Leave these trends in the past, spine surgeons say

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As spine surgery technology and practice operations evolve, there are some trends that are ready to be sunsetted.

Spine surgeons discuss the technical and business trends that they believe they should let go of in 2024.

Note: Responses were lightly edited for clarity.

Question: What trends should spine surgeons leave behind this year?

Joseph Ferguson, MD. MedStar Health (Washington, D.C.): I think we are getting further and further from traditional, open fluoroscopy surgery. I think we have a lot of new tricks and tools, and we've looked at the literature in terms of accuracy and it's becoming safer and more accurate to be using some sort of navigation robot in your spine practice. If someone is late in their practice, and they still do [open fluoroscopy] that's one thing. But I think it's time to start making moves to adopt the newer technology and the newer way of doing things.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: The concentration on making films perfect needs to go. In my community I am seeing more T10-pelvis and C2-T2 fusions than ever before. We need to get back to treating the problem, not the X-rays. I fear the push toward scoliosis analysis and obsessive angle measurement has lost the point of surgery.  Instead of listening to symptoms and understanding pain generators, many have obsessing over mismatches and incidences. These are important but not the end goal. Studies I read talk about the angle measurement like it’s the point of the surgery, and we have to stop doing that.  

Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): From the clinical standpoint, I hope more spine surgeons would transition from the traditional open surgical techniques to minimally invasive spine surgery. From the practice management standpoint, I hope more spine surgeons (as well as the rest of the physicians) stop being in-network with private and government health insurances that lower their reimbursement and create additional administrative burdens.  

Timur Urakov, MD. University of Miami (Fla.): Leaving a transforaminal lumbar interbody fusion cage at L5-S1 in otherwise multilevel lateral interbody fusion cases. As lateral retroperitoneal approach techniques become broadly accepted, surgeons are able to place large-area implants in hopes of improving subsidence and fusion rates. Disc spaces below the crest line are challenging in lateral position and inaccessible when the patient is prone. Equivalent implant placement at L5-S1 can be achieved with an acquired skill of oblique approach for lateral cases or a separate stage of supine anterior lumbar interbody fusion. Both require added time and effort, which is often foregone. Instead, a more familiar but biomechanically inferior TLIF implant is left in place. Either we generate good quality data to prove otherwise or start treating the L5-S1 with all fairness.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The outcomes data surrounding transabdominal surgery and its benefits is rapidly being questioned in its validity and overuse. For decades, correlated costs and applied beneficial outcomes have been scrutinized and repeatedly denied as a manner to limit these larger surgeries. Their unnecessary risk and extended rehabilitation have taken the spotlight over marginal benefit.

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