Here are 24 spine surgeons discussing what they are most excited about for the future of spine surgery.
Howard An, MD, Midwest Orthopaedics at Rush: I am excited about future of orthopaedic and spine surgery in that the treatment options are becoming less invasive and [the] biological or tissue engineering approach to many orthopaedic conditions may become a reality, including intervertebral disc degeneration. Invasive procedures such as lumbar spine fusion or artificial disc for discogenic low back pain might become less or replaced by biological treatments such as intradiscal injection of growth factor or stem cells. I am also excited to continue to train orthopaedic residents and spine fellows, who will make a difference in the care of patients for many years after my tenure.
Neel Anand, MD, Cedars-Sinai Medical Center: I am most excited about the minimally invasive technologies and biologic solutions that may have the potential to make spine surgery safer, less destructive and as a result, more effective by enhancing outcome.
Gunnar Andersson, MD, Midwest Orthopaedics at Rush: I am convinced that there is a biological solution to many of the problems we treat surgically today. I don't know whether it's going to happen in the next decade, but certainly at some point we will be able to treat degenerative disc disease and its consequences biologically. Having said that I think one has to be realistic about the effect of aging on all tissues in the body and the futility in trying to prevent indefinitely what ultimately is not preventable. If we can give people a better quality of life for more years I would be highly satisfied.
Scott Blumenthal, MD, Texas Back Institute: I am most excited about disc regeneration with stem cells, genetic engineering or other proteins or materials.
Scott Boden, MD, Emory Healthcare: I am excited about continued progress in the area of second generation biologic solutions for bone regeneration and potentially first generation solutions for cartilage regeneration/repair. I am also excited about the opportunity to re-design a care delivery model that focuses on delivering value and service that will be required to survive in the evolving healthcare environment.
Charles Branch, MD, Wake Forest Baptist Health: The most exciting aspect of the future is the unknown! The need to develop effective and efficient treatments for spinal degeneration in an ever-expanding aging population will drive us to develop technology that we haven't even thought of at this point in time!
Robert Bray, MD, DISC Sports & Spine: Looking towards the future, I am most excited to see the further development and acceptance of the outpatient surgery center as the premier vehicle for delivering the highest level of elective patient care. Today, our surgeons perform even the most complex cases that were typically reserved for hospitals on an outpatient basis. The surgery center environment can offer a more cost efficient, patient-centered approach that has been shown to have a reduced risk of infection. Development of specialized centers for high acuity surgery will alter the entire model of how healthcare is delivered.
Thomas Errico, MD, NYU Langone Medical Center Hospital for Joint Diseases: Frankly I have been performing spine surgery for nearly 30 years and have seen immense progress in the field. There, however, still exists many burning questions about who to operate on and what specifically should be done and can it be done successfully in a minimally invasive fashion. I look forward to answers to many of these questions as we apply a more rigorous approach to data collection and analysis of the results of spinal surgery.
Steven Garfin, MD, UCSD Medical Center: I am excited about the opportunity to continue to work with academic and spine surgical leaders and industry innovators on new products, concepts and ideas. This also leads to an unfortunate "burden" in trying to work with insurance and government and academic spine societies in developing plans, protocols and guidelines to enhance care for spine surgery patients that will move us forward in what we can diagnose and treat. I feel the next, important, future directions in spine surgery have to be in diagnostics and separately biologics/tissue altering techniques that address pain. Hopefully I can work in that arena, and also help "grease the skid" so financial impediments and predetermined negative judgments are not present when novel diagnostics and exciting biologics appear.
Jeffrey Goldstein, MD, NYU Langone Medical Center Hospital for Joint Diseases: The future of spine surgery will include a variety of minimally invasive techniques relying on an increased use of biologics in addition to motion preservation.
Richard Guyer, MD, Texas Back Institute: I think the whole field of biologic and genetic research will provide our patients tremendous treatment advancements. Someday we will be able to treat and reverse symptomatic degenerative disease before it becomes end stage, to treat and prevent osteoporosis and to treat adolescent scoliosis without fusion surgery but motion sparing techniques. The last area I am most excited about is the application of minimally invasive surgery and robotics so that someday just like robotic assisted prostatectomies, we will be able to decompress the spine from the inside out particularly with regard to spinal stenosis without taking the spine apart.
Andrew Hecht, MD, Mount Sinai Medical Center: I am most excited by the increasing emphasis not only on minimally invasive and motion preserving procedures but on advances in the understanding of the biology of spinal disorders such as disc degeneration. Our lab continues to study the basic processes involved in the pathophysiology of disc degeneration with the hope that someday this may lead to novel biologic treatments to halt or reverse the degenerative process that underlies the majority of the spinal disorders we treat.
Michael Heggeness, MD, Baylor Clinic: I view the future with both real fear and true anticipation. I am very concerned to see how all physicians in the United States have been subjected to so many additional costs (including electronic medical records, e-prescribing, "meaningful use"), and threats, (of misdirected audits), that the independent practice of medicine is rapidly disappearing. This will drastically limit choice for both doctor and patient going forward.
On the other hand, I am very excited to know that molecular medicine techniques for musculoskeletal medicine will soon be a reality. This will dramatically improve many of our treatment options in the very near future.
Harry Herkowitz, MD, William Beaumont Hospital: I am most excited about improving our imaging technology to pinpoint the source of the patients' pain; continuing our research to regenerate aging discs; improving our surgical techniques to allow for faster recoveries; and utilizing outcomes research to better evaluate the surgical procedures performed on patients to help determine the best operation for that patient's problem.
Stephen Hochschuler, MD, Texas Back Institute: Despite significant challenges facing medicine in general, I am quite excited by potential downstream opportunities for spine. There will be opportunities in: telemedicine; physician extenders; integration of treatment; emphasis on prevention; application of nano and MEMS Technology; development of biologic solutions; improvement in image guidance and robotics and more international integration.
Stephen Parazin, MD, New England Orthopaedic & Spine Surgery: Spine is a dynamic field. We still don't have all the answers. In fact, while we have felt for many years that a lot of our answers were found in surgery involving implants, screws and rods, artificial discs, etc, we are now finding that maybe some of these answers will lie more in the biologic sphere with ways to try to make discs healthier in older individuals, to try to create stability and fusion by utilizing biology, both in manufacturing chemicals and in genetic enhancements. I think the future of spine will move into a more biologic answer rather than a mechanical answer. For me, this dynamic change is very appealing.
John Peloza, MD, Center for Spine Care: I look forward to the future of spine care in spite of all the challenges ahead. Science and technology are advancing providing exciting opportunities for spine physicians to improve care. This will require careful, honest, and ethical study combining the resources of the best research and clinical minds in the field. I am presently committed to several basic research and clinical studies in biologics, nanotechnology and surgical techniques. Hopefully, these will lead to predictable, high quality, cost effective treatments in the near future.
Kenneth Pettine, MD, Rocky Mountain Associates: I remain most excited the last two-and-a-half years of being involved in two FDA studies involving biologics to treat discogenic low back pain. In addition we have injected over 130 patients with autogenous bone marrow concentrate. I believe biologics will soon change the practice of spine and am excited to be pioneering this advancement.
Raj Rao, MD, Medical College of Wisconsin: The future of spine surgery holds a lot of promise, with evolving new products and techniques in our armamentarium. The concepts of using even smaller incisions and better technology in the future, just as effectively as we do today, to relieve pain and improve function is exciting. We need to explore the whole “mind-body” concept to understand the exact role of pain in spinal disorders.
William Watters, MD, Bone & Joint Clinic of Houston: There has been a remarkable proliferation of new technologies in the arena of spinal surgery in the past 10 to 15 years allowing shorter periods of hospitalization, decreases in incision size and thus patient trauma utilizing minimally invasive technology and in many cases improved outcomes. With this use of new technology has come an increased cost of utilization which is stimulating closer scrutiny of surgical requests by payors. To me the most exciting developments heading into the future of spinal care are in the area of evidence-based medicine. We are using the techniques of evidence-based medicine to focus our interest on assessing patient outcomes with traditional and new technologies, allowing us to more carefully and thus more cost-effectively apply the correct technologies to a particular patient's surgical problem. By generating this evidence base we can better provide for our patients, increase the quality of patient outcomes and more forcefully make evidenced-based arguments with payors for the appropriate surgical intervention in our patients.
Robert G. Watkins III, MD, Marina Del Rey Hospital: The aspect that I am most excited about for the future is working with my son, Robert, and the our partner, Dave Chang, to further develop this program and make a lasting impact on the care of spinal injuries in athletes. I look forward to a continued application of these treatment and rehabilitation programs we use in athletes to all spinal patients.
Jeffrey Wang, MD, UCLA Health: I am most excited about the future. Healthcare is changing and I think surgeons need to embrace, learn and adapt quickly to these changes in order to be satisfied with their life. There will be challenges ahead, but this is an opportunity to try to make things better and make our healthcare system better. There are some positive and some negative aspects to the future depending on one's perspective, but overall, we have a chance to try to make improvements.
Franklin Todd Wetzel, MD, Temple University School of Medicine: The biggest challenge for the future will be to maintain our core values as clinicians, educators and scientists. Reimbursement for clinical activity is declining, the rewards for teaching diminishing and extramural funding for research shrinking. As the competition for limited resources becomes keener, we must be even more cognizant of the role of ethics in our professional conduct, especially with regard to management of conflict of interest and bias in the pursuit of support for these crucial activities.
James Yue, MD, Yale Medicine: The integration of advanced neuroimaging diagnostic techniques with real time intra-operative image guidance will advance the care of patients with spine related diseases especially those patients with spine tumors and those in need of minimally invasive spine procedures. Biologically based, as opposed to surgically based, treatment of scoliosis and symptomatic degenerative disc pathology are also being studied and are being presently investigated alleviate as alternative treatments for these difficult disease processes.
More Articles on Spine Surgery:
Economics, Politics & the Independent Spine Surgeon: Q&A With Dr. Craig Callewart
8 Ways to Combat Spine Surgery Claim Denials
Evolution of Minimally Invasive Spine Surgical Technique: Q&A With Dr. Arnold Feldman of The Feldman Institute
Howard An, MD, Midwest Orthopaedics at Rush: I am excited about future of orthopaedic and spine surgery in that the treatment options are becoming less invasive and [the] biological or tissue engineering approach to many orthopaedic conditions may become a reality, including intervertebral disc degeneration. Invasive procedures such as lumbar spine fusion or artificial disc for discogenic low back pain might become less or replaced by biological treatments such as intradiscal injection of growth factor or stem cells. I am also excited to continue to train orthopaedic residents and spine fellows, who will make a difference in the care of patients for many years after my tenure.
Neel Anand, MD, Cedars-Sinai Medical Center: I am most excited about the minimally invasive technologies and biologic solutions that may have the potential to make spine surgery safer, less destructive and as a result, more effective by enhancing outcome.
Gunnar Andersson, MD, Midwest Orthopaedics at Rush: I am convinced that there is a biological solution to many of the problems we treat surgically today. I don't know whether it's going to happen in the next decade, but certainly at some point we will be able to treat degenerative disc disease and its consequences biologically. Having said that I think one has to be realistic about the effect of aging on all tissues in the body and the futility in trying to prevent indefinitely what ultimately is not preventable. If we can give people a better quality of life for more years I would be highly satisfied.
Scott Blumenthal, MD, Texas Back Institute: I am most excited about disc regeneration with stem cells, genetic engineering or other proteins or materials.
Scott Boden, MD, Emory Healthcare: I am excited about continued progress in the area of second generation biologic solutions for bone regeneration and potentially first generation solutions for cartilage regeneration/repair. I am also excited about the opportunity to re-design a care delivery model that focuses on delivering value and service that will be required to survive in the evolving healthcare environment.
Charles Branch, MD, Wake Forest Baptist Health: The most exciting aspect of the future is the unknown! The need to develop effective and efficient treatments for spinal degeneration in an ever-expanding aging population will drive us to develop technology that we haven't even thought of at this point in time!
Robert Bray, MD, DISC Sports & Spine: Looking towards the future, I am most excited to see the further development and acceptance of the outpatient surgery center as the premier vehicle for delivering the highest level of elective patient care. Today, our surgeons perform even the most complex cases that were typically reserved for hospitals on an outpatient basis. The surgery center environment can offer a more cost efficient, patient-centered approach that has been shown to have a reduced risk of infection. Development of specialized centers for high acuity surgery will alter the entire model of how healthcare is delivered.
Thomas Errico, MD, NYU Langone Medical Center Hospital for Joint Diseases: Frankly I have been performing spine surgery for nearly 30 years and have seen immense progress in the field. There, however, still exists many burning questions about who to operate on and what specifically should be done and can it be done successfully in a minimally invasive fashion. I look forward to answers to many of these questions as we apply a more rigorous approach to data collection and analysis of the results of spinal surgery.
Steven Garfin, MD, UCSD Medical Center: I am excited about the opportunity to continue to work with academic and spine surgical leaders and industry innovators on new products, concepts and ideas. This also leads to an unfortunate "burden" in trying to work with insurance and government and academic spine societies in developing plans, protocols and guidelines to enhance care for spine surgery patients that will move us forward in what we can diagnose and treat. I feel the next, important, future directions in spine surgery have to be in diagnostics and separately biologics/tissue altering techniques that address pain. Hopefully I can work in that arena, and also help "grease the skid" so financial impediments and predetermined negative judgments are not present when novel diagnostics and exciting biologics appear.
Jeffrey Goldstein, MD, NYU Langone Medical Center Hospital for Joint Diseases: The future of spine surgery will include a variety of minimally invasive techniques relying on an increased use of biologics in addition to motion preservation.
Richard Guyer, MD, Texas Back Institute: I think the whole field of biologic and genetic research will provide our patients tremendous treatment advancements. Someday we will be able to treat and reverse symptomatic degenerative disease before it becomes end stage, to treat and prevent osteoporosis and to treat adolescent scoliosis without fusion surgery but motion sparing techniques. The last area I am most excited about is the application of minimally invasive surgery and robotics so that someday just like robotic assisted prostatectomies, we will be able to decompress the spine from the inside out particularly with regard to spinal stenosis without taking the spine apart.
Andrew Hecht, MD, Mount Sinai Medical Center: I am most excited by the increasing emphasis not only on minimally invasive and motion preserving procedures but on advances in the understanding of the biology of spinal disorders such as disc degeneration. Our lab continues to study the basic processes involved in the pathophysiology of disc degeneration with the hope that someday this may lead to novel biologic treatments to halt or reverse the degenerative process that underlies the majority of the spinal disorders we treat.
Michael Heggeness, MD, Baylor Clinic: I view the future with both real fear and true anticipation. I am very concerned to see how all physicians in the United States have been subjected to so many additional costs (including electronic medical records, e-prescribing, "meaningful use"), and threats, (of misdirected audits), that the independent practice of medicine is rapidly disappearing. This will drastically limit choice for both doctor and patient going forward.
On the other hand, I am very excited to know that molecular medicine techniques for musculoskeletal medicine will soon be a reality. This will dramatically improve many of our treatment options in the very near future.
Harry Herkowitz, MD, William Beaumont Hospital: I am most excited about improving our imaging technology to pinpoint the source of the patients' pain; continuing our research to regenerate aging discs; improving our surgical techniques to allow for faster recoveries; and utilizing outcomes research to better evaluate the surgical procedures performed on patients to help determine the best operation for that patient's problem.
Stephen Hochschuler, MD, Texas Back Institute: Despite significant challenges facing medicine in general, I am quite excited by potential downstream opportunities for spine. There will be opportunities in: telemedicine; physician extenders; integration of treatment; emphasis on prevention; application of nano and MEMS Technology; development of biologic solutions; improvement in image guidance and robotics and more international integration.
Stephen Parazin, MD, New England Orthopaedic & Spine Surgery: Spine is a dynamic field. We still don't have all the answers. In fact, while we have felt for many years that a lot of our answers were found in surgery involving implants, screws and rods, artificial discs, etc, we are now finding that maybe some of these answers will lie more in the biologic sphere with ways to try to make discs healthier in older individuals, to try to create stability and fusion by utilizing biology, both in manufacturing chemicals and in genetic enhancements. I think the future of spine will move into a more biologic answer rather than a mechanical answer. For me, this dynamic change is very appealing.
John Peloza, MD, Center for Spine Care: I look forward to the future of spine care in spite of all the challenges ahead. Science and technology are advancing providing exciting opportunities for spine physicians to improve care. This will require careful, honest, and ethical study combining the resources of the best research and clinical minds in the field. I am presently committed to several basic research and clinical studies in biologics, nanotechnology and surgical techniques. Hopefully, these will lead to predictable, high quality, cost effective treatments in the near future.
Kenneth Pettine, MD, Rocky Mountain Associates: I remain most excited the last two-and-a-half years of being involved in two FDA studies involving biologics to treat discogenic low back pain. In addition we have injected over 130 patients with autogenous bone marrow concentrate. I believe biologics will soon change the practice of spine and am excited to be pioneering this advancement.
Raj Rao, MD, Medical College of Wisconsin: The future of spine surgery holds a lot of promise, with evolving new products and techniques in our armamentarium. The concepts of using even smaller incisions and better technology in the future, just as effectively as we do today, to relieve pain and improve function is exciting. We need to explore the whole “mind-body” concept to understand the exact role of pain in spinal disorders.
William Watters, MD, Bone & Joint Clinic of Houston: There has been a remarkable proliferation of new technologies in the arena of spinal surgery in the past 10 to 15 years allowing shorter periods of hospitalization, decreases in incision size and thus patient trauma utilizing minimally invasive technology and in many cases improved outcomes. With this use of new technology has come an increased cost of utilization which is stimulating closer scrutiny of surgical requests by payors. To me the most exciting developments heading into the future of spinal care are in the area of evidence-based medicine. We are using the techniques of evidence-based medicine to focus our interest on assessing patient outcomes with traditional and new technologies, allowing us to more carefully and thus more cost-effectively apply the correct technologies to a particular patient's surgical problem. By generating this evidence base we can better provide for our patients, increase the quality of patient outcomes and more forcefully make evidenced-based arguments with payors for the appropriate surgical intervention in our patients.
Robert G. Watkins III, MD, Marina Del Rey Hospital: The aspect that I am most excited about for the future is working with my son, Robert, and the our partner, Dave Chang, to further develop this program and make a lasting impact on the care of spinal injuries in athletes. I look forward to a continued application of these treatment and rehabilitation programs we use in athletes to all spinal patients.
Jeffrey Wang, MD, UCLA Health: I am most excited about the future. Healthcare is changing and I think surgeons need to embrace, learn and adapt quickly to these changes in order to be satisfied with their life. There will be challenges ahead, but this is an opportunity to try to make things better and make our healthcare system better. There are some positive and some negative aspects to the future depending on one's perspective, but overall, we have a chance to try to make improvements.
Franklin Todd Wetzel, MD, Temple University School of Medicine: The biggest challenge for the future will be to maintain our core values as clinicians, educators and scientists. Reimbursement for clinical activity is declining, the rewards for teaching diminishing and extramural funding for research shrinking. As the competition for limited resources becomes keener, we must be even more cognizant of the role of ethics in our professional conduct, especially with regard to management of conflict of interest and bias in the pursuit of support for these crucial activities.
James Yue, MD, Yale Medicine: The integration of advanced neuroimaging diagnostic techniques with real time intra-operative image guidance will advance the care of patients with spine related diseases especially those patients with spine tumors and those in need of minimally invasive spine procedures. Biologically based, as opposed to surgically based, treatment of scoliosis and symptomatic degenerative disc pathology are also being studied and are being presently investigated alleviate as alternative treatments for these difficult disease processes.
More Articles on Spine Surgery:
Economics, Politics & the Independent Spine Surgeon: Q&A With Dr. Craig Callewart
8 Ways to Combat Spine Surgery Claim Denials
Evolution of Minimally Invasive Spine Surgical Technique: Q&A With Dr. Arnold Feldman of The Feldman Institute