Here eight spine surgeons discuss a number of opportunities for growth in the spine industry in 2014, including minimally invasive spine surgery and biologics.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: What are some ways in which you plan on growing patient volume this year?
Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, Feb. 12, at 5 p.m. CST.
Question: What are some of the biggest opportunities for growth in the spine industry in the coming year?
Neel Anand, MD, Director, Spine Trauma, Cedars-Sinai Spine Center, Los Angeles: First there is minimally invasive spine surgery, then biologics, and then there is also cost containment. Input seems to be in these three.
Eventually it boils down to the fact that technology has a difficult time coming through. New technology is often stalled and new technology that has no precedent has difficulty getting into the market because of the cumbersome FDA approval process and how difficult it is to get reimbursed by insurance companies. This is why there is growth in different types of procedures and different areas, such as minimally invasive spine surgery and biologics.
Jeffrey Wang, MD, Chief, Orthopedic Spine Service, Co-Director, USC Spine Center, Keck Medical Center of USC, Los Angeles: I think some of the largest opportunities for growth for the spine industry is trying to gather evidence for efficacy and favorable patient outcomes using their new technology or devices. Certainly, at least in recent years, there has been a feeling that the introduction of new technology has been somewhat stunted. Now there is a demand for evidence and efficacy which is absolutely appropriate.
The companies that can show good evidence through well-constructed clinical studies, and those that are transparent with their presentation of their studies, will have an advantage when trying to introduce novel technology. Both the surgeons and the payers will hopefully demand this evidence and will use it appropriately to help our patients with better outcomes. If you cannot show that your technology works, then you will be at a distinct disadvantage.
Nick Shamie, MD, Chief of Orthopedic Spine Surgery, University of California Los Angeles: I believe there will be a continued push for transitioning spine procedures into the outpatient setting. Minimally invasive treatments that provide equally efficacious results as traditional surgical procedures will be sought after by patients and surgeons.
There is tremendous potential for growth in this sector. We must however make sure the excitement of using new devices in our practices does not supersede the value we are providing in treating our patients.
Nader Dahdaleh, MD, Northwestern Medicine Neurosurgeon, Assistant Professor, Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago: The past two decades have witnessed a variety of technological advancement in [the] spinal surgery industry and the expectation is that this trend and growth will continue. The most important advancement, in my view, is minimally invasive spinal surgery.
Avoiding unnecessary muscle dissection with the use of tubular retractors, and the utilization of direct corridors to managing nearly the full spectrum of spinal pathology have translated into faster recovery, less hospitalization, less complications and lower costs. Many of the newer technologies now focus on applying minimally invasive techniques to deformity (kyphoscoliosis) correction, where these advantages will potentially be more pronounced.
Moreover, the ongoing research focusing on understanding mechanisms that promote bone healing and fusion, will drive newer biologics into the market. The wave of the future will include technologies that will make our spine practices cost effective and safer as well.
Scott Spann, MD, Founder of Westlake Orthopaedics Spine & Sports and Pantheon Spinal, Austin, Texas: In my opinion, I would say that there are three large opportunities for this year. We have been able to introduce some new technology that will allow new approaches to the spine. Additionally, some new devices will become available that will enhance our reconstruction capabilities. These have the opportunities to create an entire paradigm shift in how we approach lumbar spine pathology.
The second opportunity would consist of the use of biologics. As the utilization of stem cells has become more accepted and prevalent in a clinical scenario, more applications as well as an ever increasing knowledge of their benefits is continuing to evolve. I think this is going to be an ongoing trend for many years to come.
We are finding even more applications and utilization even in an outpatient setting. As we further refine our techniques on harvesting these cells autologously, I think the possibilities of application are limitless.
Amir Vokshoor, Neurological Spine Surgeon, DISC Sports & Spine Center, Marina del Rey, Calif.: In my opinion, the largest opportunities for growth in the spine industry reside in four key areas. The first is regeneration technologies including stem cells and biologics. Number two is artificial disc technology, and three is minimally invasive surgery for revision spine cases as well as in scoliosis surgery. Finally, number four is spinal navigation to decrease the necessity of X-ray fluoroscopy.
Purnendu Gupta, MD, Director, Chicago Spine Center, Weiss Memorial Hospital, Chicago: The biggest growth opportunity will surround the patient. Although the spine industry puts a lot of emphasis on technology, we need to shift our attention to better facilitate patient care. In order for new technologies to be adopted, the industry needs to grow in the direction of developing tools for physicians to better measure patient outcomes.
As we enter the next era of healthcare reform, it is not technology, but better focus on patient care that will help us to achieve better outcomes and patient satisfaction. Ultimately, this will influence payers to support patient care.
Paul Slosar, MD, President, SpineCare Medical Group, Daly City, Calif.: Spine surgeons always remain interested in emerging technologies to achieve improved clinical outcomes. There is a trend away from plastic interbody spacers and a strong interest in titanium as a surface, which has favorable bone healing qualities.
Spine surgery is now finally looking at the interbody implant as more than a simple spacer. This mirrors a trend occurred several years ago when oral surgeons and total joint surgeons focused heavily on the surface characteristics of their implants to achieve better bone integration. Also, the trend of cost-efficient and clinically effective care will emerge much more so in 2014, as reimbursement patterns shift the financial risk to surgeons and hospitals.
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