Three spine surgeons weigh in on the trends they are seeing in the spinal trauma arena.
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Question: What are some key trends in spinal trauma surgery?
Christian Zimmerman, MD. Spinal Neurosurgeon at Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Undoubtedly the state of reimbursements has affected all facets of spinal surgery and cranial-spinal trauma cases are not excluded. Whereby, acute structural abnormalities demand immediate attention, and better representation in any billing practice, there is a definitive leaning to some past methodologies; for example, the management of incomplete spinal cord injuries. These seem to warrant a more 'sit and wait' attitude thus declaring the injury extent versus more acute multi-level decompressions, which characteristically and [according to] literature-based recommendations for vigilance, demonstrate potentially better outcomes for patients over time.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: In the realm of trauma spinal surgery, the key trend, by far, is robotics. With the advent of mechanically guided screw placement and fairly soon Mako-style decompressions, we will see surgeons able to more precisely and safely treat patients. Soon, I imagine, commercial payers and Medicare will stop paying for take-backs for malpositioned hardware. That, along with increasing public knowledge of how things can go wrong in surgery — for example, the unfortunately named and rightly vilified 'Dr. Death' — there will be more demand for these services.
Another empirical trend (insurance-based mandates) surrounds the overwhelming delays partisan to the multi-level lumbo-sacral fusion procedures. The committee-consensus approach to the approval process of these large implant procedures also seems to be the preoperative approach to management with both neurosurgical/orthopedic surgery oversight in place.
Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): Percutaneous screw placement with intraoperative fluoroscopy or computer navigation allows for less traumatic fixation of unstable spine fractures. A lot of research into new medications and stem cell technology is currently under way for spinal cord injury with some promising early results.