Todd J. Lansford, MD, is a spine surgeon at South Carolina Sports Medicine & Orthopaedic Center in N. Charleston, S.C., discusses minimally invasive spine surgery and the biggest opportunities for surgeons to lower the cost of care.
Question: How is spinal deformity surgery becoming less invasive?
Dr. Todd Lansford: Of all realms of spinal surgery, it is deformity surgery which I believe to be the most impacted by minimally invasive technology. This has allowed surgeons to correct both sagittal and coronal plane deformity without using large osteotomies. What this means [for] the patient is less blood loss, less recovery time and less returns to the OR. Furthermore, in many situations you can get more correction using lateral-based surgery like XILF.
As more MIS deformity surgery is completed, the exciting news will be the decrease in adjacent segment disease. Eliminating PJK has been the holy grail to many a deformity surgeon, trying a multitude of techniques including flexible rods, cemented superior levels and even hook/laminar wire constructs. With the limited exposure of MIS, it is quite likely we can maintain the posterior tension band, decreasing the stress that those adjacent levels and hopefully significantly decrease the need for future surgery at those levels.
Q: Where do you see the biggest opportunities for spine surgeons to lower the cost of care?
TL: Many benefits of minimally invasive deformity surgery carry over to the degenerative surgery practice and those benefits are all cost containers. When you think of decreasing OR time, faster recovery and less revision surgery, they are all sources of cost. Furthermore, the ability to do more surgery in the ASC setting, which MIS techniques allow, greatly reduce the cost. The integration of these techniques is physician driven, not always reinforced by hospitals or insurance companies. With that in mind, it appears that physicians themselves have the most power to lower the cost of care.
Q: What is the next frontier in minimally invasive spine surgery?
TL: The next frontier of minimally invasive spinal surgery is two-fold. In one respect, it is increasing the adoption of MIS techniques we currently have. Technology now is quite advanced, as more surgeons use them and research their benefits, adoption will only increase. This is already seen in cervical disc replacement. Single levels have been approved for many years, but two levels were impossible to get through insurance.
Just recently, the increase use of TDA allowed for more research to be focused on two levels. This research illustrated the benefits and the insurance companies listened. They are now approving this and the patients are reaping the benefits. As adoption increases, we will see the second aspect. We will refine the technology, improving the power of these techniques. This will likely involve improved navigation systems that will increase not only the safety of the case but the speed too. Instrumentation will be evolved to be less disruptive to the anatomy, allowing even faster recoveries and decreased adjacent segment disease. The peak technology of course is preserving the anatomy before pathology leads to surgery. While stem cells have come a long way, there is a considerable way to go. I hope in my lifetime this becomes the standard of care.
Learn more from Dr. Todd Lansford at the 15th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine in June 2017! Click here for more information.