Issue link: https://beckershealthcare.uberflip.com/i/170082
Spine Advocacy & Policy 14 11 Spine Surgeons Discuss Exciting Trends for the Future Robert Bray, MD, DISC Sports & Spine: Looking towards the future, I am most excited to see the further development and acceptance of the outpatient surgery center as the premier vehicle for delivering the highest level of elective patient care. Today, our surgeons perform even the most complex cases that were typically reserved for hospitals on an outpatient basis. The surgery center environment can offer a more cost efficient, patientcentered approach that has been shown to have a reduced risk of infection. Development of specialized centers for high acuity surgery will alter the entire model of how healthcare is delivered. Thomas Errico, MD, NYU Langone Medical Center Hospital for Joint Diseases: Frankly I have been performing spine surgery for nearly 30 years and have seen immense progress in the field. There, however, still exist many burning questions about who to operate on and what specifically should be done and can it be done successfully in a minimally invasive fashion. I look forward to answers to many of these questions as we apply a more rigorous approach to data collection and analysis of the results of spinal surgery. Steven Garfin, MD, UCSD Medical Center: I am excited about the opportunity to continue to work with academic and spine surgical leaders and industry innovators on new products, concepts and ideas. This also leads to an unfortunate "burden" in trying to work with insurance and government and academic spine societies in developing plans, protocols and guidelines to enhance care for spine surgery patients that will move us forward in what we can diagnose and treat. I feel the next, important, future directions in spine surgery have to be in diagnostics and separately biologics/ tissue altering techniques that address pain. Hopefully I can work in that arena, and also help "grease the skid" so financial impediments and predetermined negative judgments are not present when novel diagnostics and exciting biologics appear. Richard Guyer, MD, Texas Back Institute: I think the whole field of biologic and genetic research will provide our patients tremendous treatment advancements. Someday we will be able to treat and reverse symptomatic degenerative disease before it becomes end stage, to treat and prevent osteoporosis and to treat adolescent scoliosis without fusion surgery but motion sparing techniques. The last area I am most excited about is the application of minimally invasive surgery and robotics so that someday just like robotic-assisted prostatectomies, we will be able to decompress the spine from the inside out particularly with regard to spinal stenosis without taking the spine apart. Andrew Hecht, MD, Mount Sinai Medical Center: I am most excited by the increasing emphasis not only on minimally invasive and motion preserving procedures but on advances in the understanding of the biology of spinal disorders such as disc degeneration. Our lab continues to study the basic processes involved in the pathophysiology of disc degeneration with the hope that someday this may lead to novel biologic treatments to halt or reverse the degenerative process that underlies the majority of the spinal disorders we treat. Michael Heggeness, MD, Baylor Clinic: I view the future with both real fear and true anticipation. I am very concerned to see how all physicians in the United States have been subjected to so many additional costs (including electronic medical records, e-prescribing, "meaningful use"), and threats (of misdirected audits), that the independent practice of medicine is rapidly disappearing. This will drastically limit choice for both doctor and patient going forward. On the other hand, I am very excited to know that molecular medicine techniques for musculoskeletal medicine will soon be a reality. This will dramatically improve many of our treatment options in the very near future. Harry Herkowitz, MD, William Beaumont Hospital: I am most excited about improving our imaging technology to pinpoint the source of the patients' pain; continuing our research to regenerate aging discs; improving our surgical techniques to allow for faster recoveries; and utilizing outcomes research to better evaluate the surgical procedures performed on patients to help determine the best operation for that patient's problem. Stephen Hochschuler, MD, Texas Back Institute: Despite significant challenges facing medicine in general, I am quite excited by potential downstream opportunities for spine. There will be opportunities in: telemedicine; physician extenders; integration of treatment; emphasis on prevention; application of nano and MEMS Technology; development of biologic solutions; improvement in image guidance and robotics and more international integration. John Peloza, MD, Center for Spine Care: I look forward to the future of spine care in spite of all the challenges ahead. Science and technology are advancing providing exciting opportunities for spine physicians to improve care. This will require careful, honest, and ethical study combining the resources of the best research and clinical minds in the field. I am presently committed to several basic research and clinical studies in biologics, nanotechnology and surgical techniques. Hopefully, these will lead to predictable, high quality, cost effective treatments in the near future. Kenneth Pettine, MD, Rocky Mountain Associates: I remain most excited about the last two-and-a-half years of being involved in two FDA studies involving biologics to treat discogenic low back pain. In addition we have injected over 130 patients with autogenous bone marrow concentrate. I believe biologics will soon change the practice of spine and am excited to be pioneering this advancement. Raj Rao, MD, Medical College of Wisconsin: The future of spine surgery holds a lot of promise, with evolving new products and techniques in our armamentarium. The concepts of using even smaller incisions and better technology in the future, just as effectively as we do today, to relieve pain and improve function is exciting. We need to explore the whole "mind-body" concept to understand the exact role of pain in spinal disorders. n