Six spine surgeons discuss where they think minimally invasive spine surgery is headed.
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.
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Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, March 15, at 5 p.m. CST.
Question: What will MIS surgery look like five years from now in terms of innovation & adoption?
Alden Milam, MD. Spine Surgeon at OrthoCarolina (Charlotte, N.C.): I expect MIS surgery to continue to grow. With better techniques that allow universal adoption by more spine surgeons, more surgeries will move to outpatient settings, decreasing the costs of care and improving patient outcomes.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: The face of MIS will look more mature, I think, and we will see more decompressions and arthroplasty being done through smaller corridors. I think MIS will be one of the mainstays of ASCs' book of business. We will see much more MIS in surgery centers and less of it being done in hospitals, which will be doing more of the high-risk, longer, higher-cost operations.
Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): Five years from now spine surgery will be even less invasive while providing same or better outcomes for surgeries for spinal stenosis, instability and degeneration. This will be achieved through further adoption and expansion of endoscopic and robotic technologies. Advances in neuromonitoring, imaging and navigation will keep the spine surgeries safe and efficient while allowing for less exposure and soft tissue trauma. More spine surgery will be done on an outpatient basis.
Kern Singh, MD. Co-Director of Minimally Invasive Spine Institute at Midwest Orthopaedics at Rush (Chicago): As the advantages of MIS become more apparent, I think we will have greater emphasis on MIS during training, increasing the adoption of MIS techniques. This, coupled with technological advances in navigation and instrumentation, will make MIS more accessible for spine surgeons and allow it to be more widely used — especially in the outpatient setting.
Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): Innovation will continue to flourish especially as more minds adopt these principles and enter the arena. There will be both technique and technology paired to make advances as there always have been. Anything more detailed belongs in a patent application instead of on this page. I do believe there will be wider spread adoption. More surgeons will be trained in the techniques during fellowship and those already in practice will adopt to serve a need and desire held by the patients they treat. It is also an obvious move for anyone wanting to move more of his or her practice into the ambulatory setting.
Payam Farjoodi, MD. Spine Surgeon at Center for Spine Health at Orange Coast Memorial Medical Center (Fountain Valley, Calif.): MIS surgery continues to evolve with the development of new technology. Techniques like MIS TLIF, standalone lateral fusions and disc replacement will be more widely adopted, reducing hospital length of stays and allowing for more rapid short-term recovery. The emergence of robot-assisted surgery has also allowed for complex surgeries to be performed more safely. I see this technology advancing and becoming more widely adopted.
The sacroiliac joint is being increasingly recognized as a pain generator and there are new, minimally invasive procedures for the treatment of this condition which will continue to be more widely adopted. As these surgeries are more widely performed, more data will be collected, leading to evolution of these procedures to even less invasive techniques.