Josh Marcus, MD, is a neurosurgeon practicing out of Danbury (Conn.) Hospital and Norwalk (Conn.) Hospital, as part of Nuvance Health — formerly Western Connecticut Health Network — and Neurosurgical Associates of Southwestern Connecticut, both of Danbury.
Dr. Marcus focuses on the minimally invasive treatment of spine and brain tumors, degenerative and traumatic spine disease and trigeminal neuralgia among other conditions.
He earned his medical degree at New York University School of Medicine in New York City. Dr. Marcus completed both a residency in neurological surgery and a fellowship in endovascular surgery/interventional neuroradiology at New York Presbyterian/Weill Cornell Medical College in New York City.
Dr. Marcus provides his insight on the biggest barriers in spine, future trends and what device has significantly enhanced patient outcomes in his practice.
Question: What do you think is the biggest obstacle facing spine at the moment?
Dr. Josh Marcus: We're seeing older patients that want aggressive treatment for their spine conditions so they can maintain their quality of life. They are active and mentally feel much younger than their age, but their spine has gone through wear and tear over time so surgical intervention may not be the safest option for them. In addition to age, the risk of complications from spine surgery increases when comorbidities exist, like heart disease, diseases of the lungs and obesity, which are common among older people. Therefore, we need to continue to develop more minimally invasive techniques to make surgery a safe option for the aging population, as well as establish more effective non-surgical options.
Q: Is there a single initiative your organization has undertaken recently that you are particularly proud of?
JM: I'm proud of the deliberate effort Nuvance Health has taken to develop multidisciplinary spine care teams that include neurosurgeons, orthopedists, physiatrists, pain management specialists, physical therapists, nurses and other medical experts. A patient with a spine condition should not be treated in a vacuum, especially considering the aging population and the array of other health conditions they may have that could impact treatment. Our spine care teams develop multimodal, personalized treatment plans for our spine patients.
Q: What recent spine device has dramatically enhanced patient outcomes?
JM: Danbury Hospital and Norwalk Hospital of Nuvance Health have historically been early adopters of new technology that enables our surgeons to perform the latest minimally invasive surgical techniques and procedures. This most recently includes the acquisition of a robotic guidance and navigation system for spinal fusion surgery.
Using robotic technology is a great option for patients undergoing spinal fusion because they go home sooner after surgery, they have less postoperative pain and they recover faster compared to traditional, open spinal fusion. Robotic spinal fusion is less invasive, resulting in less blood loss because the incisions are smaller and also less time in the OR. For these reasons, spinal fusion with robotic technology may also be a safe option for people who weren't candidates for traditional surgery due to age or other medical conditions.
Q: What do you see as the next big trend in spine?
JM: Artificial prostheses for hips and knees have been an incredible advancement in total joint replacements. I think we'll see similar advancements for how we treat spine conditions, especially degenerative disc disease. If we can replace the normal biology (discs and joints) of the spine with artificial implants, rather than repair and then stabilize the spine with hardware, we may be able to preserve the biomechanics of the spine more effectively and longer-term. Also on a par to the trend with implants will be the use of more biotechnologies, like platelet-rich plasma, to treat spine conditions non-surgically. Non-surgical biotechnology options will become more available as the demand for outpatient treatments and procedures continues to grow.
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