Dr. Zeeshan Sardar: Key thoughts on disc replacements and the double-edged sword of value-based care in spine


Zeeshan Sardar, MD, is an orthopedic surgeon specializing in spine at NewYork-Presbyterian Och Spine Hospital in New York City.

Dr. Sardar discusses artificial disc replacements in spine, what technology he is most excited about and more.

To participate in future Becker's Q&As, contact Alan Condon at acondon@beckershealthcare.com.

Question: Can you tell me about one procedure that stands out in your career? What was particularly challenging and how did you overcome it?

Dr. Zeeshan Sardar: Artificial disc replacements have been a great addition to the armamentarium of a spine surgeon. Patients do really well with this procedure. However, like any technology the success of this procedure depends on appropriate patient selection, appropriate surgical indications, the surgeon’s skills, and perfect execution of the surgery. The biggest challenge to a good outcome is selecting the right patients and addressing the right problem. You overcome these challenges with experience and with continued improvement by learning from every surgery. The key to success is to practice perfect techniques every time.

Q: What technology are you most excited about in spine now? Is there anything that you see as particularly innovative?

ZS: Robotic technology in spine is a very exciting innovation. Its biggest advantage will be to reduce the variability in the placement of spinal instrumentation across different surgeons. It definitely helps some surgeons more than the others but overall it helps the patients in getting more predictably safe surgeries. In the future it will likely allow us to even carry out procedures like decompressions more precisely and through smaller incisions.

Q:  Have you any thoughts on how to tackle the current opioid epidemic?

ZS: We need participation from everyone to tackle a problem as complex as the current opioid epidemic. The responsibility must be shared by physicians, patients, researchers, pharmaceutical companies, legislators and even the general public. Most acute pain conditions do not require opioid medications or require a very short duration of these medications. 

As physicians, our role should be to appropriately diagnose and treat the patient while understanding the risks of prescribing opioid medications. Taking the time to listen to the patient and examine the patient and carry out the right investigations can help significantly in finding the cause of the pain. Once the cause of the pain is identified we can perform targeted treatment to address the problem instead of using opioid medications to mask the pain. I also focus a lot on multimodal pain management in my practice to address the pain from different perspectives and maximize the improvement potential. While most patients do not require surgery, a select group of patients can greatly benefit from surgical treatment to address the pain generator and avoid dependence on opioids.

However, opioid treatment is still an important tool in the management of pain in patients with cancer, patients requiring palliative care, and patients with other significant chronic pain conditions.

Q: How do you see bundled payments, value-based care and other new payment models affecting spine?

ZS: Like most changes, such new payment models can have their pros and cons. The introduction of such models would have to be gradual. Spine surgery is quite unique due to the variability in the number of levels to be addressed during surgery and the type of surgery performed which may or may not involve the use of instrumentation. These new payment models would have to start with more homogenous procedures such as one level decompression, discectomy and ACDF. Implementation of such models may provide the opportunity to review the entire episode of care and optimize the use of resources as well as identify potential areas that require improvement. On the other hand, bundled payments could make surgeons and hospitals more wary of performing surgery on certain high risk patients.

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