Becker's Spine Review

33 Thought Leadership Chris Summa, MD. Sutter Health (Sacramento, Calif.): Spine Surgery in 2030 will be utilizing refined technologies and philosophies that have begun entering mainstream practice over the last 10 years. Between mo- tion preservation, minimally invasive procedures and comprehensive im- age guidance systems, patient outcomes will be notably improved. Spinal arthroplasty will continue to be shown to have less adjacent level degen- erative changes and updated devices will allow improved visualization of neural elements following implantation that we do not currently have. Surgical procedures will be more efficient with smaller exposures and less collateral damage, shortened anesthetic/operative times. As a result, hospital stays will be shortened and an increasing number of these pro- cedures will be performed outpatient. [Enhanced recovery aer surgery] protocols will facilitate quicker recoveries for patients and a more rapid return to their desired level of activity. Lastly, image guidance systems will become more encompassing, involving and integrating many dif- ferent aspects of the more complex surgical planning and procedures into a relatively simple, straightforward process that allows for greater reproducibility and safety. omas Schuler, MD. Virginia Spine Institute (Reston, Va.): Fortu- nately, we are living in the 'bio-century.' is means great advances have, and will continue to come from the rapidly evolving field of genomics. Stem cell therapy will enable us to heal injured tissues without surgery in many cases. We are already seeing great strides using concentrated bone marrow aspirate to stabilize degenerative discs and ligaments. is is standard care in the equine world today. e medical world is lagging. e same was true in the 1990s when the idea for a threaded anterior lumbar interbody cage was 'borrowed' from equine veterinary medicine. Now anterior interbody cages are essential. Motion-preserving surgeries will become standard in 2030 as insurance companies finally accept that this is not experimental. is will be es- pecially true for multilevel pathology. Minimally invasive technology will advance with multigenerational improvement in robotics, image guidance and augmented reality. Patients will get better improvements with fewer iatrogenic problems and fusion disease because of all these advancements. Domagoj Coric, MD. Carolina Neurosurgery & Spine Associates (Charlotte, N.C.): Spine surgery in 2030 will be permeated by intra- operative navigation and the rise of the robots. Spinal navigation will become the standard of care, as misplaced instrumentation and subse- quent return to the operating room for revision become viewed as 'nev- er' events. Robot-assisted surgery will be widely adopted and expand to routinely involve decompression as well as interbody device placement. Precise ultrasonic bone-cutting instruments will make rudimentary cut- ting tools such as osteotomes and rongeurs obsolete. Spinal arthroplasty will be more pervasive, including the first FDA ap- provals for posterior lumbar arthroplasty devices as well as hybrid fu- sion/total disc replacement indications for cervical and lumbar indica- tions. Population healthcare delivery and spine bundles for outpatient cases ([anterior cervical discectomy and fusion], cervical total disc replacement, discectomy, decompression, etc.) and one- and two-level degeneration fusion cases will be the norm. omas Lous, MD. Austin (Texas) Neurological Institute: I would expect spine surgery to involve more technology integration. Robot-as- sisted surgery in the spine still has significant limitations, but I would expect with time these will be improved upon. From a practice stand- point, I hope there will be a swing back toward more private practice offices and away from hospital-owned practices. e dynamic flexibility and patient-focused care of private practices are being eroded current- ly, but I expect the pendulum will swing back over time. Whether the government will succeed in trying to take over its citizens' healthcare completely remains to be seen. I expect more encroachment on individ- ual choices in their healthcare, but I hope there will still be a rigorous defense of free will for patients in their healthcare options. n 3 ways spinal care has adapted to the COVID-19 pandemic By Patsy Newitt J ocelyn Idema, DO, founder of Steel City Spine and Or- thopedic Center in Pittsburgh, spoke to Becker's about how spinal care has adapted to the COVID-19 pandemic. Question: What are your top priorities for 2021? Dr. Jocelyn Idema: The medical landscape has changed quite a bit with COVID-19 in the last year. There are three things that have changed most for me going forward: 1. We're utilizing telehealth a lot more than we used to, and it's turned out very well. Patients are actually quite happy to do follow-up appointments where they don't have to venture out and come into the office — maybe they're following up from some X-rays that I can view online, performing physical therapy, reviewing MRIs or we're seeing how they're doing after an injection. 2. Patients are now a lot more amenable to outpatient pro- cedures. These surgeries can be done very safely in an out- patient setting, but pre-pandemic I would have patients that were more used to having overnight surgical procedures. These patients thought that they need to be monitored, but in reality, a lot of the surgeries can be done very safely as an outpatient. Patients are actually looking forward to that, because they're not staying in an environment where they may have to be subjected to an infection or the potential for catching COVID-19. 3. We're becoming a lot more comfortable doing certain types of procedures in the office. I am lucky enough to have access to my own fluoroscopy suite and procedures suite. I'm actually performing more injections in the office as well as kyphoplasty, vertebroplasty and even carpal tunnel re- leases. Patients are extremely happy with the fact that they don't even have to venture to a hospital or a surgery center in and of itself. n

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