Variation in spine care, from when surgeons operate to how they operate, is drawing renewed scrutiny as costs rise and new technologies reshape training.
Spine leaders told Becker’s the specialty must tighten clinical pathways, safeguard core surgical fundamentals in the robotics era and sharpen patient selection and education to reduce waste and improve outcomes.
Question: What is one issue in spine that deserves more attention right now?
Editor’s note: Responses have been lightly edited for clarity and length.
Philip Louie, MD. Medical Director of Research and Academics at Virginia Mason Franciscan Health (Seattle): Unwarranted variation in spine care deserves far more attention right now, particularly variation that drives cost, waste and patient burden without actually improving outcomes.
We still see wide differences in indications, surgical technique, implant selection, OR efficiency and perioperative pathways for the same pathology, often with similar clinical results. So, we need to better innovate in a responsible fashion, especially at a time when economic pressures demand us to be better stewards of our limited resources — and there are many eyes on us.
Andrew Meyers, DO. Orthopedic Spine Surgeon at Orthopaedic & Spine Clinic of Louisiana (Monroe): One issue in spine that deserves more attention right now is preservation of core surgical fundamentals in the era of rapid tech adoption, specifically robotics, as it becomes default in training environments. As a young surgeon fresh out of fellowship, I see tremendous value in this technology and expect it will soon become the standard of care in most markets. But, there are still plenty of practice settings where robots are unavailable or financially unjustified.
The risk is not that robotics makes surgeons worse. The risk is that training pathways may too soon let robotics replace foundational tactile/spatial competence and intraoperative problem solving skills, instead of building upon it.
What needs more attention is the stance that fundamentals are still a non-negotiable competency. I agree it is like the shift from horses to automobiles. Eventually the new method completely overtakes, but we should not rush this specific transition period. Robotics is relatively easy to adapt and learn, once a strong foundational skill base is established. The foundation is harder to build later if it is skipped early, or worse, entirely.
Emeka Nwodim, MD. Orthopedic and Spine Surgeon at The Centers for Advanced Orthopaedics (Bethesda, Md.): An area of spine that I believe deserves more attention is the misunderstanding that many have regarding back pain etiologies and management. Unfortunately, this may lead to the over utilization of surgery to try to manage the complex and not entirely understood phenomenon of back pain. More education, efficient and transparent communication is necessary to help mitigate this trend.
Jeremy Smith, MD. Spine Surgeon and Division Chief of Spine Surgery at Hoag Orthopedic Institute (Irvine, Calif.): One issue that needs more attention in spine care is patient selection and outcomes. You do a similar spine surgery yet yield different outcomes with different patients.
Lumbar fusions or decompressions are common surgeries we perform, and oddly enough outcomes can vary. Why? More research is needed to enlighten how psychosocial and lifestyle factors, functionality and length of symptoms are key predictors of surgical outcomes, sometimes more vital than imaging. What is the exact nature of that interconnection? Precision in patient selection, such as who is a candidate for surgery, may be more important than how we perform in the OR.
