Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: What is your number one tip for developing a productive relationship with payors?
by Wednesday, Feb. 20, at 5 p.m. CST.
Vincent Arlet, MD, Orthopedic Spine Surgeon, KneeFootAnkle Center of Kirkland (Wash.): I would like to see more research on junctional syndromes, such as proximal junctional kyphosis and distal junctional kyphosis, after spinal deformity surgery.
Ara Deukmedjian, MD, Neurosurgeon and CEO, Deuk Spine Institute, Melbourne, Fla.: I would like to see research on the joints of the spine. Spinal joints are the cause of back and neck pain over 90 percent of the time and can be effectively treated without surgery in most patients. Your doctor must know which joint is painful in order to perform the correct treatment. Unfortunately, even if the doctor comes up with the correct diagnosis, many are not qualified to perform the treatment correctly. Unless patients are willing to travel, many are destined to live in pain for years.
Jeffrey Goldstein, MD, Director of Spine Service, NYU Langone Medical Center's Hospital for Joint Diseases: The importance of preservation and restoration of sagittal spinal alignment is becoming better recognized and understood. The first step is more studies which continue to evaluate the effect of changes on sagittal alignment and outcomes, adjacent segment degeneration and need for revisions. The second step is to "manage" or "program" sagittal alignment with interbody cages and instrumentation which allow us to enhance lumbar lordosis, for example.
Secondly, with regard to fusion, I would like to see research into surface technology which can enhance interbody fusion. Surface treatments can enhance primary fixation. The next generation of surface structures will allow us to move from a random morphology to a predetermined surface which can direct bony in-growth.
Jeffrey Wang, MD, UCLA Spine Center: I think the future is in the biological realm. Research into the basic mechanisms of the disease processes and developments in biological treatments are the future. In our laboratory, we are working on many novel basic science applications that I would like to see translated into better treatments for our patients. I think we are very close to improving bone healing with faster spinal fusions and with fewer complications. I would like to see biological treatments for disc pathologies come to a realization over the next five years that allow us to have better treatments for our patients and better outcomes. We have a lot of spinal devices and hardware, but in reality, research into the basic mechanisms to understand spinal disease processes will give us a great understanding of our patients' conditions and how to best treat them in the future.
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