Becker's Spine Review

10 SPINE SURGEONS Dr. Jeffrey Carlson: How minimally invasive spine surgery has evolved at the ASC By Alan Condon O ne of the first three-level lumbar spinal fusions at an ASC was recently performed by Jeffrey Carlson, MD, president of Orthopaedic & Spine Center in Newport News, Va. Dr. Carlson spoke with Becker's Spine Review about what minimally invasive spine surgery means to him and offered advice for surgeons migrating higher acuity cases to the outpatient setting. Note: Responses are lightly edited for style and clarity. Question: How has outpatient spine surgery developed to the point where you can perform a three-level lumbar fusion at an ASC? Dr. Jeffrey Carlson: is has been a process over the last 10 years, developing surgical methods that are less traumatic to the patient, with the idea that you're going to decrease the pain related to that surgery. A lot of people will define "minimally invasive surgery" as smaller incisions. In my mind, the goal of minimally invasive sur- gery is to decrease pain, which is done by decreasing the trauma of the surgery itself. Surgeons should be focused on decreasing the surgical trauma to the patient and fix the real problem, the nerve compression and/or any spinal instability. If I can fix the patient's spine through a small incision, with the same visualization and less trauma to the patient, then I would consider that a "minimally in- vasive surgery." Over the years, we've developed techniques to be able to use a stan- dard midline approach, but with a smaller incision than the standard open incision. Spine surgeons have been taught this approach as the mainstay of spinal surgery. A midline approach can allow us to do our neurogenic decompression and also place screws through the same incision. As you get more facile at this, you can make the incision smaller and see what you need to without disrupting as much tissue. So, you're able to actually visualize the nerve roots, the bone, the discs and place cages or screws all through the same incision. Over the years, we've gone from single-level to two-level and now three-level all, through a small incision. e pandemic certainly pushed us more toward outpatient surgery so as not to overburden hospitals. Now we are doing major spine procedures like this one on an outpatient basis. at has been a real silver lining. Q: What advice do you have for other spine surgeons con- sidering performing higher acuity cases like a three-level lumbar fusion at a surgery center? JC: e biggest thing is patient selection. Making sure you've got the right patients for the outpatient setting, especially when you're start- ing. Patients with significant medical issues may not be right for an outpatient surgery. Also, your goals must align with the patient's. You've got to have the family on board with the patient recovering at home aer surgery, rather than the family expecting the patient to stay overnight at the hospital. at conversation starts in the office when we talk about what the surgical options are, going over the risk-ben- efits of each particular option and helping the patient visualize what outpatient surgery looks like versus inpatient surgery. 5 updates on Elon Musk's surgical robot By Eric Oliver T esla and SpaceX founder Elon Musk is developing the Neuralink surgical robot that will be used for neuroscience. Here are five updates on the Neuralink surgical robot: 1. Mr. Musk hired neurosurgeon Matthew MacDougall, MD, in July 2019 to develop the Neuralink robot. 2. In August 2020, Mr. Musk debuted the robot during a presentation on Neuralink. The robot will have three main parts: the head, the body and the base. The head portion is helmet-like. It stabilizes a patient's head during surgery and features embedded cameras and sensors that map a patient's brain and ensures proper needle placement. 3. The short-term aim of Neuralink is to help with muscle is- sues affecting the brain, but the long-term aim is to augment the human brain to keep up with artificial intelligence. Mr. Musk views AI as the greatest potential threat to humanity. 4. In February, Neuralink was tested on a monkey, according to a CNBC report. Mr. Musk said the company implanted a computer chip into the monkey's skull and used small wires to connect the chip to his brain. The monkey was then al- lowed to play video games. Mr. Musk said Neuralink is at- tempting to see if it can get the chip-augmented monkeys to play "mind Pong" with each other. 5. On Feb. 1, Mr. Musk said Neuralink would begin human trials by the end of the year, according to an Insider arti- cle. Mr. Musk had previously said in 2019 that the compa- ny would begin testing its Neuralink at the end of 2020. In response to a person asking to join into a human trial, Mr. Musk tweeted, "Neuralink is working super hard to ensure implant safety & is in close communication with the FDA. If things go well, we might be able to do initial human trials later this year." n

• Cover