Two spine surgeons weigh in on spinal fusion surgery trends.
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Question: What are the key trends in spinal fusion surgery?
Brian R. Gantwerker, MD, founder of the Craniospinal Center of Los Angeles: Spinal fusion surgery is, has and will always have a place. If you look at what is being done right now, lots of medical corporations are hiring deformity surgeons who are doing very complex and extensive surgeries. Sometimes, they have questionable indications. That being said, deformity surgery is an excellent way to help certain patients. We will see further efforts to try to bundle surgeries and remove CPT codes, and force global payments.
The key points that continue and will continue to be missed — you cannot get a Cadillac at a Yugo price; medical organizations, instead of partnering with local established surgeons to continue to provide good care and not have to reinvent the wheel every two years or so, will try to supplant them and erase them from practice by flooding the market and diluting the pool with newer, untested surgeons. But overall, I see the tendency for the number of fusions to stabilize or even decrease. Insurance companies will continue to make prior authorizations more and more difficult, so I think fusion surgeries, and most necessary and indicated surgeries, will trend downwards.
Srdjdan Mirkovic, MD. Spine Surgeon at NorthShore University HealthSystem's Orthopaedic Institute (Evanston, Ill.): A key trend in spinal fusion surgery is trying to find better ways to accelerate fusion rates in minimally invasive surgeries. Right now, we see the best outcomes are with level 1 conditions only – when we're fusing two vertebrae. When you try to fuse three or more vertebrae, studies show fusion rates are not any better than open surgery, due to limited visualization of the affected area and a subsequent increased chance of complications such as dural tears. We are now looking to biologics to improve the gold standard of bone morphogenetic proteins. If we can discover different proteins that increase bone formation, showing similar efficacy at a lower cost, then we will see more success with fusion rates in multilevel minimally invasive surgeries.