Endoscopy, AR and more: What's new in 2024 for 8 spine surgeons


Spine surgeons are looking for new ways to streamline their work and innovate care at their practices. Here are the new things eight spine surgeons are bringing to their practices in 2024.

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.

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Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Wednesday, April 3.

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

Question: What's something new that you plan to implement at your practice this year?

Afshin Aminian, MD. Children's Hospital of Orange County (Orange, Calif.): At Children’s Hospital of Orange County we have now instituted routine use of custom pre-contoured rods in our surgical correction of spinal deformities in children.

Recent advances in machine learning have allowed us to harness the power of predictive modeling in planning the outcome of surgical correction in children with adolescent idiopathic scoliosis. This collaboration is between the surgeon and an engineer, with each offering their expertise to improve the outcome of instrumented posterior spinal fusion for the treatment of children with spinal deformity. 

The initial data gathered from the preoperative planning with the design of custom pre-contoured implants showed improvement in the restoration of appropriate alignment, such as thoracic kyphosis. Further studies on the use of machine learning and predictive modeling have shown very encouraging results in the accurate prediction of postoperative alignment in the compensatory segments that are not instrumented. This has further allowed precise, patient specific, custom implant design with pre-contoured rods and proper sagittal alignment restoration in children with spinal deformities.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: We plan on expanding our practice to cover new conditions and doing more and more cases in the surgery center. The hospital I work at is a wonderful place, with amazing staff. Unfortunately, the inefficiencies are causing me to look at other places in order to not do two cases and be home at 7 p.m. or 8 p.m.  

Sohaib Hashmi, MD. UCI Health (Orange, Calif.): I am excited to implement endoscopy procedures in my spine surgery practice this year. Spinal endoscopy has become commonplace internationally supported by published clinical safety and efficacy outcomes compared to standard open surgical techniques. This ultra minimally invasive technique allows unmatched visualization with the smallest soft tissue footprint and potentially fewer surgical-related complications. Our informed and athletic patient population demands precise and targeted surgical treatment while minimizing their recovery time and discomfort. The prospect of mastering this advanced technique excites me, as it aligns with my commitment to delivering the highest standard of care to my patients. I envision this technique to quickly become as common as tubular decompression in the near future, especially as orthopedic surgical residents perform arthroscopic surgeries more commonly than any other surgical procedure during training. Under the leadership of Don Park, MD, as the director of advanced endoscopic and outpatient spine program, spine surgeons at UCI Health will offer the most comprehensive surgical procedures to patients in Southern California. 

Osama Kashlan, MD. Weill Cornell Medicine (New York City): In the past, I was involved with virtual reality and saw how helpful VR was in surgical education. Throughout that same time, augmented reality and its use in spine surgery has continued to develop in a way that enhances connectivity and communication in the OR, and gives surgeons real-time patient-specific information in a user-friendly manner. After discussing AR with surgeon-experts in this field within my department and around the country, and evaluating the products that are already available on the market, I hope to implement that technology in my practice this year.

Emeka Nwodim, MD. Centers for Advanced Orthopaedics (Bethesda, Md.): I am constantly thinking of new strategies to optimize the workflow and efficiency within my practice. This year I hope to establish improved communication between our providers, staff, and patients. This has historically been a challenge for several reasons, including patient volume, number of daily inquiries received, variety of questions surrounding patient care and limited staff availability and resources.

This year I hope to refine a metric system which my practice can utilize to assess the number of phone calls and messages that come into our offices, the number of calls that are answered and those that are missed, in order to gauge how we are doing.  

We also plan to utilize remote staff and answering services and implement strategies to allow us to use advanced technology more efficiently, such as AI, to facilitate improved communication. 

Yoav Ritter, DO. HCA Florida University Hospital (Davie, Fla.): Although robotic spine surgery has been around for a while. We plan to push the envelope with respect to robotic spine surgery at our practice. We will continue to master this avenue of surgery over the next year. 

Steven Vanni, DO. HCA Florida University Hospital: Endoscopic spinal surgery is a new technique we plan to implement at our practice this year. Endoscopic spinal surgery has evolved over the years and the technique/tools used to achieve this surgery has been seen to be a beneficial minimally invasive surgery and cost effective procedure.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Undoubtedly, there are universal approval issues for most complex surgical procedures and notable delays for elective diagnosis as the specialty-opinion deluge for referrals remain. These barriers are not new and endure as additional scrutiny continues to plague healthcare delivery with post pandemic (economic) shortfalls. These are shared discussions among all facets of surgical medicine, as case defense and appeals are more presumed and commonplace.

Both health systems and individual hospitals have in place mechanisms for prompt surgical approvals especially in cases of manifestation decline, which includes correlative symptom explanation, correct modality reads (with illustrative examples) and more importantly, expeditious follow-up when indicated. And since systems continue to be burdened with the more comorbid patient populace, medical clearances and data forwarding are ascertained and confirmed in the most expeditious fashion. Not for much a new implementation, but certainly a refocusing for sure.

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