6 surgeons on the most exciting trends in spine: Expandable cages, outcomes data & more


Six spine surgeons discuss the trends that most excite them in the field.

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 do you think of the NBA's decision to return to play in Orlando?

Please send responses to Alan Condon at acondon@beckershealthcare.com by 5 p.m. CDT Wednesday, Aug. 5.

Note: The following responses were lightly edited for style and clarity.

Question: What is one trend that excites you as a spine surgeon?

Noam Stadlan, MD. NorthShore Neurological Institute (Evanston, Ill.): The trend that excites me is one that sounds extremely boring: data and outcomes. However, in order to better serve our patients, we need better and more detailed data collection on common conditions and outcomes, so we can more expertly tailor our treatments to fit the patient and their particular problem. Better data, utilized properly, will lead to better outcomes.

Richard Kube, MD. Prairie Spine (Peoria, Ill.): Though outpatient spine is not new to anyone reading this subscription, I continue to be excited by the increasing numbers of patients, payers and employers who have come to realize spine can be done in an outpatient setting and can be done at incredible value for the consumer. Having done outpatient spine for over a decade without any location-related complications, it is very hard to argue issues of safety. This is only amplified when considering the generally higher infection rates at large institutions as well as patient satisfaction.  

Now that we are able to show outcomes spanning that time frame, we are also compiling cost data. Over the last one to two years, we have found that we save the average self-funded, self-insured employer about $80,000 per spine surgery. We have saved on average $80,000 per spine surgery we have done in our all-inclusive bundles for self-funded self-insured employers. That is money that goes straight to their bottom line, which translates into more jobs, increased wages, increased investment into the company and greater earnings for the employer. Those resources are then invested into the local communities and economies by all of the aforementioned stakeholders. It provides another pathway for employers to maintain high quality health benefits for their employees and themselves.

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): I am excited about the new technologies being implemented in the field of spine surgery that will lead to better patient outcomes, faster recovery and lower chance of complications. These technologies that enable minimally invasive spine surgery, robotic assisted surgery, computer navigation and augmented reality bring with them extra costs. The financial savings associated with minimally invasive spine surgery result in faster recovery and return to work and function, shorter hospitalization or even avoiding an admission altogether, lower chance of complications or need for revision surgery will more than compensate for such extra expenses. Once the technologies are widely implemented, the costs will inevitably go down while we continue to provide the best and most innovative care for our patients.  

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: The increasing minimization of surgical techniques and the development of great expandable devices really piques my interest. I am finding myself using expandable cages more and more as they really help avoid making more "flat back" patients. It is reassuring when instead of doing five-level fusions, you can focus on one level, correlate with the patient symptoms and films, do a really good job and give them lasting relief.

John Liu, MD. USC Spine Center (Los Angeles): The continued changes and dynamics of spine care and surgery in general is what's exciting about spine care. What we are doing today is very different compared to when I first started, primarily based on our increased knowledge and technical advancements. The next five years will continue to bring exciting developments in regenerative medicine that will help alter how we take care of spinal cord injury and degenerative spine disease.  

Issada Thongtrangan, MD. Microspine (Phoenix): Outpatient spine surgery, endoscopic spine surgery and motion preservation are the most exciting trends for me. The advanced technologies of endoscopic spine are evolving to the point that this can be done in an outpatient center. We can incorporate nonfusion and even fusion techniques with the endoscopic technique. In Asia and Europe, there are several studies showing comparable outcomes on endoscopic lumbar fusion utilizing expandable cages and endoscopic tools. Cervical disc replacement is also gaining more popularity.

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