Dr. Frank Phillips: Surgical technologies that are carving a future in spine

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Robots have made a lot of noise in the spine industry in recent years, but currently offer more hype than clinical value, and can be cost prohibitive to ASCs, according to Frank Phillips, MD, director of spine surgery at Rush University Medical Center in Chicago.

During Becker's 18th Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, Dr. Phillips discussed innovative technologies becoming more prominent in spine surgery and accelerating site-of-care changes in orthopedics.

Below is an excerpt from the conversation, slightly edited for clarity. To view the full session on-demand, click here

Question: What technology do you think will be most essential for spine surgeons going forward? 

Dr. Frank Phillips: I've done lumbar fusions for a number of years in the surgery center, but I think [outpatient growth] has been fairly slow in spine surgery compared to sports and other areas of orthopedics. The COVID situation is accelerating that. I think it's a combination of it is more efficient, and hospitals have to deal with COVID. There's also a real patient fear about going into 'COVID hospitals' for elective surgery. The surgery centers are a good out for both the surgeon and the patient, and we've had no pushback from patients coming to the ASC, but have had people nervous going to the hospital. I think this has got to accelerate spine ASC surgery. 

In terms of technologies, companies and manufacturers need to put their effort into MIS technologies that play into the surgery center, because we were migrating there anyway and this is really going to accelerate it. I think it's about procedural innovation to enable MIS surgeries in an outpatient setting. Part of that is the widget, and part of it is the overall pain management, which is one of the biggest barriers to doing some of those cases in the surgery center. 

Big picture, where is spine going? I think, like everything else, it is driven by technology. Over the last few years, we've seen the robot hype and age, and I think that's here to stay. Personally, for now, I think robots are more hype than offering real clinical advantages. I think they're sort of image guidance dressed up with an aiming arm, but clearly they have the potential in the future to really change what we do. I think the companies that have or are developing robots recognize that. They realize that right now it won't add much, if any, efficiency and the accuracy that they provide is pretty good with other things that we already use. I think it's more the promise of what they will be. There's augmented reality technologies that are real and coming out. These are technologies with retina display headset ability to do navigation, which plays to the world we're in because it takes out the need for huge robots — huge 3D imaging machines in limited spaces, particularly in an ASC where the ORs are obviously much smaller. It's my expectation that those technologies will really evolve fairly quickly over the next few years. 

Q: Do you have any thoughts on device companies and vendors, as they're trying to develop a strategy for bringing these technologies to the ASC?

FP: A lot of it is that these huge robots just can't be in an ASC. The economics are prohibitive right now and it's just a tough thing to get into an ASC and make work there. I think they've got to be more ASC-friendly enabling technologies, like for example, the headset for the laptop concept where you can do navigation, which is real and out there, and much cheaper than a million-dollar robot. Those types of technologies will play to the ASC. A lot of the roadblocks have to do with the pricing structure, both from a manufacturer point of view and from a payer point of view. I think that needs to be better worked out to really promote the use of ASCs for cases that really belong, in my opinion, in the ASC.

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