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36 Becker's ASC 21st Annual Meeting – The Business and Operations of ASCs: For more information, call (800) 417-2035 Meridian Surgical Partners became an acquisition partner in February 2012. Surgery Center at Tanasbourne in Hillsboro, Ore., is a freestanding multispecialty surgical fa- cility. The ASC is a joint venture with Providence Health System and affiliated with Blue Chip Surgical Center Partners. There are 21 physician owners of the center and an additional 48 physi- cians performing cases there. Surgery Center of Reno (Nev.) is a multispecialty ASC that has a strong orthopedics and spine pro- gram. Spine surgeon James Lynch, MD, serves as chairman of the board of directors for the center. The center is affiliated with Regent Surgical Health. Synergy Spine & Orthopedic Surgery Center in Warren, Mich., is affiliated with Mendelson Korn- blum Orthopedic & Spine Specialists. The surgery center is fully licensed and accredited by AAAHC with a team that provides orthopedic, spine and pain procedures. There are 13 physicians associ- ated with the group. Trade Center Outpatient Surgery in Palmdale, Calif., was founded by Nick Alapour, MD, a surgeon focusing on spinal disorders. He has a professional interest in minimally invasive pro- cedures and is one of the few spine-focused sur- gery centers in Southern California. Procedures at the center include disc nucleoplasty, anterior microscopic discectomy with fusion and lumbar laminectomy. Two Rivers Surgical Center in Eugene, Ore., is a 7,911-square-foot facility designed specifically for outpatient spine procedures. The ASC opened in July 2006 and Meridian Surgical Partners became an acquisition partner in September 2008. The two-operating room ASC includes both neuro- surgery and pain management and has an effi- cient workflow. West Park Surgery Center in Cape Girardeau, Mo., includes anterior cervical discectomy and fusion, laminectomy, microdiscectomy, carpal tunnel, ulnar nerve transposition and pain man- agement procedures. The center is in association with the physicians from the Brain & NeuroSpine Clinic of Missouri and affiliated with Blue Chip Surgical Partners. n K yle Colle, DO, a neurosurgeon with Regional Brain and Spine Center in Cape Girardeau, Mo., discusses trends in complex spine surgery. 1. Minimally invasive approaches. Technology has evolved to provide less invasive procedures for more complex spine surgery, including scolio- sis. "We are able to correct scoliosis or spondylolisthesis, or other degenera- tive spine conditions, with minimally invasive approaches," says Dr. Colle. "Instead of doing the big, wide open decompression surgeons used to do, they are able to get to the spine through direct lateral or transforaminal ap- proaches, which are muscle-sparing." The smaller incisions don't disrupt the soft tissue around the spine, making recovery easier and less painful than before. However, it's not necessarily easy to incorporate less invasive procedures into practice, even for expe- rienced spine surgeons. "There is a learning curve," says Dr. Colle. "Open surgery has much easier visualization. You have to understand the anatomy through an endoscope, microscope or tube, which could cause older sur- geons not to use it." 2. Pain management advances. Pain management during spinal proce- dures has come a long way from just epidurals. There are now multiple tech- niques surgeons can employ depending on the patient's situation, and new in- novation is on the horizon. "I think the future is going to be topical aids, even intraoperative topical aids, for pain management," says Dr. Colle. "When the surgeon finishes the procedure, he'll be able to place something in the wound that will help the healing process and give postoperative pain relief." Pain management specialists and surgeons are now working together on which techniques to utilize — whether they are pain pumps, nerve stimula- tors or another device — to make the patient as comfortable as possible. 3. Biological solutions. Several research and development projects in spine are currently examining biologic and stem cell solutions for spinal pro- cedures. Some use stem cells from fat or cadaver bone, but Dr. Colle says the future is in amniotic stem cells. "There is a lot of excellent healing protein across the glands inside the amnion that we have found beneficial," he says. "There needs to be more studies, but I think we'll find stem cells will help with the patient's pain management." In orthopedics and spine, injectable stem cells are becoming more accepted, especially in the facet and sacroiliac joints for pain relief. "They help the heal- ing process," says Dr. Colle. "We'll see more work looking into stem cells to see how they could benefit spine patients because they have both anti-inflam- matory and regeneration potential." 4. Disc nucleus regeneration. Disc nucleus regeneration has been in the background of research projects for years, but now researchers are making bigger strides to learn more about genetics and the ability to regenerate soft tissue. "That's one of the things we're getting excited about, and the ability to regenerate the disc will be very helpful," says Dr. Colle. "We aren't there yet — there's still a ways to go — but this will be a huge benefit to spine patients." 5. Advanced training. A trend toward advanced training and spreading knowledge about spinal developments has brought better treatment to the more remote areas of the United States. "You used to just have centers of excellence for complex spine, but now you get more highly-trained surgeons going to blue collar areas and guys are becoming more facile with the tech- nique to help their patients," says Dr. Colle. "As a result, more patients are returning to their daily activity after spine surgery and benefiting society. There is a much improved technique and understanding of how to balance the spine." n Biggest Strides in Complex Spine Today By Laura Dyrda Symmetry Surgical's broad portfolio brings together more than 300 years of experience with quality product lines that clinicians trust to deliver best-in-class patient care. symmetrysurgical.com Instruments | Sterilization Solutions | Retractors | Energy sharp tip any time it's needed! Symmetry Surgical's patent-protected technology provides four detachable tip sizes and three reusable handles to customize the optimal Sharp Kerrison for each case. What if you had a sharp tip every time? 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