Outpatient surgery and fewer fusions are likely the future of spine surgery, according to Peter Derman, MD, a spine surgeon with Texas Back Institute in Plano.
Dr. Derman joined the Becker's Spine & Orthopedic podcast March 4 to discuss big trends and his upcoming research on minimally invasive surgical techniques.
Below is an excerpt from the conversation. Click here for the full episode.
Note: Responses are lightly edited for clarity and style.
Question: How do you see spine changing in the next three years?
Dr. Peter Derman: There is going to be more outpatient surgery. This was already a trend toward outpatient, but COVID-19 really brought this to the forefront, especially because hospitals were overwhelmed, and patients didn't want to be in the hospital. There has been an even greater push toward doing surgeries that were traditionally considered inpatient stays on an outpatient basis. Part of that does fold into minimally invasive surgery because you can't send someone home the day of surgery if they had a big cut.
I think less fusion is something we're seeing, and will continue. We'll look back in 30 years and say, 'Look how barbaric the things we were doing 30 years ago were. We were fusing people.' I came to spine surgery through orthopedics, and when you have knee or hip arthritis they use to fuse your joint. But if you went to a hip surgeon now with hip arthritis and they planned to do a fusion on you, you'd run the other way, albeit slowly because you have hip arthritis.
I think we're going to view it similarly in the future in spine. We'll realize we were fusing patients, and that's not a natural way for the spine to move, or not move. Motion preservation, whether through disc replacement, or perhaps in many cases, by decompressions that are minimally invasive and don't further destabilize the spine. One of the cool things about endoscopic procedures is it's allowed me to do decompressions on many different patients who would have traditionally obtained a fusion. You can sometimes decompress transforaminally even to the center of the canal without destabilizing the segment in any way. As our disc replacement devices improve, and our ability to decompress without destabilizing improves, we're going to see more and more of a trend away from fusion as a treatment paradigm.