Robotics, endoscopy and artificial discs: What spine practices are implementing this year

Practice Management

Endoscopic spine surgery, enhanced recovery after surgery protocols and robotic platforms are among the procedures and technologies that spine surgeons across the country are integrating into their practice this year.

Six spine surgeons and two physical medicine and rehabilitation specialists discuss what procedures, protocols and technologies they plan to implement in 2022.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.

Next week's question: How do you anticipate management service organizations and private equity groups affecting consolidation among orthopedic practices in the coming years?

Please send responses to Alan Condon at by 5 p.m. CST Wednesday, Feb. 9.

Editor's note: The following responses were lightly edited for style and clarity.

Question: What procedures, protocols or devices are you considering implementing this year?

Roy Vingan, MD. New Jersey Brain and Spine (Oradell): As we are awaiting our primary hospital's purchase of a comprehensive robotic and low-dose radiation imaging and integrated navigation system, I expect we will see a significant utilization of these technologies in the near future. We have also been active in the use of cervical disc replacement since 2007. As already strong advocates, we are expanding the use of disc arthroplasty as confidence grows with outcomes, especially with more advanced spondylitic cases.  

Richard Menger, MD. USA Health (Mobile, Ala.): I want to become comfortable with endoscopic posterior cervical work. I think that would be a great asset to provide to my patients who are indicated for posterior foraminotomies. Our generation (I graduated residency in 2018) has had tremendous anterior surgical exposure and posterior fusion based-work. I think this would be a great opportunity to better serve my patients by adapting new enabling, safe technology with a tried-and-true surgical procedure. This would be a great complementary addition to our work with our [Enhanced Recovery after Surgery] team and our movement from large opioid utilization.

Todd Lanman, MD. Lanman Spinal Neurosurgery and the Advanced Disc Replacement Spinal Restoration Center (Beverly Hills, Calif.): We are implementing a new procedure for inserting artificial lumbar discs as part of a new clinical trial by the FDA. This unique device, called Balanced Back, is placed through the back instead of the front of the abdomen. Through a midline incision in the mid-back, spine joints are removed, as well as the sides of each disc. Then we insert two pieces of the artificial disc from each side. I am the principal investigator on the trial, which is for the entire West Coast at this point. The Balanced Back can be placed at multiple levels, from the upper to lower lumbar levels, and does not require the anterior abdominal approach. We anticipate great outcome measures and are excited to offer this unique new device later this year.

William Taylor, MD. University of California San Diego: Our group is looking to gain approval from the Joint Commission's spine center of excellence program. This is a rigorous approval process which requires input from hospital management, cooperation between different services and the development of patient-oriented care systems. It includes the maintenance of databases, complication profiles and outcomes. We feel this is an opportunity to set our hospital and our program apart in a meaningful way.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: In 2022, we are all looking to add some new arrows to the quiver. I would like to do some robot cases and more endoscopic cases. But more importantly, I would like to do more hybrid constructs and continue to press payers on approving this helpful and demonstrably effective procedure. We have been working on adding more arthroplasty choices to my hospital and I hope to be able to give patients a full range of options for cervical and lumbar arthroplasty.  

Ali H. Mesiwala, MD. DISC Sports & Spine Center (Newport Beach, Calif.): We are a full-service spine practice, and no type of spine procedure is excluded. With that in mind, we are bringing more complex cases to the outpatient setting. This is possible due to advances in surgical techniques and complementary technologies. The other emphasis this year will be on streamlining our protocols. Standardization of pre- and postoperative education, comprehensive and clear consent processes, reduction of intraoperative variability between surgeons and adherence to recovery practices will maximize efficiencies, improve patient care and minimize waste.

Michele Perez, MD. PM&R specialist, Resurgens Orthopaedics (Atlanta): To implement the [peripheral nerve stimulation] device in my practice for patients that have failed other nonsurgical options. The PNS device is a small system implanted near the spinal column to provide pain relief using electrical stimulation. The device is removed after 60 days and many patients can have months of relief afterward. It is appropriate for patients that have failed other nonsurgical procedures and may not be surgical candidates. 

Marly Dows-Martinez, MD. PM&R specialist, Resurgens Orthopaedics (Atlanta): I am excited to start offering more neuromodulation this year. The field of interventional pain medicine is getting more and better quality evidence supporting nonsurgical interventions. Spinal cord stimulation is not only efficacious for post-laminectomy syndrome and chronic back pain, but high frequency stimulation has a new FDA approval for diabetic peripheral neuropathy, which is notoriously difficult to treat.  

I will also start offering peripheral nerve stimulation, which is an effective targeted approach for patients with definite peripheral nerve injuries or chronic joint pain, especially shoulder and knee pain. Unfortunately, peripheral nerve stimulation is still limited mainly to governmental payers, but as the data continues to be published, coverage will hopefully expand.

I am excited to offer these treatment options for our patients, especially those whose chronic pain has negatively impacted the quality of their lives. Offering nonsurgical interventions will help improve pain levels and activity levels but also help reduce dependence on medication management.

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