Issue link: https://beckershealthcare.uberflip.com/i/1293265
48 pendent data. ere's no independent study of any other biologic treatment on the horizon, but we're waiting with optimism." Spinal cord injury treatment. One of the big innovations in the traumatic spine injury arena is spinal cord stimulation to treat quadriple- gic patients. "ere's a lot of smart people out there and the best thing to do is to collaborate," said Jeffrey Wang, MD, co-director of the USC Spine Center at Keck Medicine of USC in Los Angeles. "Spine surgeons are somewhat intelli- gent but there are a lot of basic scientists out there in other areas that may have therapeutics that could be applied to the spine. I think we need to collaborate with scientists in other spe- cialties to come up with the best techniques." ere have also been several clinical trials in the past decade showing the benefit of stem cell treatment for patients with spinal cord injury. Neuromodulation and advances with electrical stimulation and computer programs are also giving patients the ability to perform functional actions by bypassing the spinal cord and using a direct brain to peripheral nerve stimulation or interference, said James Harrop, MD, chief of the division of spine and peripheral nerve surgery at Jefferson University Hospitals in Philadelphia. Patient positioning. e art of patient posi- tioning has traditionally been overlooked in the spine space and is an area ripe for innovation. In the typical spine case, surgical teams waste invaluable OR time positioning patients with a combination of pillows, towels, foams, sticky rolls, IV bags, arm pegs and tape, which creates an inefficient operative setup. It also makes for inconsistent operative access and a surface that isn't optimized for patient safety. Bone Foam developed the Nextend Position- ing System to simplify the complex positioning methods of anterior cervical cases. e technol- ogy optimizes cervical spine positioning while providing a safe and stable operative surface. e system contains a single-use biocompati- ble padding and straps that comfortably posi- tion the extremities and depresses the shoulder girdle to enhance visibility of the lower cervical spine during imaging. Nextend can help sur- geons achieve more consistent and repeatable positioning while eliminating inefficiencies and complex tape configurations. Awake spinal fusion. In some pockets of the U.S., surgeons are beginning to perform awake spinal fusions. Alok Sharan, MD, director of spine and orthopedics at NJ Spine and Wellness in Freehold, was among the early adopters of the procedure. He began performing awake spi- nal fusions for patients undergoing minimally invasive transforaminal lumbar interbody fusion procedures in 2017, administering spi- nal and regional anesthetic while keeping the patients awake. e patients typically listen to music over headphones during the procedure and many return home within 24 hours of sur- gery. As care migrates more towards the ambulatory setting, he sees this as becoming a more realistic option for patients. "I'm confident in the abili- ty of awake spine surgery to deliver high-value more efficient care," he said. Minimally invasive tubular retractors. e development of minimally invasive tubular retractor systems transformed spine surgery by allowing surgeons to quickly accomplish the procedure with minimal tissue disruption. John Wilson, MD, vice chair of the department of neurosurgery and executive director of the neuroscience service line at Wake Forest Bap- tist Health in Winston-Salem, N.C., said, "In the circumstance of incidental durotomy, cere- brospinal fluid leak is virtually unheard of. As experience with this minimally invasive tech- nique has increased, the types of cases that can be done have expanded beyond decompressive procedures to include fusions, intra and extra dural tumors, and at any level in the spine." Pediatric scoliosis treatment. In pediatric sco- liosis treatment, growth modulation with ver- tebral body tethering has emerged as an option for some children to achieve better outcomes, but that's just scratching the surface, said Amer Samdani, MD, chief of surgery for Shriners Hospital for Children – Philadelphia. "I feel in pediatric spine, growth modulation will be- come a more utilized technique," he said. New techniques also include anterior verte- bral body tethering, a non-fusion technique for scoliosis correction. According to a post from Cleveland Clinic, the procedure can be performed on pediatric patients with growth remaining and idiopathic curves between 35 degrees and 70 degrees. Surgeons perform vid- eo-assisted thoracoscopy through four to five portals in the hemithorax and use fluoroscopy as well as camera visualization to place anteri- or screws in the vertebral bodies along with a staple at each level. e surgeons connect the instrumentation with a tether device for the correction. Multimodal pain management. Over the past decade, an addition to the multimodal pain management protocol for spine surgery pa- tients helps them mobilize quicker aer surgery and supports the transition to outpatient spine ASCs. "e use of multimodal approaches such as pre- and postoperative gabapentin, celecoxib and intraoperative Ketamine have helped but there is still room for improvement," said Fred Naraghi, MD, of Comprehensive Spine Center in Klamath Falls, Ore. "An ideal pain medica- tion would be non-opioid, non-habit forming with minimal side effects and equivalent poten- cy for pain relief." Anther tool surgeons can use is a bupivacaine liposome injection, a local anesthetic that can reduce pain associated with the procedure for the immediate postoperative period. As a result, patients are able to stand up and walk sooner aer surgery and return home with minimal pain. e injection also helps patients use fewer or no opioids during the recovery period. Telehealth. e pandemic forced many spe- cialists to postpone elective procedures tempo- rarily in early 2020 and turn to telehealth for office visits. Patients are now comfortable with the technology and expect spine surgeons to be available for consultation virtually. Surgeons are also adapting to the technology change. Al- exander Vaccaro, MD, PhD, president of Roth- man Orthopaedics in Philadelphia, believes he could diagnose patients appropriately through telemedicine 80 percent of the time. "We can do interviews with patients using tele- health, so you call up front for an appointment and I could sit down and I could talk to you," he said. "at's how spine surgery will change, will be much more efficient, be less likely to get burnt out, be more resilient because we're doing things we really love to do." Physical therapy is another area that is going virtual amid the pandemic. James Lynch, MD, founder of SpineNevada in Reno, has been working on tele-physical therapy for several years. "e COVID-19 crisis has really fast-for- warded the technology, and I think telemed- icine will continue to be huge. What would traditionally take years to change the mindset of providers, patients and the community oc- curred within a one-month period, and now it's standard accepted practice," he said. n Bone Foam Inc. is an industry leader in medical grade foam positioners that are utilized in hospitals, clinics, and surgery centers around the world. The company is focused on discovering and developing innovations in patient positioning that are mutually beneficial to surgeons, medical staff, and patients.