Becker's Spine Review

25 Thought Leadership How 4 spine surgeons are thinking about growth in the next 3 years By Alan Condon Four spine surgeons share how they are thinking about growth in the coming years. Question: How is your practice looking at growth in the next three years? Neel Shah, MD. DISC Sports & Spine Center (Newport Beach, Calif.): is question hits close to home. I packed up my prac- tice in New York City and moved to Southern California in the middle of the pandemic. In terms of growing my practice, I am looking at how to better engage with patients both inside and outside of the office. is includes developing a curated, well-re- viewed informational portal on my website and using social me- dia to better educate our patients. Richard Kube, MD. Prairie Spine (Peoria, Ill.): We are focused upon growing our spine surgical presence in the free market medical space. With rising costs, there is a distinct synergy that is created between healthcare consumers and value-based pro- viders. I believe that further educating consumers regarding options will help to grow this market. We believe much of this market is obtainable by our practice. Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Practice growth is looking more and more like diversification. As so many practices are absorbed or closed by larger entities, we look to distinguish ourselves by our availability, outcomes and patient experience. What sets good practices apart from the larger entities is that patients are seen by a doctor, not a midlevel or resident. Patients that wish to have an experience where their surgeries are explained to them in detail, what they can expect and have an open forum to ask questions and understand not just the 'how,' but also the 'why,' and not shuffled off, will find us. Hopefully that will continue to happen. I have no single benchmark or level that I am going aer, but I look to my patients and staff and see how we are doing. Just getting more referrals and operating and doing 20 cases a week is not growth. Growth is the enhancement of patient lives, whether it is doing or not doing surgeries, helping someone however you can whenever you can, building your reputation not only as a surgeon, but as a doctor, and holding yourself accountable all the time. Andrew Hecht, MD. Mount Sinai Health System (New York City): Our plan for growth is tied to the unwinding of the COVID-19 pandemic. As our surgeons and noninvasive special- ists resume normal activity, we will continue to grow our volume and physician complement. We are also expanding our Mount Sinai spine care network throughout the region. n Overcoming the learning curve: 3 surgeons on endoscopic spine surgery By Alan Condon S urgeons are increasingly touting the advantages of endo- scopic spine surgery, but its widespread adoption is re- stricted by a lack of training programs, its reimbursement structure and challenging learning curve. Here, three surgeons detail their experience with endoscopic spine surgery and offer advice for overcoming the learning curve: Tony Mork, MD. (Newport Beach, Calif.): I think there's a steep learning curve. The physician must have an interest and perhaps be thinking that maybe there's a better way to treat back or neck problems than with a fusion. The problem is there's not currently a detailed guided pathway. It requires a lot of practice. If you start with the easy cases and begin developing your skill set, while becoming comfortable with the process, you can master the easier cases, and move on to more difficult ones. If you do some of the more difficult cases in the beginning, you might fall off the horse and not want to get back on. Saqib Hasan, MD. Webster Orthopedics (Oakland, Calif.): There are certainly some initial difficulties. The magnified anat- omy from an unfamiliar perspective combined with the me- chanical peculiarities of handling a uniportal endoscope can be daunting for novice surgeons. However, the mechanics and relative anatomy can be learned fairly easily. Like most things in surgery, the wisdom is in knowing when not to use a particular technique. I believe the most difficult aspect is understanding which scenarios endoscopic techniques provide a benefit for both the surgeon and the patient. I think when you understand what the endoscope can and cannot do, you prepare yourself for success. Ashish Patel, MD. DuPage Medical Group (Downers Grove, Ill.): The learning curve is real; it's a different skill set. Orthope- dic spine surgeons have this comfort with arthroscopy. Being able to use a camera through a small incision has been part of my training in orthopedic surgery. My learning curve will consist of doing the more straightforward cases first. Once I've mas- tered those, I will push myself to do the more complex cases. The straightforward, most accessible cases would be disc herni- ation cases at L2-3, L3-4, L4-5. Once you've mastered those, you proceed to L5-S1 and perform disc herniation cases that have gone into the foramen or the far lateral region to do more central disc herniations. After you mas- ter these and feel comfortable with all disc herniations in the lower back, you then move onto lumbar stenosis cases, which would be more of a midline approach using slightly different equipment. Then, you can move on to cervical cases, such as laminoforaminotomies or thoracic cases. Once you have a com- fort in that, you then proceed to what surgeons are now working toward, which is lumbar fusions through the endoscope. n

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