'One of the biggest opportunities for spine surgeons is also one of its biggest threats': What we heard in April

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Spine and orthopedic experts in April spoke with Becker's about topics from media depictions to robot-assisted joint replacements.

"As a private practice orthopedic surgeon for the last 10 years, I am most afraid of rising overhead costs and decreasing reimbursement throughout medicine. I am not talking about my income; I am talking about disincentivizing people to go into healthcare or care for certain populations or go the extra mile for their patients. How often do we see nurses get abused by patients and family members and as they walk out the door that day they say, 'This just isn't worth it anymore?; How many surgeons have been victim to a lawsuit because a patient sustained a known complication of a surgery? Surgeons carry the stress of a lawsuit and worry about the immediate and future ramifications, both professional and financial. I fear that access to care will decrease as time goes on, creating a terrible healthcare system that makes us sicker, not healthier. Not what you would expect in the world's greatest country," Arjun Saxena, MD, of Rothman Orthopaedic Institute in Philadelphia, on what he is most afraid of as a surgeon.

"What television shows and movies get right when depicting neurosurgeons is the dedication to their patients and their rigorous pursuit of surgical perfection. There is great satisfaction in restoring a patient’s health particularly under dire circumstances and emergent scenarios. Dealing with life-threatening scenarios is a part of the daily life for neurosurgeons. What television shows and movies do not depict well is the uninspiring moments such as the longevity of training, the emotional and financial hardships during the education and training process, and the unglamorous meetings that most neurosurgeons have to complete," Brian Fiani, DO, of Mendelson Kornblum Orthopedic & Spine Specialists in Livonia, Mich., on media depictions of spine and neurosurgeons.

"The fastest adoption I see coming in the next couple of years will be spinal endoscopy. We are seeing a rapid uptick in the adaptation of the techniques. I myself have done a handful and I think for decompression surgery, it is extremely impactful. Fusion outcomes being done via this technique I think remains to be really studied in detail. I am a bit leery of it as the basic tenets of fusion require good bone preparation, a large surface area and solid fixation. That being said, if it is found to be not inferior to the standards of lateral, anterior and transforaminal fusions, I see no reason for it to be more popular," Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles, on spine innovation.

"One of the biggest opportunities for spine surgeons is also one of its biggest threats in 2023. Technology has dramatically changed how spine surgery is planned and performed. More and more spine surgeons use intraoperative navigation for screw placement. This aid enables spine fusion surgery to be safer and more precise. However, it also allows trainees to go through residency and fellowship without a thorough understanding of spinal anatomy and critical landmarks. Their ability to take over when navigation is incorrect or not available is increasingly lost. Robotics may exacerbate this problem by removing the trainee further from even choosing the correct screw trajectory during the operation. Lastly, algorithms that enable the spine surgeon to supply the patient’s preoperative imaging studies and receive an operative plan remove the surgeon even farther from needing to understand the indications and tradeoffs for a particular surgical approach. The threat to spine surgeons, especially ones in training, is the inability to create an operative plan or to carry out that plan safely without this technology. Additionally, it may enable any doctor to perform spine surgery just as well as a surgeon fully dedicated to spine surgery," Bow Hansen, MD, of UCI Health in South Orange, Calif., on the biggest threats to spine surgery.

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