Becker's ASC Review

18 ORTHOPEDICS e traditional lateral lumbar spine approach with the patient lying in lateral decubitus position is still easier and safer. It will likely remain the most common way to perform lateral lumbar interbody fusion for years to come. Prone lateral surgery, however, will continue becoming more common in 2023 for specific cases when access to the posterior lumbar spine is needed. e surgeons will need to ensure that they have proper equipment and training to perform this procedure safely and efficiently. William Taylor, MD. University of California San Diego: Unlike many new spine procedures that require special equipment, advance, training, or difficult approvals, PTP represents an extension and advancement of an existing procedure with clear benefits. New spine procedures oen require, special equipment, advanced training, or difficult approvals, PTP represents an extension of an existing procedure with while limiting the issues surrounding other options Time savings in the OR, ease of positioning, standard bed and application to existing procedures are self evident. As more publications become available and the research condenses, I believe you will see improve. Patient outcomes due to reduction in complications, operative time and superior fusions with improved lordosis is is an appropriate revamping of the existing lateral procedure that takes advantages of all of its positives and limits, many of the concerns that surgeons may have had. Make sure to use equipment and a company that both prepares you, the OR and your patients for success by a dedicated prone system, rather than off-the-shelf lateral systems not designed for prone application. Issada ongtrangan, MD. Microspine (Scottsdale, Ariz.): Prone lateral is slowly gaining momentum. I think the concerns are the potential retroperitoneal and intraperitoneal complications, especially vascular injury for the prone lateral despite the fact that the incidence rate is low. Also, there are some nuances and tips to be sufficient with prone lateral. It will need more education and training from the industry side, especially to demonstrate how significant patient outcomes compare to the lateral position. Many of us are so familiar with lateral position and flip for posterior fixation. Kushagra Verma, MD. Verma Spine (Los Alamitos, Calif.): Prone lateral surgery is an exciting innovation in spine surgery. e challenges remain visualization, especially with obese patients. Specialized retractors are utilized that can allow the surgeon to visualize the disc space clearly. Another challenge with this technology is having appropriate abilities to manipulate the spine while in a prone position. is is especially critical at the L45 disc space. Special pads on the operating room table are being developed to manipulate the spine in the prone position. It remains an exciting and emerging technology. e potential advantages of prone lateral surgery is that the spine is naturally in a lordotic position, which would aid the surgeon in generating lordosis while operating. In addition, there is not a need to change positions in the operating room, which could improve the efficiency of the surgery. Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Ostensibly, the surgical indications for the PTP approach are growing as the market and awareness expands. Albeit the concept of enhanced surface area fusion and additional overlapping posterior instrumentation procedures are basic and enviable, yet they will certainly trigger reimbursement issues as to efficacy and outcome. Pardon the closure but "black disc disease" of two decades ago seems to have found a new home. n How total knee replacement is expected to change at ASCs in 2023 By Carly Behm M edicare ASC payments for total knee replacements are expected to increase in 2023, according to VMG Health's "ASCs in 2022: A Year in Review" report released Jan. 26. Here is a summary of the estimated Medicare ASC payments for 2022 and 2023 for total knee arthroplasty: CPT code: 27447 Estimated 2022 payments: $182 Percent of total Medicare: 3.1 percent Estimated 2023 payments: $189 Percent total Medicare: 3.1 percent Estimated 2023 change: 4 percent n What the future holds for independent orthopedic surgeons By Riz Hatton W ael Barsoum, MD, president and chief transformation officer at Healthcare Outcomes Performance Company, recently connected with Becker's to discuss what the next five years will look like for independent orthopedic practices. Note: This response has been lightly edited for length and clarity. Dr. Wael Barsoum: As payers continue to signal a shift from fee-for-service to value-based care models, independent practices will need significant resources and infrastructure to facilitate this successfully. Independent practices may encounter substantial challenges in building these capabilities, given limited resources and experience. Practices can, however, consider aligning or partnering with organizations that have a comprehensive and proven infrastructure and platform for [musculoskeletal] value- based care success. n

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