Becker's Spine Review

7 SPINE Spine surgeon diversity isn't getting better By Laura Dyrda O rthopedic spine surgery is dominated by white males, and that won't change any time soon, according to a study published in the journal Spine. Despite efforts to bring diversity into the field, little has changed and the demographics of spine surgeon fellows are overwhelmingly male. Study authors examined demographic data from the Accreditation Council for Graduate Medical Education and calculated diversity statistics. Study authors found no significant movement toward a more diverse pool of spine fellows, with white, non- Hispanic males continuing to represent the largest percentage of surgeons in training. Four key points: 1. Males made up 81% to 95% of the fellows. 2. Whites were 28% to 66% of the fellows. 3. Asians accounted for 9% to 28% of the fellows. 4. Blacks comprised 3% to 16% of the fellows. 5. Hispanics made up 0% to 10% of the fellows. "Orthopedic spine surgery fellowship programs have not made substantial progress in diversifying its population," study authors concluded. "More attention is needed to increase diversity in residency programs through pipeline programs, increased mentorship and sponsorship, and early exposure to the field." n Cervical disc replacements plateaued By Laura Dyrda T he volume of cervical disc replacements grew steadily for nearly a decade, but have leveled off in the last few years, according to a study published in the journal Spine. Study authors examined data for cervical disc replacement and anterior cervical discectomy and fusion entered into the PearlDiver M151Ortho data set. ere were 19,301 single-level disc replacements and 181,476 ACDFs performed over the study period, 2010 to 2021. Researchers found: 1. Disc replacement use relative to ACDF jumped from 4% in 2010 to 14.15% in 2018. By 2021, the proportional utilization was just slightly increased to 14.47%. 2. Younger patients and patients with commercial insurance were more likely to undergo disc replacement than spinal fusion. 3. Patients in the Midwest, Northeast and Western regions of the country were more likely to undergo disc replacement than spinal fusion. 4. Orthopedic spine surgeons were more likely to perform disc replacements than neurological surgeons. 5. e five-year survival rate for disc replacements and spinal fusion were the same. e authors said reasons for the plateau in disc replacement are "unclear." In 2023, there have been multiple insurers updating policies to cover disc replacements, which could lead to additional patient volume in the future. n Spine surgeons' next payer battle By Carly Behm S pine surgeons saw a major victory in a yearslong payer battle in 2023 when Aetna revised its lumbar disc replacement policy in February. Now, some surgeons are looking ahead to the next hurdle they could face from insurers. Endoscopic spine surgery, a minimally invasive technique, has grown its reach in the U.S. in recent years. But it's seeing some resistance, Michael Gallizzi, MD, said. "Payers currently pose a significant barrier," Dr. Gallizzi, of the Steadman Clinic in Vail, Colo., told Becker's. "Some states strongly oppose the adoption of this technology on the payer side, even though it's an approved Medicare procedure." However, Dr. Gallizzi didn't think conflicts with payers and endoscopic spine would mirror those of disc replacement. "I believe that part of the issue with disc replacement in the neck and lumbar spine arises from the fact that it involves an implant rather than a technique or technology," he said. "Because it's an implant, payers are oen reluctant to cover something that's expensive. Conversely, adopting these tools and performing procedures in this manner usually falls under the category of equipment, typically the responsibility of hospitals." Saqib Hasan, MD, of Walnut Creek, Calif.-based Golden State Orthopedics and Spine, said he's encountered challenges with the current coding for the technique. "e coding of spinal endoscopy is premature and inconsistent," Dr. Hasan said. "e early use of endoscopic procedure codes were conflated with percutaneous procedures performed by non- spine surgeons. e lumping of apples and oranges resulted in an inaccurate reflection of the true value of the work inherent to full- endoscopic spine surgery. e key distinction between percutaneous

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