Adding a new spine procedure to a surgeon's arsenal can come with many challenges, including the learning curve, case selection, cost and reimbursement. Four spine surgeons share best practices to ensure great outcomes can be achieved right out of the gate.
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: For surgeons with little time and resources, what areas of their practice should they invest in over the next two to three years?
Please send responses to Alan Condon at firstname.lastname@example.org by 5 p.m. CST Tuesday, Dec. 22.
Note: The following responses were lightly edited for style and clarity.
Question: What are your best practices for implementing a new spine procedure?
Grant Shifflett, MD. DISC Sports & Spine Center (Newport Beach, Calif.): Implementing new procedures can be scary, but this is a necessary step on the pathway of innovation. With surgical procedures, I think you cannot overstate the value of training labs where you can practice new techniques on models, sawbones or cadavers. Make the mistakes and avoid the steepest part of the learning curve by developing comfortability when nothing is on the line. When you translate that technique to a live patient, you will have greater confidence that you can perform the procedure successfully.
Jeffrey Deckey, MD. Hoag Orthopedic Institute (Irvine, Calif.): Implementing new procedures in one's practice can be extremely exciting, but also frightening. First of all, one should educate themselves on the indications and contraindications of the new procedure. Attending a course is always helpful. Often experts will provide critical information and clinical pearls that will reduce the learning curve. A cadaver lab is always helpful, allowing hands-on experience. If possible, having a visiting expert present for your first case can be extremely valuable. Educating the OR staff is also important in order to avoid the unexpected. Selecting a relatively straightforward case for the first attempt is also a good idea. Finally, preparation and preoperative planning are the most important tools to ensure success.
Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): First and foremost, do your research. Make sure the new procedure makes scientific sense and will provide benefits to our patients above and beyond your current techniques. Make sure you clearly understand the indications and limitations of the procedure. Once you have confirmed this, determine if it is financially feasible. Does it require significant capital investment or use a lot of expensive disposables per case? Does insurance reimburse for the procedure, and if not, will you find enough cash-paying patients to make this worth purchasing the equipment? Only after those questions are satisfied, should you start the implementation. Make sure you are comfortable performing the procedure — practice in cadaver labs and observe real procedures performed by experts. Understand the "plan B, C, etc." If the procedure cannot be performed, or if a complication occurs, you must be able to handle it and have the appropriate equipment available.
All of this may sound overwhelming, and unwillingness to go through this process is what holds many surgeons back from embracing new procedures. Keep in mind that the field of spine surgery is constantly evolving, and better techniques, procedures and technology are being introduced every year. A lot of these new procedures can provide great benefits to our patients when compared to the traditional "tried and true" techniques. I would encourage every spine surgeon to keep abreast of the new and emerging procedures and embrace the ones that make sense to you to provide the greatest benefit for your patients.
Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Repetition is best for implementing a new procedure. If you are planning on adding a new surgery, such as endoscopic spine, talk to the experts and don't care if your questions are overly simple. Draw out the anatomy, read some books. Start out with straightforward cases. Do not try to create an indication for surgery. Do wait for that perfect case. Then, when you get better and more comfortable at it, you may spread your wings a little.