4 spine surgeons weigh the decision to try new surgical technology

Carly Behm -   Print  |

The choice to adopt surgical technology isn't taken lightly among spine surgeons. While surgical robots can improve efficiency and safety, surgeons also have to evaluate factors including cost-effectiveness and patient outcomes.

Four spine surgeons told Becker's Spine Review how they weigh that decision.

Note: Responses were edited for style.

Question: What are key considerations when trying new surgical technology in your practice?

Kern Singh, MD. Midwest Orthopaedics at Rush (Chicago): As the pace of technological progress hastens, new advances in surgical technology offer the promise to improve the quality of care we can offer to our patients while concurrently improving surgeon workflow. With limited bandwidth and many potential technologies to evaluate, innovative technologies present both an opportunity and a threat for surgical practices. When considering new technology for integration into your spine practice, caution is critical and slow integration must be employed in order to ensure safety and efficacy. First, any innovation being considered must demonstrate substantial clinical benefit to the patient, with improved surgeon experience and workflow being considered only after patient benefit is established. After the technology demonstrates a strong safety profile and clear positive impact on clinical outcomes, it must then be considered for its effect on the efficiency and convenience of the surgeon and finally on its long-term cost effectiveness. If a new advancement in surgical technology can offer improvements in patient outcomes, surgeon workflows and long-term cost-effectiveness it’s likely that I will adopt it in my spine practice.

John O'Toole, MD. Rush University Medical Center (Chicago): The key aspects in evaluating the utility of new technology in surgical practice are whether the technology:

1) addresses a true unmet clinical need,
2) engenders a clear improvement in patient outcomes or safety,
3) enhances surgical efficiency or occupational safety and
4) manages to accomplish any of the above without an undue increase in overall costs (or ideally does so with cost-savings).

The enticement of using new surgical devices and tools in the operating room ultimately has to be balanced by an assessment of their actual value through early and active clinical research.

Domagoj Coric, MD. Carolina Neurosurgery & Spine Associates (Charlotte, N.C.): Evaluation of new surgical technologies has certainly become more complicated and sophisticated in recent years. The first and most important question that needs to be addressed is: How will this technology benefit my patients? Is it a better version of an existing product? Such as an upgrade to an existing core product, e.g. pedicle screws or anterior cervical instrumentation. Or is it genuinely novel? Such as a new arthroplasty device or MIS indication. Is there an evidence basis for the superiority of this new product? Is it compared to a standard-of-care device in an Investigational Device Exemption trial? Or is its regulatory approval based on a similar, predicate device (510k approval)? Second, does the new product offer value? If it is more expensive (as new technologies typically are), is there a justification for the increased cost based on patient benefit? Is it easier to use, saving OR time? Is it less invasive, decreasing patient morbidity or hospital length of stay? Does it offer a unique advantage, such as a motion-preserving or expandable device?

Another consideration involves the hospital-physician relationship. Does the new technology fall in the hospital’s capital equipment budget? Does the hospital have a limited number of preferred vendors? If so, does the new device fit into the hospital contract grid? Does the new device offer an ability to standardize care and decrease variability among spine surgeons, such as the widespread adoption of intraoperative navigation? Does this technology set the stage for future advancements, such as an investment into a robotics platform? Does it offer a technological advancement that can be used as a marketing advantage?

Finally, each surgeon needs to ask themselves how a new technique or device complements their individual practice. What is the learning curve? Does it involve a novel approach requiring time spent in training or a cadaver lab? Does it address a common pathology seen in my patient population? Or is it a niche product that is only applicable to a small percentage of my practice population? Bottom line, every surgeon cannot evaluate every new device. The costs of new technology, in both time and money, must be balanced by the benefits to the patient and each individual surgeons’ skill set.

Issada Thongtrangan, MD. Microspine (Scottsdale, Ariz.): Advanced technology is evolving all the time. I always compare the new technique to the current techniques in all aspects, 360 degrees. How do the new technologies help the patients? How do the technologies help the surgeons? How do the technologies help the facilities? Any unbiased data or outcomes? What is the bail-out if it fails? I need to learn all the tips and tricks with new technologies. Going to the workshop and talking to experienced surgeons are always helpful. Troubleshooting when things are not going as planned is essential with all these new technologies.


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