How the pandemic is changing spine surgery: 5 surgeon insights


From the acceleration of outpatient migration to the increasing popularity of certain spinal approaches, five spine surgeons discuss how the COVID-19 pandemic has altered the field:

Note: Responses have been lightly edited for clarity.

Greg Gullung, MD. OrthoAlabama (Birmingham): Medicine in general has always had a tradition of cooperation and sharing of information, and I think this must continue now and in the future. Due to the current medical climate, many practices are forced to evaluate daily operations with a more business-minded approach, but we must remember to continue sharing knowledge, tips and personal assistance to colleagues locally and internationally. This way the maximum number of patients can have access to the highest quality of care. One must also be open to taking on extra patient care responsibility; be it clinical, emergency or consultations, given the probability that physician availability may be limited during the current crisis.

Daniel Lieberman, MD. Phoenix Spine & Joint: Due to COVID, we are seeing more patients having spinal fusions in the ASC, as many of them are not willing to go to the hospital. In the past, a patient and surgeon may have opted to do the procedure at the hospital. Now, we're seeing the opposite. Patients are telling surgeons that they will not have their procedure done at a hospital. Similarly, surgeons are recalibrating risks for ASCs, because the risk of going to the hospital is higher. 

We're seeing rapid growth in the number of surgeons who want to operate primarily in an ambulatory setting. We initially thought the transition to the ASC environment was going to take place over the next five to 10 years, but now I think it's going to over the next one to five years. 

Jeffrey Cantor, MD. Cantor Spine Institute (Fort Lauderdale, Fla.): COVID-19 gave one gift to spine surgeons that is desperately needed and never available — time. Time to think. Time to critically look at our processes, both nonsurgical and surgical. Time to review our cases, digest data and understand what we are doing well, and more importantly, what we are not. Time to develop ways to better help our patients. 

Raymond Gardocki, MD. Vanderbilt University Medical Center (Nashville, Tenn.): Since COVID, I've been doing almost all my lumbar surgeries, such as decompressions and discectomies, as an awake procedure. That was one of the benefits of COVID. It minimizes the anesthesia complications, such as nausea, sore throats and urinary retention, especially for elderly patients. As a surgeon, we kind of just accept the complications that can be associated with general anesthesia, because you might think "what other options are there?" That's where awake surgery comes in, but you have to do the surgery in a way that's not very painful or invasive for the patient. 

James Lynch, MD. SpineNevada (Reno): COVID-19 has really revolutionized telemedicine. There were so many barriers to it in the past. Patients were not all that into it. There were also concerns about data sharing, regulations, cost and payments. But CMS really came in and changed [telemedicine] entirely. Patient adoption has been huge. We did telemedicine over five years ago. It cost over $10,000 to reach out to remote areas in Nevada; now you can do it on an iPhone or an iPad with no added cost.

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