Much of the conversation about where spine surgery is headed comes from surgeons with decades of cases behind them. Matthew Meade, DO, a spine fellow at Chicago-based Midwest Orthopaedics at Rush, is approaching the same questions at the start of his career, as he and his peers decide which techniques to build their practices around.
His own training path is not typical.
“Being at Rush is actually my second spine fellowship, which is somewhat unique,” Dr. Meade told Becker’s. “And a lot of my residency training and my first fellowship was really foundational spine surgery, more classic, open, and I think that gave me a really unique perspective to kind of come into a fellowship which does have more minimally invasive, tons of endoscopic surgery to have a kind of forest-through-the-trees perspective.”
Asked what is drawing younger surgeons toward these procedures, Dr. Meade started with what trainees are reading.
“Especially if you look at in the last five years, the number of publications in minimally invasive surgery, more specifically endoscopic spine surgery, that rate specifically within the United States has just risen so much,” he said. “That’s what everyone’s talking about.”
He said that while the conversation is booming, the number of surgeons actively practicing these techniques is still relatively low.
“So there’s a kind of yearning for seeking out people who do those techniques or are willing to try them and learn from them and see what’s new,” Dr. Meade said.
Social media is part of the picture as well.
“I think younger surgeons, residents, fellows probably consume more social media personally and professionally, in a sense,” he said. “And social media, no doubt, plays a role in perpetuating the minimally invasive and endoscopic publicity. That definitely plays a huge role in it too.”
Dr. Meade also compared today’s fellowship applicants with those of just a few years ago.
“I do think, however, if you probably surveyed a group of fellowship applicants five years ago, and asked them who wanted or who had interest in endoscopic spine surgery, or knew much about it, I just think the rate at which people knew about it or were interested in it would be a lot lower,” he said. “And I think that wouldn’t be specific to applicants. That would probably be specific to just everybody in spine surgery.”
Beyond the buzz, there is the clinical case for doing less.
“As much as I’m a surgeon, and I love operating, if we can continue to manage patients with as little surgery and as small of a surgery as possible, that’s always the goal,” Dr. Meade said. “And that’s why things like motion preservation, decreasing adjacent segment disease, endoscopic spine surgery, minimally invasive, giving as much tissue preservation, and really focusing on that soft tissue management is critical.”
He said fellows like himself are interested not only in less invasive surgery, but also in surgery that causes the least disruption to patients’ bodies and everyday lives.
“Less is more in a sense, and I hope that we can continue down that path and figure out how we can do as little as possible to get people back to their activities while making sure that they don’t have to keep coming back to us for revision after revision after revision,” he said.
Endoscopic surgery is only one of the options on the table for a trainee today.
“There’s just a really large general interest amongst young surgeons wanting to pursue spine surgery to have more tools in their toolbox as these tools become available,” Dr. Meade said. “Whether that’s endoscopic, whether that’s minimally invasive, whether that’s maximally invasive, whether that’s new deformity techniques, I think there’s a role to have all of that so that everyone can be able to use these techniques.”
Dr. Meade said that despite the increased interest, fellows in his field are interested in adding endoscopic surgery to their practices, not forgoing traditional spine procedures altogether.
“I do think that knowledge is power, and having more tools in your toolbox, which is everything that we do as spine surgeons, all the procedures are a tool to accomplish a goal,” he said. “And the more things that you know how to do extremely well, the better off you’ll be.”
He returned several times to the role of clinical research.
“I think that as doctors, we need to keep that mindset, being open to new things, but also being understanding that all new things aren’t necessarily the best things, and that clinical research is really where we figure out long term what is maybe the best option, or if there’s multiple options, which one is maybe right in different scenarios,” he said.
For a surgeon just starting out, the takeaway is about how the field adopts what comes next.
“I just think the biggest thing as we continue to progress, and it’s not specific to spine surgery, but as we learn new things in medicine, we have to adopt them cautiously and really focus on clinical research and make sure that what we’re doing is what we truly believe is providing the best outcomes for our patients,” Dr. Meade said.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
