Alexander Lenard, MD, is a fellowship-trained orthopedic spine surgeon in West Palm Beach, Fla. He's been in practice for more than 10 years and currently serves as the director of spine surgery at a St. Mary's Medical Center. Dr. Lenard specializes in corrective spinal surgery. Here are Dr. Lenard's five tips for integrating innovative spinal technology and techniques into the operating room.
1. Learn from your colleagues and competitors. Other spine surgeons in your area are often the best resource for learning new techniques or approaches, Dr. Lenard says. Develop relationships with other spine surgeons in your market and look to one other to share skills and techniques.
"It's good to have a relationship with other surgeons, and they can teach you techniques," he says. "You can have someone in the local area to scrub with you the first time you perform a new technique on a patient."
Be willing to share new techniques you've picked up with other surgeons, too, even competitors. In the long run, sharing knowledge will benefit both of you, and working with competing surgeons will help you get better at operating.
"You are going to have a much more enjoyable career if you early on establish good working relationships with people who are your competitors and your colleagues in the area," he says. "As a young spine surgeon, remember every time you are seeing a competitor's patient complaining in your office, that competitor has probably seen one of your patients, too."
2. Start with simpler procedures. Before a surgeon does any minimally invasive spine procedures that require hardware or implants, he should perfect the discectomy and procedures that do not require instrumentation, Dr. Lenard says.
All procedures are different and require various amounts of practices before mastering. For artificial disc replacement, Dr. Lenard says he felt comfortable after doing one cadaveric course because it was a variation on another procedure he was familiar with. Know your skill set and practice as much as you need to before adopting a technique.
Also, some devices or tools turn out to have no real benefit to patients or even to be detrimental. Spine surgeons should make an objective determination if a procedure will actually benefit a patient population. "A little education and common sense should be the tools used," he says.
3. Beware of biased industry training. Much of the training for new devices and implants is sponsored by device developers. "Implant companies are naturally inclined to educate surgeons on how to use their products," Dr. Lenard says. "But implant companies can also get biased on their product or technique."
Look for less biased training sources, such as spine societies and organizations. If you do opt for the industry-sponsored courses, he says, be aware of the possible bias and do not let it cloud your perception of a product or approach.
Dr. Lenard's personal rule is to give a device two years on the market before implementing its use into his practice. Implant research is often biased or industry-funded, and he prefers to judge a device's efficacy in the hands of less-biased surgeons.
4. Know when to use minimally invasive techniques. The most challenging part of incorporating minimally invasive techniques into a spine practice is knowing when use the more traditional, open methods instead.
"Your temptation is going to be doing more minimally invasive than less," Dr. Lenard says, "even though traditional spine surgical techniques are traditional for a reason. In some situations they are better than less proven minimally invasive techniques."
For instance, in spine trauma, MIS is not yet as successful as more traditional approaches, he says. MIS is often used as a misguided selling point to convince patients to undergo surgical interventions, rather than just a way to preserve soft tissue during a necessary procedure.
"Patients can be under the false impression that minimally invasive surgery is going to be less rigorous of an undertaking than it's actually going to be," he says.
Fully inform patients of the risks associated with procedures and the options available. They should have clear expectations before undergoing surgery, and a less invasive technique should never be used as a way to sell the surgery, he said.
5. Abide by accreditation requirements. Hospitals' Ongoing Professional Practice Evaluations and Focused Professional Practice Evaluations are becoming increasingly stricter and can stunt bringing innovation into the operating room. The recommendations dictate what training physicians must have before performing a new procedure or a procedure outside the scope of their specialty.
"Nowadays surgeons need to show accreditation and the acquired skill set in the procedure, monitored by someone else capable of doing the procedure," Dr. Lenard says.
Surgeons should be mindful of any accreditation requirements, such as having performed the technique a certain number of times or with the proper oversight before attempting to begin operating on patients.
More Articles on Spine:
9 Surgeons on Adopting Minimally Invasive Spine Techniques
Newport News Orthopaedic and Spine Center Helps Support Free Clinic
ISASS Names Best Paper Winners
1. Learn from your colleagues and competitors. Other spine surgeons in your area are often the best resource for learning new techniques or approaches, Dr. Lenard says. Develop relationships with other spine surgeons in your market and look to one other to share skills and techniques.
"It's good to have a relationship with other surgeons, and they can teach you techniques," he says. "You can have someone in the local area to scrub with you the first time you perform a new technique on a patient."
Be willing to share new techniques you've picked up with other surgeons, too, even competitors. In the long run, sharing knowledge will benefit both of you, and working with competing surgeons will help you get better at operating.
"You are going to have a much more enjoyable career if you early on establish good working relationships with people who are your competitors and your colleagues in the area," he says. "As a young spine surgeon, remember every time you are seeing a competitor's patient complaining in your office, that competitor has probably seen one of your patients, too."
2. Start with simpler procedures. Before a surgeon does any minimally invasive spine procedures that require hardware or implants, he should perfect the discectomy and procedures that do not require instrumentation, Dr. Lenard says.
All procedures are different and require various amounts of practices before mastering. For artificial disc replacement, Dr. Lenard says he felt comfortable after doing one cadaveric course because it was a variation on another procedure he was familiar with. Know your skill set and practice as much as you need to before adopting a technique.
Also, some devices or tools turn out to have no real benefit to patients or even to be detrimental. Spine surgeons should make an objective determination if a procedure will actually benefit a patient population. "A little education and common sense should be the tools used," he says.
3. Beware of biased industry training. Much of the training for new devices and implants is sponsored by device developers. "Implant companies are naturally inclined to educate surgeons on how to use their products," Dr. Lenard says. "But implant companies can also get biased on their product or technique."
Look for less biased training sources, such as spine societies and organizations. If you do opt for the industry-sponsored courses, he says, be aware of the possible bias and do not let it cloud your perception of a product or approach.
Dr. Lenard's personal rule is to give a device two years on the market before implementing its use into his practice. Implant research is often biased or industry-funded, and he prefers to judge a device's efficacy in the hands of less-biased surgeons.
4. Know when to use minimally invasive techniques. The most challenging part of incorporating minimally invasive techniques into a spine practice is knowing when use the more traditional, open methods instead.
"Your temptation is going to be doing more minimally invasive than less," Dr. Lenard says, "even though traditional spine surgical techniques are traditional for a reason. In some situations they are better than less proven minimally invasive techniques."
For instance, in spine trauma, MIS is not yet as successful as more traditional approaches, he says. MIS is often used as a misguided selling point to convince patients to undergo surgical interventions, rather than just a way to preserve soft tissue during a necessary procedure.
"Patients can be under the false impression that minimally invasive surgery is going to be less rigorous of an undertaking than it's actually going to be," he says.
Fully inform patients of the risks associated with procedures and the options available. They should have clear expectations before undergoing surgery, and a less invasive technique should never be used as a way to sell the surgery, he said.
5. Abide by accreditation requirements. Hospitals' Ongoing Professional Practice Evaluations and Focused Professional Practice Evaluations are becoming increasingly stricter and can stunt bringing innovation into the operating room. The recommendations dictate what training physicians must have before performing a new procedure or a procedure outside the scope of their specialty.
"Nowadays surgeons need to show accreditation and the acquired skill set in the procedure, monitored by someone else capable of doing the procedure," Dr. Lenard says.
Surgeons should be mindful of any accreditation requirements, such as having performed the technique a certain number of times or with the proper oversight before attempting to begin operating on patients.
More Articles on Spine:
9 Surgeons on Adopting Minimally Invasive Spine Techniques
Newport News Orthopaedic and Spine Center Helps Support Free Clinic
ISASS Names Best Paper Winners