All facets of healthcare are working to scale back costs — including complex spine procedures. Innovators are devising new technologies and surgical tools for spine surgery that will yield enhanced outcomes for patients, and ultimately, will drive down costs.
"Complex spine surgery is trending towards becoming more cost-effective due to pressures we face to decrease healthcare costs," says Han Jo Kim, MD, spine fellowship co-director and spine surgeon for the Hospital for Special Surgery in New York. "There is increased focus on reducing complications and length of stay while maximizing outcomes – which ultimately increases the value proposition of a particular intervention."
Here are five trends in complex spine surgery.
1. A patient's pathology dictates treatment options. Minimally invasive techniques prove successful for a certain pool of patients and provide benefits including shorter recovery time and less pain. However, analyzing the patient's pathology is critical as not all patients are ideal candidates for such techniques. "What we are finding is that MIS techniques do not work for all patients. While some patients are good candidates for MIS, it will fail miserably in others," Dr. Kim says. Studies have shown patients who have mild deformities respond well to MIS procedures, while patients with larger deformities do not yield good outcomes when using MIS techniques."
2. A 30-year-old patient is not the same as a 70-year-old patient. Surgeons are increasingly taking into account a patient's age as well as patient-specific pathology. Technological advancements allow surgeons to do massive corrections of a patient's spine. However, just because the surgeon has the ability to do the procedure doesn't mean that every patient is a suitable candidate. Studies on normative populations have found that increasing sagittal balance is a part of aging, and the regional alignments of the lumbar, thoracic and cervical spine change with age. For example, a patient in their 30's may have a sagittal balance closer to 0 compared to a patient in their 70's, making the younger patient better suited for spinal reconstructions aiming for perfect sagittal balance, as opposed to the patient in their 70's who may benefit from less aggressive corrections leaving them with slight positive balance. "The problem is that the cookie cutter approach to spinal reconstructions may cause complications when it is not appropriately age matched," Dr. Kim explains. "It might be that spinal reconstructions should be age-specific."
3. Surgical planning tools help surgeons visualize procedures. Dr. Kim and other surgeons at HSS utilize intraoperative three-dimensional imaging as well as preoperative surgical planning tools. "These tools help us reach our correction goals which we tailor toward each patient based on the deformity type, age and any prior operations they may have had," he says.
Revision procedures are usually more complex and surgeons may have difficulty devising a successful surgical plan. Dr. Kim explains that the pre-operative planning tools help to visualize an intervention such as an osteotomy in order to plan the type of osteotomy and location for it to be performed in order to optimize the correction and achieve the intended correction goals.
4. Biologics are the way of the future. Biologics, in combination with technological advancements, are paving the way for more advanced treatment options. In 2014, the spine biologics market was valued at $1.9 billion and the market is expected to continue to growth through 2020, reaching $2.4 billion. Biologics have the potential to reduce the need for interbody fusions and other procedures, which Dr. Kim explains can lead to shorter OR times, reduced complication rates and lower overall cost for care.
5. Risk stratification of patients. Researchers will continue to conduct studies analyzing the risks for different patients to identify which patients have the highest risk for complications and therefore may not be viable candidates for surgery. "Risk stratification will help in the bigger scheme of picking candidates who can get the most benefits to improve costs," Dr. Kim says.
Complex spine surgery will evolve to meet healthcare's growing demand for better patient outcomes. To achieve optimal outcomes, spine surgeons may need to analyze each patient individually and devise the best course of action.
"Surgical strategies for complex spine surgery will deal with the combination of the patient's pathology, a patient's specific needs and optimizing the use of technology such as biologics to maximize patient outcomes and minimize operative time," Dr. Kim says. "This will ultimately lead to improved cost effectiveness."
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