Issue link: https://beckershealthcare.uberflip.com/i/1164972
20 SPINE SURGEONS The potential for 3D robotics in spine + key thoughts on new technology from Dr. Dale Horne By Laura Dyrda D ale Horne, MD, a Cincinnati-based neurosurgeon, began using spinal robotic technology in 2007 and hasn't looked back. Here, he discussed how robotics has evolved and the potential threats for the spine field in the future. Question: What emerging technolo- gy are you most interested in today and why? Dr. Dale Horne: Two emerging technologies we will certainly be seeing more of will im- pact both general neurosurgery and spine. Exoscopes, particularly 3D robotically-con- trolled scopes will eventually dominate and replace conventional intraoperative micro- scopes. As the availability, cost and integra- tion of ultra-high definition sensors grows, the current footprint and size of intraoper- ative microscopes will transition to unobtru- sive, high-resolution 3D optical exoscopes that will automatically focus, zoom and move to maintain the field of interest in view. ese scopes also provide ease of involvement of other surgeons and operating room staff to be engaged in the surgery. is will benefit all aspects of neurosurgery. Spinal robotics, which began with the Mazor SpineAssist in 2004, passed multiple reitera- tions and improvements in planning, intra- operative registration, and integration into the surgeon's natural workflow. Currently, multiple systems are on the market and in development by a variety of major spine ven- dors. e ability of the spinal robot to assist the surgeon in accurately and reproducibly placing spinal implants while decreasing the radiation exposure to the patient and opera- tive staff, ultimately providing for improved outcomes, is the force that will continue to drive this technology. I began using spinal robotics in 2007 and at that time, it was clear to me, that they would ultimately become a standard in operative spine care. Q: How do you think your practice will change in the next three years? What are you doing today to prepare? DH: e best method for preparing for the future is to become familiar with these tech- nologies and gain and maintain facility with applying these tools to neurosurgery. Patients learn about new technology and ask about it. Where appropriate to the patient's condition, we should be able to skillfully use our new tools to further improve patient outcomes. Q: What is the most dangerous trend in healthcare, spine or orthopedics today and why? DH: Complacency and cutting corners by surgeons, physicians and staff, oen due to the increased regulations and time demands, is dangerous. Practice and hospital admin- istrations must respect that quality care requires time with patients. Furthermore, unless a surgical emergency exists, patients should be given the option of conservative measures and stable conditions should be followed. Just because we have the technol- ogy to perform a surgery does not mean we should. n Trends in spine to watch from Dr. Ashutosh Pradhan — lumbar disc replacement, practice demographics and cost control By Laura Dyrda A shutosh Pradhan, MD, is chief of neurosurgery at Ascension St. Vincent's Riverside, a 528-bed hospi- tal based in Jacksonville, Fla. The hospital was recognized as among the best hospitals in the nation for spinal surgery by Healthgrades. Here, Dr. Pradhan discussed the big trends in spine technology and how the field will change within the next few years. Question: What emerging technology are you most in- terested in today and why? Dr. Ashutosh Pradhan: Lumbar arthroplasty and robotics. Lumbar arthroplasty is not necessarily a new idea, but we have had limited improvement on current offerings. I think we still need to evolve in maintaining motion in the spine rather stopping motion. There are only two FDA approved lumbar arthroplasty devices: Centinel Spine's prodisc-L and Aescalup's Active-L. I hope there will be more prod- ucts to come to market. Robotics have a lot of possibilities, but we are not there yet. Improving outcomes and decreasing revisions would go a long way in spine. The robots are currently limited in capa- bilities and do not have live feedback. I think the growth of use will force improvement and indications. Q: How do you think your practice will change in the next three years? What are you doing today to prepare? AP: The aging population is forcing the average age of my patients to go up. I am trying to be more aware or proactive in general health issues that will affect operating on this pop- ulation. A good preoperative checklist and education for this population will be important to reduce complication rates. Q: What is the most dangerous trend in healthcare, spine or orthopedics today and why? AP: I am concerned that there is a race to the bottom to control cost without necessarily evaluating patient benefit. We should all be good stewards of our healthcare system. In a race to improve our cost structure, I think we are elim- inating opportunities for new technology and burdening physicians with documentation requirements that seem unnecessary. In addition, it seems like I am spending more time on the phone with insurance companies for patients I have documented appropriate conservative treatment. n