Becker's ASC Review

26 ORTHOPEDICS oblique X-rays are not indicated to diagnose spondylolysis. If the diagnosis is not obvious on a PA or lateral X-ray, and there is clinical suspicion, move up to more advanced imaging. In addition, in young people there is no reason to get flexion and extension X-rays in the setting of spondylolysis or spondylolisthesis. It does not add to the patient's prognosis or suggest treatment. From a technological perspective many centers are now investing in EOS imaging which can drastically decrease radiation load in a deformity practice. Also on the horizon are MRI sequences which can do a surprisingly good job of imaging bone. I predict in the next year or two one may not need a preoperative or intraoperative CT scan to use navigation or robots as the MRI/bone imaging technology is advancing quickly. Alexander Tuchman, MD. Cedars-Sinai (Los Angeles): Another trend that spine surgeons should get ahead of is using pre-operative planning soware routinely for multilevel fusions. We now have improved understanding of alignment targets for multilevel fusions. Furthermore, the evidence that meeting patient-specific alignment targets reduces the rate of mechanical complications continues to grow. Preparing a patient-specific plan and executing it in the OR with enabling technologies and/or pre-contoured rods will likely become the standard of care for elective spinal fusions over the next several years. n How often are new spine devices recalled? 4 notes By Carly Behm N ew spine devices had a reduced recall risk compared to orthopedic devices in general, and some tech didn't have any increase in risk, according to a study in the Nov. 1 issue of Spine. Four things to know: 1. Researchers examined data for spine devices that were FDA-cleared between Jan. 1, 2008, and Dec. 31, 2018. They also analyzed interbody fusion and vertebral body replacement devices as a recall risk factor. 2. A total of 2,384 spine devices were cleared by the FDA through the study period, the study found. The risk of recall after five years was 5.3% and 6.5% after a decade. 3. There weren't any differences in recall risk for interbody fusion and VBR devices. 4. The study concluded, "The risk of recall at 5 and 10 years of a novel spine device is about half the 12% rate reported for orthopedic devices in general. Despite lowered FDA regulations for interbody fusion devices and recent approval for VBR device use in the cervical spine, no increased risk of recall was detected. Further research is necessary to explain the reason for the lower risk of recall with spine devices." n Spine group lauds new ICD-10 back pain code By Carly Behm C MS' move to establish the new ICD-10 code — M62.85: Dysfunction of the Multifidus Muscles, Lumbar Region — is part of ongoing efforts by spine surgeons who want more coding clarifications for back pain. The code went into effect Oct. 1. "This update brings essential specificity to diagnosing patients with chronic mechanical low back pain, a condition that has long frustrated patients and clinicians alike," the International Society for the Advancement of Spine Surgery's Co-President Morgan Lorio, MD, told Becker's in a statement. "For those who have exhausted conservative treatments and are not surgical candidates, this code represents a meaningful advancement, opening new pathways for appropriate and effective treatment." Chronic lower back pain has historically been challenging to manage since it often lacks structural indicators, but recent developments into multifidus dysfunction bring new understanding to the pain, Dr. Lorio said. The organization collaborated with Mainstay Medical, which develops the ReActiv8 neurostimulation device, to advocate for the coding update. ISASS reviewed evidence of ReActiv8 and published a statement in the International Journal of Spine Surgery last year — "Restorative Neurostimulation for Chronic Mechanical Low Back Pain Resulting From Neuromuscular Instability." "We are proud of the compendium of evidence that has been built to demonstrate the long-term benefits of the ReActiv8 therapy," Mainstay Medical CEO Jason Hannon said in a statement. "We are confident that this new diagnostic code will help national payors to support the use of this therapy with their patients." Dr. Lorio said he's excited about what the new ICD-10 code means for spine care. "This new code represents a significant step toward establishing restorative neurostimulation as a standard of care for patients with CLBP, enabling clinicians to more accurately diagnose and treat this population," Dr. Lorio said. "Additionally, it will facilitate national payors in covering treatments that rely on this more precise diagnostic framework." n

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