Peter Derman, MD, is a surgeon at Plano-based Texas Back Institute.
He focuses his research on developing better medicine for the future generations and has an MBA from Wharton School of Business. Here, he discusses big technology trends in spine and where the field is headed.
Question: What emerging technology are you most interested in today and why?
Dr. Peter Derman: Cost effectiveness has become a significant driver in healthcare and will continue to drive innovation of devices and techniques that provide similar or better outcomes at a lower expense. I am particularly excited about the explosion in surface technologies for interbody fusion devices. Rather than implanting inert materials, we will increasingly be using bioactive devices that participate in fusion rather than simply permit it. It is easy to envision a scenario in which such implants lessen the burden of revisions for pseudoarthrosis, thereby reducing overall expenditures while improving outcomes. But if such implants can obviate the need for expensive biologics, even greater cost savings will be realized.
The push toward minimally invasive approaches and outpatient spine surgeries also has the promise of improving outcomes while reducing costs. Advances in anesthesia and analgesia protocols as well as surgical techniques have allowed more and more surgeries to be performed in the outpatient setting. While the adoption of endoscopic techniques has not been as brisk in the United States as it has been in Europe and Asia, I believe that endoscopic surgery for certain spinal conditions is the wave of the future. The concepts are certainly not new, but the instruments and techniques continue to evolve and improve with time such that I think there will soon be an inflection point in which U.S. surgeons begin to embrace the technology.
Q: How do you think your practice will change in the next three years? What are you doing today to prepare?
PD: I find it imperative to constantly update my practice and thoughtfully incorporate to the latest knowledge and techniques. One of my mentors during training used to say, 'If you come back five years from now and I'm still doing things the same way, you can consider me a failure.' I embrace this sentiment as well. From a knowledge perspective, I stay up to date by reading the latest journals, participating in society meetings, and producing original research of my own. From a technical standpoint, I seek out additional opportunities to hone my skills and broaden my repertoire, whether that be cadaver labs, courses, or even co-scrubbing with my partners on interesting cases. My goal is always to be able to offer my patients the optimal treatment for their unique pathology, not just a standard 'go to.' This requires comfort with the entire spectrum of spinal procedures.
I believe that the next wave of innovation in spine surgery is in the endoscopic space, and I anticipate that this will become an increasingly significant component of my practice in the coming years. I also think we're going to see a major shift away from fusion and toward motion preserving techniques such as disc replacement, both in the cervical and lumbar spine. It seems absurd to me that spine surgeons are routinely fusing motion segments. Where else in the body is this a standard practice? Hip and knee surgeons do not spend their days fusing joints for degenerative conditions. While the biomechanics of the spine are more complex, we will be performing arthroplasty in more and more instances that previously would have required fusion as motion preserving devices and our comfort with them improve.
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