The need for minimally invasive spine procedures is boosting the demand for ASCs, with endoscopic spine surgery a prime procedure for the outpatient setting due to its lower risk of complications, reduced blood loss, smaller incisions and faster recovery time.
Here, five surgeons discuss benefits of endoscopic approaches to spine surgery and how the procedure is likely to grow in the outpatient setting:
Kenneth Nwosu, MD. Neospine (Puyallup, Wash.): I see endoscopic spine surgery becoming the standard of care for spinal decompression. We will be able to perform a decompressive surgery through an incision less than 1 centimeter safely and as effectively as open spine surgery. It's a no-brainer. In my perspective, I see that being a standard of care for most providers, and I think that will be the expectation by payers and patients as well.
Peter Derman, MD. Texas Back Institute (Plano): One of the cool things about endoscopic procedures is it's allowed me to do decompressions on many different patients who would have traditionally obtained a fusion. You can sometimes decompress transforaminally even to the center of the canal without destabilizing the segment in any way. As our disc replacement devices improve, and our ability to decompress without destabilizing improves, we're going to see more and more of a trend away from fusion as a treatment paradigm.
Daniel Lieberman, MD. Phoenix Spine & Joint: Over the last five years we've seen real energy pulling away from deformity correction and multilevel fusion surgery, and the entire field of spine surgery moving into much more focused interventions based on structure. I think the next horizon is focused interventions based on symptoms. What patients really are concerned about is their pain. Our surgery centers offer endoscopic dorsal rhizotomy, so ultra-minimally invasive surgeries that eliminate pain are really the next horizon. It's almost like we're going to see spine surgery absorb and move into more of a pain management approach, rather than a structural correction approach.
Brian Gantwerker, MD. Craniospinal Center of Los Angeles: We are looking forward to the purchase of an endoscopic surgery system for the ASC setting. It would be wonderful to recruit patients from other places to a center of endoscopic spine excellence. As more patients realize its benefits and legitimacy as a procedure, the more patients will be looking for someone to perform it.
Saqib Hasan, MD. Webster Orthopedics (Oakland, Calif.): I think the migration to endoscopic procedures is just one component of the larger shift to the outpatient setting. This move is largely facilitated by more surgeons utilizing minimally invasive techniques and leveraging technologies to provide reliable outcomes and faster postoperative recovery. However, most simple decompression surgeries are typically already done as outpatient procedures. The move toward endoscopic spine surgery is more intuitive — if you can utilize a 7mm camera to achieve equivalent or superior outcomes compared to current standard techniques, the question becomes, "Why wouldn't I use endoscopic techniques?"