Becker's Spine Review

16 SPINE SURGEONS Should pain management physicians perform endoscopic spine surgery? By Alan Condon E ight spine specialists debated which physicians should and should not be able to perform endoscopic spine surgery. Note: e following responses were edited for length and clarity. Question: What is your opinion on pain management physicians per- forming endoscopic spine surgeries? Tony Mork, MD. Newport Beach (Calif.): I believe pain management physicians can per- form endoscopic procedures outside of the spinal canal with proper training and men- toring. Since so many pain generators/facets in the spine are located outside of the spinal canal, endoscopic spine surgery is synergistic with a pain management physician's scope of practice. e endoscopic approach to pain of- fers society, government and payers a proven therapy to decrease the use of opioids, by 'cur- ing' spine pain rather than managing it. For example, endoscopic techniques offer low risk possibility of a 'cure' of facet syndrome pain. ere is not much a spine surgeon can offer for facet syndrome except a spinal fusion, which is too much treatment for the patient and too costly for payers and the government. Issada ongtrangan, MD. Microspine (Phoenix): is is a tough question. As a fel- lowship-trained spine surgeon who adopted this technology, I can say that it's not easy. We must put the patient's best interest as the first priority. I would say it is OK for a well-trained pain management specialist to perform en- doscopic spine surgery if they can take care of the complications or have a well-trained spine surgeon scrub in the case. Another area is how well they can select the appropriate patients who have solid indications as most of the pain specialists are likely trained in the different aspects of spinal disorders. Fred Naraghi, MD. Comprehensive Spine Center (Klamath Falls, Ore.): I don't think it's a good idea. Endoscopic spine surgery has a steep learning curve and may be associated with sig- nificant complications. Spine surgeons are bet- ter trained to treat the possible complications of the endoscopic procedures. Ultimately, patient safety and improved outcome is the goal. James Chappuis, MD. Spine Center Atlan- ta: Any physician who is well trained should be able to conduct procedures that they are trained in as long as they can handle the complications that could arise from that procedure. Currently, in our practice, endo- scopic spine surgery is only performed by board-certified, fellowship-trained spine sur- geons. is doesn't mean it will always be this way. is is just what I am comfortable with at this time for the best interests of our patients. Brian Adams, MD. Spine Center Atlan- ta: As an interventional spine pain manage- ment physician, I am intrigued about the utilization of endoscopic surgery. Since this is largely an image-guided technique, I feel that it is a tool that can be safely incorpo- rated into an advanced interventional spine practice. While I think there are certainly limitations to what procedures are appropri- ate for an interventional physician, the most important consideration is a good symbiosis between interventionalist and surgeon. is is probably best utilized in a practice with both interventionalists and surgeons working together under one roof. Noam Stadlan, MD. NorthShore University HealthSystem (Evanston, Ill.): e optimal care of spine patients requires the expertise of a number of specialists: surgeons, pain man- agement specialists, physical and occupation- al therapists, pain psychologists, radiologists and more. Patients benefit most when all spe- cialists do what they do best and collaborate with others who have differing areas of exper- tise. Spine surgeons spend hours developing the experience and diagnostic skills to make the clinical diagnoses that are fundamental to the success of any treatment. Pain man- agement physicians who perform endoscop- ic surgeries are best served by working with spine surgeons who can provide expertise in diagnosis and radiographic interpretation, as well as complication management when they occur. Performing these surgeries without integration of spine surgeons in the deci- sion-making process and postoperative man- agement, when necessary, can result in less than optimal results. Harel Deutsch, MD. Rush University (Chi- cago): While pain management physicians are billing for these procedures and want to get the higher valued codes, the procedures they do are not effective or equivalent to spine surgeries done by neurosurgeons and ortho- pedic surgeons. Christian Zimmerman, MD. Saint Alphon- sus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): is topic begs the fundamental premise of training, ability and accountability. My rebuttal is centered in complication management and one's ability to administer care in the likelihood of that situation arising. e actual dissent and fric- tion of this extraneous practice surrounds the efficacy of such procedures, where both radiologists and surgeons alike, cannot mea- sure or detect the actual surgical interven- tions of these 'surgical procedures' on CT or MRI scanning. e determinations for these procedures markedly exceed the indications, characterizing the process as deluding. n PE firm invests in 10-location orthopedic practice By Alan Condon Private equity firm Cobepa closed a growth equity investment in Laurel, Md.- based Precision Orthopedics on Jan. 12. Precision Orthopedics will use the capital to enhance operations and expand the practice, which features 10 clinical locations, one ASC and 18 providers, according to its website. The practice plans to open more ASCs and partner with additional hospitals. Cobepa North America Managing Director Peter Connolly and Vice President Peter Batesko joined the practice's board of directors. Financial terms of the deal were not released. n

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