Challenges and Opportunities in Complex Spinal Correction: Q&A With Dr. Krzysztof SiemionowWritten by Laura Miller | January 24, 2012
Krzysztof Siemionow, MD, a spine surgeon with Illinois Bone & Joint Institute in Morton Grove and an Assistant Professor at University of Illinois in Chicago, treats many patients with complex spinal deformities and conditions every year. Here, he discusses the biggest challenges and opportunities in complex spinal correction as we head into 2012.
Q: What are the most common types of complex spinal conditions you treat?
Dr. Krzysztof Siemionow: In my practice, I see a wide variety of spinal deformity patients, both children and adults. We see a lot of degenerative spinal deformities, scoliosis, tumors and infections. Currently my practice is approximately 30 percent deformity, 30 percent tumor/infection and 30 percent degenerative and 10 percent trauma.
I also travel to Uganda, East Africa with Izzy Lieberman, MD, Mark Kayanja, MD, and Selvon St. Clair, MD for an annual spine surgery mission. In Uganda we are exposed to a number of challenging spinal conditions rarely encountered in the United States.
Q: What challenges do you often face in treating adult patients with complex spinal conditions?
KS: Usually some of the biggest deformities I see are in patients who are in their 70's and 80's. A lot of these patients have multiple medical problems in addition to poor bone quality making them poor surgical candidates. Even patients who appear to be healthy, usually have some underlying medical condition, such as coronary artery disease, which may manifest itself as a result of surgery. It is a real challenge to define a guideline for who is a good surgical candidate and who is not.
However, as technology and medical treatment develop, I feel we will be able to perform surgical correction for more patients who were not good candidates in the past. We are also getting a lot of valuable data from analyzing outcomes surveys and searching our databases. I feel that this will help us define patient populations that are best suited for surgical intervention.
Q: Are the difficulties different when treating pediatric patients?
KS: In the pediatric world, you need a different approach and mindset. It is important to keep in mind that surgical intervention affects these patients early on in their life and they will carry this burden with them into adulthood. It is important to do everything we can to minimize the trauma associated with having surgery. The second challenge in dealing with pediatric patients is their families. You want to make sure everybody is on the same page and that if the parents are separated doctors need to ensure that all parties are well informed. I like to get the know the families prior to surgery, and we usually have multiple office visits before proceeding with surgical intervention
Q: What new technology is on the horizon for spinal deformity correction?
KS: I used pedicle screw instrumentation from the beginning of my surgical training, but we have to remember that it wasn't as widespread 15-20 years ago. Spinal technologies will continue to evolve, but I am concerned that the Food and Drug Administration may slow medical innovation in the future. The current economic environment makes securing funding challenging and many potential start-ups never take off. Funding research has also gotten more competitive as a lot of the industry-funded research has dried up. That being said America is an innovative place and I'm very optimistic about what lies ahead.
The middle of the last decade has seen a lot of excitement about motion preservation technologies, but enthusiasm has waned recently. Development of minimally invasive technologies is currently popular, but there may be a limited role for it in patients with certain complex conditions. Patients, surgeons, and companies are attracted to the idea of less invasive surgery and early outcomes data certainly is encouraging. That being said we need long term follow-up before we start claiming superiority of any new technology.
I see that the next wave of technology development will be in computer navigated robotic surgery. There are several robotics companies out there working on new systems. I believe there is a role for computer and robotic guidance, but we must remember that these are only tools — not a solution to every problem. Navigation and robotics will make a difference in certain select applications.
Q: What are the biggest challenges spine surgeons will face in delivering care this coming year?
KS: The challenges are three-fold:
1. Patients with surgical conditions having access to spine specialists. We as a physician community may face challenges as they pertain to access to care. I will be following the Supreme Court decision on the constitutionality of the health law.
2. On the surgeon side, being able to recommend and perform appropriate procedures without interference from outside parties.
3 From the institutional perspective, the hospital must be prepared to deliver specialized services or they may jeopardize patient safety. We are seeing a high demand for spine surgeons around the country. Some of the facilities that bring on a new surgeon may not be prepared to accept a high volume of spine patients. These patients need an appropriately staffed ICU, nursing staff trained in taking care of spine patients, and physical and occupational therapists with spine experience.
Q: Where do you see the most change and growth in spine care over the next few years?
KS: On the technology side, we are going to see new motion preservation devices. Navigation and robotics will also play a bigger role.
As far as healthcare expenditures, physicians are fully aware that they have a stake in the game, and they are implementing various models to control costs while providing quality care. One popular example of this is standardization of implants to reduce implant related costs. Medical devices, in contrast to other technologies, have increased in price over the decade while electronics continuously become cheaper with each new generation. I believe that this will change and we will see significant price pressures on implants.
On the research front, the problem with spine is you cannot easily standardize the patient population to study the treatment effect of a particular pathology. Although this is challenging, our ability to mine outcomes data is growing and this will certainly allow us not only to analyze the treatment effect but will also drive innovation.
Related Articles on Spine Surgery:
5 Points on ACDF in Surgery Centers
Importance of Minimally Invasive Spine Surgery in the ASC Setting: Q&A With Dr. John Peloza
8 Statistics on Spine Surgeon Compensation
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