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 are some pros and cons to insurance company mega-mergers?
Please send responses to Anuja Vaidya at firstname.lastname@example.org by Wednesday, Feb. 1, at 5 p.m. CST.
Question: What are the most exciting spine industry trends you expect to see in 2017?
Kevin Ju, MD. Spine Surgeon at Texas Back Institute (Plano): Spine surgery is an ever-changing landscape. Throughout 2017, I expect that we will continue to see interest in motion-preserving procedures as an alternative to spinal fusion. As a field, we have seen the development and emphasis of several techniques and technologies over the years that are meant to effect neurological decompression while preserving spinal motion. Examples include laminoplasty over laminectomy and fusion, cervical and lumbar total disc replacement over ACDF or lumbar fusion as well as various interlaminar spacers.
Some of these have been very successful while others have been less so. In addition to new technical advancements, there will also be more research on when fusion surgery is beneficial. For example, in the last several months two papers were published in the New England Journal of Medicine that investigated the benefits and risks of spinal fusion in addition to decompression for degenerative spondylolisthesis. Throughout 2017, we will likely continue to see an emphasis on trying to avoid spinal fusion surgery when it's appropriate.
On a related note, something that I hope to see in the upcoming year is more attention on bone health and osteoporosis. As our population ages, this issue is becoming an increasingly prevalent problem. We need to team up with our medical colleagues and ask our patients about recent bone density tests, history of fragility fractures and prior osteoporosis treatments. Not only can we help diagnose this problem, but if the patient ultimately requires surgery down the road, optimizing bone health preoperatively is ideal as we all know the perils and complications that plague instrumenting osteoporotic bone. Early detection and treatment of osteopenia and osteoporosis is key to improving these patients' lives.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: I am most keyed in on endoscopic spine. I had the opportunity to meet a colleague from South Korea where they are doing some amazing things through a scope. I expect it to become pretty hot in the coming year as we focus on outpatient surgery. Also, we will likely see more instrumentation being done on an outpatient basis, especially with cervical arthroplasty and interspinous stabilization. Lastly, deformity correction is becoming more and more important in the inpatient setting. I think the focus will be on faster and safer surgeries, possibly with robotic assistance.
Richard Kube, MD. Founder and CEO, Prairie Spine & Pain Institute (Peoria, Ill.): With the election and the nomination of former orthopedic surgeon, Congressman Tom Price, to secretary of HHS hopefully we will see the slowing if not an actual rollback on regulations. This is one of the most time consuming and least rewarding aspects of practicing medicine and management of the business. Only time will tell, but I am currently more optimistic than I have been in a while.
Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): Robot-assisted spine surgery will be the most exciting development of 2017. Further improvements in programming, instrumentation, navigation and expanded indications will make the robots more versatile and capable of assisting spine surgeons with more complex cases, while allowing for minimal soft tissue disruption.
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