During the Becker's Spine, Orthopedic & Pain Management-Driven ASC virtual event, four orthopedic and spine surgeons outline answered the question: Q: What technology will be most essential for spine surgeons in the future?
Click here to view the full interview on-demand as well as access several other fireside chats, panels and workshops during the event.
Frank Phillips, MD. Midwest Orthopaedics at Rush (Chicago): COVID is really accelerating the push toward outpatient surgery centers. I was already there. I've done lumbar fusions for a number of years in the surgery center. But I think it's relatively slow in spine when compared with even in our own practice, to joints and sports and other areas of orthopedics. The COVID situation has accelerated that. It's more efficient and hospitals have to deal with COVID and there is a real patient fear about going into hospitals for COVID. ASCs offer a good alternative for both the surgeons and the patients, and we have had no pushback from patients coming to the ASCs, but we have had patients nervous going to the hospital. COVID-19 will accelerate spine going to the ASC.
Companies and manufacturers need to put their efforts behind technologies that play to the surgery center because I think we're migrating there anyway and this is really going to accelerate. There aren't specific widgets that we are going to point to in that space. But it will really be procedure innovation in the outpatient space. Part of that is the widget, part of that is the overall pain management, which is one of the biggest barriers to doing [more spinal surgery] in the ASC.
Evalina Burger, MD. University of Colorado Anschutz Medical Campus (Aurora): There are two technologies. The first one is data collections with outcomes. There are multiple platforms available for quality outcomes collection, and I think it would be essential to have this. If you cannot participate in this, I think it would be very detrimental. It's absolutely a must. A lot of places were collecting outcomes over the last 10 years, but we know that the compliance was in the low 30th percentile for patients filling out all these forms. As modern technology and apps have developed, it has become much easier for patients to fill this out. Patients have become more app-based because they all have cell phones. Technology also helped us to collect their outcomes. I think that would be phenomenal to see how this massive data collection and technology on outcomes will be essential in the future in the surgical realm.
I do think that navigation, robotics, making sure that surgery is more accurately done and that there are less and less never events in the OR is going to play an important role in the future as well.
Cynthia Emory, MD. Wake Forest Baptist Health (Winston-Salem, N.C.): Orthopedics has traditionally been on the forefront of new technology, whether its robotics, new implants, or new techniques. However, the gadgets and shiny new toys that we usually see at meetings and want to bring back for use will be on hold with the financial constraints that everyone is seeing. It's unlikely that hospitals are going to be buying million-dollar robots for joint surgeons anytime soon and implant costs are going to be on the front and center for large health systems and ASCs.
What we need the most in coming months and years of technology that will save us time and money. Telehealth is probably the best example of that. Now video visits are supported by payers and hopefully this will be a permanent change. We have the ability to reach a larger population and provide care that they need at a time that's convenient for a patient. Think of a single mother of three who works two jobs and has shoulder pain; for her to go see a doctor she has to take off work, arrange for childcare, or bring her children with her to the office and all of the headaches that go along with that. For those of you with children, think of how enjoyable it is to get them ready to leave the house.
While we can't examine a patient via telehealth, we can obtain a pertinent history and hear their stories, and actually talk with our patients. We can get back to treating the patient, not treating an x-ray after the initial visit. We can always arrange for x-rays to be done locally, and these can often be sent to our own imaging system through image sharing and exchange systems that are very much adapted across multiple platforms. That's a relatively recent technology that we've underutilized. If there's a suspected surgical issue, we can likely make that determination probably from the initial telehealth visit and then arrangement and office visit and final decision and examination them.
Alexander Vaccaro, MD. Rothman Orthopaedics (Philadelphia): [For telemedicine] I think we need to have functional monitors. If you take your cell phone, it has a gyroscope in it. I can follow the function of my patient and for spine surgery to see if they're doing well. If their function drops off, I get an SMS text that tells me there's a problem. I need to see that patient sooner. I need to be able to communicate with patients to the cell phone or whatever they want to use. So that type of remote monitoring is so key in the future for spine surgery. Telemedicine is key, and then in the operating rooms, we're entering into the age of navigational robotics.
So what's the barrier there? I use robotics all the time, but the cost is too expensive, so we have to bring that cost down and we have to streamline it. We have to get rid of the requisite preoperative CAT scans, which cause radiation. Radiation is a bad word nowadays; we've got to get away it. We have to be able to download MRIs, to correlate and register the patient. So I, once we get image guidance better, we can now really, really exercised the value proposition of minimally invasive surgery because we haven't met that and we can really go places and the companies are moving in that direction. So remote monitoring, telemedicine, navigation and robotics are the future of technology in spine surgery.