Issue link: https://beckershealthcare.uberflip.com/i/936525
14 Michael Musacchio, MD. NorthShore University HealthSystem's Neu- rological Institute (Evanston, Ill.): Technology is the game changer for spine surgeons and their patients, especially 3-D capabilities. A paradigm shi is in play; 3-D navigation has improved accuracy and safety of screw placement and the overall procedure. It has further advanced minimally invasive techniques and it reduces, if not eliminates, redo surgeries for screw misplacement. Robotics has better enabled the integration of 3-D navigation through soware to aid in deformity correction. Deformity correction technologies include preop planning soware, intraoperative assist devices, rod benders and more. Dr. Brian Gill: I am interested in seeing how 3-D technology/printing capabilities will translate into implant design and function; whether this technology translates into quantifiable better outcomes remains to be seen. Andrew Hecht, MD. Chief of Spine Surgery at Mount Sinai Hospital and Health System (New York City): e most important technology trends in 2018 are continuing to find the appropriate carriers and doses for the use of BMP-2 (Infuse) to minimize complications and yet harness its effective capabilities. In addition, spine surgeons continue to explore the appropriate indications for minimally invasive fusions for degenera- tive, trauma and deformity applications. Lastly, spine surgeons continue to define the appropriate indications for cervical disc replacement and how to minimize heterotopic ossification aer TDR. Jocelyn Idema, DO. Advanced Orthopaedics and Rehabilitation (Washington, Pa.): ere is recent data with regard to lumbar disc replacement and a five-year follow-through that has shown highly favorable patient outcomes and reduction in overall healthcare costs due to a significantly decreased revision rate for adjacent-level pathology. As more insurance companies and hospital systems begin to align and recognize these significant changes in spine surgery, there will be more opportunities in the near future for improved quality of care. Other innovative technologies, such as improved navigation systems, robotics and the various implant techniques, will continue to positive- ly impact the spine industry in the future. It is important to note that although these technologies continue to change and improve, the spine industry must also balance the cost-effectiveness and value of these technologies, always striving for the best patient outcome and experience for the patient. Dr. Todd Lansford: e most important trend in spine technology would be the continued integration of biplanar fluoro to navigation. I say this especially because the use of robotics is an expanding field; advances in imaging will increase the speed for robot procedures. Once navigation improves in speed and ease, robots will be used more frequently. e second trend I see is use of titanium/tritanium implants. is has shown superiority over PEEK and will gain in use throughout the year. omas Schuler, MD. Founder of Virginia Spine Institute (Reston): e top two areas affecting spine surgery are artificial intelligence and arthroplasty. Both of these shi the paradigm of decision-making and treatment options. Artificial intelligence applied to robotic surgery simplifies surgeries, decreasing complication rates while enabling smaller, less invasive operations. ese preserve more natural passive and active stabilizers of the spine, minimizing adjacent segment disease. Arthro- plasty is achieving a similar outcome by protecting adjacent segments. Regenerative medicine is impacting nonoperative care and providing a new option for mild adjacent segment pathology. Paul Slosar, MD. President of SpineCare Medical Group (Daly City, Calif.): e focus is now on surface technologies for fusion implants. e most sophisticated and advanced surface has a unique titanium nano-technology to stimulate the host bone to grow rapidly, promot- ing early osseous-integration. is should lower surgeons' dependence on expensive or inflammatory biologics. e porous implants may be better than smooth surfaces, but still lag behind in terms of stimulating a cellular response. Dr. William Tally: e biggest technical change will be the continued rise of minimally invasive spine and the correlated transfer of spine pro- cedures into an ambulatory surgery center setting. Christian Zimmerman, MD. Saint Alphonsus Medical Group (Boise, Idaho): Advancements in onsite hardware creation may be a thing of the extreme future, but online custom-made hardware may realize a place in the implant market. Opportunities for the future Roger Hartl, MD. Director of Spinal Surgery at Weill Cornell Medical Center and Director of the Weill Cornell Center for Comprehensive Spine Care (New York City): e best opportunity for spine surgeons in 2018 is integration of spinal surgical care in the setting of multispecialty practice. e times of solo spine practitioners are over. Targeted mini- mally invasive surgery has lots to offer for most spinal pathologies. is requires, however, accurate diagnosis and effective aercare, rehab and lifestyle modification in the interdisciplinary setting. Dr. Todd Lansford: e best opportunities for spine surgeons will continue to be ASCs. We are expanding the types of cases and patients suitable to this environment. As spine surgeons, there is still growth in this arena, so the opportunities are quite plentiful. Robert Masson, MD. Founder of Masson Spine Institute (Ocoee, Fla.): We have only scratched the surface of the [outpatient spine industry's] net potential to expand the outpatient spine arena on behalf of our patients. e payers have been difficult in opening outpatient panels for contracting, but all trends suggest outpatient cost reductions are a mandate, and I think this will improve the payer receptiveness toward outpatient contracts and believe progressive practices will continue to invest heavily in their outpatient capabilities. Dwight Tyndall, MD. Private Practice (Munster, Ind.): Important trends are the growth of outpatient spine surgery, bundled payments and application of robot technology. e key business challenges spine surgeons will face this year are decreasing reimbursements and access to patients as narrow networks continue to grow. e best opportunity is to show value within bundled care and to capitalize on outpatient spine surgery as a way to contain cost while showing superior patient outcomes and satisfaction. Sunny Uppal, MD. Glenwood Surgical Center (Riverside, Calif.): e next type of case that will move to the ASCs will include any case in which so tissue dissection can be minimized. is will include minimal invasive techniques to place posterior pedicle instrumentation for lum- bar fusions. e limiting factor [right now] in cases done at ASCs is so tissue dissection and pain control. Dr. Paul Slosar: Although it's been on the radar for several years, this may be the year that bundled payment models finally hit their stride. While CMS has adopted a more voluntary posture toward participation, that hasn't discouraged interest in their Bundled Payments for Care Improvement program, now entering its third year. Commercial payers are following and, in 2018, some will begin with small, selective networks of spine specialists to grow their own risk-sharing programs. Scott Blumenthal, MD. Texas Back Institute (Plano): e biggest opportunities for spine surgeons next year is social media and clinical research. e smartest way for young entrepreneurial-minded surgeons to begin their business today would be to offer a service that no one else does — maybe medical or a service such as an app for your practice or the ability to schedule or get answers to other inquiries digitally. ink of your future patients as millennials and how do they access other services?