Becker's Spine Review

May/June Issue of Becker's Spine Review

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22 DEVICES & IMPLANTS The spine surgery devices, techniques that won't stand the test of time By Laura Dyrda N ine spine surgeons discussed the technology and techniques that will fade over the next few years, and factors driving the disappearance. Q: What do you think will fade or dis- appear from the spine field over the next few years? Mitchell Levine, MD. Lenox Hill Hospital (New York City): Interventions for focal back pain and neck pain without neurological in- volvement are going to trend down. Insurance companies are tightening their criteria for ap- proving fusion surgeries and evidence-based care will be standard. is increased scrutiny on efficacy will be brought to bear on all aspects of spine care, including pain management and physical therapy as well. e overuse of epidural steroids and ablative procedures in spinal steno- sis treatment is already being evaluated. Nigel Price, MD. Children's Mercy Kansas City (Mo.): Several value-driven practices are changing the outcomes. We will see few- er infections, less need for transfusions, early mobilization and earlier discharges from the inpatient side. We will hopefully make better decisions in terms of preoperative planning and execution so avoidable complications ne- cessitating revision surgery will be reduced. Collaboration across many institutions will help refine technique through sharing of data. ere will be fewer spine fusions for deformi- ty in the younger age group as techniques and technologies for doing guided growth will en- courage more fusionless surgery. Jeffrey Cantor, MD. Cantor Spine Institute (Fort Lauderdale, Fla.): Traditional bone cutting tools are the easiest old technology to replace. Eugene Koh, MD, PhD. University of Mary- land School of Medicine (Baltimore): Cur- rently, insurance companies are collecting data on each individual surgeon, including expense for each individual procedure (for example, the cost for a single-level ACDF). Certain insurance companies are financially incentivizing primary care physicians to refer to the least expensive surgeons. As they accu- mulate more data, including outcomes data, the insurance companies would dictate the procedure or surgeon with the lowest revision rate. Numerous reports have demonstrated interspinous devices for lumbar spinal steno- sis have poor outcomes and a high re-oper- ation rate. Insurance companies will make it more and more difficult for surgeons to justi- fy placing these implants or any devices that have a high revision rate. Andrew Cordover, MD. Andrews Sports Medicine & Orthopaedic Center (Birming- ham, Ala.): I have a concern with the over-re- liance on technology and the disappearance of knowledge of basic, technical surgical principles. e burden will fall on teaching institutions to make sure that doesn't happen as image guidance and new biologics (which may allow for suboptimal surgical technique) gain acceptance. Avery Jackson, MD. Michigan Neurosur- gical Institute (Grand Blanc): I think inter- body spinous devices will eventually fade. I think halo fixation will eventually fade. Michael Goldsmith, MD. e Centers for Advanced Orthopaedics (Bethesda, Md.): Hopefully revision surgery for pseu- darthrosis will be less prevalent in the coming years. As our implants and techniques become better and our adjuncts to bone gras become more powerful through advancement in bio- logics, I would expect to see fusion rates rise. Revision surgery is extremely costly and has higher complication rates than index fusions, so the goal is to avoid reoperation to benefit both the patient and health system. One concern I have, which is a bleak predic- tion, is that innovation may decrease as well. In an effort to save money, many hospitals, in particular the larger health systems, are moving to one or two vendor systems which drives out smaller companies and may have the downstream effect of diminishing inno- vation. Oentimes smaller companies have the ability to be more innovative either be- cause they were created around a new tech- nology or in order to differentiate themselves. We need to continue to encourage true inno- vation at the ground level by supporting all technology, not just from the big companies. Robert Jackson, MD. Orange County Neu- rosurgical Associates (Laguna Hills, Ca- lif.): Narcotic consumption will decrease over the next five years as practitioners and public become more aware of the dangers. n Brainlab buys robotics platform company: 5 key notes By Laura Dyrda B rainlab acquired an applica- tion-specific robotic technolo- gies developer to strengthen its cranial and spine surgery offerings. Five things to know: 1. Brainlab acquired Medineering; the company currently markets Med- ineering under the name Cirq, an intuitive assistant modeled after a human arm designed to assist during surgical procedures. Cirq can be aligned in seven degrees of freedom for positioning flexibility. 2. This acquisition will add to Brain- lab's portfolio and enables other medical technology companies to design solutions and applications across many specialties. 3. Brainlab has had a relationship with Medineers as an investor and distri- bution partner. The Medineering arm is vendor-neutral robotic platform de- signed as lower-cost equipment than other robotic technology and can mount on the side rails of the OR table. 4. The Medineering technology will be available to Brainlab's 4,000 exist- ing customers and helps expand the company's reach into ASCs. 5. FDA clearance for Cirq is pending in the U.S. n

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