Education, outpatient migration key to growing endoscopic spine cases: Dr. Michael Gallizzi

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From endoscopic surgery education to regenerative medicine research, Michael Gallizzi, MD, already has a vision for his upcoming post at The Steadman Clinic in Vail, Colo.

He will join the clinic in March and brings expertise in robotics and endoscopic spine surgery. Ahead of his arrival at Steadman, Dr. Gallizzi spoke with Becker's Spine Review about his ambitions in the coming months and his outlook for endoscopic spine surgery.

Note: This conversation was edited for style and length.

Question: What are your top three goals heading into The Steadman Clinic this year?

Dr. Michael Gallizzi: My first goal is to re-establish my Globus ExcelsiusGPS premier spinal robotics training site that I had in Denver at Vail Health and The Steadman Clinic. The cool thing is Vail Health and everybody at The Steadman Clinic were amazing transferring all my robotics instruments to Vail. My entire armamentarium of robotic spine equipment will be available at Vail Health with some new things in the pipeline. I'm excited to re-establish that premier teaching program because that brings in surgeons from all over the U.S. to continue helping train people that maybe didn't get that experience in their fellowship or residency training and help them bring robotic spinal surgery to their practices.

Number two for me would be expanding the already existing outpatient spine surgeries at the Vail Valley Surgery Center. This is especially important with COVID-19 going on and with inpatient hospital beds being so valuable these days. The more spine surgeons can do outpatient procedures, the less burden we create on the inpatient facilities. It is important to maintain high quality of care, [and] perform procedures through smaller incisions that are less disruptive to the natural anatomy to allow people to be done as an outpatient and recover quicker. 

Lastly, I had a biomechanics lab at Duke University during my spine fellowship looking at the interactions of different ligaments in the spine and how that interplays with certain pathology and disease. I'd like to re-establish my biomechanics research as well as start working with the Steadman Philippon Research Institute, which has a new golf sports medicine simulator lab. Trying to integrate some of that biomechanics work into actual real-life data in their golf simulator would also be a goal of mine next year.

Q: What are the biggest challenges you're expecting and how do you plan to tackle them?

MG: The biggest challenges are just getting staff to work with the robotics system. Any new process/procedures will have its kinks and a learning curve to it. On the good side, my entire team in terms of robotic representatives as well as hardware representatives are all transferring up to the mountains, and they've already established multiple programs throughout the Denver metro area. 

I was part of the first program established in Colorado with the Globus Excelsius GPS, so we've identified all the different learning curve issues, and really it involves getting people comfortable with the equipment because it is a little different than just standard spine equipment. Understanding that it's not going to be the most perfect thing when no one's ever seen it means my team will devote training time to get the staff up to speed. Just like you practice a sport on the practice field, surgeons practice new techniques on cadavers, our practice field. We have a training program through Globus Medical as well as myself to get everybody up to speed. 

Q: Can you speak more about your plans to bring endoscopic spine surgery to the Steadman Clinic?

MG: Endoscopic spine surgery is a growing trend in the U.S. It's been done overseas, especially in the Asian region and European region, especially in Germany and South Korea, for a lot longer than the United States. Part of the issue is that the training and access to it in the United States is very limited. A lot of the places that you need to train or get your certificate is time away from family, and you have to take time away from your family and practice to get it. You then have to figure out how to make sure your skills are up to snuff before you attempt to do any of these procedures on patients. 

Part of what I'm doing at The Steadman Clinic is bring endoscopic spine capability. It wasn't previously at The Steadman Clinic before and a lot of procedures that I can do, [such as] treating back pain and leg pain with endoscopic surgery, is a great option for the correctly indicated patient. Being able to access those herniations and take them out through smaller incisions as opposed to a tubular discectomy is trying to make a great surgery even better. Then, really being able to merge endoscopic techniques with robotics in the next step. Using the robot as a targeting mechanism and then passing the endoscope through the robot to be more accurate with some of our disease pathology treatments will be a game changer.

Q: What will be needed for endoscopic spine surgery to become more widespread?

MG: I think the movement of spine cases to outpatient settings will help drive this change, because the surgery is significantly less disruptive. I think quite honestly, once people know it's available, consumers are going to start demanding it. 

We also need industry support. We need major players in the industry and medical device companies to really step up and start large training programs to get more people interested and get them the skill set. A surgeon doesn’t want to introduce the technology without the right training behind it. 

As much as it pains me to say this, continuing education is real, and you have to take time out of your life outside of work and continue to train. What I do is I take personal time away to go learn or train with other surgeons. Surgeons come to visit me and I visit other surgeons. I think really being open-minded and trying to look for different ways to maximize patient outcomes is really important. If you've been doing spine surgery the same way for the last 10 years, I don't think in the future that's going to cut it.

Q: What healthcare trends are you following right now?

MG: One thing I'm really interested in and what drew me to The Steadman Clinic and the Steadman Philippon Research Institute is their dedication to regenerative medicine research. They are on the cutting edge of really figuring out if there is a way to harness our own tissues to regenerate. It will be a big trend in the future to customize regeneration with our own stem cells and/or figuring out how to induce our cells to do what we want inside our bodies. 

From an engineering standpoint, I think we need to more thoroughly understand the spine as a dynamic structure and treat it more like we treat knees, shoulders, wrists and ankles. Spine surgery needs to evolve to consider ligaments, muscles, tendons in addition to the bones and the neural structures, which have traditionally received most of the attention. I think we're missing a large part of the sports medicine part of the spine, where we're not really addressing ligament injuries and other cartilage injuries, disc injuries that may be symptomatic for patients. We are just starting to create the right tools to fix those problems. 

The other big trend is telemedicine. This allows different virtual consultations with patients with imaging reviews and more. Utilizing this great technology over the past few years during the pandemic has been a game changer, really allowing surgeons to coordinate care for patients without seeing them in the office. So let's say a patient has a child care issue or is feeling ill and they can't drive in to meet the appointment — that's OK. Through the computer, we can do the appointment right there. We're helping to continue that therapeutic relationship in a remote fashion, which is more focused on patients’ needs.

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