Becker's Spine Review

24 THOUGHT LEADERSHIP AR vs. robots: What spine surgeons prefer today By Alan Condon W hile still in their infancy, robotics and augmented reality have demonstrated significant potential in spine surgery, with many surgeons excited to see how these two technolo- gies will be integrated in the future. But which technology are surgeons gravitating toward as they stand now? Question: If you had the opportunity to imple- ment either an AR spine system or a robot at your practice tomorrow, which technology would you choose and why? Frank Phillips, MD. Midwest Orthopaedics at Rush (Chicago): I have used AR for the past two years and it has been a breath of fresh air. is eliminates the cumbersome and time-consuming set up of robots at a fraction of the price. In addition, the use of AR in percuta- neous spinal procedures provides surgeons with a 3D view of the spinal anatomy and allows visual and tactile feedback, which are sacrificed by current robots. I'm looking forward to seeing AR technologies com- bined with robotics to optimize outcomes. Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): is is a tough question: I'd like them both! Both are critical components and emerging technologies with early evidence-based benefits to intra- operative care. Similarly, both can be instrumental pieces that are in- corporated into a more comprehensive integrated platform (hopefully in the near future). But if I had to choose one tomorrow, I would likely select the robot. Although AR spine systems provide incredible benefits with newer baseline technology, here's why I would choose a robot: 1. From an ergonomic standpoint, I think we are moving toward maintaining the neck in a neutral position while operating, especially in a minimally invasive surgery setting. AR in its current form requires looking down with a headset that adds additional weight to the neck. 2. e evidence is more robust for robotics at this point in time. I rec- ognize that this is an evolving target. 3. Currently, robotic systems are far more integrated with the ability to perform pre-op/intraoperative planning and evaluate postoperative outcomes; ultimately assessing the intraoperative execution of our plans. Kris Radcliff, MD. Rothman Orthopaedic Institute (Philadelphia): Robotic technology has tremendous potential to enhance overall spine surgery patient safety and outcomes. e next generation of robots will lead to safer, more reproducible neural identification and decompres- sion by incorporating safe zones, haptic feedback and machine vision. Robots have the potential to contribute to every spine surgery. Robots can also detect physical condition changes such as a loss of resistance or change in sound that are imperceptible to humans. Ultimately, robotic technology will enhance spine surgery in the same manner that machine vision and sensors contribute to self-driving vehicles. Kornelis Poelstra, MD, PhD. e Robotic Spine Institute of Las Ve- gas: It all depends on your individual requirements for enabling tech, and the type of surgical practice you have. We see over and over that many users agree the planning component of current robotic systems is the true game changer. It is potentially less the robotic technology at this point, but more the holistic view and planning ability of the MSOs vs. private equity: How consolidation trends will play out in orthopedics By Alan Condon M usculoskeletal management services organiza- tions and private equity firms continue to make in- roads into the orthopedic field as small to midsize independent groups look for strategic partnerships to allow them to grow and maintain their autonomy. Two spine surgeons discuss the ups and downs of these consolidation models and how they see them playing out in the orthopedic field. Question: How do you anticipate management ser- vice organizations and private equity groups affect- ing consolidation among orthopedic practices in the coming years? Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Of all the things that result in the curtailing of physician independence, MSOs offer the best hybrid model. When it comes to offloading overhead while letting surgeons or groups be "themselves," it allows for growth, cost containment and likely the most job satisfaction com- promise. Private equity is not good for patient care. The corporate practice of medicine is not the solution to what ails our system. Patients over profits should always be the physician's mantra. While it is tantalizing to partner up, go to expensive lunches, and sign lucrative deals, it is not worth the sacrifice of autonomy and very likely, selling the soul of your business. By the time one realizes patients are not get- ting the same quality of care one would customarily give, it will be too late to change. This, I fear, will be the endgame of our system. Robert Bray Jr., MD. DISC Sports & Spine Center (New- port Beach, Calif.): In recent years, high-acuity surgeries, including both spine and orthopedic cases such as total joint replacement and shoulder reconstruction, have migrat- ed from the inpatient to the outpatient environment. This trend is progressing quite rapidly. Private equity groups have taken the opportunity to help control this migration by investing as financial supporters and capitalizing on the op- portunity. To do so, they are instituting significant business input and quality control as this transition takes place. The goal is to develop a more cost-effective outpatient world that can handle the shifting insurance market and position it for managed care in its ultimate version. You can look to the MSOs integrating multiple centers together via either purchase or management to accomplish this goal.n

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