Jeffrey Wang, MD, chief of the orthopedic spine service and co-director of the USC Spine Center in Los Angeles, discusses biologics in spine surgery and the best opportunities for practice growth in the future.
Question: How do you see spine technology evolving over the next few years? What do you think will be the biggest innovation that will stick?
Dr. Jeffrey Wang: I think there will be some innovative products in the device area, but I am hopeful that we are seeing more biological products and potential trials, that may be treating the spinal pathologies at a more basic level. I do think this is ideally possible in the future, and hope there is continued innovations in this area. I also hope that we see more evidence to support some of the biological treatments that are currently being used today. One of the largest problems that I see in the arena is the lack of real scientific evidence supporting some of the biological products being used.
There are a lot of marketing materials and pamphlets, and even white papers, which are not peer-reviewed. It is difficult to separate the marketing from the real science. I would love to see real evidence of efficacy for some of these biological treatments. This includes the stem cell injections, platelet rich plasma, all the way to demineralized bone grafts and bone graft extenders. We should be basing our clinical decisions on real science, which I would love to see published in the near future. Certainly, novel technology for new treatments will need this evidence to justify the development and use of novel products.
Q: Where do you see the best two to three opportunities to improve your practice within the next few years? Will you make any strategic changes?
JW: All practices are different in size, community, and academic versus private practice. But, the increasing regulatory environment, electronic records and the ever-changing requirements, put more strain on each physician. I see in the near future, practices learning to adapt and develop more efficient workflows. I think it is very important to work with your hospital to develop pathways for more comprehensive and better care for the patients, and to focus on reducing costs and length of stay.
Basically, everyone needs to look at efficiency, and optimize workflows throughout their practice and in all areas of patient care. We have partnered with our hospital to deliver better care that is more efficient and cost-effective. Along those same lines, the practice needs to eliminate waste and improve communication within the practice, and between the practice and referring physicians, the hospital and the university. We are also focusing on improving our international referrals and streamlining the process for those increasing international patients who are seeking care and opinions from our institution.
Q: What percentage of your practice is vertebral compression fractures and how do you manage treatment for those patients?
JW: This comprises a smaller part of my practice. Certainly, we see patients with compression fractures, and in our emergency room and our referrals, these patients are seen as a larger problem. We try to treat them as a whole and consider their metabolic needs, connecting them with the appropriate medical care providers. As for surgeries or procedures, we are seeing more interventional radiologists doing these without a general anesthesia, and in many cases, this could be a safer way to treat them, avoiding a general anesthesia. Certainly, there are those who do need surgery, but I am seeing that this is a smaller part of my surgical practice.