Becker's Spine Review

33 Thought Leadership Dr. Roger Hartl: The biggest opportunity in spinal biologics By Laura Dyrda R oger Hartl, MD, professor of neurological surgery and director of spine surgery at Weill Cornell Medicine in New York City, as well as director of the Weill Cornell Medicine Center for Comprehensive Spine Care, discussed the key trends in spine technology to consider in the future. Question: What emerging technology or technique will have the biggest impact on the field over the next five years? Dr. Roger Hartl: We are seeing an emergence of surgical navigation including robotics but this is a subset of overall navigation and still in its early stages, surgi- cal planning and simulation, and virtual reality technology that will significantly change the way that we will plan, perform and assess spinal surgery for all types of pathologies. Deformity is a clear and obvious target, but this will expand into degenerative and revision surgery, tumors, etc. Biologics are starting to enter the surgical arena, but we are still at the beginning. We need better data that biologics really have an impact on disc regeneration and repair. Many groups are working on this, and we will likely have much more and better evidence soon. Also, the advantages of tissue engineering in addition to just injecting cells have not been taken advantage of. So far, we just use cells but a combination with tissue-engineered materials and strategies for annular repair and disc regeneration may have an additional positive impact. Q: Where are the biggest opportunities for innovation in spinal bi- ologics? What are you working on right now? RH: In my opinion annular repair is the most obvious target for biologics. It's an obvious and huge clinical problem, and our patient clearly understand this. For example, many of my patients will ask: "Aer you have removed the herniated disc, what will you use to seal the hole in the disc?" We have made significant improvements in developing compounds that have the ability to quickly and effectively seal the annular defect that is created by a disc herniation and/or by the surgical discectomy. Combining this with cellular therapy results in a greater ability to achieve short-and long-term annular sealing and repair. Animal data is promising, and we need to translate these results in order to move them into the clinical arena. A few groups, including ours, are working on total biological disc replacement that will eventually replace cervical disc arthroplasty and maybe even offer new options in the lumbar spine. is is very exciting and will require the combina- tion of biologics, tissue engineering, but possibly also the combined use of other technologies such as resorbables. Q: What technologies or techniques do you think will become less common or fade over the next few years? RH: e combination of minimally invasive spine, biologics for disc repair, re- generation and replacement, better surgical planning (navigation/robotics) and a better understanding of the pathophysiology will result in a reduced need for fusion surgery. is will take some time but will surely happen. As surgeons, we can decide to be at the forefront of research and innovation or have insurance carriers and governmental decision-makers take the lead. n Dr. Lawrence Lenke: The big opportunity for innovation in spine patient safety By Laura Dyrda L awrence Lenke, MD, surgeon-in-chief of NewYork-Presbyterian Och Spine Hospital and co-chair of the Safety in Spine Surgery Summit, discussed the culture of patient safety in spine and where the best organizations are headed. Question: What are the biggest challenges for spine surgeons when devel- oping a culture of patient safety in their operating rooms? Dr. Lawrence Lenke: I think the biggest challenge is team engagement. All surgeons want to practice safe spine surgery for their patients, but it is only when the entire operating room team embraces this philosophy that true change and improvement can occur. Q: How can surgeons become advocates for patient safety within val- ue-based care models? LL: I believe it will actually be easier for spinal surgeons to embrace a safety culture when value-based medicine is adopted versus the current pay for ser- vice model. In value-based care, all components of the patients' continuum from presentation to recovery will be managed with an eye towards safety rather than strictly operative volume. Q: Where do you see the biggest opportunity for surgeons to innovate within patient safety? LL: I think the biggest innovation will occur with the promotion of special- ized care teams for spinal surgery patients, especially in the ORs. Spinal sur- gery is a challenging specialty of surgery for the entire OR team, including not only the surgeons, but also the surgical technicians, scrubs and circu- lating nurses and other ancillary staff. Cardiac surgery founded this model several decades ago, and when you ask those who scrub complex spinal cases, they oen state that what is required of their skills and efforts is much greater than those taking care of cardiac patients. e entire spine surgery community needs to spread this word so others, in- cluding hospital administrators and those with administrative responsibility in the ORs, understand and appreciate this specialized need. Q: What inspires you to make your spine practice better every day? LL: I am inspired to make my patients' experience better each and every day. Seeing someone go through the spectrum of care from the preoperative, in- traoperative, early post-surgery hospitalization and through long-term fol- low-up care makes me appreciate how everyone involved in the care process. It is awesome and rewarding but also quite a serious responsibility. n

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