Max Kahn, MD, and Sohail Syed, MD, said they're both optimistic about the direction endoscopic spine surgery is taking, and they see its growing potential in spinal care.
They work with OSF HealthCare, which added endoscopic spine services at Peoria, Ill.-based OSF Saint Francis Medical Center and Bloomington, Ill.-based OSF Saint Joseph Medical Center earlier this year.
Dr. Khan and Dr. Syed have reached double-digit numbers in endoscopic case volume and are now booking consistently, they told Becker's.
They spoke with Becker's about bringing endoscopic spine to the health system and what's next for it.
Note: This conversation was edited for clarity and length.
Question: Can you just talk a little bit about how the endoscopic spine program began at your hospitals and with OSF health?
Dr. Sohail Syed: Both Dr. Khan and I have a pretty extensive background from our training and our fellowships in endoscopic spine. So when they were recruiting us, that was one of the things that we focused on — that we had seen through our training that it is of great value to patients in terms of both outcomes and recovery from surgery. It was something that we really pushed for. On the health system side, they were very excited about the technology.
Dr. Max Kahn: Basically when we were coming on board, OSF was very proactive about what they needed to sort of bring the spine program to the next step. That was one that both Sohail and I felt was probably going to play a really really big role in spine care going forward.
Q: Could you dive deeper into the pitch that you gave the hospital leaders?
MK: Basically the idea is that right now they're providing great spine care. But what is it that we can do to make it even better? The idea that smaller incisions, less blood loss, less pain, shorter hospital stay and potential for same day surgeries that previously required several days — all these things were essentially the impetus behind trying to get this moving forward. An additional part of it was this is a technology that nobody around us is really using this yet, and this is a means to stand out, while elevating the level of care that we're providing.
Q: When you think about endoscopic spine surgery what do you think will be the next big step that this will take in terms of innovation and adoption?
SS: I think that right now the biggest indications for endoscopic spine surgery is in minimizing the degree of destruction, and it's pretty much applied for degenerative disease. But I think as the instruments that are available improve, it's going to be applied to a wider variety of diseases. We're really hoping that it'll eventually be used in cases like trauma or even oncology cases. Especially with the latter, it's really important to try to minimize your incision because these patients tend to be immunocompromised. They are going to require chemo and radiation post-op. So smaller incisions mean quicker time to chemo, radiation and less likelihood of complications from that.
MK: I think over time I think it's probably going to get combined with robotics for planning optimal trajectories. And truthfully, the way I see it, neurosurgery as a whole is sort of behind general surgery and orthopedic surgery. In general surgery or orthopedic surgery, endoscopic or arthroscopic technology gets the first pass. Right now that's not really the case in spine or in neurosurgery. My prediction is that probably within the next 10 and 20 years, that's where it's going to go. It's going to be first pass endoscopic to almost any pathology at the larger open stuff is going to be a salvage.
Q: Besides endoscopic spine, what other innovations in spine surgery are you guys most excited about?
MK: Joint replacement. Right now a lot of surgeons are using artificial discs. But I think the next big thing is going to be posterior facet replacement. I think we're going to see a lot more products like that come onto the market, and I think over time they're going to start to gradually replace fusions where possible.
SS: One impetus for endoscopic surgery is motion preservation, especially for transforaminal surgery. The idea is you minimize bony destruction, minimize accelerating degeneration while still getting a good decompression and only really targeting the area of pathology. The only other way to really get to it well is to do a complete discectomy or fusion. Motion preservation, whether that be through minimizing decompression or through a true joint replacement, I think is definitely part of the future.
Robotics I think is getting better and better, so I think that that is going to have a bigger and bigger role. Most places have adopted some sort of robotic technology. It's helped a lot with deformity surgery and multilevel surgery. As those platforms become quicker and integrate a lot more preoperative and post-operative planning, it's going to replace a lot of the old ways of doing things.
Q: Are there any other interesting things happening at your hospitals' spine departments?
SS: We've opened up this new cancer center with a proton beam, and so our ability to deal with spinal oncology is vastly improved. We can now offer a new modality for patients. And that has a lot of implications for what we can treat in terms of spine and spinal oncology.
MK: I agree with that. Our newer cancer center and cancer therapies are really exciting. We're also advancing our robotic hand deformity technology as well. I think that's already starting to make a difference, and we're very fortunate in that OSF is very forward thinking and very physician and patient oriented.