Becker's Spine Review

29 Thought Leadership Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Down the pipeline, spine care delivery will be increasingly hybridized with more motion preservation, augmented reality/virtual reality, robotics, endoscopy and telemedicine. We are seeing more spine care also being moved to the surgery center in an extended-stay modality. By 2026, I think we will see a very different payer landscape as well. Whether for better or worse, there might be a single payer and/or bundled payment system. I do not think this will necessarily be a good thing. e reason being, part of what makes spine surgery so important is the positive effect it has on patient lives. e impact of being without pain, or being much relieved, and being able to return to work and their fam- ily life is utterly undervalued by the payers. Unless something changes, and both physicians and patients push back, despite all the innovations and amazing technology, unless someone makes the payers actually pay for it, patients will not enjoy its benefits. Adam Bruggeman, MD. Texas Spine Care Center (San Antonio) and CMO of MpowerHealth (Addison, Texas): Spine care delivery will clearly shi toward the outpatient setting as payers see cost savings and providers have greater opportunity for ownership in surgery centers. Trends are shiing toward employment models and consolidation of practices as we see hospital systems, private equity and insurance com- panies continue to employ a greater percentage of the workforce. Also pushing this trend is the growing attitude of physicians who prefer to avoid the ever-growing practice management requirements and increas- ing burden of preauthorization associated with payers. Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): e surgical expectation of early discharge is already the accepted norm for those who are capable following spinal surgery. e length-of-stay issue and patient education surrounding the pandemic has been an accepted shi of practice, result- ing in temporary unit creation, focal physical and occupational consul- tation and early readiness for discharge. Diagnoses that are complex to treat such scoliosis, deformities, remote fractures, or intracanal tumors of the spine, coupled with systemic illness, will remain challenges even in the best health systems and providers. Issada ongtrangan, MD. Microspine (Scottsdale, Ariz.): I expect there will be more spine cases being done in outpatient settings. ere will be more adoption in motion preservation and endoscopic spine surgery on both sides, the surgeons and the insurers. I predict we will continue to see the growth in robotics, navigation and artificial intelligence. n 'A true paradigm shift': 6 surgeons on endoscopic spine surgery By Alan Condon E ndoscopic spine surgery offers many benefits over traditional spinal fusion, including shorter operative times, less bleeding and quicker recovery times. Awake endoscopic procedures also avoid intubation, pro- tecting staff from exposure to respiratory secretions directly from the lung, which has become a particularly useful tool for surgeons during the COVID-19 pandemic. Six spine surgeons share their thoughts on endoscopic spine surgery: Peter Derman, MD. Texas Back Institute (Plano): I am also excited about endoscopic spine surgery, which is becoming an increasingly large part of my practice. It is a true para- digm shift in the field, which allows surgeons to access and address spinal pathology without the morbidity associated with traditional techniques. In many cases, it allows me to perform an ultra-minimally invasive decompression when a fusion might otherwise have been necessary. Patients are comfortably home within hours of surgery and often only take Tylenol for postoperative pain control in the days after the procedure. Daniel Lieberman, MD, Phoenix Spine & Joint: What pa- tients really are concerned about is their pain. Our surgery centers offer endoscopic dorsal rhizotomy, so ultra-minimal- ly invasive surgeries that eliminate pain are really the next horizon. It's almost like we're going to see spine surgery ab- sorb and move into more of a pain management approach, rather than a structural correction approach. Kern Singh, MD. Midwest Orthopaedics at Rush (Chica- go): This is truly the next generation of spine surgery. I've been performing minimally invasive spine surgery for 13 years and now with the endoscopic procedure, my patients are out of the surgery center in usually half the time. Being able to provide this procedure to my patients means I can deliver them pain relief in an even safer manner. Raymond Gardocki, MD. Vanderbilt University Medical Center (Nashville, Tenn.): I expect endoscopic interbody fusion to grow significantly. I also expect that outcomes data will be collected, showing higher fusion rates and less sub- sidence due to better visualized disc prep and less endplate violation. Look for new instrumentation advancements and technique refinements that make this procedure feasible for more surgeons to perform outpatient and awake one- and two-level lumbar fusions. I think this will lead to more main- stream acceptance and use of endoscopic spine surgery. Brian Gantwerker, MD. Craniospinal Center of Los An- geles: Current techniques in endoscopy look promising, although I am not totally sold on endoscopic transforaminal lumbar interbody fusions. I think decompressions and dis- cectomies will all be done endoscopically in 10 years. Issada Thongtrangan, MD. Microspine (Phoenix): Out- patient spine surgery, endoscopic spine surgery and mo- tion preservation are the most exciting trends for me. The advanced technologies of endoscopic spine are evolving to the point that this can be done in an outpatient center. We can incorporate nonfusion and even fusion techniques with the endoscopic technique. In Asia and Europe, there are sev- eral studies showing comparable outcomes on endoscopic lumbar fusion utilizing expandable cages and endoscopic tools. n

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