5 emerging trends spine surgeons must monitor


A number of trends are expected to gain momentum in spine surgery in the coming years, such as the growth of minimally invasive procedures and technologies, shifting hospital strategies and site-of care changes.

Five trends spine surgeons should prepare for, according to physicians:

1. More multilevel disc replacements and fusions will be performed in the outpatient setting.

More surgeons will adopt multilevel anterior discectomy and fusions and cervical disc replacements and lumbar fusions in the outpatient setting.

"There will be continued pressure for more surgeons to adopt this trend," according to Kiran Alluri, MD, of University of Southern California Spine Center in Los Angeles. "This is in large part going to be driven by efforts to contain healthcare costs. Some studies have demonstrated that outpatient surgery can decrease the cost of a given procedure by 30 to 60 percent, and in some cases 90 percent compared to inpatient cases. Furthermore, CMS is phasing out more than 60 inpatient-only spine codes by 2024, which will likely further contribute to the increase in outpatient spine surgery."

2. Artificial intelligence will become another tool in spine surgeons' arsenals.

AI technologies are in their infancy in healthcare, but researchers are exploring how AI and machine-learning-based platforms can predict certain outcomes in spine surgery.

"In terms of deformity surgery, these are large surgeries that we perform for certain patients who are in dire straits," Saad Chaudhary, MD, of New York City-based Mount Sinai, told Becker's. "We don't want to undertake these larger surgeries without really being granular in guiding our patients about what to expect and how to achieve those corrections intraoperatively. When we place all these parameters about patients such as their disease status, their bone quality, their specifics and spine needs into an algorithm which uses AI technology, we hope we can better predict and better effectuate a good, effective treatment option for them."

3. Demand will increase for endoscopic spine surgery.

Over the next decade, spine surgery is expected to continue its path toward more minimally invasive approaches to care. Endoscopic spine surgery is largely touted as the least invasive option currently available in spine surgery, but its widespread adoption has been limited by a lack of reimbursement and training programs. But these drawbacks could be eliminated in the coming years as more hospitals and ASCs look to make long-term surgical investments that have been shown to deliver quality outcomes in the outpatient setting.

"Endoscopic spine surgery, which I would consider is ultra-minimally invasive, is going to become the preferred and a better alternative choice for patients who not only require decompression, but even more importantly, save many patients from having fusion done," Hooman Melamed, MD, of Hoag Orthopedic Institute Surgery Center-Marina del Rey (Calif.), told Becker's. "You are preserving most of the normal anatomy with very minimal blood loss, much lower risk of infection and way faster recovery. Most importantly, you're not burning any bridges with this approach. These surgeries all can be done outpatient, and most of them [are] going home the same day."

4. Hospitals will fight to remain competitive in spine surgery.

Hospitals will adopt new strategies and partnerships as spine surgeries continue to migrate outpatient.

"Hospitals will continue to do spine surgery with a different mix of patients. Sicker and more complex cases will stay in the hospital. Cases that require more complex instrumentation will continue to be performed in the inpatient setting," Alok Sharan, MD, of East Brunswick, N.J.-based NJ Spine and Wellness, told Becker's. "Progressive hospitals will partner with ASCs to develop combined programs. Currently, there are many joint ventures between ASCs and hospitals. In the future, hospitals should look to develop outpatient-focused factories — ASCs that perform either spine surgery or joint replacements very well. These focused factories should be connected to a disease-specific center of excellence. For example, a spine center connected to an ASC focused on spine surgery."

5. Augmented reality technologies will become more prominent.

As outpatient migration continues, it will be critical for ASCs to invest in navigation systems that allow for more complex spine surgeries to be done in the ambulatory environment. Augmented reality continues to pick up steam, with spine surgeons seeing the technology being of particular use to smaller ASC operating rooms as well as for training and educating surgeons.

"Given the significant capital expenses associated with spinal robotics, making them largely cost-prohibitive in ASCs, the far more manageable cost of the AR system I am currently using makes it ideal for ASC fusion procedures," said Frank Phillips, MD, of Chicago-based Midwest Orthopaedics at Rush. "As AR evolves, it could play an increasing role in surgical planning and providing virtual guidance intraoperatively as to how our surgical execution [for example, deformity correction] is matching preoperative goals."

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