Becker's Spine Review

32 Thought Leadership Spine surgery in 2030 — 6 surgeon predictions By Alan Condon F rom the rise of robots to the use of big data and a move away from hospital-owned practices, changes in the field of spine sur- gery will be very evident by 2030, six spine surgeons predict. Note: Responses are lightly edited for style and clarity. Question: What will spine surgery look like in 2030? Oren Gottfried, MD. Duke Health (Raleigh, N.C.): I am hopeful that advances and validation of predictive analytic tools and use of big data will allow spine surgeons to precisely focus care on the right patient at the right time and with the right surgery. Also, there will be improved standardization of all spine surgeries to reduce variability in cost and quality, thereby maximizing value. ere will be greater enforcement on only practicing evidence-based guideline concordant care. Further, more patients who need or will only benefit from conservative treatment would see and be managed by primary care teams, physical therapy, chi- ropractors and other clinicians, reducing unnecessary and costly visits to spine surgeons. Surgeons will be incentivized to only provide low- cost, high quality care. Additionally, there will be more successful efforts and algorithms to achieve better optimization of physical and mental health before sur- gery, and we'll do better to improve outcomes to populations who have not previously benefited from spine surgery, or have had poorer out- comes. As spine surgeries will have improved and more predictable out- comes and procedures become even less invasive, we will see a reduction in patients' time off work and quicker recoveries. ere will likely be fewer spine Centers of Excellence destinations, and patients may have to travel out of state more oen to these locations providing the best out- comes at the lowest cost. We will push the limits of outpatient surgery by better methods of postop pain control and even less invasive surgeries. Finally in this prediction, patients and spine surgeons will have access to significant and specific outcome and quality data when making deci- sions on surgery. Ronald Lehman, Jr. MD. Columbia Orthopedic Surgery (New York City): Spine in 2030 will look very different than it does currently. One of the fascinating things about the current advancements in spine sur- gery is that we are moving toward spine 'solutions' and not just using and placing 'widgets.' e advancement in technology is rapidly chang- ing the landscape for us and we are truly embarking on surgical synergy. We now have very advanced ability to: 1. Plan surgical strategy with advanced planning platforms. 2. Safely, reliably and expeditiously place implants. 3. Using machine learning and artificial intelligence to 'predict' the correction and define the goals for our surgery. 4. We have the ability to appreciate if we have achieved the desired goals of the surgery intraoperatively. 5. We will advance incorporating EMR and long-term follow up with patient-specific monitoring aer they leave the hospital. It is an exciting time for spine surgery, and we will truly have a more comprehensive approach to the patients in terms of planning, execution and patient-reported outcomes. Using data and predictive analytics will allow us to tell each patient what their 'expected' results will be before they consider a spine surgery, and also perhaps who best to perform the surgery as all of our metrics, as surgeons, will be available as well. 5 ways spine surgery is changing: ASCs, endoscopic surgery & more By Alan Condon T he last year has been a particularly transformative one for spine care, with telehealth, accelerating outpatient migration and updated site-care-strategies taking center stage. Hanbing Zhou, MD, a spine surgeon with Orthopedic Associ- ates of Hartford (Conn.), outlines five areas that will continue to evolve in the spine field in the coming years: Note Responses are lightly edited for style and clarity. Question: How do you see spine care changing in the next 5 years? Dr. Hanbing Zhou: Five areas: 1. ASCs. There will be an increasing movement toward the ASC/outpatient setting. This is valued by the patient and pay- er and will drive new technology to enable outpatient care. 2. Endoscopic spine. The drive to outpatient care will require focus on the endoscopic spine approach for many pathologies as it becomes the standard of care for decompression to re- duce morbidity and return patients to their lives more quickly. 3. Artificial intelligence. AI-guided surgery will be the next wave to improve safety, planning and outcomes for spine surgery. It will be interesting to see how they can integrate and complement current technologies to improve patient care and manage costs. 4. Value-based care. How do health systems, surgeons and device companies converge (or not) to facilitate cost-fo- cused and outcome-focused care? This will be important to increase access to spine care with the choices that patients and surgeons want. 5. Telemedicine. App-enabled telemedicine will provide the opportunity for more personalized pre- and postoper- ative virtual patient care visits. This is a scalable technology that will increase patient satisfaction and access. n

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