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22 JUNE 2017 CONFERENCE PREVIEW Personalized Medicine in Spinal Care: Q&A with Dr. Nitin Khanna of Orthopaedic Specialists of Northwest Indiana By Jessica Kim Cohen N itin Khanna, MD, a spine care specialist at Orthopaedic Specialists of Northwest Indiana in Munster, discusses the importance of personal- ized medicine in the spinal care field. Question: What led to your interest in nonsurgical techniques? Dr. Nitin Khanna: While I am a surgeon, I believe that the vast majority of patients can do better without having a surgical intervention. I'm a big believer in holistic care when dealing with any patient. I think this concept of personal- ized medicine has actually been around for a long time, but with recent changes in healthcare, such as consolidation, there has been a drive to have everything be protocol driven. e challenge is that sometimes you have a square peg and a round hole, and it doesn't fit, so having individualized treatment plans is im- portant. You can have the same MRIs of two patients, but their ages might be different, their bone quality might be different; you need to have different ways of treating those patients. I think everything from diet, to exercise, to physi- cal therapy, to medications — both allopathic medications and treatments like acupuncture, herbs, etcetera — all of these things have a role and should be part of spinal care. Q: Are you working on any research projects? NK: We recently published on a procedure called MAS-PLIF [Maximum Access Surgery Posterior Lumbar Interbody Fusion], which is a medialized approach to lumbar spinal fusion. I think it's the next step in the evolutions of MIS lumbar degenerative surgery. e advances made with MIS have data to support the fact that costs are better, length of stay is better, complication rates are better, but the challenge is that there's not a lot of great data on transition syndromes, ability to maintain alignment and some of these other long-term parameters, which have been better established with open procedures. MAS- PLIF, which is a minimally invasive procedure, aims to address those issues. Our paper looks at sagittal alignment correction aer the procedure. I think that's where minimally invasive spine surgery has to go: to prove durability and longevity. It needs good short-term, mid-term as well as long-term data, and I think this is a step in the direction of proving long-term outcomes. Q: What is the biggest challenge facing the orthopedic sur- gery field today? NK: In general, I think it's consolidation. Insurance companies are consol- idating and driving healthcare decisions, and also hospital consolidation, in which hospitals basically own patients and are driving patients to their employed physicians. I think that really hurts a free-market environment; it really hurts choice. I do not believe the net effect is going to be a net benefit, either in terms of clinical outcomes for patients or in terms of cost savings for the healthcare system. n Dr. Nitin Khanna will be speaking on "Developing a Great Patient Experience with Outpatient Spine Surgery" at the conference Thursday, June 22 at 1:15 p.m. 'Surgery is Like Comfort Food for My Soul' — Dr. Thomas Scully on Being a Neurosurgeon in an Evolving Landscape By Megan Wood N eurosurgeon Thomas Scully, MD, of Northwest NeuroS- pecialists in Tucson, Ariz., discusses the evolution of neuro- surgery, how value-based care will affect the field and major challenges he faces as a neurosurgeon. Question: How has the neurosur- gery field evolved in the last de- cade? Dr. Thomas Scully: Neurosurgery has undergone many significant changes in the past 10 years. I started private practice in 1994. In many ways, it is a completely different landscape. First, imaging, especially MRI proliferation, has allowed us to see far more pathology than we may have thought existed. This is great, but double edged. Patients receive their reports and immediately assume that a radiographic diagnosis is equivalent to a clinical diagnosis. Much of my office visit is spent explaining why an annular tear visualized by the radiologist is unimportant in their care. Additionally, intraoperative imaging allows for more accurate instrumentation. Image-guided spinal procedures reduce risk to patients and reduce radiation to surgeons and staff when utilized appropriately. Motion-preservation technologies in spine are also a great addition to our armamentarium. Cervical disc replacement and the coflex device come to mind. I use both technologies in my practice. Q: How do you think value-based care will impact the neurological surgery field? TS: Value-based care is here to stay. MACRA implementation and pay-for-performance will open up new cottage industries to help surgeons recover lost reimbursements. A potential downfall for patients is rationing. Smokers, diabetics and obese patients may not get operations because their results are potentially less good than those patients without such diagnoses. Q: What core challenges have you faced in your career as a neurosurgeon? TS: The core challenges facing me are numerous. Electronic health records and computerized physician order entry in my hospital are labor and time intensive. In addition, they are cumbersome and, frankly, dangerous to patient care. They are not ready for prime time, but, government Dr. Thomas Scully