Many of the major breakthroughs in spine surgery were the result of gradual advancements over time, John Peloza, MD, said.
Dr. Peloza joined the "Becker's Spine and Orthopedic Podcast" to discuss the future of minimally invasive spine surgery and his thoughts about growth.
Note: This is an edited excerpt. Listen to the full conversation here.
Question: What surgical technologies are shaping the future of minimally invasive spine care?
Dr. John Peloza: Generally we make incremental improvements. It's not like we have a eureka moment, but then every now and then, the accumulation of incremental improvements comes to something big. I think one of the big things was to be able to do surgery through small tubes, and now endoscopic tubes.
Then the other thing was the ability to navigate the spine in real time in the operating room, and that was CT navigation. To go further on that, there are robots. The robots are dependent on the CT navigation, but the robot itself can fire in or can place the metal. Now you know the ultimate goal is to have the robot be able to do the decompression part two, controlled by the surgeon as an adjunct to the surgery.
In addition to that, a whole lot of improvements have been made in the biologics and how we get tissue to heal, along with the metallurgy in our implants. We don't have to take a bone graft, and because of the surface treatments or the internal architecture of the implant, the chance to get a good, solid fusion is now approaching almost 100%.
Another thing has been the improvements in disc replacements. The first disc replacement was designed in Germany in the 1980s, and so that eventually was brought to other different iterations of that design was brought to America in the late 1990s and early 2000s. There's been improvements since then to the implants we are using now. We also have done these level one studies and randomized control trials for the FDA, so we have lots of data. We have up to 10 year data comparing disc replacements, fusions, and — in our European colleagues — we have 20-year outcome data.
When people talk to us about what's likely to happen, we really do have a robust literature that could draw on. It's an exciting place to be as a physician, because we have all these tools, plus we have outcome data. So as a physician, you can take all that and prove your skills and say, minimally invasive surgery and then do the surgery in a venue that is actually conducive to a very good patient experience.
Q: When you think about the next two years, how are you thinking about growth?
JP: That's a complicated question. The bigger problems in medicine are insurance and reimbursement. It's having an effect on if you can even do an operation, and not from the technical part of it, but if you're allowed to. How do you afford all these wonderful things?
The idea is to put in a less expensive venue where you can negotiate with patients and vendors and insurance companies to get the cost down so that you can offer the passive savings on the patient. There are a couple things afoot to do that. Usually the business guys are very good at that — how to manage costs, but that's the biggest issue.
One thing we're doing is we're getting involved with a more of a concierge or cash pay business where we can actually present to the patient exactly what's wrong, how we would deal with it, how to pay for it and put in a less expensive venue so patients can afford it. If they get denied by Medicare or an insurance company, we can do something that we think works best at an affordable price.