Seven spine and neurosurgeons discuss the area of spine with the biggest need for advancement in patient care.
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. We invite all spine surgeon and specialist responses.
Next week's question: What advice do you have for young physicians considering a career in spine?
Please send responses to Alan Condon at firstname.lastname@example.org by Wednesday, August 28, 5 p.m. CST.
Note: The following responses were edited for length and clarity.
Question: Where do you see the biggest need for advancement in spine patient care?
Plas James, MD. Atlanta Spine Institute: The biggest hurdle for spine care in general, including most specialties, is being able to get approval for tests and surgery. We need to find a way to eliminate the approval/review bottleneck that occurs every time a patient has a test. Approvals/reviews should be done randomly, not every patient. It's a lot of wasted healthcare dollars. I think getting direct access for tests is the best thing for surgery and medicine. There is too much bureaucracy in unnecessary places.
Scott Russo, MD. Orthopaedic Associates of Michigan (Grand Rapids): Spine surgeons and nonoperative spine specialists are often focused on the problem at hand and miss the opportunity to enhance a patient's health in a holistic manner. What I mean is using rehab services to strengthen a patient's general physiology as well as treat their musculoskeletal condition. To leverage surgery to help patients quit smoking. Dietary programs to promote weight loss. Mindfulness programs to control anxiety. All this to improve surgical outcomes. And with the movement towards shared savings this makes great sense. This is the process of prehabilitation.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Spine patient care needs to move towards demand for more accurate outcomes. Even though as spine specialists — where every surgery and patient have their own nuances — payers and patients will want to know how good we are. Eventually, we will all come to share our data and special sauce for good outcomes. I think therefore the biggest need is for collaboration. Joining together and doing better together is the only way we can fight for our patients and for our control over their care. We need to support helpful, pro-patient organizations and abandon any notion or delusion that payers or hospital administrators know or care about patients or their outcomes. So, the second biggest need is to be tough. Once we abdicate responsibility and practice learned helplessness, then we lose the ability to protect our patients and ourselves.
Mark M. Mikhael, MD. Spine Surgeon at NorthShore Orthopaedic & Spine Institute and Illinois Bone & Joint Institute (Chicago & Glenview, Ill.): Value-based care. Insurance carriers are focused on value, efficiencies and the prevention of complications when it comes to patient care. Spine surgeons need to keep moving forward in that direction to see further advancements. Because we have established standardized protocols and efficiencies, patients are leaving the hospital sooner and recovering faster, and that is leading to value in patient care. We are getting patients out of the "sick state" and back to a normal life quicker, which usually means less opioid use and fewer readmissions. Many people think advancement means implementing more technology, but that's not the case. Making patient care better starts with streamlining the process, so patients spend less time in the hospital and more time at home recovering.
Issada Thongtrangan, MD. Microspine (Phoenix): We still have no great treatments for spinal cord injury and chronic low back pain. Advancement in stem cells will be a breakthrough treatment for those with devastating conditions. It will definitely need more research, clinical data and investments in both private and federal sectors.
Andrew Cordover, MD. Andrews Sports Medicine & Orthopaedic Center (Birmingham, Ala.): We must continue outcomes research and evaluate predictors of outcomes. Additionally, we need to keep assessing the outcomes metrics we use, so we will responsibly spend our healthcare dollars.
Kevin Pauza, MD. Founder of Texas Spine and Joint Hospital (Tyler): Although I live and work in a "spine surgery environment" after founding the Texas Spine and Joint Hospital, admittedly research outcomes and patient driven trends are quickly directing care towards biologics offered in ASCs. Physicians offering only minimally invasive disc replacements and fusions (no matter how minimally invasive) will be left behind, because pain’s true origin is chemical, not mechanical. Even in my “spine surgery environment,” patients travel from around the world for biologic treatmentsto avoid surgery because spine surgery — no matter how small — potentially causes iatrogenic disc breakdown. Therefore, the future of spine is biologic disc restoration.
Spine biologics are three types: (1) stem cells, with or without scaffolding, from EmCyte and others; (2) disc sealants, such the Discseel procedure, using fibrin to seal annular defects, whether they’re iatrogenic or natural, while stimulating disc tissue growth,and; (3) miscellaneous biologics such as growth factors, and anti-inflammatory molecules including A2-M.
Surgeons will routinely: (1) decompress herniated discs with minimally invasive surgery; (2) immediately seal resultant surgical defects with the Discseel Procedure; and (3) introduce miscellaneous growth or antiinflammatory constituents into sealed discs to optimize disc healing.
Spine’s treatment’s future excites me. especially with patients and logic directing thought leaders towardsdisc biologics.