5 spine, orthopedic surgeon insights to know

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Here are five spine and orthopedic surgeon insights to know from the last 30 days:

"I think the area that is in most need of disruption is not necessarily with an implant or a device. It is a method to keep up with the Herculean task of keeping up with preauthorization. So having more tools and equipment to access the available literature quickly, accessing insurance indications more quickly, and getting an ability to do an automated response. So it's more along the preauthorization, getting people through the system, through the operator to the operating room. I think that the preauthorization process is in line for disruption because we're using antiquated equipment, we're sending faxes and trying to find old patient records. It should be a much more automated, unified system to get across our indications of reasons for doing surgeries that we do," — Ernest Braxton, MD, on where the spine industry needs a disruptor.

"Two large misconceptions exist that are probably equal in amount. One is how physical spine surgery often can be. Many patients believe the procedures are very delicate. While work around the neural structures is delicate and precise, the bony work is quite physical. I also believe most patients would grossly underestimate the amount of administrative time spent throughout the week to be able to provide the medical services the patients need," Richard Kube II, MD, on patient misconceptions of spine surgeons.

"There are two pieces of advice that I would like to provide for up-and-coming orthopedic surgeons. The first is to remember why we first went into medicine and that everything we do is centered around the patient. As we continue to advance the field of orthopedic, we must remember that our focus is on improving patient outcomes and we should not lose sight of that as our primary goal. Second, continue to pass down wisdom to the next generation of surgeons. Orthopedic surgeons endure rigorous training, including five years of residency and a year of fellowship after four years of medical school. We must ensure we pass on our knowledge to the future surgeons so that we can continue to improve on clinical and surgical techniques. Passing down the information you have learned is as important as the first piece of advice above," Matthew Harb, MD, on advice for early-career orthopedic surgeons.

"The hardest choice an orthopedic surgeon can make is when not to do surgery. In residency and fellowship, we are trained to be the best surgeon we can be, which is extremely important. But what often gets lost to the young practicing physician is when not to do surgery. To rely on your clinical acumen and not always jump headfirst into surgery that is not needed or into a procedure where someone else may be more qualified," Steven Gorin, DO, on challenging decisions orthopedic surgeons make. 

"My idea of "smart" implants in spine surgery would be some kind of microscopic pressure sensors, chemical sensors, and accelerometers with wireless connectivity and a small and long-lasting power source that could be fitted inside an interbody spacer, pedicle screw, or a disc replacement device to provide data on mechanical loads, inflammatory or infection markers, and motion. This could help the surgeon to analyze when the fusion becomes solid, if there is evidence of micromotion and potential failed fusion, if there is evidence of focal inflammation or infection, or how well the disc replacement device is moving. The technological challenge would be to fit all of that technology inside the implant in a manner that is durable, safe to the patient, and does not interfere with the main mechanical function of that implant. That would be quite a significant challenge and will likely significantly increase the cost of such implants. The final challenge would be to demonstrate if the clinical benefits of having this real-time data justify the increased costs," Vladimir Sinkov, MD, on what smart implants could be like in spine surgery.

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