Gerald Schell, MD, of Saginaw (Mich.) Valley Neurosurgery discusses lateral spine surgery and where it's headed in the future.
Q: How does the Zeuss-O OLLIF procedure differ from other minimally invasive spine surgery techniques?
Dr. Gerald Schell: The Zeus-O OLLIF is done with very little tissue damage. The standard surgeries or interbody fusions require a large incision, removal of major facet joints and a lot of scarring around the nerves, which makes it difficult to send the patient home that day. The OLLIF procedure allows for a pathway where the interbody part of the procedure, which is in front of the spinal canal, can be done laterally. It doesn't require the removal of any bone, there is very little trauma to any tissues and the work is pretty much done directly to the pathology.
Q: What about the procedure makes it ideal for the outpatient setting?
GS: It's idea for the ambulatory surgery setting because you don't have the risks you have with other surgical techniques. You can perform major reconstructive procedures on spinal conditions with little destruction and repair the anatomy so it's similar to the normal, pre-disease condition.
Q: What advantages are there for patients to perform spine surgery in the ASC?
GS: One of the advantages for patients is the anesthetic time is much less because the surgical procedure doesn't involve cutting or retracting tissue. There is less time in surgery, less blood loss and less risk. The other obvious advantage to the outpatient setting is it's much cheaper than the hospital.
Q: Where do you see the most opportunity for outpatient spine surgery to grow and develop in the future?
GS: I think the opportunity is in the cost of medicine. Right now, it seems like the major increases in cost are hospital costs for procedures including spine surgery. I am currently able to do 80 percent of my major spinal surgeries in an ASC. If 80 percent of all spine surgeries could be done in outpatient surgery centers, I think it would be huge for the country that is currently being brutalized by the cost of healthcare and spine care.
The timing is perfect for this type of procedure to come with the crisis in the cost of care.
Q: Many surgeons are considering the adoption of new spine surgeries and minimally invasive techniques in to their practices. Do you have any tips for them?
GS: Basically, there should be training with experienced doctors and observe experienced physicians. For their first few procedures, make sure they have access to their teaching physician to ask any questions that come up while evaluating the patient and what would come up during the patient's evaluation. They need to know which patients are good candidates for the procedure and which should avoid surgery.
Have an available physician to talk to during the procedure if something comes up. They want to feel open to discuss their patients with those who have done the procedure before and review any issues that may arise.
Having been a busy spine surgeon for the last 25 years and now doing these procedures for about 10 years, in my mind the absolutely best way for spine surgery to be done is with minimally invasive techniques in the outpatient setting. Performing cases at the ASC with the right technique and the right context is the future of spine surgery in our country.