Endoscopy, robotics & more: What 8 spine surgeons want to master


Endoscopic spine surgery, robotic procedures and spinal deformity cases are among the skills that these eight spine surgeons are focused on mastering in the next five years.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.

Next week's question: How can spine practices ensure they get the best contracts possible when negotiating with payers?

Please send responses to Alan Condon at acondon@beckershealthcare.com by 5 p.m. CDT Wednesday, Sept. 14.

Editor's note: Responses were lightly edited for clarity and length.

Question: What spine surgical skill, technique or technology do you wish to learn or master in the next five years?

Emeka Nwodim, MD. The Centers for Advanced Orthopaedics (Bethesda, Md.): In the next five years, I hope to master a few different types of spine surgical skills. I aim to master spine navigation and robotic spine surgery, while simultaneously accomplishing goals that are commonly better achieved with open surgery. I also hope to acquire more skills with different minimally invasive surgical techniques. 

Issada Thongtrangan, MD. Microspine (Scottsdale, Ariz.): I would like to master full endoscopic spine surgery including endoscopic fusion surgery. I also would like to master navigation and robotic-assisted surgery to incorporate with endoscopic technique. This will be the least invasive technique that can be done safely in the ASC. Several studies in Asia and Europe show comparable outcomes in selected patients. I also would like to master artificial disc replacement and start looking at awake spinal surgery in an ASC setting.

Alok Sharan, MD. NJ Spine and Wellness (East Brunswick, N.J.): Endoscopic spine surgery is a skill that I will focus on in the next few years. It is the next advancement in spine surgery, and the next evolution for awake spine surgery. I am amazed at the work that my colleague Dr. Ray Gardocki has been doing, combining endoscopic techniques with awake spine surgery.  There have been times where we have video conferences and in the background I can see his patients, who have undergone an endoscopic spinal fusion, walking 1-2 hours after a lumbar fusion.

My colleague from Duke, Dr. Muhammad Abd -El-Barr, has discussed and written about the concept of reducing our surgical footprint after spine surgery. By using regional anesthesia we are minimizing the collateral damage from general anesthesia. By keeping the surgical scar at a minimal size, endoscopic spine surgery reduces the surgical footprint of a large incision. I am looking forward to integrating endoscopic spine surgery into our awake spine surgery program.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): One of the most exciting and debated subjects in spinal neurosurgery is the multilevel degenerative spine and prevailing application of motion preservation techniques. Being adventuresome at a particular stage in one's career becomes less attractive; yet the physiological basis and technological improvements of these options have widened. Barring healthcare economics and the current strains, coupling surgical navigation with additional utilization is a progressive reality for the aging populace.  

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: I have done a few more endoscopic surgeries in the past year and the patients did really well. Getting more comfortable in that space has been an aspiration of mine since I first took the courses three years ago. I would love to increase the various pathologies I feel comfortable addressing using this technique. I am looking forward to doing my first midline and bilateral decompression using only an 8mm incision. 

Chester Donnally, MD. Texas Spine Consultants (Addison): I'd like to get a lot more efficient surgically on big deformity cases. I feel like when I have these booked it's my only case that day. At Rothman, when I would see these cases with Dr. Alex Vaccaro or Dr. Greg Schroeder, they would have maybe another two to three cases that day and were wizards surgically with these. I need to get more consistent with my surgical steps and be more consistent with the same team.

Zachary Goldstein, MD. Spine Surgery Fellow, Beaumont Health (Royal Oak, Mich.): In addition to mastering traditional open and minimally invasive tubular techniques, I also wish to learn more about endoscopic spine procedures over the next few years, both during my spine fellowship as well as continuing into my first few years in practice. The trend for endoscopy has been growing in the U.S. recently, and I hope to gain plenty of hands-on experience with both uniportal and biportal endoscopic spinal discectomies, for both interlaminar and transforaminal approaches. I also hope to learn how to perform endoscopic-assisted minimally invasive lumbar fusions. 

Brian Fiani, DO. Weill Cornell Medicine/NewYork-Presbyterian Hospital (New York City): The importance of mastering minimally invasive spine surgery will continue to heighten in the next five years. Technology and innovation within spinal surgery is continuing to advance and change, which will further the utility of minimally invasive techniques to achieving maximal results, a concept which is timeless. It is important to keep in mind that not all facilities will have the same robots or endoscopy equipment so one should not lose their sense of versatility in an attempt to find a niche. Rather, attaining competency in a wide range of skills and techniques is vital and is something that I have been mastering through performing a very large scope and volume of surgeries.

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