How This Philly Doctor Combines 3D-Printing with A.I. to Repair Patients’ Spines

Dr. Theresa Pazionis, Spinal Surgeon at Temple Health and Assistant Professor of Orthopaedic Surgery and Sports Medicine at the Lewis Katz School of Medicine at Temple University

Spine surgery is one of the most intricate challenges in modern medicine. There’s often no single cure for pain that originates with the patient’s spine or nervous system, only a combination of treatments intended to get the best result for a patient’s functionality and quality of life. Treating spinal conditions therefore requires not just a steady hand while working on millimeter-sized sections of the body, but accounting for as many relevant factors as possible–from each patient’s unique physiology to their lifestyle–that will shape and stress the spine now and in the future.

This need to process and control a massive amount of seemingly unquantifiable data makes spine surgery one of the fields that can benefit the most from the rise of data analysis and artificial intelligence in medicine. And as a few trailblazing surgeons begin to incorporate the technology into their practice, it’s changing what’s possible in spine surgery.

“Patients have been doing well, but why not have them do better?” says Dr. Theresa Pazionis, spinal surgeon at Temple Health and assistant professor of orthopaedic surgery and sports medicine at the Lewis Katz School of Medicine at Temple University.

Pazionis is leading this medical revolution in Philly. She’s among the first surgeons in our region to use robotic surgery, artificial intelligence, and 3D printing as an integrated process, using modern data-driven capabilities to account for almost every aspect of spine surgery, from the individual tendencies and skills of the surgeon to the way an implant aligns with a patient’s unique vertebrae.

The goal, according to Pazionis, is to get more patients’ spines closer to the perfect alignment for long-lasting durability–a systematic solution for a complex problem.

“When you obtain optimal spinal alignment for your patient, they will do better clinically and the risk of revision surgery decreases,” Pazionis says.

It’s a model that her colleagues around the city are already looking to mirror in their own practice, and as Pazionis shares her findings through initiatives like the Temple Spine Symposium, it could be another significant step forward in a still-growing field of medicine.

The Changing Landscape of Spine Surgery

Spine surgery as a field has surged forward in the past few decades. As recently as the late 20th century, surgeons relied on relatively primitive technologies, such as straight metal rods implanted to correct for curvature of the spine, known as Harrington rods. Even today, there can still be varied approaches to care across different hospital systems.

“Spine surgery is still young compared to other surgical fields. I still have patients who I’m taking Harrington hardware out of, so it’s a rapidly evolving field. And the technology now is very different than what we had even ten years ago,” Pazionis says. “As a surgeon, you’re not only holding yourself accountable to the patient, but to the spine community. All our technological advances are great, but they allow us to emphasize the importance of thorough surgical planning, technical excellence, and considering the whole patient as a person. A.I. predictive analytics is just a way for us to quantify that.”

Pazionis considers her use of artificial intelligence an extension of her fundamentals as a spine surgeon. Even without A.I., spine surgeons need to start with data, scanning for and taking into account factors such as bone density and body composition in order to understand where the patient’s problems originate from, how they’re going to tolerate surgery, and how any treatment is going to hold up over time. They also need to know how to address these factors outside of surgery to give the patient their best possible outcome.

“For example, if a patient has osteoporosis, we optimize their bone density before surgery,” she says.

A treatment plan also needs to be pragmatically built around a patient’s current and future needs, rather than an abstract, perfect surgical result. A patient of advanced age who has debilitating back pain, for example, may not be in strong enough health to go through an intensive fusion procedure, but can still benefit from a less-taxing, simpler surgery. That’s a process that Pazionis works through with each patient, and one that A.I. alone can’t replicate.

Jen, Temple Health Spine Surgery Patient

Finding the Right Surgery for Every Patient

When patients receive that kind of care, it can be life-changing. One of Pazionis’ recent patients, Philadelphia-resident Jen, had faced severe scoliosis from an early age. Now an adult, multiple surgeries during her childhood failed to provide a permanent solution.

“My curvature was so severe for being so young–I was diagnosed at 6,” Jen says, describing how she wore a brace for nearly four years before doctors told her that she needed a spinal fusion. The procedure was supposed to provide long-term stability and prevent further curvature, but as Jen grew, her spine had nowhere to expand except sideways.

At age 12, she underwent a second spinal surgery. For a while, it seemed as though she had regained some stability. But decades afterward, her condition deteriorated once again. Pain became a constant part of her adult life. Then one day, suddenly, she lost function in her right leg, a symptom she would struggle with regularly.

“I was in constant pain,” she recalls. “I had to stop driving because I didn’t know if my leg was going to work or not.” Formerly an avid hiker, she began using a cane to stay mobile. When she finally sought help from a doctor at another hospital, she was told that she would only be considered for surgery if she lost bowel and bladder function, an answer that left her feeling hopeless.

That’s when Jen remembered how her mother was cared for during a serious illness at Temple Health. Her search at Temple led her to Pazionis, whose care would significantly change the trajectory of her life.

A Life-Changing Innovation

For patients like Jen who have exhausted traditional treatment options, Pazionis offers miracle-like solutions thanks to a combination of advanced technology, surgical ability, and attentiveness to the patient’s needs.

Her unique approach is rooted in her early life. As a child, Pazionis wanted to be a neurosurgeon, but when she attended college at the age of 13, she pursued a degree in economics, where she learned about creating statistical models that could help predict future behavior. When she came back to a demanding surgical field in her 20s, she developed a rigorous commitment to exacting, detailed work and iterative improvement.

Her combination of interests equipped her to meet the current demands of rapid innovation in the field of spine surgery. In the past few decades, robotic surgery has become an important part of many spine procedures. While surgeons still conduct the surgery, robotic arms allow for greater stability and precision, which can be transformative in a field where the site of the operation can be a tiny fraction of space.

As a side benefit, robotic surgery has also supported a new level of data collection–a capability that has been transformational in an era of artificial intelligence. During an operation, the robot’s movement can be recorded for future analysis, then combined in a data pool with information on the surgery’s short-term and long-term results. The physician can then minutely track outcomes of their approach over time, and even begin to understand their own tendencies as a surgeon quantitatively.

Now, artificial intelligence can use those patterns in both patient and surgeon to make recommendations on surgical plans. Each new patients’ spinal scans can be uploaded into the A.I. system, and the model can recommend the best approach based on predicted outcomes, resulting in the best solution for not just the patient or surgeon individually, but how the two can work best together.

“With A.I., we can say, ‘This patient has the same anatomy as another, but because they’re older or have lower bone density, they’re going to do better with surgery A versus surgery B,’” Pazionis says.

With the particularities of both patient and surgeon addressed by A.I. modeling, there’s still one other element of surgery that can benefit from a data-based approach. Pazionis also uses the insights provided by the patient’s scans and artificial intelligence to inform custom 3D-printed implants, making even her surgical hardware backed by data. Instead of a rod that needs to be shaped during surgery to fit the patient, or a standardized disc implant that offers uneven support to the vertebrae, the A.I.-guided implants are designed to work with the patient’s spine as seamlessly as possible–even taking into account how the spine is likely to operate long-term. That extra support yields real results.

“When implants exactly match the surgical planning, the patient is less likely to need revision surgeries,” Pazionis says.

In total, Pazionis’ system is a 360-degree accounting for the many complexities of spine surgery. And Pazionis hopes to not only improve that system in the near-future–she hopes to help more patients like Jen benefit from its holistic capabilities.

Progress and the Patient

For Jen, that desire to help above all else became clear the moment she met Pazionis. Unlike her previous doctors, Pazionis asked about her experience and goals in living with scoliosis.

“She really gets to know her patients,” Jen says. “She wants to know: ‘What are you thinking? What are your concerns? What can I do to help?’ I can’t even tell you how many times she’s said that to me.”

During a series of preoperative consultations, Pazionis walked her through how her mobility and quality of life could improve. Pazionis left the decision to pursue surgery up to her, but Jen felt that the treatment was the clear route.

Jen’s operation lasted ten hours, and it involved the removal of Harrington rods that had been there since Jen was a child. During her recovery and rehabilitation, Pazionis kept in close contact, even making Jen feel calm during an unrelated health scare in the hospital, calling her partner for her to update him on her condition.

“When she’s with a patient, that patient is her focus,” Jen says. “It doesn’t matter what else is going on.”

The Future of Personalized Spine Care

Supporting the patient’s complete experience is in part where Pazionis would like to take her model of care in the near future. She hopes to expand her use of data in order to run digital simulations of treatments. And with more comprehensive information, she envisions capabilities to prioritize treatments of related conditions.

“This kind of model would help the patient and the entire health care team,” Pazionis says. As Pazionis is working to make that approach come to life, she’s also lifting up other surgeons nationally, through collaborative education and research initiatives. In particular, as the organizer of the Temple Spine Symposium, she brings together leading surgeons and researchers to share the latest advancements in robotic surgery, artificial intelligence, and patient-specific modeling at the Lewis Katz School of Medicine.

“The symposium gathers thought leaders right here in Philadelphia, looking at the advances in our fields and the implications this will have for all surgery,” says Pazionis.

In the meantime, patients are already feeling the benefits. For Jen, life after surgery has been transformational. A problem that she has struggled with since childhood is finally gone.

“I still remember looking in the mirror at myself after surgery and standing straight for the first time. I had not seen myself standing straight since I was a kid,” she says. “She has by far changed my life.”

After rehabilitation, Jen is able to walk without a cane and drive again. For months after her surgery, she worked little by little to make it farther around a lake near Philadelphia. Now, she can make it around the lake on her own two feet.

“You have to be your own best advocate. There is help out there–all I needed was twenty seconds of insane courage to make a decision that changed my life,” she says. “It turned out better than I could have hoped for. I have a second chance, and I’m so grateful for that.”