Becker's ASC Review

24 ORTHOPEDICS a tubular retractor and through an endoscope. e endoscope allows for a much smaller incision — about 7 millimeters compared to 18 to 22 millimeters for a tubular retractor — and lets you visualize directly at the level of the pathology. Moreover, the short-term outcomes for endoscopic patients and the ergonomic benefits for the surgeon make it a worthwhile transition. Q: What's your outlook for endoscopic spine surgery? What do you think it will take for it to become more widespread? DP: I think it's only a matter of time before more surgeons adopt it. Endoscopy is already widespread in Eastern cultures, such as Korea and Japan. Patients increasingly want smaller, minimally invasive procedures, and they'll seek out surgeons who offer them. e main barrier in the U.S. is the learning curve, especially since this technique isn't widely taught during residency or in most fellowships. Q: Somers is part of Health Plus Management. Can you talk about how that relationship affects your day-to-day work? DP: From a private practice standpoint, what's great is that Health Plus allows physicians to maintain their autonomy. ey've certainly facilitated my progress with endoscopy, and there's none of the red tape you might encounter at larger academic centers or hospitals. Health Plus has been very open to trying new technologies and incorporating them, provided they make sense both clinically and financially. In terms of advancing care and giving patients the best opportunities from a technological perspective, Health Plus has been fantastic. Q: When it comes to arguing the validity of new technology or a procedure, and securing the financials, how do you approach that? DP: You can incorporate new technology by reviewing literature on short-term outcomes and financial considerations, including both immediate costs and postoperative expenses. Endoscopic procedures, for example, help people return to work more quickly and are associated with fewer complications, like lower postoperative infection rates. To mitigate costs, you might use different technologies or companies to reduce disposable expenses. Additionally, offering cutting-edge technology like spinal endoscopy can attract patients, who will return for other orthopedic or spine-related procedures. As demand for these technologies grows, costs should come down, making them more accessible. Q: What other technologies are exciting to you? What do you think will come to the forefront in the next few years? Dr. Perfetti: Two exciting technologies we've started utilizing are mixed reality and robotics. With mixed reality, the surgeon and co- surgeon wear helmets that allow us to see three-dimensional slices of the spine while actively navigating and instrumenting it. is has helped ergonomically by eliminating the need to twist or contort to view navigation screens. Robotics is also an exciting development, as it enhances a surgeon's precision and accuracy during instrumentation. Robotics is beginning to play a role in other parts of procedures as well, such as decompression. Q: What are some other trends you've been keeping an eye on lately? Dr. Perfetti: Outpatient surgery is another significant trend. Not just 23-hour stays, but same-day discharge, similar to how you would discharge a knee or hip arthroscopy patient. at's one of the real advantages of endoscopy. In Texas and with my own patients, I've seen that they can leave the hospital two to three hours aer surgery, oen with significant relief. ey might experience some flank pain for a day or two, but aer a week, they're generally very happy with the results. Minimally invasive spine surgery isn't the solution for every condition, but for single-level degenerative problems, it's an excellent way to address the issue without distorting anatomy or causing adjacent segment problems that require instrumentation later on. n The common thread across all PELTO Health Partners practices By Carly Behm S ince its launch in 2023, PELTO Health Partners has doubled its number of practices in 2024, and its leaders are thinking about what future expansion will look like. PELTO has a footprint in nearly every region of the U.S. Its founding practices are Durham, N.C.-based EmergeOrtho, Indianapolis-based OrthoIndy and Seattle-based Proliance Surgeons. And this year Wilmington-based Delaware Orthopaedic Specialists, Olympia (Wash.) Orthopaedic Associates and Cincinnati-based OrthoCincy joined. Leaders with the new additions all shared similar reasons for joining PELTO in conversations with Becker's. What stood out to them was the opportunity to continue working independently with the support of physicians who shared their values. "We're not taking over any of their back office functions," Ed Hellman, MD, president and board chair of OrthoIndy, said. "We're helping them to be more efficient, helping them to save money, and they're helping us too. Because the bigger we get, the better position we are in to negotiate with service providers and other companies that we contract with. We are starting to touch a larger percentage of the country. So where are we going from here? I don't want to say we're going to have unlimited members." Although there isn't a specific number of practices Dr. Hellman envisions for PELTO, leaders are looking for mutually beneficial partnerships. One of the advantages of casting a wide net across the U.S. is that practices benefit from each other's unique success strategies instead of working in opposition, Frank Aluisio, MD, physician president of EmergeOrtho said. "The greatest thing has been it's a think tank, and each group brings different skills and strategies to make them successful," Dr. Aluisio said. "We've sat down and we've shared the best practices of all these great practices. As physicians we've learned a lot of new things, and our administrators have learned a lot of new things that have made all of our practices better at home. So when we bring in new practices, we want to bring in practices that have something to bring to the table that we might not have existing already." n

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