5 key questions in spine surgery: Threats, opportunities & more


From the evolution of lumbar disc replacement to the biggest threats to independent spine practices and the healthcare trend every provider should be following, five surgeons answer key questions about the future of the specialty:

Note: Responses were lightly edited for length and clarity.

Question: How do you think lumbar disc replacement will evolve?

Jack Zigler, MD. Texas Back Institute (Plano): I think that lumbar disc replacement is going to be more generally used as time goes on. The payers of the future, whoever they are, whether it's a single payer in the government or a consolidation of insurance companies or hospital systems, whoever is controlling the healthcare dollar is ultimately going to see a significant decrease in the need for expensive spinal reoperations is in the public good. Reoperation is one of the largest drivers of healthcare economics, so by cutting down the necessity for additional surgery, with the data that we've been able to generate, I think it's going to be a no-brainer for the powers who are controlling the healthcare dollar to recommend disc replacement over fusion. 

Q: Is there a danger of the next generation of spine surgeons becoming too dependent on enabling technologies?

Ehsan Jazini, MD. Virginia Spine Institute (Reston): The next generation of spine surgeons must be able to do every aspect of spine surgery without the assistance of enabling technology. The most important skill set for a spine surgeon is being able to deal with option A, B and C. And that means that the surgeon continues to refine and improve upon what option A is by using enabling technologies such as robotics and augmented reality to improve the precision of surgery, do more minimally invasive surgery to help patients recover faster with fewer complication but also always have option B and C in the back pocket. 

Q: What is the biggest threat to spine surgeons today? 

Colin Haines, MD. Virginia Spine Institute: Spine surgeons today are faced with a huge challenge to maintain the ability to care for their patients as they see fit. Too often, payers dictate care based on either archaic literature or cost-cutting measures. I am concerned that the biggest threat to our patients is that, as spine surgeons, we lose ground in appropriately treating our patients. While evidence-based medicine is a cornerstone by which we all practice, large-scale population-based medical systems often leave the patient in the dust. In ideal medical care, each of my patients needs an individualized diagnosis and treatment plan. This level of customization is lost if we plug everyone into the same treatment algorithm. Big data and unilateral decisions by payers risk further loss of control over appropriately treating our patients.

Q: Where is regenerative medicine headed in the next decade?

Randy Dryer, MD. Central Texas Spine Institute (Austin): The goal of all treatments should be the greatest benefit with least risk to patients. That would mean fewer surgeries if possible.  Regenerative medicine holds great promise but is not there yet. With any such treatment, proper dosing, safety and efficiency need to be determined in controlled prospective studies. Stem cells may not succeed if placed in too high concentration or if too few used for any given environment. This will require a longer-term study with controlled variables. Lots of basic work needs to be done. Anything less is experimenting on our patients and charging a fee that is not supported by science. 

Q: What is one healthcare trend you feel is not getting the attention it deserves?

Nicholas Grosso, MD. The Centers for Advanced Orthopaedics (Bethesda, Md.): I believe direct-to-provider contracting between employers and physician practices should be getting more attention as the cost of healthcare continues to rise. Employers are feeling this increase and have no choice but to pass costs down to employees. As recruiting and retaining talent remains a challenge across industries, employers can save by contracting directly with providers, which will be more attractive to employees.

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