The growth of spine technology and outpatient spine migration are two things that can benefit from each other.
The outpatient spine landscape, which is already strong, will "greatly expand" from what's happening now, according to Don Park, MD, of UCI Health in Orange, Calif.
"With the increased adoption and utilization of endoscopic spine surgery in the U.S., more surgeries can be performed in the ASCs using these ultra-minimally invasive techniques," Dr. Park, said. "In addition, awake spine surgery techniques with epidural, spinal and fascial blocks can allow more patients to undergo spine surgery without the need for general anesthesia. This will allow older patients with more medical comorbidities to have endoscopic spine surgery performed in the outpatient setting."
Endoscopic spine surgery, while slower to grow in the U.S., has seen success abroad. In 2023 the technique was gaining traction with surgeons and medtech companies. Endoscopic spine surgery may also be a better fit for ASCs — a study published in the January edition of the Journal of Neurosurgery: Spine, found the minimally invasive technique cost more than open spine procedures at hospitals.
Awake surgery has also seen growing interest in recent years. In December Portland-based Oregon Health & Science University completed its first awake spine surgery, led by Josiah Orina, MD.
The benefits of ASCs and allowing at-home recovery make the outpatient setting increasingly attractive, and can push spine technology toward the trend.
"Embrace the transition of surgical procedures migrating to the outpatient setting," Steven Barnett, MD, chief medical officer at Hoag Orthopedic Institute in Irvine, Calif., said. "Evolution of surgical technique including the use of technology as well as anesthetic protocols allows us to perform many more procedures safely with day-of-surgery discharge. Patients benefit in that they can often receive treatment in a local ASC while recovering at home, reducing the risk of infection in these historically inpatient surgeries."
Frank Phillips, MD, of Chicago-based Midwest Orthopaedics at Rush, said although enabling technologies have been costly for ASCs, continued growth could even help bring some complex cases outpatient.
"Evolution of these platforms with an eye on the ASC will undoubtedly allow for migration of more complex cases to ASCs," Dr. Phillips said. "Implant manufacturers have been reluctant to embrace ASCs for fear of cannibalizing their hospital margins on products. By using procedural bundled payments, we have made this a win-win at our ASCs. As less-invasive fusion techniques advance, these will facilitate further ASC migration."