The biggest opportunities in spine: 8 surgeons on practice & technology growth

Laura Dyrda -   Print  |

Eight spine surgeons discuss the biggest opportunities for growth in the practice of spine today.

Question: Where do you see your practice growing or evolving over the next five years?

Neil Badlani, MD. Spine Surgeon at The Orthopedic Sports Clinic (Houston): We plan to grow our practice through continued direct-to-consumer marketing. Healthcare is becoming an increasingly consumer-driven industry. Patients have access to healthcare information everywhere, are more educated about their healthcare choices and they have higher expectations and want to be active as long as they possibly can. Healthcare dollars are also being shifted more toward our patients in the form of higher deductibles and co-insurance payments. This trend of consumerism in healthcare is not going away, and physicians should be equipped to handle it.

As physicians, it is our responsibility to educate our patients with accurate and comprehensive information about their conditions and treatment options. Direct-to-consumer marketing is an increasingly important way to provide that patient education and an opportunity for physicians to grow their practices for continued success.

The best opportunities in our market are to continue to become a comprehensive healthcare provider. Offering a full gamut of services including physical therapy, advanced imaging and surgical facilities allows us to control the patient experience from start to finish and provides significant ancillary revenue streams. Strategic hospital alliances can help our independent practice facilitate this growth and provide this complete array of healthcare services.

Nitin Khanna, MD. Spine Surgeon at Spine Care Specialists (Munster, Ind.): Growth is a combination of word of mouth and marketing. As an independent practitioner it is important to "invest in your business." Marketing is a key driver and ensuring an efficient and effective approach are keys to success. The best opportunities in our market and every market are to focus on the patient in the room. Convenience is king and making sure that each and every patient is seen and treated in a timely manner is just the beginning. Delivering great care and engaging the patient with relevant information regarding their conditions will always be the future.

Todd Chapman, MD. Spine Surgeon at OrthoCarolina Spine Center (Charlotte, N.C.): I see my practice growing to include more minimally invasive techniques without sacrificing the surgical tenets that I have been taught through my training. Combining these tenets and techniques is where I feel I can continue to seek to improve patient outcomes. Furthermore, seeking the non-fusion technologies and working to develop and implement them is an area I am eager to explore.

I see the most opportunity for growth to be focused around fusionless surgery. Decreasing spine motion through fusions to correct underlying spine conditions is a sacrifice that our patients make to have their current ailments alleviated. And while we can continue to perform fusions that offer better outcomes with less disruptive impacts on our patients, targeting non-fusion technologies is an area that has not been adequately explored.

Nima Salari, MD. Partner at Desert Institute for Spine Care (Phoenix): There is tremendous buzz around improved navigation technology and the emergence of robotics in spine surgery. We will see the technology further the adoption of minimally invasive techniques as it increases safety, accuracy, and reproducibility all while reducing radiation exposure to the patient and surgical team.

My concern, however, remains the capital expenditures required to implement such technology. The push to move care delivery to outpatient surgical centers and optimize cost savings is in direct contrast to this type of advancement.

Patient-matched 3D-printed drill guides carry the same promise of increased safety, accuracy, and reliability, but at a fraction of the cost. Medacta International first hit the scene with this technology for open screw placement in large deformity cases. Its latest line of drill guides take advantage of the cortical screw trajectory via a minimally invasive midline approach. The radiation exposure is minimized by obtaining a low-dose CT scan of the lumbar spine to create the patient-matched drill guides. Intraoperative fluoroscopy use is minimized, limited to final confirmation of implant position. This technology can easily be implemented in the outpatient surgical setting.

Q: Which orthopedic and spine device trends and technologies do you think will make the biggest impact long term? What do you think is just a fad?

Nick Shamie, MD. Chief of Orthopedic Spine Surgery and Vice Chair of International Affairs in the Department of Orthopedic Surgery at UCAL School of Medicine: I believe consolidation of companies and high cost of trials and research has stinted new research and innovation. There still remains opportunity for smaller and more agile companies to invent and push the technologies forward. As navigation technology is evolving, we can deliver more precise care to our patients. Companies who have adopted the navigation technologies will be more impactful in the near future.

Thomas Scully, MD. Neurological Surgeon at NeuroSpecialists (Tucson, Ariz.): I think robotics combined with artificial intelligence will continue to expand and innovate. Besides planning and executing screw placement in the spine, I see it developing for decompressions, discectomy and other standard spinal surgeries. I think AI will progress to help us determine algorithms based on imaging and patient characteristics, which will predict patient results.

Genetics and biologics will evolve, and motion preservation in the spine is here to stay.

Emeka Nwodim, MD. Spine Surgeon at Centers for Advanced Orthopedics, Bay Area Orthopaedics & Sports Medicine (Glen Burnie, Md.): I'm most excited about the technological advancements in spine navigation. Being able to decompress and instrument the spine with 3-D computer technology. This not only improves surgical accuracy but also improves time spent in the operating room and minimizes numerous complications and surgical risks. I look forward to further advancements and the incorporation of live 3-D imaging and even virtual or augmented reality into the operating room.

Seyan J. Armaghani, MD. Spine Surgeon at Florida Orthopaedic Institute (Tampa): I'm interested in the future of robotics and improvements in navigation. Currently, the technology is just a way to accurately place pedicle screws in the end. Personally, I think there are good ways to use it and other ways where it's more efficient to place them freehand. In the future, I'd be interested to see something more than screw placement. Ability to aid in decompression or cage placement, for example, would be a step forward. The integration of augmented reality technology to improve safety would also be interesting to see.

To participate in future Becker's Q&As, contact Laura Dyrda at

To learn more about the biggest trends and opportunities in spine, register for the Becker's 17th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference June 13-15, 2019 in Chicago. Register here.

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