Becker's ASC Review

33 ORTHOPEDICS navigation guidance for pelvic reconstruction and sacroiliac joint fusion. I believe the next big advancement will be using robotic guidance to prepare the interbody space for fusion and also to perform fully automated robotic-guided laminectomy/decompression." Kornelis Poelstra, MD, PhD. e Robotic Spine Institute of Silicon Valley (Los Gatos, Calif.): "e future for robotics is bright. In addition to trajectory guidance to place hardware and perform complex preoperative planning procedures, robots are soon going to be able to have greater autonomy in the OR, I hope. We must discuss these advances together with regulatory bodies such as the FDA, but this autonomy will not be far off. Robotic systems should be able to nearly autonomously place hardware, further reduc- ing outliers and human error, help us with discectomy procedures and end plate prepara- tion in a more predictable form as well as with decompression surgery or the spinal canal. "Utilizing advanced learning, I am confident that we can start manipulating muscle and fascia and have robotic assistance that will help us open and close surgical approaches. People should also not forget the highly advanced predictive analytics that help us with the decision-making processes of which surgical technique to offer to which patient. Robotic and computer systems are much more capable of analyzing large amounts of variables to help us reduce complications and make better choices for our patient population." Brian Gantwerker, MD. Craniospinal Cen- ter of Los Angeles: "In a year, the spine space will be more crowded in terms of robotics and endoscopy. We anticipate a larger market share being taken from Medtronic/Mazor and going toward DePuy and Nuvasive. ere will be larger patient demand for minimally invasive outpatient and awake surgeries." Christopher Blanchard, DO. Resurgens Or- thopaedics (Atlanta): "Robotics in spine sur- gery is still in its infancy compared to robotics in general surgery. Currently, the largest utility of a robot is with screw placement. is is rapidly changing with soware and hardware updates. In the next five years, I think robotics will continue to evolve, allowing surgeons to perform surgery in a less invasive way to al- low for quicker recovery. I believe as robotics develops, it may completely change how we think about and perform spinal procedures." Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): "I am excited about new technol- ogies in spine surgery that will lead to better patient outcomes, faster recovery and lower chance of complications. ese technologies that enable minimally invasive spine surgery, robotic assisted surgery, computer navigation and augmented reality bring with them extra costs. e financial savings associated with minimally invasive spine surgery result in faster recovery and return to work and func- tion, shorter hospitalization or even avoiding an admission altogether. Lower chance of complications or need for revision surgery will more than compensate for such extra expenses. Once the technologies are widely implemented, the costs will inevitably go down while we continue to provide the best and most innovative care for our patients." n How the pandemic is changing spine surgery: 5 surgeon insights By Alan Condon F rom the acceleration of outpatient migration to the increasing popularity of certain spinal approaches, five spine surgeons discussed how the COVID-19 pandemic has altered the field: Note: Responses were edited for clarity. Greg Gullung, MD. OrthoAlabama (Birmingham): Medi- cine in general has always had a tradition of cooperation and sharing of information, and I think this must continue now and in the future. Due to the current medical climate, many practices are forced to evaluate daily operations with a more business-minded approach, but we must remember to continue sharing knowledge, tips and personal assis- tance to colleagues locally and internationally. This way the maximum number of patients can have access to the highest quality of care. One must also be open to taking on extra patient care responsibility; be it clinical, emergency or consultations, given the probability that physician availabil- ity may be limited during the current crisis. Daniel Lieberman, MD. Phoenix Spine & Joint: Due to COVID-19, we are seeing more patients having spinal fu- sions in the ASC, as many of them are not willing to go to the hospital. In the past, a patient and surgeon may have opted to do the procedure at the hospital. Now, we're seeing the opposite. Patients are telling surgeons that they will not have their procedure done at a hospital. Simi- larly, surgeons are recalibrating risks for ASCs, because the risk of going to the hospital is higher. We're seeing rapid growth in the number of surgeons who want to operate primarily in an ambulatory setting. We initially thought the transition to the ASC environment was going to take place over the next five to 10 years, but now I think it's going to over the next one to five years. Jeffrey Cantor, MD. Cantor Spine Institute (Fort Lauder- dale, Fla.): COVID-19 gave one gift to spine surgeons that is desperately needed and never available: time. Time to think. Time to critically look at our processes, both nonsurgical and surgical. Time to review our cases, digest data and understand what we are doing well, and more importantly, what we are not. Time to develop ways to bet- ter help our patients. Raymond Gardocki, MD. Vanderbilt University Medi- cal Center (Nashville, Tenn.): Since COVID-19, I've been doing almost all my lumbar surgeries, such as decom- pressions and discectomies, as an awake procedure. That was one of the benefits of COVID-19. It minimizes the anesthesia complications, such as nausea, sore throats and urinary retention, especially for elderly patients. As a surgeon, we kind of just accept the complications that can be associated with general anesthesia, because you might think "what other options are there?" That's where awake surgery comes in, but you have to do the surgery in a way that's not very painful or invasive for the patient. James Lynch, MD. SpineNevada (Reno): COVID-19 has really revolutionized telemedicine. There were so many barriers to it in the past. Patients were not all that into it. There were also concerns about data sharing, regulations, cost and payments. But CMS really came in and changed [telemedicine] entirely. Patient adoption has been huge. We did telemedicine over five years ago. It cost over $10,000 to reach out to remote areas in Nevada; now, you can do it on an iPhone or an iPad with no added cost. n

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