As spine procedures continue to accelerate to the outpatient setting, surgeons will need access to technologies that enable higher-acuity procedures to be done with accuracy and predictability in the least traumatic manner.
Here are three key technologies that ASCs can invest in to support spine surgery:
1. Intraoperative imaging
In the last decade, intraoperative imaging has increased in its prevalence and capabilities, especially for spine surgery. Surgeons can now use these image-guidance systems by way of fluoroscopy, 3D imaging and robotics for improved precision and patient safety.
"Intraoperative imaging that allows real-time 3D navigation, whether with a pre-op CT scan or an intra-op CT spin, will allow surgeons to perform fusions and motion-preservation surgeries with full confidence in desired interbody device as well as posterior instrumentation placement," according to Sanjay Khurana, MD, of LA Spine and Orthopedic Institute in Los Angeles. "Whether this is done with the assistance of a robot or done manually, the ability to confidently predict or actually visualize postoperatively will be paramount. Endoscopy and advanced microscopic technology will also be critical in these surgeries for careful and minimally invasive neurological decompression."
2. Augmented reality
Many spine surgeons said it will be important for ASCs to invest in navigation systems that allow for more complex spine surgeries to be done in the outpatient setting. Augmented reality continues to gain traction in various areas of medicine, with spine surgeons seeing the technology being of particular benefit to smaller ASC operating rooms as well as for training and educating surgeons.
"Given the significant capital expenses associated with spinal robotics, making them largely cost-prohibitive in ASCs, the far more manageable cost of the AR system I am currently using makes it ideal for ASC fusion procedures," said Frank Phillips, MD, of Chicago-based Midwest Orthopaedics at Rush: "As AR evolves, it could play an increasing role in surgical planning and providing virtual guidance intraoperatively as to how our surgical execution [for example, deformity correction] is matching preoperative goals."
3. Endoscopy
Over the next decade, spine surgery is expected to continue its path toward more minimally invasive approaches to care. Endoscopic spine surgery is largely touted as the least invasive option currently available in spine surgery, but its widespread adoption has been limited by a lack of reimbursement and training programs. But these drawbacks could be eliminated in the coming years as more hospitals and ASCs look to make long-term surgical investments that have been shown to deliver quality outcomes in the outpatient setting.
"Endoscopic spine surgery, which I would consider is ultra-minimally invasive, is going to become the preferred and a better alternative choice for patients who not only require decompression, but even more importantly, save many patients from having fusion done, according to Hooman Melamed, MD, of Hoag Orthopedic Institute Surgery Center-Marina del Rey (Calif.). "You are preserving most of the normal anatomy with very minimal blood loss, much lower risk of infection and way faster recovery. Most importantly, you're not burning any bridges with this approach. These surgeries all can be done outpatient, and most of them [are] going home the same day."