Dr. Christopher Kager: The standout spine procedure in his career, future of biologics & more

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Christopher Kager, MD, is a neurosurgeon with Lancaster (Pa.) NeuroScience & Spine Associates and chief, division of neurosurgery at Lancaster (Pa.) General Hospital of Lancaster General Health Physicians NeuroScience & Spine Associates.

Here, Dr. Kager shares his insight on the most challenging procedure in his career, biologics in spine and how bundled payments will develop in his field.

Question: Can you tell me about one procedure that stands out in your career? What was particularly challenging and how did you overcome it?

Dr. Chris Kager: Kyphoplasty, which was being developed and refined at the end of my residency and fellowship, was the first minimally invasive spine procedure I learned. This procedure made a surgeon really consider the 3D anatomy and how it was represented on fluoroscopy. It helped that I trained with Isador Lieberman, MD, and Ed Benzel, MD, at the Cleveland Clinic during my fellowship. Dr. Lieberman helped perfect the procedure, and I either took or taught the kyphoplasty class six to eight times. The biomechanic principles were sound. Learning about and seeing the procedure, doing the procedure, then teaching the procedure reinforced the basic principles and nuances.

Q: What technology are you most excited about in spine now? Is there anything that you see as particularly innovative? 

CK: I pay close attention to both biologics and healthcare technology, including artificial intelligence. I believe that these two areas hold the most promise in spine, as well as medicine in general. The ability to enhance the body's own biologic processes to assist in healing or curing disease is the most important development of the last 50 years, in my opinion. AI can assist in these endeavors, as well as facilitate the analysis of data in all forms. From a professional standpoint, I welcome the chance to implement some of these breakthroughs. I have also joined an angel venture capital firm that looks at promising technologies and companies in the healthcare technology realm.

Q: What do you consider when thinking about becoming an early adapter of a new device?

CK: 1) Is it safe? What are the risks compared to what is currently available? 

2) Is it effective? What is the device meant to do, and does it make sense biomechanically and clinically? What are the early results in the lab or in early human usage? 

3) What is the cost? How does this compare to the current solutions? 

4) Could there be unintended consequences? Are there any possible short- or long-term effects?

Q: Have you any thoughts on how to tackle the current opioid epidemic?

CK: On a micro level, we do a lot of patient education about the issues surrounding pain and pain management as well as the opioid crisis. Most of our spine patients understand what to expect and how we can reasonably help them. A good physician-patient relationship can instill trust that we are truly looking out for their best interests in managing pain. Alternative methods of pain control also can be useful on an individual basis.

On a macro level there are many problems that are intertwined. Opioid manufacturers were quick to fill a perceived need, and normal pain became overtreated. In many cases, opioids are overprescribed for minor procedures. Reversing these trends with education of patients and providers will take time. Finally, we also need an aggressive multipronged approach to combat the illegal movement and distribution of narcotics in the United States.

Q: How do you see bundled payments, value-based care and other new payment models affecting spine?

CK: These types of models will continue to expand in all areas of medicine and surgery for a variety of reasons. All physicians need to be aware of the details and differences of each model and also be involved in development, evaluation and/or implementation. As spine surgeons, we need to ensure that spine patients are taken care of appropriately, and the surgeon and all parties are remunerated fairly.

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