Roundtables

Spine Roundtable: Innovation in Spine MIS, Biologics and More: Can Anything Stem the Flow?

Issue link: https://beckershealthcare.uberflip.com/i/348374

Contents of this Issue

Navigation

Page 1 of 4

Innovation in Spine MIS, Biologics and More: Can Anything Stem the Flow? By Anuja Vaidya F ive spine surgeons discuss excit- ing innovations in spine surgery, roadblocks to innovation and the best opportunities for growth over the next five to 10 years. Question: What are some of the most exciting innovations in spine surgery at the moment? Samuel Cho, MD, Mount Sinai Hos- pital (New York): ere are several in- novations. In the cervical spine, artifi- cial disc replacement has been shown to have equivalent clinical efficacy compared to ACDF. e investigators are following patients long-term to see whether this motion preservation tech- nology can decrease the inci- dence of adjacent segment disease. Minimally invasive spine surgery now has some evidence to support that its use results in similar long-term clini- cal outcome compared to traditional open procedures but with shorter hos- pital stay and quicker recovery. It has also been shown to be cost effective in a couple of papers. On the other hand, it exposes the surgical team to greater radiation. Biologics are another exciting field. Many companies are coming up with stem cell-based products such as bone gra substitutes. Its efficacy is yet to be proven. Jeffery Carlson, MD, President, Managing Partner, Orthopaedic and Spine Center (Newport News, Va.): e advancement of bone gra and bone gra substitutes are making great strides. Manufacturers are making products that are becoming more ad- vanced. ese products will continue to push the envelope of fusion tech- nology. e "Gold Standard" autogra bone is now being challenged by vi- sionary companies that are enhancing bone proteins, collagen platforms and stem cells. ese creations will eventually prove to be better than autogra bone as the technology advances to exactly repro- duce autologous bone, then enhance the matrices to make gras that can exceed the potential of autogra bone. Mick Perez-Cruet, MD, MSc, Chief, Spine Surgery, Department of Neuro- surgery, William Beaumont Hospital (Royal Oak, Mich.): What interests me is minimally invasive spine surgery and how innovations in MIS are being developed. I think, in general, we are developing certain technology for more focused care so that patients are recovering quicker and with better outcomes. We are treating a variety of pathologies of the skull base, cervical, thoracic and lum- bar spine using MIS techniques and technologies. I've been doing this for quite a while and we are definitely seeing long-term improvements that are lasting and sat- isfied patients who are receiving those treatments. omas Schuler, MD, FACS, CEO, Virginia Spine Institute (Reston): Developments in artificial disc tech- nology, regenerative treatments for the disc and spinal structures as well as advancements in minimally invasive spine surgery are positively benefiting patients. Hybrid cervical arthroplasty/fusion is a monumental improvement for our patients. e PRP injections and the stem-cell injections used intradiscally to repair the disc and ligament helps patients avoid surgery or postpone surgery. ese non-operative options are helping improve patients' daily lives and function. Q: What are some new technologies you are using in your work? Roger Hartl, MD, Chief, Spinal Surgery, NYP/Weill Cornell Medical Center (New York): I use a lot of 3D navigation for spinal surgery cases. e technol- ogy has been available in the last 10 years, but it has evolved, and it has now become more us- er-friendly. Dr. Schuler: We're using posterior Mazor robot-guided surgery, lateral in- terbody fusions with plate fixation and anterior spine reconstruction to ad- vance minimally invasive spine procedures. ese approaches are improving patient outcomes. Stem cell injections for disc regen- eration and complex cervical hybrid ar- throplasty-fusion operations are providing our most exciting advances for patients. Innovation in Spine: Can Anything Stem the Flow? 2 46 Another problem is the tendency among spine surgeons to focus on instru- mentation and fusion surgery. They are so focused on implants and that makes it difficult to open them up to other treatment options such as mini- mally invasive spine surgeries or biologics that can help avoid fusions. Dr. Perez-Cruet: One of the biggest roadblocks is finding good partners to work with to develop these technologies. Also, it takes money and resources. Currently, there is a concern amongst the companies about making large investments in healthcare when they are not sure if they are going to be re- imbursed for developing these technologies. Whether the current changes in healthcare will foster reimbursement for these technologies remains to be seen. Dr. Cho: I think it would be the cost. In order to run an investigational device exemption trial, companies need to spend millions of dollars. I don't know how this problem can be overcome. Medical research is expensive and we don't want to cut corners either. Dr. Schuler: The biggest roadblock is insurance companies, governmental payers and third-party payers denying physicians and patients the ability to undergo contemporary treatments and denying physicians the ability to per- form these modern surgical advances. We are seeing an enormous rise in denials for patients to certain types of care and an increase length of time for approvals for all procedures. To overcome this negative process, physicians need to continue producing data showing which techniques work most effectively. This needs to be financed through patient-centered funding programs and nonprofits, not corporate funding. The insurers and the third-party payers are discrediting research funded by corporations and are claiming that there is a conflict of interest. Payers are choosing the studies that support their reimbursement policies and are deny- ing any studies that counter their financially motivated coverage decisions. This is unethical, and it is wrong. Q: How can surgeons overcome some of the regulatory burdens on innovation? Dr. Perez-Cruet: We need to be able to foster innovation from a regulatory and governmental standpoint. We need to think about how we can make bringing products to the marketplace easier and in ways that are not cost- prohibitive. There are ways in which it could be more streamlined. Also, there needs to be legislation that protects innovation. There should not be a huge liability burden for bringing new technologies to the marketplace. Q: Beyond strictly technology, how are surgeons evolving their approach to provide better care for patients? Dr. Carlson: We are always looking for patient-specific improvements in our procedures. With advancing technology, some of the more complex procedures can now be done as outpatient. Patients don't really want to stay in a hospital overnight. The patients understand the need for the operating room but the po- tential risks in staying in the hospital environment frightens most patients. From wrong medications and wrong dosing to risks of hospital-acquired infections, patients don't want to add to the potential complications of their procedures. Another development is the advances in anesthesia. Anesthetics necessary for the performance of surgery. With influence mand, drug companies are making medications that can be or prevent pain. These new medications will also have fewer have the potential to make patients uncomfortable and require stay. Patients are able to [procure] medications in real time control and directly relate the need for treatment to activity Q: Will the current healthcare environment bring innovation to a standstill? Dr. Carlson: Advances in spinal care will continue although by changes in the healthcare system. As patients demand improvements their care, it will be the healthcare system that may not be quickly enough to the demand. There will always be a demand vative care that provides the best outcome, but the system is and will lag behind the desires of the patients. I believe over years, healthcare delivery will change drastically. Unfortunately, I see the current system as a hindrance to advancement. means that patients will seek care outside of the system anytime chance. This will slow the ability of the best and brightest among the improvements that will be demanded in the future. I see trending toward outpatient environments and hospitals becoming evant to the healthcare systems as a whole. Dr. Perez-Cruet: I don't think it will bring innovation to a standstill. nies will have to foster innovations that provide cost-effective always be value in products that improve healthcare for patients. Q: What do you hope to see in terms of spine surgery in the next five to 10 years? Dr. Perez-Cruet: I think we can do a better job understanding physiology of some of the disorders that we treat, so that we focused treatments, which can provide patients with really of life. A more focused approach addressing the underlying tient's symptoms is what we need. Additionally, I feel that tion of the spinal column — that is, intervertebral disc via stem become a reality. Dr. Schuler: Regenerative techniques, which will obviate the surgeries. The more we can heal through regenerative treatments, the patient can avoid or procrastinate the need for surgery. Dr. Cho: I would like to see long-term follow-up studies on discs. Hopefully, they will answer whether this technology incidence of adjacent segment disease and also stay functional If there is a way to decrease radiation exposure during minimally surgery, I think that would be a huge step forward. I would data on biologics such as stem cell technology before they are mans. n

Articles in this issue

Links on this page

view archives of Roundtables - Spine Roundtable: Innovation in Spine MIS, Biologics and More: Can Anything Stem the Flow?