The best opportunities for treating aging spine patients and vertebral compression fracture: 3 Qs with Dr. Joseph Gjolaj

MIS

Joseph Gjolaj, MD, an orthopedic spine surgeon with the University of Miami Health System, discusses how he approaches vertebral compression fracture patients and where he sees the biggest opportunities for technology growth and development in the future.

Question: What percentage of your practice is vertebral compression fractures and how do you manage treatment for those patients?

Dr. Joseph Gjolaj: About 10 percent of my practice involves these types of patients who present with this being their only issue. If their symptoms are severe in the early post-fracture phase, then vertebroplasty or kyphoplasty is a viable treatment option.

About 30 percent of my patients present with compression fracture(s) co-existing with other conditions that may require surgery such as spinal deformities (scoliosis, kyphosis, spondylolisthesis) and other spinal conditions. These spinal deformity patients with diminished bone density pose a particular challenge but comprehensive preoperative assessments, individualized surgical plans with risk stratification and a multifaceted postoperative spinal rehabilitation protocol have allowed us to successfully treat these traditionally challenging patients and become a referral center for adult spinal deformity patients.

Q: How do you see spine technology evolving over the next few years? What do you think will be the biggest innovation that will stick?

JG: As our population ages, we are more commonly seeing patients with diminished bone density (osteopenia or osteoporosis) who oftentimes require surgery for symptomatic spinal conditions I've mentioned above. The technologies that allow us to treat these patients' spinal deformities and other spinal conditions in the setting of poor bone density will continue and have already begun to provide our patients a higher quality of life, when just years ago they were told they are not surgical candidates due to their osteoporosis.

These technologies include devices designed to work in conjunction with traditional vertebral augmentation procedures such as fenestrated pedicle screws and novel implants with improved compatibility to osteoporotic bone and enhanced capability for bony ingrowth.

Q: Where do you see the best two to three opportunities to improve your practice within the next few years? Will you make any strategic changes?

JG: I believe the best opportunities will be in treating our aging population with cutting edge treatments that facilitate their recovery and minimize the need for future surgeries. These opportunities to improve will exist not only with the surgical techniques and technologies, but also with the preoperative assessment tools and postoperative recovery protocols.

Image guidance and robotic surgery are helping us improve surgical precision but that alone is not enough to achieve a positive outcome. Improved clinical pathways, intraoperative efficiency initiatives and evidence-based rehabilitation protocols also contribute to expeditious recovery from spine surgery and lay the groundwork for surgical longevity. I have prioritized these three areas in my practice over the past five years with very positive results.

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