Q: Where do you see the biggest opportunity for growth in the spine field today?
Dennis Crandall, MD, Founder and Medical Director of Sonoran Spine Center, Mesa, Ariz.: Pain management and conservative care seems underdeveloped in our area.
Ara Deukmedjian, MD, Founder, Deuk Spine Institute, Melbourne, Fla.: Degenerative spinal conditions and pain management will be the areas of greatest growth for the next decade. We are getting better at treating and curing back and neck pain with very little risk to patients due to advances in technology and dissemination of knowledge and skills amongst providers.
Walter Eckman, MD, Founder, Aurora Spine Center, Tupelu, Miss.: We have learned that most chronic low back pain can be successfully treated with single level minimally invasive fusion. The challenge is to identify the level and have a successful operation without significant long term morbidity. We have tracked patient outcomes for nearly 10 years and identified specific anatomic patterns which have great outcomes. We need for these various patterns to be subject to more rigorous randomized studies with long term follow-up (five years or more). If these diagnostic and treatment concepts are proven, there will be great demand for definitive surgical solutions instead of temporary measures which are ineffective with long term problems (ESI, PT, narcotics, manipulation, traction, etc ad infinitum). In contrast to the attitude of most insurance companies, surgical solutions will be more beneficial and less costly in the long run and lumbar fusions should increase to help many more people with chronic back pain.
Brian R. Gantwerker, MD, Spine Surgeon, The Craniospinal Center of Los Angeles: Minimally invasive techniques minimizing patient stay, blood loss and pain, close collaboration with pain doctors to form organizations to pressure insurance companies to continue to pay for services rendered and to augment our negotiating power.
J. Brian Gill, MD, Spine Surgeon, Nebraska Spine Center, Omaha: I would say the ability to provide spine surgery on a more outpatient basis where patients go home the same day. We are already doing this for several procedures such as discectomies, decompressions and selected cervical fusions. The challenge will be lumbar fusions.
Richard Kube, MD, Founder & CEO, Prairie Spine and Pain Institute, Peoria, Ill.: I would say the best opportunity is in creating an integrated care model for spine and pain. As carriers begin adopting ACO models, having all services under one roof will help negotiating power given you can control all cost variables. Also, it is a model that is attractive to patients and referring providers. When that type of model can be coupled with cutting edge technologies such as minimally invasive procedures or stem cells, there is potential for significant growth.
Paul Slosar, MD, President, SpineCare Medical Group, San Francisco Spine Institute: Survive the onslaught of negative pressure being brought to bear by unreasonable insurance companies telling patients we have no surgical success with spine surgery for DDD. Spine surgeons, and their patients, are being told that the end-of the line treatments for severe disc degeneration is not surgery but continued "non-operative" care. This is not true and unacceptable in the long-run. Spinal fusion surgery has been shown to be as effective as other common "end-stage degenerative" surgeries such as knee/ hip replacements. We must consider winning this access-to-care battle as the primary focus of all of our research and societal advocacy efforts in spine today.
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