Becker's Spine Review

7 SPINE Dr. Michael Gallizzi on opportunities, challenges for endoscopic spine By Carly Behm S pine surgeon Michael Gallizzi, MD, has had his eye on endoscopic spine surgery for years. Dr. Gallizzi, of e Steadman Clinic in Vail, Colo., spoke with Becker's about his endeavors with endoscopic surgery, collaboration with Arthrex and potential payer challenges ahead. Note: is conversation was lightly edited for clarity and length. Question: How would you describe the current state of endoscopic spine surgery and what are your predictions for the next couple of years? Dr. Michael Gallizzi: It is evident from a significant amount of media coverage and the increasing interest, particularly among younger surgeons, that their interest in endoscopic spine surgery will drive its adoption. I believe that its prevalence will continue to grow in the United States. Internationally, especially in South Korea and among our European counterparts, it has already gained significant traction. However, the United States lags behind in its adoption. One contributing factor is the absence of a major player in the market willing to provide training and education. Q: Could Arthrex be one of those major players? MG: Absolutely. e most significant takeaway from my residency, as I began to specialize in spine, was the lack of substantial work being done in terms of device development and procedures for so tissue and motion preservation. In 2013, I pitched the idea of getting into spine to Arthrex, as I believed that this company had the potential to make a real difference in this field. We then created what is now the Spine Scorpion to assist in the facial closure of minimally invasive spine surgeries. Rather than solely focusing on metal screws, they prioritized so tissue and motion preservation. It's crucial that we start considering the treatment of spinal diseases in a manner similar to how we approach sports injuries. Q: When you're looking back at these 10 years up to now and this launch, what were some of the biggest challenges? MG: We encountered several significant hurdles. Ensuring that we had a comprehensive offering from the outset was a primary challenge. We aimed to avoid merely creating a "me too" product and instead sought to incorporate extensive feedback from surgeons into the design. Q: What does Arthrex's endoscopic line entail? MG: It will primarily focus on four key domains. First, there's medial branch transection, which provides a way to permanently innervate the facet joints. Rather than using radiofrequency ablation, endoscopic medial branch transection allows the identification and cutting of the medial branch using a punch or scissors. is method offers more thorough relief from extension-based axial back pain. e next aspect is the discectomy, whether through a transforaminal or intralaminar approaches, to remove disc herniations with minimal bony work compared to even a tubular approach. is can be done without violating adjacent structures, thanks to their visualization system, which has been used in sports medicine for years. e system provides 4K super clear images of the spine, revealing details that were previously difficult to see up close. e third area focuses on decompression space, which involves different drills and bone resection devices in the pipeline to facilitate the endoscopic approach. When necessary, patients can undergo motion- restricting procedures or fusion safely and successfully. One of the primary issues we've encountered over the last decade is that most major companies require surgeons to either pay for their own training or find ways to get trained. However, my experience in the spine industry is that when surgeons are learning a new procedure, companies should provide educational events and support. ere's oen a lack of guidance on what to prepare for and no clear pathway for easy skill acquisition in these areas. Touching on what we're doing at Steadman, Dr. Sonny Gill and I have started a Spine Fellowship at the Steadman Clinic. We are currently interviewing candidates for the class of 2025, with the program encompassing minimally invasive, complex cervical, endoscopic and robotic cases. is initiative at the Steadman Clinic represents our effort to provide more people with hands-on experience and advance this technology. Q: When you're thinking about forming this program, what advice would you give to other spine surgeons who might want to do something similar? MG: e most significant aspect is that surgeons need to actively perform these cases and undergo training while relying on the expertise of others. I recently hosted a visiting surgeon from Texas who came to learn some of these techniques. During my journey in learning endoscopic spine surgery, I had to allocate time away from my practice to visit other surgeons. When you're building a program, it's essential to seek diversity in techniques, providing individuals with as many tools as possible. I'm not suggesting that the endoscopic approach is suitable for all cases, but it is a valuable tool. When used appropriately and in well-indicated cases, patients can benefit significantly from it Q: It sounds like with these increased efforts in endoscopic education, we're probably going to eventually start seeing more spine surgeons using this. What's the situation between like payers when it comes to endoscopic spine surgery? Do you anticipate that being any kind of barrier to people wanting to get this procedure done? MG: Payers currently pose a significant barrier. Some states strongly oppose the adoption of this technology on the payer side, even though it's an approved Medicare procedure. e only way to address this issue is through data, demonstrating either equivalency or, ideally, superiority in certain aspects. is could include getting patients back to work faster and reducing opioid use aer the procedure. I believe that other aspects, such as the complication profile, will likely remain similar due to the nature of spine surgery. However, by minimizing damage to so tissue in endoscopic cases, there's the potential for reduced dependence on opioids. In fact, I collaborate with some endoscopic peers who don't prescribe any opioids aer surgery. Achieving this in the field of spine

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