With the regular onset of new devices and technologies, spine surgeons are using a variety of strategies to stay on top of the latest products.
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. Becker's invites all spine surgeon and specialist responses.
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Editor's note: Responses were lightly edited for clarity and length.
Question: How do you stay current with the rapidly changing landscape of spinal implants and devices, and what criteria do you use to evaluate new technologies?
Tan Chen, MD. Geisinger Musculoskeletal Institute (Danville, Pa.): I stay up to date by attending conferences, reading and publishing research, and interacting with industry on upcoming developments. I evaluate new devices on whether it makes biomechanical sense to me, the ease of use, clinical outcomes, and financials.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: There will always be new doodads and gadgets on the market. Especially when walking around meetings or opening a journal, you will be inundated with new things. I usually look for something that would work for me and my technical skills and not just looking cool or being invented by someone I know. If it looks cool but is cumbersome, it's a no-go.
Brandon Hirsch, MD. DISC Sports & Spine Center (Newport Beach, Calif.): One of the most enjoyable aspects of spine surgery is the dramatic technological advancement that occurs in the field on a regular basis. New implants, procedures and devices are constantly being introduced to the market. It is critical for spine surgeons to be able to form their own opinions of new technology and whether it fits in their practice. This can be challenging in an era of advanced industry-driven marketing tactics and strategy. When I evaluate new technology, the first question I ask is: "Does this technology improve my patients' outcomes or solve a clinical problem in my current practice?" Improving patient outcomes is central to everything I do as a spine surgeon. If a technology does not make surgery safer or materially improve my patients' results, I am unlikely to make a change to my practice. This is important for spine surgeons to keep in mind, as it is easy to get swept up in industry hype and the desire to always offer "the latest and greatest."
If I find that a new technology does improve patient outcomes and/or meets a genuine need in my practice, the next question is: "What does the peer reviewed, non-industry sponsored data show with regard to its effectiveness and safety?" Unfortunately this information is not always available to us. When that is the case, I typically turn to trusted friends and mentors in the spine surgery community and ask them about their perspectives and experience. I find it critically important and also very fulfilling to engage with our specialty societies for this reason. The Society for Minimally Invasive Spine Surgery does a tremendous job of connecting and educating a global community of surgeons who are passionate about advancing the field via new technology.
Mohammed Faraz Khan, MD. New Jersey Brain & Spine (Hackensack): I keep pace with technology like driving on the Autobahn — constantly looking ahead but mindful of the signs. I stay current through conferences, journal readings, and connections with innovators. When evaluating new spinal technologies, I focus on clinical efficacy, safety, and long-term outcomes. If a device meets these criteria and enhances surgical efficiency, I'm on board — just as long as it’s not merely the 'next shiny object.'
M. Kamran Khan, MD. Endeavor Health Neurosciences Institute (Naperville, Ill.): Our various society meetings as well as colleagues continue to inform us about emerging technologies in spine. Personally, I am always receptive to new technology as long as it is safe and efficacious for my patients and remedies a concern I have in their treatment. It is important to discern those technologies that can and will be best in the long term for the management of our patients and not just a short-term solution that may me more problematic than beneficial.
Jason Liauw, MD. Hoag Orthopedic Institute (Laguna Hills, Calif.): With the exception of robotics and maybe arthroplasty technologies, I don't think there is a rapid change in our field. I think there have just been iterative improvements in spinal technologies over the last 20 years and perhaps just a lot of me-too noise. This is evident by the lack of new innovations I see at NASS/AANS/AAOS in the last few years. That being said, I do think that surgeons should still engage with the industry to keep up with these iterative advances in technology, as even small improvements can help improve the field with time.
Philip Louie, MD. Virginia Mason Franciscan Health (Tacoma, Wash.): New technologies are the lifeblood of improving and advancing the care that we provide!
To stay current:
- Need to actually be open-minded to learning about new technologies and seek out opportunities when they arise (easy to ignore when busy)
- Society Meetings
- Social Media (which is crazy how effective these platforms can be from a new technology marketing perspective)
- Serve as a journal reviewer
Criteria to evaluate: Does this new technology…
- Improve outcomes in a meaningful way that is sustainable?
- Provide a solution to a problem that we currently face? (Not just providing a solution to a 'problem' that doesn't exist)
- Allow us to provide a service that we do not currently provide?
- Have opportunities for wider adoption among our group?
- Help us grow our practice and outreach to patients?
- Provide the health system with a return on the investment? Because we cannot simply adopt new technologies without being a good steward of our limited resources.
- Fill a niche in the spectrum of spine care in which we can actively research with our colleagues?
Justin Mathew, MD, Norton Leatherman Spine (Louisville, Ky.): Spine surgery is a dynamic field. I tend to stay abreast of changes in the field by conversing with my colleagues at other institutions, as well as engaging with the medical literature — not only by reading it, but also by publishing it. When I assess a new surgical technology, I evaluate it based on several criteria, some of the most important of which are safety, efficacy, and cost. Safety is my top priority for patients. If I am concerned that a device or technique may compromise their safety, I am unlikely to use it. Secondly, I consider whether it addresses a problem or a gap in our ability to care for patients. If it does not, I would hesitate to use it, unless it improves upon a previous iteration. Moreover, I would evaluate the evidence — as well as the quality of that evidence — supporting the use of a new device over similar products. Lastly, resources are finite. A new device should not cost so much that it constrains other critical aspects of care.
Michael Oh, MD. UCI Health (Orange, Calif.): Staying current in the rapidly evolving field of spinal implants and devices involves multiple approaches:
Continuous Education: Attending conferences, symposia, and workshops, especially regional programs like the Spine by the Sea Symposium, provides insights into the latest advancements and trends. These events often feature key opinion leaders and present cutting-edge research and technologies.
Clinical Research and Trials: Being involved in clinical studies allows firsthand exposure to new devices and innovations, but this is often limited to academic centers. For private practitioners, this engagement with emerging technologies can be obtained in some measure by working as a consultant with industry.
Literature Review: Regularly reviewing reputable journals and publications keeps me informed on peer-reviewed studies and case reports related to new spinal devices. Open Evidence is an example of an AI-powered system that allows me to do quick searches for areas that I am not as familiar with.
For evaluating new technologies, I apply the following criteria:
Non-industry Studies: New technologies must demonstrate safety and efficacy through non-industry studies, in addition to randomized clinical trials that are necessary for FDA approval, and offer a clear benefit over existing solutions.
Registry : How well does the device improve patient outcomes in terms of recovery, function, and quality of life in real-world settings.
Cost-Effectiveness: The economic impact on healthcare facilities matters. A new device must offer benefits that are proportionate to its cost. As an example, endoscopic spine surgery has been limited because of its additional cost not being covered by payers despite the benefit to patients.
Joseph Schwab. MD. Cedars-Sinai (Los Angeles): In a professional setting, no one likes surprises. As surgeons, we rely on our staff to prepare the operative environment for seamless patient care. This involves substantial preparation on the staff's part, much of which goes unnoticed when things run smoothly. However, when things don't go well, we often feel "surprised" and disappointed.
Incorporating new technology disrupts the normal workflow and adds stress to both the system and the staff managing it. If staff members are not informed in advance, it sends the message that they are not valued as part of the team. This can lead to frustration and contribute to burnout. To avoid these issues, it's crucial for surgeons to involve the team in discussions about the new technology early on.
Explaining the purpose of the technology and how it will improve patient care helps set the stage for a smoother transition. Attending in-service training alongside the staff fosters team spirit and ensures everyone understands the potential challenges. If concerns arise during these meetings, the surgeon should work actively with the team to address them.
Conducting a "trial" or "pilot case" is another effective step to ensure the integration process is seamless. It provides an opportunity for feedback and fine-tuning, and the surgeon's involvement in these adjustments is key. Finally, celebrating the successful incorporation of the new technology reinforces team cohesion. This can be done by highlighting improvements in patient care or simply thanking the staff for their efforts.
Ultimately, everyone shares the same goal: providing excellent patient care. This is only possible through mutual respect and true teamwork.
Noam Stadlan, MD. Endeavor Health Neurosciences Institute (Skokie and Highland Park, Ill.): I regularly read a number of spine and neurosurgery journals, paying attention to both the articles and the advertisements. One of the best ways to keep current is attending the annual meeting of a major society, in my case the North American Spine Society and the American Association of Neurological Surgeons. Not only are the presentations and posters a great source of up-to-date information and studies, but the display area has almost all of the new implants and devices, not just for viewing, but also for hands-on evaluation. I try to imagine how a new device can benefit my patients and how it may fit into my practice. Many "new" devices are either remakes of old technology, or technology in search of a use. I think it is important to continue to find new and better ways to help our patients, while at the same time avoiding using something new simply because it is "cool technology."
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): My go 'to' for currency concerning technology changes in spinal implants are the product engineers and marketing folks involved in the thicket of spinal implant development. Our adumbrative company is market leading, hospital/patient minded thought based, dedicated to R and D through significant fiscal allocation. Discussions are centered around outcome based data, ease of use and of unit cost to patient and facility.
On the other hand, the majority of my practice is idiomatic and mostly habitual in the conservative approach to caring for patients at this point. Having a younger staff of advanced providers and support staff, who provide exemplary care to our complex spine patients, superintends forward and prospective discussions and idea sharing as it pertains to patient care. Coupling this with enhanced patient access through media sources about healthcare, adds additional thought provocation as new technologies are unveiled.