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Sign up for Becker's Orthopedic, Spine Business & Pain Management E-Weeklies at www.BeckersOrthopedicandSpine.com or call (800) 417-2035 creasing reimbursement the doctor will be less able to afford to do this." 7. More surgeons will jump on the minimally invasive bandwagon. Over the past five to 10 years, the biggest trend in spine surgery technological development has been less invasive surgical technique. "Minimally invasive approaches are really revolutionizing the field," says Dr. Chong. "At times in the past, we were often limited to offering a patient a more invasive procedure. The advancements and increased adoption of minimally invasive techniques are resulting in shorter hospital stays, less post-operative pain and a reduction in traditional complications." While most surgeons were initially skeptical of these developments, solid evidence have shown certain techniques and procedures — performed with the same goal as open surgery — have good outcomes while minimizing comorbidities such as pain and blood loss. "Minimally invasive spine surgery should play a role in the practice of every spine surgeon," says Dr. Watkins. "Surgeons should perform less invasive surgery when they feel confident that it will treat patients' conditions as safely as more invasive surgery. Surgery may be performed as an outpatient [procedure] if the safety is not compromised." In time, the procedures that don't show clinical and cost improvements will fall out of favor and those with clear, proven benefits will continue to grow. "There are some procedures that are good and we know work well, but even among these procedures there will be innovation," says Dr. Chong. "We'll want to reduce the rate of revision surgery and maximize long term patient satisfaction. We're also looking for new technology that will make us more accurate and expose surgeons to less radiation." New developments in minimally invasive procedures for more complex surgeries, such as spinal deformities, are on the horizon and pioneers in the field are already using them. "I think the minimally invasive correction of spinal deformity is a massive move forward," says Dr. Anand. "It represents a huge paradigm shift in performing major spine surgery. I see that continuing in the future because many centers are adopting it, societies are accepting it and courses are teaching it. A big operation being done through minimally invasive techniques is showing equivalent to better outcomes; we have five and seven year outcomes data proving it works." 8. Artificial discs and lateral fusion research is coming due. For years, spine surgeons and medical device companies have collab- orated on artificial disc replacements and lateral fusions with mixed results for coverage. Lateral procedures are now becoming a standard approach from device companies across the board. "Compared to many other spine procedures, direct lateral interbodies are relatively new," says Dr. Chong, "but within the next decade we will have long-term feedback to help us determine what techniques work and where we need further development." Insurance companies are covering these procedures more readily than artificial disc replacements, which still have some room for development. "There are trends right now that are going in the direction that will try to maintain mobility but they haven't been completely successful yet," says Dr. Corenman. "The problem with current artificial discs — and it may be resolved in the next generation — is impact absorption. There are a few discs out of Europe that may show some promise in fixing this problem." One of the road blocks facing many artificial discs is payor coverage. A few discs have gained 510(k) clearance, but even after that insurance companies often continue to deny coverage, citing lack of evidence for clinical efficacy. "There are new technologies out there that are being hampered by coding and regulations in that they are put forward as experimental and insurance companies won't pay for it," says Dr. Anand. "These issues will determine whether new technology moves forward and whether it will become more ubiquitous." Current research in these fields is promising and coverage could be expanded in the future, if cost- and quality-effectiveness are shown. "One way to influence the decision by insurance companies on whether to provide coverage for this procedure," says Dr. Chong, "is to conduct studies designed for superiority to determine if artificial disc replacements are better than traditional fusion in long term follow up." 9. Online marketing and patient education becomes a must. There is a huge opportunity for spine surgeons to market themselves and their practice to patients online. Beyond the standard practice website, spine surgeons must engage the online community with patient education platforms, videos and blogs related to spine conditions. "I think the internet is going to be the next wave for spine care," says Dr. Corenman. "Patients are coming into the office having significant fear and not understanding anything about spine surgery, and they are hungry for knowledge. Unfortunately, there is not a lot of education in typical spine offices, and that's where I think the internet is really going to shine." 11 Dr. Corenman has a website that includes a forum where anyone can ask general questions about spinal conditions and he answers to the best of his ability. One common problem is patients receiving different diagnoses and treatment recommendations from multiple spine surgeons and specialists; he tries to help patients sort through this information and find the right pathway to care. "There is a significant lack of continuity for different problems," says Dr. Corenman. "When I'm interacting with them online, I'm not practicing medicine, it's purely education. When you can gain accurate and succinct education, it makes patients more confident and empowers them in their own decisions." Dr. Corenman receives two to seven questions per day on his forum and spends around an hour answer the questions daily. He also writes articles for the website and uploads videos of procedures. He has nearly 40 videos on his YouTube site, which receives about 100,000 hits per month. While the website has gained traction, it takes significant time and effort to maintain. "It's still uncommon for surgeons to have a vast online presence," says Dr. Corenman. "The problem is that it takes a tremendous amount of time to write these things and an understanding of how patients think so you can write in a way they will understand. Even though there are a lot of plug in sites where you can purchase information and publish it on your webpage, it might not be accurate or accessible to patients. It behooves you to write that information yourself." 10. Physician ratings and online reputation management won't go away. Over the past five years, several physician rating websites have sprung up from various organizations, allowing patients to "rate" their physician and leave comments. "The most difficult part of the internet will be how to rate doctors," says Dr. Corenman. "Now a patient can go on the internet and there are a number of different rating sites. They can express their opinions and you don't know how sign up Today Stay updated on the latest news, trends and business concepts for spine surgeons and practices Spine Business E-Weekly Sign up today for our Spine Business Review E-Weekly at www.beckersorthopedican spine.com