Ezriel Kornel, MD, has spent his career at the forefront of spine surgery's advancement.
From exploring minimally invasive surgery to the advent of endoscopic spine surgery, he said he's optimistic about the specialty's future.
Dr. Kornel, of Carmel, N.Y.-based Somers Orthopaedic Surgery and Sports Medicine Group in September, shared what's next for endoscopic spine, ASCs and the next generation of physicians.
Note: Responses were lightly edited for clarity.
Question: When it comes to the evolution of minimally invasive spine care, where have you seen the most improvement, and what areas still need innovation?
Dr. Ezriel Kornel: One of my greatest joys as a surgeon has been contributing to advancements in spine surgery, particularly in developing and expanding minimally invasive techniques. My interest in this field began years ago with the introduction of endoscopes. I was initially trained in cranial surgery with endoscopes, but I struggled to see how they could be applied in non-open spaces, like the spinal canal, as opposed to open spaces like the abdomen or ventricles.
The development of the tubular retractor system changed this perspective. It was initially designed to serve as a pathway for endoscopes. However, after trying it out, I realized it was more effective when paired with a high-quality microscope rather than an endoscope. The capabilities of a microscope far exceeded what an endoscope could achieve in this context.
Using the tubular system with a good microscope enables a wide range of procedures, from simple discectomies to complete laminectomies. The learning curve is steep, which has discouraged some surgeons who weren't trained with it initially. However, for those who embraced it, the benefits for both surgeons and patients are remarkable—procedures are faster and less invasive, offering significant advantages.
The introduction of computerized guidance systems combined with intraoperative CT scans further revolutionized the field. I had the first intraoperative CT at Northern Westchester, which was transformative once the spine-specific guidance system became available. This innovation allowed for precise, minimally invasive procedures using small incisions, eliminating the need for extensive muscle dissection. For me, it’s been an incredible journey.
Q: What are your predictions for this technology? What will the next generation look like?
EK: I believe we'll see a significant increase in endoscopic spine surgery. Surgeons are already exploring endoscopic approaches for more complex procedures, such as laminectomies and cervical surgeries. Future advancements will likely include a broader range of equipment specifically designed for endoscopic use, enabling procedures to be performed through small, "stab-wound" incisions.
As the technology evolves, we’ll also see the development of more specialized tools and techniques that allow surgeons to address various areas of the spine with greater precision and efficiency.
Q: Minimally invasive surgery has been a huge driver in pushing spine surgery outpatient. What’s your outlook for spine surgery in ASCs, and what might be holding back its growth?
EK: Outpatient spine surgery will continue to grow, but it's essential to ensure patients are medically stable and suitable for this setting. Factors like pre-existing conditions or pulmonary issues may require closer monitoring, which limits the feasibility of outpatient procedures for some patients.
Pain management is another consideration. Certain patients may experience more post-operative pain, requiring overnight observation for pain control. While minimally invasive techniques reduce trauma and stress on the body, outpatient procedures won't be possible for every case or every patient. Some surgeries will always require a hospital setting for optimal care.
Q: As a professor, you work with the next generation of spine surgeons. Are you excited or concerned about their future in this healthcare landscape?
EK: I'm always excited about the future, as long as young surgeons are well-informed about the challenges they'll face in healthcare. My biggest concern is the decreasing amount of time physicians are allowed to spend with patients.
One of the reasons I’ve remained in private practice is to provide patient care on my own terms. I can spend as much time as needed with patients before and after surgery, ensuring their treatment is thorough and personalized. Unfortunately, this autonomy is being restricted in larger healthcare systems, where time with patients is limited by administrative policies.
For up-and-coming surgeons, I emphasize the importance of prioritizing patient care over becoming mere technicians. If they truly care about their patients, they’ll need to find the right practice model that allows them to maintain this focus. Large medical groups often prioritize efficiency over patient-centered care, which I see as the biggest challenge for the next generation of physicians.