Becker's Spine Review

18 SPINE SURGEONS What must change for more widespread adoption of endoscopic spine surgery in the US By Alan Condon M ore surgeons are expected to take a deeper look at endoscopic spine surgery as the technology contin- ues to advance and spine procedures rapidly migrate to the outpatient setting. From increased training programs to address- ing reimbursement shackles and improving patient awareness, five spine surgeons discuss changes that would lead to widespread adop- tion of endoscopic spine surgery. Question: What needs to change for endoscopic spine surgery to become more widely adopted in the U.S.? Issada ongtrangan, MD. Microspine (Scottsdale, Ariz.): I have been consistent- ly performing endoscopic spine surgery for three to four years now. Here is my opinion: 1. Surgeon education and training: Most companies invested in weekend cadaveric courses before the COVID-19 pandemic, but the format was changed to virtual meetings when the pandemic hit. But live courses are now coming back again. I participated in several workshop courses during the week- end, having a mentor for the first three to four cases. My surgical time significantly in- creased in the first five to ten cases, and then got faster when I felt more comfortable and familiar with the anatomy, equipment, etc. e surgeon must commit and dedicate their time for training and accept that it will take time to build the new skills. ere are short-term and long-term fellow- ships available in Korea, India and Japan. Unfortunately, they were shut down because of the pandemic. I was planning to go to Ko- rea for further training before the pandemic hit. I hope they will resume their fellowship programs when it is safe to do so. 2. Hospitals and ASCs: ey have to work with surgeons and vendors to bring this technology to the hospital. e data is unde- niable. e patients' outcomes are superior in many level 1 studies. It will be a great invest- ment in the long run. 3. Insurances: I would love it if the insur- ance carriers accept the new data and change their guidelines to accept this technique. Most commercial payers are still confused that the endoscopic technique is similar to percutaneous discectomy even though they have separate CPT codes. ey need to be 'You will fall in love with it': Dr. Richard Wohns on the rewards of volunteerism in neurosurgery By Carly Behm N eurosurgeon Richard Wohns, MD, founder and president of Nashville, Tenn.-based NeoSpine, has shared his talents in spine surgery by volunteering his services in Nepal and the Maldive Islands. He spoke about his time volunteering through the Foun- dation for International Education in Neurological Sur- gery and his advice for surgeons considering their own trips at the Becker's Spine, Orthopedic and Pain Manage- ment-driven ASC virtual event. Here are three quotes from the conversation: On his perspective on U.S. healthcare: "We take so many things for granted in the U.S. and in other developed parts of the world. Everything is available at all times, latest tech- nology and approaches to the spine. Everything we do is cutting edge. But in much of the world those sorts of med- ical devices approaches and technology simply are not available. It's just a wonderful thing to realize that we are very privileged and get away from that situation and be able to bring your knowledge, talents and experience, and some medical devices, and bring this to another part of the world where it just doesn't exist. So that's been an eye opener for me, and it's just extremely gratifying." On one of his memorable cases: "It was a patient who had tuberculosis of the spine who was treated medically, but the spine continued to deteriorate, collapse and compress her spinal cord. She was not able to walk for nine months and was in bed. She was a wife and a mother with kids. We saw her and we brought the type of technology that was neces- sary to decompress and fuse her with neuromonitoring, and literally she was able to walk within a week of the surgery and get back to her family with an incredible outcome." On why neurosurgeons should consider volunteer trips: "My pitch would be, you will fall in love with it. The first moment you go over to a wonderful place like Katman- du or the Maldives, or there's obviously numerous other places in the world where you can volunteer, the experi- ence is so monumental in so many ways. Professionally, you realize that you yourself are a treasure trove of infor- mation, and you can put your energy, knowledge and ex- perience to use in a whole new environment where you're well-respected and your endeavors are highly valued. You meet new people, and you create a new relationship with the place and the people and the patients that you are to- tally engaged in. You want to continue this, and you want to invite your friends. My pitch is if you try it once, you'll never look back. It'll be one of the major things in your life." n

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