Becker's ASC Review

22 ORTHOPEDICS Spine surgeons predict 'tremendous growth' in endoscopy over the next 10 years By Alan Condon D espite pushback from payers and some reimbursement and training obstacles, many spine surgeons expect endoscopic spine surgery to become more prominent in the U.S. over the next decade. Eleven spine surgeons from independent practices and health systems across the country discuss what's next for endoscopic spine surgery. Editor's note: Responses were lightly edited for clarity and length. Question: How will endoscopic spine surgery evolve in the US over the next decade? Vik Mehta, MD. Hoag Hospital (Newport Beach, Calif.): ere will be tremendous growth in endoscopic spine surgery over the next decade. Faster recovery time, less pain and better relief of symptoms will be primary drivers behind the growth of this approach. Additionally, as fusions come under more pressure from patients and payers, more proven techniques such as decompressions to achieve relief of pain will come to the forefront. We have many patients in their 70s, 80s and even 90s who remain highly active with degenerative lumbar disease and stenosis as a primary pain generator. Providers who can safely and effectively help these patients get back to an active life using endoscopic and other minimally invasive techniques will be quite busy. Sheyan Armaghani, MD. Orlando (Fla.) Health Jewett Orthopedic Institute: With improvements in optics, navigation and instrumentation, I wouldn't be surprised if endoscopic surgery became the standard for most, if not all, disk herniations and single level stenosis cases. As more teaching institutions begin to adopt the technique, you will also see more surgeons making it a part of their practice. is is already the case in many countries, especially in Asia. More long-term data needs to be collected on endoscopic fusions. I see endoscopic surgery as being similar to tubular surgery which began more than 20 years ago. Now the tube is 7 mm wide with a camera instead of 18 mm to 22 mm. Peter Derman, MD. Texas Back Institute (Plano): I am optimistic that endoscopic spine surgery will become more widely adopted over the next 10 years in the U.S. It is currently a niche technique that requires motivated surgeons to proactively seek training. However, interest is growing, and we will eventually hit a critical mass of endoscopic spine surgeons at major training institutions such that large numbers of future surgeons will be exposed to it during their residencies and fellowships. ese trainees will witness the benefits of endoscopic spine surgery firsthand and will have a head start on the learning curve. Other trends promoting the adoption of this technique will include growing patient demand (as the general public becomes increasingly aware of spinal endoscopy); an expanding body of high-quality research supporting its benefits; and increasing utilization driving industry competition to push down capital and disposable expenses. From a technical perspective, there are many exciting avenues in which endoscopic technology can continue to develop. Integration with navigation, augmented reality, and robotics stands to reduce reliance on fluoroscopy and increase efficiency, particularly in more complex cases. Improvements in surgical instruments will allow for more rapid resection of bone, ligamentum flavum and other tissues. Future optics may provide true depth perception and facilitate three dimensional visualization of anatomical structures. e development of massively expandable interbody cages will provide ALIF-like anterior support through an ultra-minimally invasive single position posterior approach. e possibilities for endoscopic spine surgery are endless, and the future is bright. Brian Gantwerker, MD. e Craniospinal Center of Los Angeles: My prediction is the tremendous amount of deformity surgery being done, albeit there is and will be good data to justify it, will be met with a backlash from payers. Whether or not the surgeries are indicated will be irrelevant for the payers. eir main issue is to create value for their shareholders, not pay for quality work. Endoscopic spine surgery could offer an alternative in some cases in lieu of a large correction. It pains me to paint a picture this way, because endoscopy is a fascinating way to solve problems that used to require large incisions being done in the hospital setting. e market pressure from payers is a small but significant driver. However, in a more optimistic tack is patient demand. As the field becomes more and more recognized as a legitimate surgical approach, patient demand will drive the market and the skill set of individual surgeons. e learning curve will bend as residents become trained by experienced surgeons during their residencies and fellowships. ings are looking up, and for the patients' outcomes as well hopefully. Image Credit: Adobe Stock

• Cover