What the new president of ISASS thinks about spine care accessibility, outpatient migration & more

Carly Behm -  

Domagoj Coric, MD, a spinal neurosurgeon at Carolina Neurosurgery and Spine Associates in Charlotte, N.C., has a unique position leading the International Society for the Advancement of Spine Surgery.

The organization has a global reach with 20 percent international membership and 80 percent U.S. membership. While the society focuses on spine surgery, it also draws membership from neurosurgeons and orthopedic surgeons.

Dr. Coric, who was named the president of ISASS in June, spoke with Becker's Spine Review about his plans for the organization, the most pressing issues for members and his outlook on spine surgery.

Note: This conversion was edited for style and length.

Question: How have things been since you were named president?

Dr. Domagoj Coric: It's kind of been an interesting year because of COVID-19 last year. Our annual meeting in 2020 was actually one of the final meetings there was before COVID-19 kicked in. Obviously 2020 was kind of an odd year, and we had to push our meeting back to June in Miami, and that's when I became president. It was one of the first meetings back for me and for a lot of people in person, so that was unique.

One of the things that we sought to do was build bridges between orthopedic, neurosurgeons and spine surgeons. So that's been one of my big pushes. It's serendipitous that I also chair this year of the double ASA joint session on spine and peripheral nerves, which is the biggest neuro spine society. So I'm trying to take those two hats and get neurosurgeons and orthopedic surgeons on the same page moving forward.

Q: What are some of the other goals you hope to achieve as president of ISASS?

DC: One of the important things is getting spine, orthopedic and neurosurgeons on the same page. That's important because in this day and age of limited resources there's a little bit of a movement afoot to devalue surgical services and in favor of primary care services or non-procedure based specialties. That's difficult because the healthcare pie is only so big, and everybody deserves to get a slice. And having said that, surgery is life changing for people, sometimes literally life saving. But it's important to maintain the access of patients to specialty services like spine surgery.

Within that, there is constantly a fight to make technologies available to serve patients like minimally invasive technologies and motion preserving technologies, cutting-edge technologies. One of our big goals is to get surgeons on the same page, but at the same time continuing to be able to offer those specialty services to patients to allow them to have access to cutting-edge technologies and state-of-the-art technologies.

Q: What spine technologies do you believe need to be more accessible to patients?

DC: In general, you want to have access to specialty care. As an example, you can consider motion preserving technologies or arthroplasty in the spine. The cervical artificial disc has by and large become pretty accepted.

For the lumbar artificial disc and lumbar motion-preserving technologies, even though there's regulatory approval, there's still insurance companies that put constraints on the access of patients to those types of technologies. Insurance companies more and more are making it harder for patients to gain access to the technologies they need in terms of high copays or not approving things that are FDA approved.

The lumbar artificial disc has been FDA approved since 2003, yet most insurance companies continue to consider it an "investigational product," which is a little bit mystifying. With new technologies that are coming down the pike, there are always new concepts of disc repair with just stem cells or new arthroplasty approaches and devices. So we want to maintain an ability for patients to have access to those devices as long as there's an evidence basis for their efficacy and outcomes that show they're safe for patients.

Q: What are ISASS members most concerned about?


DC: ISASS is a little bit of a unique society because it's a mixed specialty society, and it's also an international society. That's one of the things that I actually like about it. It appeals to both international and American surgeons. We have a good base in the Pacific Rim and South Asia Pacific area, and we are in Europe as well as the United States.

So there are different concerns for different surgeons in the United States. A lot of the U.S. members are involved with advocacy for dealing with coding and reimbursement. But outside the U.S., surgeons aren't as concerned about that. They're more concerned with staying up to date with the latest technologies. There's a big push for endoscopy in the Asia Pacific region, and we want to be able to let our members know what's going on over there and keep everyone on the same page in terms of emerging technologies, minimally invasive technologies, and what is safe and efficacious for our patients. So we both have a lot to learn about us and us surgeons, and that's why I like the fact that society is a big society.

Q: What do you think spine surgeons will need to thrive in the outpatient setting?

DC: There's no question there is a move towards ambulatory centers in spine surgery and surgery in general. We've been involved with cervical artificial disc studies since they started. We're currently doing a study of a newer artificial disc compared to another artificial disc. It's a disc on disc trial as opposed to most of the initial trials, and for the last three sets of trials that we've done, every one of those were done as an outpatient setting.

It really becomes a win-win-win situation. It's a win for the healthcare dollar because the cost of doing those procedures in the outpatient centers is anywhere from 40 to 60 percent less than it would be to do that in a hospital. It's a win for surgeons because the patients are happy. That's the biggest one. Patients like to be in the ambulatory setting. They like to go home and not be in the hospital, especially with the specter of COVID-19 still hanging over us. So being able to do all the spine surgery that we can safely and efficaciously do in the outpatient centers. So that is something that we're also committed to doing.

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