Becker's Spine Review

43 PRACTICE MANAGEMENT SPINE DEVICE & INNOVATION HEALTHCARE REFORM collection now is showing outcomes are adequate for minimally invasive ap- proaches in spine." ere are many operating rooms with CT scans available interoperably. "I think we'll continue to see evolution here," says Dr. Kitchel. "Oen the most challenging part of the procedure is tying the imaging to the procedure to make sure you are doing it safely and efficiently. e positive data will lead to further adoption." The value of new techniques Minimally invasive techniques for spinal disorders and diseases have evolved tremendously over the past 15 years, but there is a learning curve for surgeons trained in traditional open techniques. "I think the training should be done in a lab and under observation by other surgeons," says Dr. Fischer. "A lot of surgeons aren't comfortable with these techniques if they've been doing open sur- gery for a long time. at's why it's nice to have navigation tools and technology like intracavity illumination, because surgeons can feel more comfortable that they've achieved what the patient needs." One of the biggest value areas has been in the sacroiliac joint. For years, patients presented with low back pain and surgeons treated the lumbar spine instead of the SI joint because of lack of experi- ence with the SI joint. However, minimally invasive SI joint fusions and a new push to re-examine the SI joint as a pain generator are yielding positive results. "e whole diagnosis and approach is being reconsidered," says Dr. Kitchel. "It's really revolutionized our patient care as sacroiliac joint pain represents a signif- icant percentage of lower back pain and the new minimally invasive technique and rapidly growing diagnosis understanding bodes well for patients." He participated in a prospectively randomized comparison of patients who received surgical or non-surgical treat- ment for SI joint disease with positive results. ree new studies were recently published examining the iFuse system from SI-BONE and the results include: 1. In the first study researchers found iFuse achieved a 52-point reduction in SI joint pain at six months on the Visual Analog Scale compared with a 12.2-point decrease in the non-surgical management group. At 12 months, the surgical group reported a 54.2-point reduction from the baseline VAS measurement. Nearly 80 percent of the non-surgical group elected to have the iFuse procedure aer six months of non-surgical care. 2. e second study reported one-year results from a multicenter clinical trial of minimally invasive SI joint fusion that included 172 subjects at 26 centers in the United States; 12-month postoperative follow-up was available in 157 of 172 initially-enrolled subjects (91 percent). Six months aer surgery, 81 percent of the patients reported a "successful" treatment; at 12 months, the procedure had an 80 percent success rate. e average SI joint pain improved from 79.8 at baseline to 30 and 30.4 at six and 12 months. ere were around 92 percent of the patients report- ing they would have the procedure again at six months aer surgery; 91 percent said the same one year aer surgery. 3. e third study was a systematic litera- ture review examining 18 articles measur- ing patients' pain, disability and quality of life following MIS SI joint fusion. e researchers found the procedure was 59 minutes on average, blood loss was 36.9 cc and hospital length of stay was 1.7 days. Pain scores and ODI scores improved for patients aer surgery. n Has Orthopedic Surgeon Salary Diminished in the Last 5 Years? By Anuja Vaidya A ccording to Merritt Hawkins' 2014 Review of Physician and Advanced Practitioner Recruiting Incentives Review of Physician and Advanced Practitioner Recruiting Incentives, the average base salary (not including production bonus or benefits) for orthopedic surgeons has decreased slightly over the last five years. The 2014 Review is based on 3,158 permanent physician and advanced practitioner search assignments that Merritt Hawkins and AMN Healthcare's sister physician staffing companies had ongoing or were engaged to conduct from April 2013 to March 2014. n 2009 to 2010 $519,000 2010 to 2011 $521,000 2011 to 2012 $519,000 2012 to 2013 $483,000 2013 to 2014 $488,000

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