Issue link: https://beckershealthcare.uberflip.com/i/1406663
19 SPINE SURGEONS educated as they still deny the coverage due to their stubbornness. e other aspect is re- imbursement: It has to be adjusted to reflect the skills of the surgeons who can perform this technique as well as the incurred expens- es (disposable tools). 4. Device companies/vendors: ey must continue to support surgeon training and ed- ucate the patients and staff. Brian Gantwerker, MD. e Craniospinal Center of Los Angeles: e reporting of same or better patient outcomes in side-by- side comparisons with traditional or "vanil- la" minimally invasive techniques will lead to wider adoption. Buzz creation is key in get- ting patients to demand this technology. On the company side, creating a more affordable, modular system that is adaptable to existing in-house camera solutions with high-quality components and great service will pay divi- dends. Marrying it to newer augmented real- ity visualization solutions will create a much more dynamic and truly watershed moment in terms of widespread adoption and practice of endoscopic spine surgery. James Mok, MD. Northshore Orthopae- dic & Spine Institute (Skokie and Des Plaines, Ill.): The major and perhaps in- surmountable barrier to endoscopic spine surgery is cost. With minimally invasive approaches, lumbar decompression sur- gery (microdiscectomy, laminectomy) can be achieved outpatient with short oper- ative times, minimal blood loss and with predictably excellent outcomes. Improving on this in a tangible way with an alterna- tive surgical technique will be difficult to demonstrate. Equivalence is not enough. Endoscopic spine surgery entails substan- tial additional cost (capital equipment and disposables) that are not offset by ad- ditional reimbursement. Additional cost without additional reimbursement and without an easily appreciable difference in patient outcome are daunting obstacles. If patients start demanding endoscopic spine surgery on a widespread scale, then there may be change, but I think this is less likely. Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): Endoscopic spine surgery of- fers a lot of advantages to patients as being the least invasive option currently available in spine surgery. It is a very new and differ- ent set of skills for a spine surgeon to learn, however. erefore, there is a lot of hesitancy in adoption and a steep learning curve. For better adoption, there needs to be more and better courses that surgeons can attend and learn, just like the industry did with min- imally invasive spine surgery techniques. Instrumentation needs to become more "user friendly" and there needs to be better acceptance from payers with reasonable re- imbursement. John Burleson, MD. Hughston Clinic Or- thopaedics (Nashville, Tenn.): We need more training programs teaching the tech- nology to residents and fellows. Endoscopic surgery can be daunting to tackle for a new surgeon if they didn't see these performed by their mentors in training. New surgeons are also a little intimidated to ask a hospital to purchase equipment that they might not end up using much. n