of Complications, Revision Rates, and Fluoroscopy Time Using the Latest Technology in Robotic-Guided Surgery to Historic Fluoroscopic-Guided Controls
      • Opioid Utilization After Elective Spine Surgery: How Many Pills Are Leftover?
      • Intradiscal Injection of Autologous Bone Marrow Aspirate Concentrate Improves Low Back Pain at One Year
      • Augmented Reality-Assisted Spine Surgery: An Early Experience Demonstrating Safety and Accuracy with 218 Screws

May 9-13, Boston, MA. www.issls.org…

    • Podium presentation
      • Augmented Reality-Assisted Spine Surgery: An Early Experience Demonstrating Safety and Accuracy with 218 Screws
    • Poster presentations
      • Opioid Utilization After Elective Spine Surgery: How Many Pills Are Leftover?
      • Intradiscal Injection of Autologous Bone Marrow Aspirate Concentrate Improves Low Back Pain at One Year

June 1-4, Las Vegas, NV. http://gsc2022.org

    • Podium presentations:
      • Augmented Reality-Assisted Spine Surgery: An Early Experience Demonstrating Safety and Accuracy with 218 Screws
      • Intradiscal Injection of Autologous Bone Marrow Aspirate Concentrate Improves Low Back Pain at One Year
    • Poster presentation:
      • Opioid Utilization After Elective Spine Surgery: How Many Pills Are Leftover?

June 1-4, Bahamas. www.eventscribe.net…

    • Podium presentations:
      • Enhanced Surgical Recovery for Thoracolumbar Spine Surgery is Associated with Decreased Opioid Consumption, Length of Hospital Stay, and Hospital Readmissions: Evaluation of 51,236 Cases
      • Anterior Cervical Hybrid Constructs Reduce Upper Adjacent Segment Hypermobility Compared to Multilevel Anterior Cervical Discectomy and Fusion
    • Poster presentation:
      • Opioid Utilization After Elective Spine Surgery: How Many Pills Are Leftover?
      • Intradiscal Injection of Autologous Bone Marrow Aspirate Concentrate Improves Low Back Pain at One Year

October 12-15, Chicago, IL. www.spine.org/am

    • Podium presentation
      • Enhanced Surgical Recovery for Thoracolumbar Spine Surgery is Associated with Decreased Opioid Consumption, Length of Hospital Stay, and Hospital Readmissions: Evaluation of 51,236 Cases
    • Poster presentation
      • Intradiscal Injection of Autologous Bone Marrow Aspirate Concentrate Improves Low Back Pain at One Year

October 19-21, Milan, Italy. www.eurospinemeeting.org/

    • Poster presentation
      • Opioid Utilization After Elective Spine Surgery: How Many Pills Are Leftover?

Awards and Nominations.

Special Poster Nominee - ISSLS 2022

Bhatt FR, Orosz LD, Thomson AE, Namian S, Bharara N, Jazini E, Good CR, Schuler TC, Haines CM. Intradiscal Injection of Autologous Bone Marrow Aspirate Concentrate Improves Low Back Pain at One Year.Poster Presentation at the International Society for the Study of the Lumbar Spine, Boston, MA, May 11th, 2022.

Best Poster Award - ISASS 2021

Jazini E, Thomson AE, Sabet A, Carreon LY, Roy R, Haines CM, Schuler TC, Good CR.  “Adoption of Enhanced Recovery After Surgery (ERAS) Protocol for Lumbar Fusion Decreases In-Hospital Post-operative Opioid Consumption.” Poster Presentation at the International Society for the Advancement of Spine Surgery 21st Annual Meeting, Miami, FL, USA, May 14th, 2021.

Best Paper Nominee - ISASS 2021

Haines CM, Orosz L, Thomson AE, Schuler TC, Good CR, Grover P, Dreischarf M, Roy R, Jazini E. “Novel Artificial Intelligence Algorithm can Accurately and Independently Measure Spinopelvic Parameters.” Podium Presentation at the International Society for the Advancement of Spine Surgery 21st Annual Meeting, Miami, FL, USA, May 15th, 2021.

Additional Research and Resources.

01

Spine-Talks

A video series featuring world class experts from our Board that provides patients with information on all manner of spinal topics, including lower back pain, spinal injury prevention, osteoporosis, and advances in pain treatment.

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02

Get Back to It Podcast

Hosted by the Foundation’s CEO Rita Roy, MD, this podcast features interviews with real patients who have been able to ‘get back’ to their lives after spinal healthcare.

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03

The Spine Health Journal

This free journal provides patient-friendly articles and interviews with spinal specialists for those who want to learn more about their spinal health in an accessible way.

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04

SpineOnline®

SpineOnline® is a nationwide, multi-centered technology project created to prove the effectiveness of spinal treatment options. At SpineOnline, we have compiled the definitive collection of provider and patient data in the form of reported treatment outcomes.

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Your donation to the Foundation ensures that we can continue to produce and provide the crucial information that can give people the chance to overcome their spinal pain.