The Making of a Minimally Invasive Spine Institute: Q&A With Dr. Frank Phillips of Midwest Orthopaedics at Rush FeaturedWritten by Laura Miller | April 25, 2012
Frank Phillips, MD, director of the section of minimally invasive spine surgery at Rush University Medical Center and a founding member of the Minimally Invasive Spine Institute at Rush, discusses the institute and where the future is headed for minimally invasive spine procedures.
Q: What was the catalyst for opening the Minimally Invasive Spine Institute?
Dr. Frank Phillips: I've been interested and involved in minimally invasive spine surgery for a long time. Over the past five years, minimally invasive spine surgery has come into it's own and we can address many of the traditional open procedures using minimally invasive techniques. One of the problems out there is that minimally invasive spine surgery is loosely defined; some of the procedures are proven effective and some are not. The purpose of our center is to provide a one-stop-shop for minimally invasive surgery that is clearly defined and proven in the literature. This isn't marketing hype, but about quality surgery that actually works. The real goal of minimally invasive spine surgery is to perform the same surgeries that have a long track record and are proven effective and perform these in a less-invasive fashion without compromising the surgical goals. This is not about "fringe" procedures or unproven technologies searching for an application.
Q: What are your goals for the new facility?
FP: My goal is to perform minimally invasive procedures that are validated and proven effective; that is going to be my and the center's focus. Another component of the institute is it provides a venue to focus on minimally invasive spine research. We will be gathering patient outcomes and conducting clinical trials among surgeons who are really dedicated to the minimally invasive techniques.
Q: Where is the most research needed for minimally invasive procedures?
FP: Many published studies compare two techniques — minimally invasive surgery and traditional open surgery. Almost uniformly, as you would expect, minimally invasive procedures show improved early outcomes, less blood loss, shorter length of stay and a better postoperative experience. The challenge is to show minimally invasive procedures have better long-term results — the jury is still out on that. In the short term, there is an easier recovery and faster return to activity rates.
One of my personal interests and research passions is examining the economics of healthcare and really looking at the economic impact of what we do as spine surgeons.
Q: Based on your research, how big of an economic impact do minimally invasive procedures have among spine patients?
FP: There is a perception that minimally invasive procedures are more expensive and there is no incremental advantage to doing them; people think the money is not well spent. I've spent a lot of energy looking at the economics and value provided by spinal surgery. We recently looked at some of these parameters and presented them at the International Society for the Advancement of Spine Surgery annual meeting. Our research showed that the costs related to minimally invasive surgery for the hospital is less than for open surgeries because the hospital stay is shorter, there are fewer ICU stays and fewer blood transfusions. With all these factors combined, there is a considerable savings to the hospital. Those are the kinds of studies and outcomes that become important in today's healthcare environment.
Q: Did you experience any challenges in forming and opening the institute?
FP: I think the time is right for minimally invasive spine surgery and an Institute dedicated to this field. I first started performing minimally invasive procedures in the 1990s and people viewed it as "out there" at that time, but I think it's reached the mainstream over the past decade. One of the challenges with minimally invasive techniques is that there is a steep learning curve because the skills are so different than open surgical skills. In a state-of-the-art minimally invasive spine center, you want surgeons who have experience and done hundreds of these surgeries.
Q: What is your strategic plan for success with the institute in the future?
FP: Success is really all about providing outstanding patient outcomes. One of the things I joke about is that the last thing people want is minimally invasive, minimally effective surgery. If we deliver on the promise of excellent outcomes, less postoperative pain and morbidity, the center will be successful. Dr. Singh and I both already teach minimally invasive techniques and I would like to see the institute become a center for minimally invasive spine education and learning. We want to continue doing research and validating every day in the clinic our patient outcomes
You've got to collect outcomes data on patients you treat. Payors are demanding it and its good medicine to keep track of your outcomes. Regardless of whether you are in a community hospital or academic medical center, economic incentives demand that we collect relevant outcomes data.
Q: Do you have any words of advice for spine surgeons looking to dedicate their practice to minimally invasive surgery and opening a center similar to the Minimally Invasive Spine Institute?
FP: First of all, you have to have commitment to minimally invasive techniques and philosophy. It's something you must make the focus of your career. You can't just do a few cases minimally invasively; you have to be really committed to the field and make it a big part of your practice.
You also need to have the right people and like-minded individuals involved who have the same passion for minimally invasive surgery. It's not just about the surgeons — physician extenders, physical therapists and other specialists must understand the procedures as well. Finally, the hospital system has to be behind you and provide the optimal operating facility and equipment to perform minimally invasive surgery safely and effectively. Then you will have success.
More Articles on Spine Surgery:
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8 Steps for Opening a Spine ASC on a Tight Schedule
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