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41 JUNE 2017 CONFERENCE PREVIEW Spinal Fusion Trends & Challenges — Q&A With Dr. Vladimir Sinkov By Anuja Vaidya V ladimir Sinkov, MD, a spine surgeon at Nashua-based New Hampshire Orthopaedic Center, discusses trends and challenges in spinal fusions. Dr. Sinkov focuses on spinal decompression, fusion, minimally invasive techniques, scoliosis correction and disc replacement. Q: What are some of the most exciting new trends in spinal fusions? Dr. Vladimir Sinkov: While minimally invasive surgery is not a new trend any more, new and less invasive techniques, tools and implants are currently being developed. Benefits of minimally invasive lumbar fusions over the open techniques have been clearly demonstrated in current literature. Wider adoption of these techniques is still lagging, however. is is likely due to the steep learning curve and fairly significant additional cost and complexity of these procedures. New techniques and instrumentation will allow these proce- dures to be done faster, cheaper and more effectively. I am hoping this will help with wider adoption of MIS surgery, which will be highly beneficial to our patients. Another trend is computer navigation and robotics. ere is still a lot of work to be done to improve robotics applications in spine surgery, but the future is promising and new devices will be coming out on the market soon. Q: What are two to three of the most pressing challenges facing sur- geons who perform fusions? VS: Declining reimbursements and increased surgery denials make it harder to help our patients and remain financially afloat. Additionally, as the population ages we are seeing more spine problems in patients that are more complex — with higher number of medical co-morbidities, lower bone mineral density and more spine deformity. Finally, surgical innovations such as MIS fusions, computer navigation and robotic sur- gery increase the cost of the procedures. We must justify their use by showing greater safety and efficiency as well as improved outcomes. Q: How can surgeons overcome those challenges and grow their practice? VS: Surgeons will increasingly consider opting out of insurance networks or not accepting insurance payments completely and making financial arrangements directly with the patients. Also, aging patients will need a more multidisciplinary approach to their spine problems to deliver most effective and safe care. Continued research and implementation of innovations in spine fusion surgery will likely need more industry support in the future. n Dr. Vladimir Sinkov will be speaking on "Key Evolutions in the Medical Device Arena" at the conference Friday, June 23 at 1:05 p.m. University of Chicago's pain program for seven years. I was busy as an anesthesiologist and a pain physician in the Chicago suburbs. We de- cided to do something that was not done be- fore in the Chicago area, and that was to start a multi-site private pain practice. Q: How have approaches to treat pain man- agement evolved over the last few years? JP: Pain management treatments have become more precise in their diagnostic abilities. There are better outcomes from the treatments that are available and reduced incidence of surgeries. The market has more competition as there are more people putting themselves out as pain physicians. It is more fun to practice because outcomes are better. Q: What challenges do pain management physicians continue to face and what are the opportunities? JP: There are continually challenges with insurance companies. There are also challenges if providers are in a state that does not have caps on medical malpractice awards. I am aware of these issues on a micro scale because of my practice, as well as on a macro scale with the leadership positions I hold with various professional and medical societies. The opportunities for interventional pain phy- sicians are especially present for those who can reduce or eliminate the need for spine sur- gery while also reducing the number of opioid narcotics they prescribe. There is a wide range of outcomes from one pain physician to another. Those that are more in tune to precisely diagnosing the source of a patient's pain and then fixing it with non-surgi- cal techniques are going to be able to reduce opiate narcotic dosing. There are also multiple medications that help reduce the pain by fixing the problem, not masking it, thereby reducing the need for opiate narcotic pain medications. n Dr. John V. Prunskis will be speaking on "The Best Ideas Now - New Initiatives in Spine and Pain Management" at the conference Saturday, June 24 at 10:10 a.m.