The next phase of spine growth

Spine

Outpatient migration and disc replacements will play an increased role in spine surgery's future, Dean Perfetti, MD, said.

Dr. Perfetti, of Carmel, N.Y.-based Somers Orthopaedic Surgery and Sports Medicine Group, joined the "Becker's Spine and Orthopedic Podcast" to discuss what's next for outpatient spine surgery and the specialty's biggest growth opportunities.

Note: This is an edited excerpt. Listen to the full conversation here.

Question: How will the spine and orthopedic field evolve in the next two to three years? 

Dr. Dean Perfetti: Over the next two to three years procedures are going to be more commonly performed in an outpatient setting — not only the 23 hour stay, but probably even shorter. Endoscopy opens up that ability to essentially be treated almost like a knee arthroscopy, where you get your surgery and within an hour or two you're discharged home. That's a big benefit of endoscopy, where you have not only small incisions from a minimally invasive point of view, but you have no dead space in terms of the dissection. Everything closes up as you take the small tube out, and it's even smaller than the tubular retractors that are 18 to 22mm that you hear in microdiscectomy. This is truly minimally invasive. Having a camera down at the level of the pathology, as opposed to looking at it from a normal standard surgical perspective, we could really deal with the problem at hand and then get people back to their lives and to work significantly quicker.

Q: Where do you see the best opportunities for growth?

DP: There's a lot of growth that's happening in not only techniques like I was talking about with endoscopy, but in implant sciences in the form of arthroplasty. These are motion preserving procedures as opposed to fusions, which obviously limit the motion at that segment. When you understand biomechanically the anatomical segment, the cervical and lumbar spine, it makes sense that you can preserve motion. 

We saw this sort of change with hip and knee surgeries earlier on. When we didn't have the capabilities to do arthroplasty for those joints, we did fusions. Now if you ask a hip or knee surgeon to do a fusion, they'd look at you kind of crazy … It's the same concept with the cervical and lumbar spine. We're getting better knowledge of the biomechanics, and where I trained at Plano-based Texas Back Institute, we had 20 plus years of spine arthroplasty. I think that's a big thing along with robotics. I've done a lot of training with a number of robotic systems, and that adds another benefit to having more accurate instrumentation as well as having another reliable source of information on that patient by coordinating not only MRI and CT scans specifically, but maybe trying to merge that with MRIs and other visualization technologies.

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