Becker's Spine Review

14 SPINE SURGEONS The next game changer in spine: 4 surgeon insights By Alan Condon F rom telemedicine to augmented reality and the advancement of single-posi- tion procedures, the technology that will have the most significant effect on the future of the field is discussed by four spine surgeons. Question: What technology do you see as the next true game changer in spine surgery? Alexander Vaccaro, MD, PhD. (Rothman Orthopaedic Institute (Philadelphia): Telemedicine is an inevitable game changer in spine surgery. As the field advances, the traditional doctor's visit is due for a much needed update. With the pandemic, the im- plementation of telemedicine was kicked into overdrive, and its utilization will continue to reshape clinical practice. is will ultimately allow patients to receive the best care possi- ble at their convenience, despite common boundaries such as busy work schedules, living in rural areas or having functional limitations. Patients can now receive second opinions from world-class thought leaders at a fraction of the price, and a surgeon's office hours can now be mobile, exploiting down- time at medical meetings and between surgi- cal cases if necessary. Brian Gantwerker, MD. Craniospinal Cen- ter of Los Angeles: I think it remains to be elucidated what is and is not a game changer in spine. We have seen so many pretenders to the throne. In truth, this is a marathon, not a race. As a whole, spine surgery is getting saf- er. When technology is used in conjunction with good judgment and not the ringing up of [relative value units] or maintaining a sur- geon's lifestyle, we all get better at what we do. Shrewd selection of cases, application of the plethora of helpful technology, surgical ex- perience and good outcome data applied in a thoughtful manner will lead to the continued progress and safe evolution of spine surgery. Alok Sharan, MD. NJ Spine and Wellness (East Brunswick, N.J.): I think the next big game changer in spine surgery will be the common use of virtual surgery tools, such as augmented reality glasses. ese glasses, along with the technologies that will allow other surgeons to proctor a surgeon in an- other state or country, will help improve the quality and efficiency of surgeons. As there is a greater emphasis on quality and outcomes, surgeons will have to ensure that they are able to produce reproducible results. is will re- quire virtual coaching by other surgeons who can help a surgeon attain higher quality and efficiency in the OR. Currently, to learn a new technique, a sur- geon has to travel to a weekend course. is becomes burdensome in terms of time off from your practice and personal obligations. With AR glasses, surgeons will be able to learn new techniques and also improve their current surgical techniques. Issada ongtrangan, MD. Microspine (Scottsdale, Ariz.): Endoscopic spine sur- gery, including fusion, will be a game changer as it is gaining more acceptance in the U.S. e challenges are training, steep learn- ing curve, cost of the equipment and reim- bursement. Motion preservation, especially cervical disc replacement, will continue to gain more acceptance, as the data is undeni- able. Single-position surgery, such as prone- transpsoas, will be a game changer as well. n Spine surgeons create guide to inform patients about artificial disc replacement By Alan Condon A group of spine surgeons created a patient guide that outlines when a person should consider artificial disc replacement and when to see a physician for herniated disc symptoms. The guide is featured on the educational website CentersForArtificialDisc.com. Artificial disc replacement, or motion-preservation surgery, can reduce the need for additional surgery at other levels in the neck, according to Eeric Truu- mees, MD, president of the North American Spine Society. "New research documents that with an artificial disc, you are preserving mo- tion which lessens the risk to other disc levels," Dr. Truumees said in a June 24 news release. "This is especially important in the neck as you only have six disc levels to preserve motion." Too many spine surgeons recommend fusion and never discuss disc replace- ment as an option, said Michael Rohan Jr., DO, of Northwest Florida Spine in Panama City. "Those people with arthritic knees and hips now routinely have artificial joints," Dr. Rohan said. "It's unthinkable today that surgeons would recommend fusing a knee or hip, which was the old-style treatment back in the 1930s and 1940s. We are at the same place with spine where new implant technology offers new alternatives to patients with herniated discs." The patient guide describes the limitations of spinal fusion and explains why not every patient can qualify for disc replacement. n "The implementation of telemedicine was kicked into overdrive, and its utilization will continue to reshape clinical practice." - Dr. Alexander Vaccaro

• Cover