Question: How has the spine surgery field evolved since you graduated from medical school?
Dr. Richard V. Chua: The spine surgery field has evolved in so many ways — from the clinical aspects (early rehabilitation, weight loss, smoking issues), techniques (MIS, especially including complex spine and deformity), implant and hardware technologies, image guidance technologies, robotic technologies, as well as regulatory and outcomes registries. Virtually every facet of spine surgery has evolved over the last 20 years.
Also, I have noticed a profound improvement in my quality of life after adopting MIS techniques. Due to the efficiencies gained in doing MIS lumbar fusions, I am not as tired at the end of the day, and have fewer patients in the hospital to round on after surgery. The vast majority of MIS lumbar fusion patients are able to go home the day after surgery.
Q: What sparked your interest in minimally invasive spine surgery?
RC: My interest in minimally invasive surgery came about during my initial collection of cases in my early career, which need to be submitted to our board examiners. I noticed a subtle clinical scenario that I thought could be addressed by MIS techniques, namely postop pain. About that same time, the MIS techniques were being developed and published in the literature. Also, I wanted to find a way to differentiate myself from my partners and competitors. So, as I started down the road of incorporating MIS techniques into my practice, I noticed a difference in patient experiences, outcomes and office phone calls. The MIS techniques and their evolution also fit very well with the field of neurosurgery being “techie.”
In addition, I started adding the MIS techniques to my skill set slowly, and over time have adopted them almost exclusively, particularly for the lumbar spine. We can now do simple decompressions, instrumented fusions and deformity surgeries using these techniques. Early on, I did not believe we could achieve the same results with open surgeries, especially for the more challenging conditions. At this point, I have even applied these techniques to intraspinal and intradural tumor pathologies with the same successes as the other techniques.
Q: What is the biggest challenge facing the spinal care field today?
RC: The biggest challenge of spine care today is the regulatory pressures to demonstrate quality and outcomes with limited resources from the provider side, declining reimbursements, bundling and the entire notion of medicine being over-regulated.
Learn more from Dr. Chua at the 15th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine in June 2017! Click here for more information.
More on the Spine, Orthopedic & Pain Management-Driven ASC Conference:
Access to Joint Care: Q&A with Dr. Keith Berend of Joint Implant Surgeons
Personalized Medicine in Spinal Care: Q&A with Dr. Nitin Khanna of Orthopaedic Specialists of Northwest Indiana
Experiences in Emergency Medicine: Q&A with Dr. Michael Boyle of ECI Healthcare Partners
