Becker's Spine Review

41 PRACTICE MANAGEMENT SPINE DEVICE & INNOVATION HEALTHCARE REFORM Defining Value in Spine: Improved Outcomes & Cost Reduction By Laura Dyrda M ini- mally inva- sive spine surgery is carving out its place in the indus- try and spreading from simple pro- cedures to tech- niques for more complex disorders and diseases. e benefits could include quicker recovery times, less collateral damage and lower overall costs. It also adds value to a surgeon's practice. "My patients are happier with the minimally invasive procedures," says Scott Kitchel, MD, of NeuroSpine Institute in Eugene, Ore. "ey are undergoing outpatient surgery or shorter hospital times with quicker recoveries. ere are increased costs for specialized instrumentation for some procedures, but as the field evolves, the cost curve will be driven down for minimally invasive surgery because the procedure can be done in a setting where patients return home quickly." He sees value spreading in two sepa- rate arenas: improved outcomes and cost reduction. ere are an increasing num- ber of researchers dedicated to proving value in clinical outcomes for minimally invasive surgery and publishing their results. The value of outpatient setting e outpatient surgery center affords convenience for the patient and surgeon, with less administrative burden and in- creased efficiency. "e next major phase of MIS surgery is the concept of making routine lumbar degenerative spine surgery in the ambula- tory surgery center," says Charla Fischer, MD, with Columbia Doctors and e Spine Hospital at New York-Presbyterian in New York. "rough patient safety, quality management, good pain protocol, infection prevention and proper patient selection, I am achieving good results with outpatient spine surgery. at's the next step." e outpatient surgery center allows surgeons to perform cases faster and patients return home quicker. But patient selection is key and surgeons must ensure the outpatient center is helping the patient and preventing postoperative issues. "I think we are almost at the tipping point where MIS surgery will become more prevalent because the technology allows us to feel comfortable with it," says Dr. Fischer. "Everyone will see how well patients do with it and then it will become the standard of care." Data shows patients like the out- patient setting and ambulatory surgery centers prize spine procedures if they can be performed safely. "e surgeons I know who have ex- perienced spine surgery at the outpatient center are always looking to adopt new cases there as long as they can achieve equal or superior results," says Dr. Kitchel. "e primary goal of the surgeons on the behalf of their patient is outcomes, and the outcomes of any minimally invasive procedure have to be as good or better than the traditional approach. I don't think you'll see many surgeons willing to compromise patient outcomes to turn a procedure outpatient." The value of technology One of the primary developing areas in technology for less invasive procedures is imaging and real-time visualization to techniques. irty years ago, surgeons oen took multiple plane X-rays for a case to confirm placement. Now, surgeons are performing cases with real-time fluoros- copy, multiplane fluoroscopy and comput- er-guided technology. "e technology is just getting better and better, and the MIS approaches can be done safely for a wider range of patients," says Dr. Fischer. "Some of the technologies that are helping surgeons provide MIS surgery for more patients includes Invuity's Intelligent Photonics. e technology allows me to see more of what I'm doing with a smaller incision. I am exposing less, but I'm still able to see the whole surgical field." Surgeons have more confidence in their less invasive procedures when they can visualize the surgical field. Invuity's Intelligent Photonics Technology is in- tegrated into illuminated access systems, handheld illuminators and "drop-in" il- luminators, which illuminate the surgical cavity from the inside out. at allows surgeons to operate with better precision, efficiency and safety. Dr. Fischer is now training residents with the technology. "With technology improving and surgeons gaining more experience with this new technology, they can do more advanced procedures," says Dr. Fischer. "I may need to perform surgery on multiple levels such as revision surgeries or defor- mity surgeries, and with new technology I can use an MIS approach. is allows me to do more with less time for recovery, and this is particularly helpful for older patients in whom a long recovery would be very difficult." e technology shi in spine now is similar to the shi in knee arthroscopy. e older generation of surgeons said knee arthroscopy wouldn't catch on in the 1980s and that it was just a fad, but now knee arthroscopy is the gold standard. "I can't recall the last time I saw an open meniscectomy," says Dr. Kitchel. "I think this is an evolutionary pathway and generational change. When I went through my orthopedic fellowship, we didn't have MIS training. But the data Dr. Charla Fischer Dr. Scott Kitchel

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