Biggest need for advancement is 'biologics for spinal fusion,' says Dr. Andrew Hecht

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Andrew Hecht, MD, is chief of spine surgery at New York City-based Mount Sinai Hospital and Mount Sinai Health System and professor of orthopedic and neurosurgery at the Mount Sinai Medical Center and Icahn School of Medicine.

Here, Dr. Hecht discusses key patient evaluation considerations for outpatient surgeries and future trends in spine care.

Note: Responses are lightly edited for style and content.

Question: What are your key patient evaluation considerations when performing outpatient spine surgery?

Dr. Andrew Hecht: First and foremost is the overall health of patient. The procedure must also be straightforward and simple. Lumbar microdiscectomy, single level laminectomy, cervical foraminotomy and single level anterior cervical discectomy and fusion are ideal. However, it's also necessary to have capability for overnight observation and a plan for unexpected complications.

Q: What does the future hold for spinal fusion procedures?

AH: The indications will tighten to avoid axial back pain surgery except in limited idealized cases. The techniques will continue to become less invasive and a greater understanding for the use of biologics — principally BMP — as the carriers and doses are formulated.

Q: Where do you see the biggest need for advancement in spine patient care?

AH: The biggest need for advancements are in biologics for spinal fusion and disc biology/degeneration and annular repair. I think the biggest problem facing spine surgeons is how to prevent adjacent segment degeneration.

Q: What do you see as the next big trend in spine?

AH: The next big trends in spine will be:

1. Annular repair and the field of disc biology.

2. Refinements in navigation and robotics will also increase the use of minimally invasive surgery techniques as the need for radiation exposure to the surgeon can be greatly reduced.

3. The Wild West mentality of stem cells in spine care will need to be reined in and studied carefully. The results are underwhelming with too little science and there is a rush to treatment without good evidence.

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