Khoi Than, MD, is a neurosurgeon who recently left his practice at Oregon Health & Science University in Portland to join Chris Shaffrey, MD, and his team at Duke Spine Center in Durham, N.C.
Here, Dr. Than discusses how his practice will change when he joins Duke, where he will have an emphasis on minimally invasive surgery and robotics, as well as his continued studies into implant material.
Question: What emerging technology are you most interested in today and why?
Dr. Khoi Than: The most interesting emerging technology available right now is robotic spine surgery. The capabilities of robotic technology in spine aren't extremely beneficial right now, in that the robots simply provide data for screw placement. But, I think as robotics evolves it will be able to do more complicated procedures, such as challenging osteotomies and corrections, and that's when robotic technology will be really useful as an adjunct to surgery.
All technology has to begin simple and progress to accommodate more difficult procedures. I know different companies have this in mind and are working toward it.
Q: How do you think your practice will change in the next three years and what are you doing today to prepare?
KT: For me personally, I'm moving from OHSU to Duke, and the expectation for me at Duke is to really focus on minimally invasive and robotic surgery. I have done plenty of MIS work, but will need to learn about robotics since we didn't have a robot at OHSU.
For my new role, I will slightly change my mindset when thinking about procedures. Before, I would generally perform the most efficient procedure for my patients. Now, with my emphasis on MIS and robotic technology, I will utilize these techniques even if they may not be the fastest. I am thinking about the least invasive options. For example, I would generally treat patients with one- or two-level stenotic or degenerative disease with MIS procedures. At three or four levels, before I would have transitioned to an open procedure, but now I will treat these via a minimally invasive approach as well.
Q: What is the most dangerous trend in healthcare, spine or orthopedics today and why?
KT: I am really interested in the subject of graft materials in anterior cervical discectomy and fusion. I did research on this at OHSU and will continue to do so at Duke. We looked back at all one-level ACDFs done at OHSU, and the rate of pseudarthrosis when PEEK was used compared to structural allograft was five times higher with PEEK. This was published in the Journal of Neurosurgery: Spine, and our article on multi-level ACDFs will be published soon with essentially the same findings.
The problem is that surgeons can bill more using PEEK than structural allograft. If you perform a multilevel ACDF, you can charge for the structural allograft just once but you can charge for the PEEK cages at each level. That is a potential motivator for using PEEK and I'm interested in exploring that further.
There are hundreds of thousands of ACDFs performed in the U.S. per year and we are potentially negatively impacting those patients if they are not healing and require additional surgery. That is a dangerous trend and it has been going on for decades, unfortunately. I'm hoping to be part of changing that.
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