From implants to robots, surgical technology for the spine has advanced at an exponential rate, and many surgeons are excited about the potential they hold.
However, surgeons have to weigh the pros and cons of trying new technologies in the operating room. Four spine surgeons told Becker's Spine Review the factors they consider before adopting new technology.
Note: Responses were edited for style.
Question: What are key considerations when trying new surgical technology in your practice?
Samuel Joseph Jr., MD. Joseph Spine Institute (Tampa, Fla.): There is a lot of new technology being offered to surgeons around the country. My key considerations in choosing which ones I’m going to use or try depend on cost to the facility, safety and improvement in clinical outcomes.
As a surgery center shareholder, it’s hard to justify a robot or intraoperative CT scan in an outpatient surgery center setting. Other navigation techniques like TrackX, which can be applied on a case-by-case basis, make more economic sense. In the hospital setting these more expensive technological advancement can be justified and more applicable to more invasive spinal surgery.
The goals of safety include reduction in risk to the patient as well as the surgeon. Less radiation with improved accuracy in instrumentation placement are important considerations.
In regards to clinical outcomes, biologics and surface technology are important to consider in fusion rates and complications. There needs to be an improvement in outcome without a reduction in safety and with a reasonable cost increase.
Kevin Foley, MD. Spine surgeon in Memphis, Tenn.: I am interested in new technologies, devices, and processes that have the potential to improve (or even transform) spine care. This encompasses many potential advantages for the new technology and/or device and/or process, which can range from providing a pathway to improved outcomes, lowering costs, enabling or improving treatment of pathologies that currently lack an effective solution, etc.
Brandon Hirsch, MD. The CORE Institute (Mesa, Ariz.): New technology is one of the most exciting parts of spine surgery. When considering a new device or technique in my practice I believe there are two fundamental criteria that must be met. It is important that the technology solves a clinical need or problem in my practice. Ideally its ability to do so should be backed by clinical data that demonstrate improvement over the status quo. In this era we can no longer use new technology just because we think it is interesting. New products must be of clinical benefit to the patient.
Value is the second part of the equation. Almost without exception, new products cannot increase the overall cost of spine care. Many spine surgeons are ambivalent to product cost if they are not a stakeholder in the facility they operate in. Even when this is the case, surgeons should understand that the more payers and facilities spend on a device, the less resources there are for other needs like staffing, physician extenders, other technology, operational infrastructure and physician reimbursement. U.S. healthcare costs are already some of the highest in the world. At the end of the day, the money that we spend on new technology comes out of the same pie that funds the rest of what we do.
Manish Kasliwal, MD. University Hospitals Cleveland Medical Center: Improvement in surgical technology has really made spine surgery safe for both patients and surgeons alike. Our understanding of treatment of spinal pathologies have improved significantly over the past decade or so and continue to evolve. There are multiple goals that we need to accomplish following any procedure on the spine to ensure the best clinical outcome for our patients with the least complication rates and avoidance of revision surgeries. Any surgical technology that will allow me to accomplish these goals is something I would strongly consider implementing in my practice. While often it may be cost prohibitive upfront; but by increasing the safety and efficacy of the procedure it may eventually prove cost-effective in the long run.