Issue link: https://beckershealthcare.uberflip.com/i/1335763
8 SPINE SURGEONS The most controversial trends in spine By Alan Condon F rom artificial discs to stem cells and complex deformity surgery, 10 surgeons discuss some of the most controversial trends in spine today. Note: e following responses were lightly edited for style and clarity. Question: What is the most controversial trend in spine today? Alexander Vaccaro, MD, PhD, and Bryce Basques, MD. Rothman Orthopaedic Institute (Philadelphia): e most controversial trend I see in spine surgery is the development of "solutions looking for problems" by the device industry. e core fundamentals of good spine care have remained the same for years, yet there continues to be massive investment and marketing in various spinal technologies that seem to fill a void in untapped intellectual property voids, rather than a demand by patient needs. Today, robotics and various minimally invasive techniques have high potential, yet I would caution surgeons, especially those early in prac- tice, from broadly adopting these techniques without scrutiny. Espe- cially in saturated markets, spine surgeons may think that these newer technologies are an opportunity to differentiate or market themselves. However, if adoption of these techniques leads to inefficiency, com- plications and poor outcomes, your reputation will suffer and any potential marketing benefit will be lost. In the current financial cli- mate, surgeons will be expected to justify the cost of this technology to payers as well. I would encourage surgeons to be highly discerning in the technologies or advancements they adopt and pursue patient care avenues that demonstrate high value. Neel Shah, MD. DISC Sports & Spine Center (Newport Beach, Calif.): One controversial trend in spine is the evidence of more and more invasive procedures, such as endoscopic discectomies or place- ment of paddle leads for spinal cord stimulators, being undertaken by interventional specialists. is becomes dangerous when these pro- viders cannot adequately address complications that may arise from such procedures. It is especially concerning when invasive procedures are being done within the spinal canal, where they can cause disas- trous complications without the right precautions. Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): As a regional referral center for complex spinal disorders, our practice has witnessed many more minimally invasive spine surgery cases. Albeit, the conceptions and training emphasis of these surgeries varies among programs and individuals, motives and intent are ill-defined and usually cost expan- sive. Invariably, the decompressive component of the surgery is lack- ing/not achieved and nonunions are convention. Corrective surgical methods are usually much more involved because of lateral instru- mentation and protracted in recovery. Hamid Abbasi, MD. PhD. Inspired Spine (Burnsville, Minn.): e artificial disc, as well as unjustly applying the deformity parameter to degenerative spine disease. Todd Lanman, MD. Lanman Spinal Neurosurgery (Beverly Hills, Calif.): Oddly, it still remains relatively controversial — placing arti- ficial discs, multilevels or adjacent to fusions, and certainly reversing fusions, as off-label indications. I find this odd in the sense that hybrid surgeries, or combinations of artificial discs with fusions, have such a huge body of published experience throughout the world that shows superiority, or at least equivalency, to fusion, while maintaining nor- mal motion of the spine. Why this controversy still exists escapes me. Similarly, with multilevel cervical disc replacement, many surgeons feel that this type of surgery, because it's off label, means it doesn't work, when it is clear that using devices in an off-label manner is certainly allowed by the FDA and entirely proper if the clinician feels it is in the benefit of the patient. John Burleson, MD. Hughston Clinic Orthopaedics (Nashville, Tenn.): I find the most controversial issue in spine to be the use of un- proven technologies. I get questions from patients all the time about stem cell injections into their spine, or injections into their discs to "heal" them. ese newer treatments do not have adequate evidence that they are helpful and could be harmful. ey are also extremely costly to desperate patients. It is frustrating to have to tell patients that there is no data for those treatments and that they might need more than an injection to fix their misaligned spine or back/leg pain despite what other doctors have told them. Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Com- plex deformity surgery I believe is the most controversial trend right now. ere is a lot of it being done at this point in time. While I feel there is good work being done, especially in robotics and minimal- ly invasive surgery, as well as AI solutions to get the job done, I fear there is a great deal of surgery being done based on films, rather than symptoms. We are starting to see patients being fused from C2-pelvis, and I fear some surgeons have lost their way. Ultimately, the long-term outcome data will need to be shown the light of day, so we can honest- ly judge if the significant perioperative and postop consequences are worth it for the patients. I hope we, as a specialty, can learn to live with a patient who is functional and off pain meds, rather than one who has perfect films but also has a proximal junctional kyphosis, pseudoar- throsis, or a completely fused spine. Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): The most controversial trend is probably stem cells. The hope is that they will become the holy grail of spine surgery, capable of "repair- ing" injured discs and reversing years of degeneration, thereby re- The most controversial trend I see in spine surgery is the deployment of 'solutions looking for problems' by the device industry. - Dr. Alexander Vaccaro, Rothman Orthopaedic Institute