Becker's Spine Review

15 SPINE SURGEONS 3 spine surgeons on other countries where they'd like to practice and why By Alan Condon W hether for procedural expertise, humanitar- ian reasons or medical tourism, three spine surgeons discussed countries outside the U.S. they would consider practicing in and why. Note: The following responses were lightly edited for style and clarity. Question: In what other country, if any, would you consider practicing spine surgery? Why? Todd Lanman, MD. Lanman Spinal Neurosurgery (Bev- erly Hills, Calif.): Australia and Germany come to mind. These two countries have extensive experience in arthro- plasty and are quite welcoming to it, as well as medical tourism. They're very friendly to international surgeons, observing and working within their systems. Hamid Abbasi, MD, PhD. Inspired Spine (Burnsville, Minn.): Nowhere. I don't think any country in the world parallels the U.S. in our level of expertise or innovation. Not yet. Issada Thongtrangan, MD. Microspine (Phoenix): I would like to return back to my home country, Thailand. My ultimate goal is to teach and spread knowledge to the younger generations, so they can serve the community. I would love to volunteer in an underserved area in my home country. Some other parts of the world, such as Ne- pal, Bhutan and Mongolia, etc., also interest me as there are a lot of rural regions that have no access to healthcare at all. I would love to volunteer there and use my skills to help those as much as I possibly can. 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 (Bir- mingham): Medicine in general has always had a tradition of cooperation and sharing of information, and I think this must contin- ue now and in the future. Due to the current medical climate, many practices are forced to evaluate daily operations with a more busi- ness-minded approach, but we must remem- ber to continue sharing knowledge, tips and personal assistance to colleagues locally and internationally. is way the maximum num- ber of patients can have access to the highest quality of care. One must also be open to tak- ing on extra patient care responsibility; be it clinical, emergency or consultations, given the probability that physician availability may be limited during the current crisis. Daniel Lieberman, MD. Phoenix Spine & Joint: Due to COVID-19, we are seeing more patients having spinal fusions in the ASC, as many of them are not willing to go to the hos- pital. In the past, a patient and surgeon may have opted to do the procedure at the hospi- tal. Now, we're seeing the opposite. Patients are telling surgeons that they will not have their procedure done at a hospital. Similarly, sur- geons 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 Lauderdale, Fla.): COVID-19 gave one gi to spine surgeons that is desperate- ly needed and never available: time. Time to think. Time to critically look at our pro- cesses, both nonsurgical and surgical. Time to review our cases, digest data and under- stand what we are doing well, and more im- portantly, what we are not. Time to develop ways to better help our patients. Raymond Gardocki, MD. Vanderbilt Uni- versity Medical Center (Nashville, Tenn.): Since COVID-19, I've been doing almost all my lumbar surgeries, such as decompressions and discectomies, as an awake procedure. at 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, be- cause you might think "what other options are there?" at'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 tele- medicine. ere were so many barriers to it in the past. Patients were not all that into it. ere 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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