'The numbers don't lie': Endoscopy to become more prominent among next generation of spine surgeons


Many physicians see endoscopic spine surgery as a key growth opportunity in the next five years, but argue the U.S. needs more endoscopic training programs and the reimbursement structure must be improved. 

Four spine surgeons told Becker's why they expect endoscopic spine surgery to become more prominent in the future:

Stewart Kerr, MD. Orthopedic Specialists of Seattle: One of the big opportunities [to grow] is going to be endoscopic spine and robotics. If I have a patient with a large thoracic disc herniated, the conventional way of treating that oftentimes requires a fairly substantial resection where you may even have to take portions of the rib head in order to access the decompression effectively.

Now we have endoscopic spine techniques that will allow us to truly do this through a more minimally invasive procedure where you're directly looking at the pathology and directly peeling that away from compressed neural structure, specifically the spinal cord. I think that can be much more safely accomplished through some of the technologies so long as the individuals that are performing have received, you know, a very, very thorough adequate training regimen and signed off to the point where they can do this safely. So I think that that's a really big opportunity that we're gonna see emerge over the next three to five years.

Saqib Hasan, MD, Golden State Orthopedics and Spine (Oakland, Calif.): Endoscopic spine surgery is already a global phenomenon and the numbers don't lie. Every year I see a steady increase in the number of publications related to endoscopic techniques and the number of surgeons utilizing endoscopic techniques. There are numerous publications highlighting high levels of adoption of these techniques across Europe and Asia. The U.S. is tricky because many of the "old guard” are resistant to change. The common debate typically revolves around cost, efficiency, learning curve and reimbursement. Interestingly, a recent randomized controlled trial from the Netherlands showed that endoscopic spine surgery may be more cost effective than open techniques when looking at quality-adjusted life years. Regardless, it is intuitive for patients to want to have a surgery performed by a miniature camera. They are already used to that idea from arthroscopic and laparoscopic surgery.

Michael Gallizzi, MD. The Steadman Clinic (Vail, Colo.): The movement of spine cases to outpatient settings will help drive this change, because [endoscopic spine surgery] is significantly less disruptive. I think quite honestly, once people know it's available, consumers are going to start demanding it.  We also need industry support. We need major players in the industry and medical device companies to really step up and start large training programs to get more people interested and get them the skill set. A surgeon doesn’t want to introduce the technology without the right training behind it. 

As much as it pains me to say this, continuing education is real, and you have to take time out of your life outside of work and continue to train. What I do is I take personal time away to go learn or train with other surgeons. Surgeons come to visit me and I visit other surgeons. I think really being open-minded and trying to look for different ways to maximize patient outcomes is really important. If you've been doing spine surgery the same way for the last 10 years, I don't think in the future that's going to cut it.

Vik Mehta, MD. Hoag (Newport Beach, Calif.): The establishment of endoscopic spinal procedures for the most common degenerative diseases of the spine has provided more patients with the opportunity to forgo open spine surgery in favor of minimally invasive procedures. This has opened the door for patients who might not have otherwise been candidates for surgery to undergo procedures that restore their quality of life. The coming years will see an increased focus on minimally invasive techniques that provide patients with relief from back pain with shorter hospital stays and faster recovery times.

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