The challenges and opportunities to bring spine technology abroad: Dr. Roger Härtl

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Helping spine surgeons hone their craft in Tanzania and assisting fellows has been one of the proudest accomplishments this year for Roger Härtl, MD.

Dr. Härtl, of Och Spine at NewYork-Presbyterian Weill Cornell Medical Center in New York City, discussed the progress in Tanzania and the healthcare landscape in the state. 

Note: This conversation was lightly edited for clarity.

Question: What are you most proud of from this last year?

Dr. Roger Härtl: I was elected as a member of the ​​American Academy of Neurological Surgery, which was very nice. Personally, that was a big honor for me. But what I'm really most proud of is  the fellows and residents that we've been training now, both here and in Tanzania, where we have a training program that we're supporting. Our program focuses on training and education in minimally invasive spine surgery and clinical and basic science research, and also in global neurosurgery. That encompasses the clinical spine fellowship at Weill Cornell and New York Presbyterian Spine in New York City, and our research program there.

Q: How has it been working with surgeons in Tanzania? What kinds of spine surgery opportunities excite them most?

RH: The work that we do in Tanzania really consists of fellowships that are going back and forth. We have a fully trained neurosurgeon who is in Tanzania currently — Magalie Cadieux, MD. She's originally from Canada, and she did a spine fellowship at Saint Louis. She participates in training and teaching of neurosurgeons locally in Tanzania. That has been incredibly gratifying and successful for me personally to watch that program evolve. 

Then we have fellows from Tanzania who come to New York as observers. Recently we had an intraoperative monitoring specialist who came from Tanzania to New York to learn how to do intraoperative neurophysiological monitoring, and they went back to Tanzania. We were able to donate an intraoperative neuromonitoring system for the hospital in Tanzania, and they're using that now successfully.

Q: What strategies have you guys or have you all used to help surgeons learn these new techniques and technologies quickly so then they can bring it to their home countries?

RH: I've been doing this for almost 15 years in Tanzania, and there has been a real learning process. You have to be very careful. Originally we would bring a lot of equipment over and like ventilators, operating room tables, drills and all types of fancy equipment. But what we saw was that it would break down and then it was not usable. Basically it was wasted. 

So for the next 10 years, I stopped bringing over any equipment, and we focused on teaching and training. That involves these fellowships, and it's only now more recently that we started bringing again equipment like this monitoring system. The only reason I did that was because I knew that there was a real need and interest from the Tanzanian surgeons. 

I'm very careful now with equipment because you have to make sure that it's being maintained. A company donated a navigation system for spine surgery, and we already evaluated the technology, taught it locally and made sure that there's a program in place to support things in case something breaks down. I only bring things there if I have a program in place to fix it.

Q: What is surgeon adoption for endoscopic spine and total disc replacement like in Tanzania? 

RH: It's non-existent. But the Tanzanian surgeons are very good with cranial endoscopy. They use cranial endoscopy a lot. So they're used to using the endoscope but not in the spine. So one of my one of my goals is to try to introduce them to spinal endoscopy because I think that there's a huge potential there.

Q: What else are you looking forward to in 2024?

RH: The things I'm working on and that I'm excited about are in minimally invasive surgery. We've done a lot of work using expandable technology like interbody cages and expandable technology for the lumbar spine. I'm working on improving the design of these cages, and I'm excited about that because I think it's going to really help us achieve better results with minimal invasive surgery in terms of lordosis restoration in the lumbar spine with minimal invasive approaches. 

The other technology that I'm very involved with and I'm very excited about is augmented reality for minimally invasive spine surgery to improve the workflow and efficiency of these procedures. The third thing is biologics. We're working on an annular repair using tissue-engineered collagen and riboflavin. We have a patented technology that we want to get into clinical trials, and we're working with the FDA to hopefully get this done over the next few years. 

Q: What other healthcare trends are you following closely?

RH: I've been following the whole situation with reimbursement for spine procedures. There's also a tremendous variation regionally. I practice in New York, and the situation here in terms of out-of-network and insurance is very different from from other parts of the country, which is quite interesting. 

I'm also following New York's big health care systems such as Northwell, NYU and Mount Sinai. It's interesting to see the shift in how neurosurgeons and spine surgeons practice. They're mainly part of large health care networks now rather than private practice, especially in New York City, and it's interesting how that changes the landscape. 

The other thing that I'm obviously consumed by is integration with Och Spine, which is really the spine program now at New York Presbyterian Hospital. It's something that we've been working on now for a number of years — the integration of the spine surgery programs at Cornell and Columbia under Och Spine. It's the integration of the multidisciplinary spine services, and what that means is high quality, concierge service care for patients and multidisciplinary spine care wherever possible. 

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