Harel Deutsch, MD, is an associate professor at the department of neurosurgery at Rush University in Chicago and co-director of the Rush Spine Center. He specializes in the treatment of degenerative and traumatic disease of the cervical, thoracic and lumbar spine, with an emphasis on minimally invasive surgery.
Note: Responses are lightly edited for length and clarity.
Question: Have you any thoughts on how to tackle the current opioid epidemic?
Dr. Harel Deutsch: It takes a cultural change. Medical societies and society were pressing doctors to treat pain with narcotics. Doctors were reluctant for the most part but because of patient demand, many patients were on long-term narcotics for chronic pain complaints. Now there is more cover for doctors to refuse to prescribe narcotics. I’ve seen a dramatic reduction in the number of patients coming in on long-term narcotics.
Q: Can you tell me about one procedure that stands out in your career? What was particularly challenging and how did you overcome it?
HD: The procedure was the posterior lumbar interbody fusion. The procedure was introduced into wide use by Dr. Harms from Germany. Initially the surgery was quite difficult, requiring large incision, blood loss, and risks of complications. Over a long time, surgeons have chipped away at the challenging elements of the procedure and minimally invasive techniques have made the procedure much easier for the patient and the surgeon. Tubular retractors have allowed for smaller incisions and navigation and percutaneous systems allow for better pedicle screw placement.
Q: What technology are you most excited about in spine now? Is there anything that you see as particularly innovative?
HD: Expandable lumbar interbody cages have resulted in improved outcome and fusion yields.
Q: What are your primary considerations when deciding on becoming an early adapter of a new device?
HD: What is the benefit versus risk reward? Any new device may have some risk. The risk may not be fully known. Therefore, the benefits need to be substantial.
Q: How do you see bundled payments, value-based care and other new payment models affecting spine?
HD: We have participated in pilot programs for bundled payments but none have been successful so far. I’m not sure if these programs will result in lower costs.