Awake spine surgeries, robotics & more: 6 surgeons look one year ahead

Spine

Robotics, endoscopy and the acceleration of spine surgeries moving to the outpatient setting are what lie ahead for the field, according to six spine surgeons. Read their thoughts on how the industry is evolving below.

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. We invite all spine surgeon and specialist responses.

Next week's question: What is the next major regulatory change you would like to see in the spine field?

Please send responses to Alan Condon at acondon@beckershealthcare.com by 5 p.m. CDT Wednesday, Oct. 7.

Note: The following responses were lightly edited for style and clarity.

Question: How do you envision the spine field one year from now? What will be different and what will remain the same? 

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: In a year, the spine space will be more crowded in terms of robotics and endoscopy. We anticipate a larger market share being taken from Medtronic/Mazor and going toward DePuy and Nuvasive. There will be larger patient demand for minimally invasive outpatient and awake surgeries. We will also see a shift in the payer space. There will likely be a shift toward a single payer. Due to a most likely downturn in the economy, hopefully for a short time, many will not be able to afford their plans. 

There will be more pressure to provide cheaper cost plans. The downward pressure will cause pressure on Congress to make changes to the Affordable Care Act. Most likely, it will be to move toward more government-sponsored plans. The bad news is that we most likely will not learn the lessons of other systems and try to reinvent the wheel.  

Neel Shah, MD. DISC Sports & Spine Center (Newport Beach, Calif.): The spine field is ever-evolving. Some emerging technologies include artificial intelligence and robotic surgery as well as the push towards motion restoration and preservation over fusion. These innovations that have been evolving over the last decade seem to be coming to fruition and are accepted and widely used.

The biggest change to spine care over the next year will be due to the pandemic. There has been a large push to move spine surgery to an outpatient-centered model. This will only accelerate due to patients and providers wanting to avoid the hospital and inpatient stays. Similarly, telemedicine has been thrust onto the main stage. Before the pandemic, telemedicine was slowly gaining traction. However, its implementation has exponentially accelerated due to the pandemic. I hope this trend continues and payers continue to support its use as it is a win-win for patients and providers. 

Jeffrey Wang, MD. USC Spine Center (Los Angeles): The major difference in the spine field will be the difference in our academic meetings. Currently, we have only virtual meetings. In the future, at the very least, there will be the ability for us to attend virtually, even if there is a face-to-face component. The explosion of telemedicine for our patients has led to an explosion of virtual meetings and the postponement of all of our major meetings. The ease of attending virtually in the pandemic will likely carry over into the near future at least for the next year, if not longer. We may see an exponential growth in virtual offerings, potentially leading to a near replacement of our academic meetings as we know them. 

Richard Kim, MD. DISC Sports & Spine Center (Newport Beach, Calif.): Right now, patients are still wary of getting medical care, especially surgery. I think this heightened threshold for surgery will continue for some time. Eventually, things will probably go back to pre-pandemic times. There will always be a need for careful decision-making, weighing of risks and benefits, and setting realistic treatment goals. 

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): The pandemic presented significant challenges to innovation in spine. I am hoping that one year from now we will be back to "normal" spine surgery and office visit volumes, normal funding for spine surgery research and scientific and technological innovations, and further drive toward less invasive spine surgery with lower complication rates, faster recovery and greater patient satisfaction.  

John Burleson, MD. Hughston Clinic Orthopaedics (Nashville, Tenn.): It is my opinion that the largest change in spine surgery one year from now will be the increase in telemedicine. I think COVID showed many patients and providers that telehealth is a valuable tool. Once the learning curve was completed by the providers, there were less technology-related issues and patients were able to wait in their own living rooms. For many types of visits, these are a huge win for everyone. Hopefully we get the policy makers to understand how valuable this is and we are allowed to continue to see people in other states. 

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