Dr. Alex Cruz on the 'Golden Age' of spine surgery, the lasting effects of COVID-19 on orthopedics


Advances in surgical technology have established a "Golden Age" of spine surgery, according to Alex Cruz, MD. 

Dr. Cruz is an orthopedic surgeon at Texas Orthopedics in Austin. He joined the "Becker's Healthcare Spine and Orthopedic Podcast" to discuss how far technology in spine surgery has come, the migration of orthopedic surgeries to ASCs and the lasting effect COVID-19 will have on orthopedics.

Question: What new technologies and platforms are most interesting to you?

Dr. Alex Cruz: We're kind of living in a golden age of spine surgery right now. It's a cool time to be alive. We really went from 20 years ago, where there was controversy as to whether even putting in screws was necessary for fusion procedures. Nowadays we know screw techniques, putting in implants and using X-rays is beneficial because you're putting them in safely and you know exactly where you're putting them in. But as time has gone by and as technology has evolved, we've gone through CAT scan navigation or CT navigation, [meaning] we are able to use a real-time cat scan in the operating room to really take a look at the anatomy of a patient, and we're able to place screws and any other instrumentation very safely for patients, and it minimizes the risk of any complication down the line. Now there's an advent over the last three or four years of robotics in spine surgery. Robotics is really cool because, kind of like with the Mako robot with knee surgeries, there's a Mako equivalent to spine surgeries where you really do a lot of planning at the time of surgery and you're really working with an artificially intelligent robot that's able to pinpoint and map out where screws should be placed. That's where technology has gotten us so far and that minimizes complications, makes patients happier, fewer returns to the operating room, makes operations a lot quicker and they're all done in a minimally invasive manner, which is really cool for the patients. 

Q: What movement are you seeing with orthopedic surgeries in the outpatient setting?

AC: There's been a large shift throughout the country doing surgeries from the hospital setting into the ambulatory surgical center, where patients are done essentially as an outpatient, or if not within 23-hour observations and discharge. Part of that is it saves in healthcare costs, but also we've gone to a point where these procedures that we're doing now that are similar to what we used to do before are a lot safer. They're more efficient. They're done in a way that minimizes pain in a postoperative period. So patients are able to really get home in a safe manner within 23 hours for a fusion procedure, which was unheard of 10 years ago. That's where we are going now. I think that's where my practice will end up going as well. It makes everybody happier, including patients considering it saves a substantial amount of money in healthcare costs. 

Q: What kind of lasting legacy will COVID-19 have on orthopedic and spine surgery?

AC: I hope we can get past COVID-19 and you never have to think about it again, but from the spine standpoint, we've really learned to work on pushing toward more outpatient elective procedures. People would have surgery done and you'd be in the hospital for a while. And then you're predisposed to getting COVID-19 while you're in the hospital, which was a real thing at the height of the pandemic. People being the hospital for four or five days after a large surgery, and they come in communication with healthcare providers who have been exposed with COVID-19. Patients would end up getting COVID-19, they would stay in the hospital for even longer. Having that push toward doing outpatient [procedures], that was once unheard of and unthought of. So there's been a large drive toward doing more outpatient surgeries because of COVID-19.

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