Dr. Paul Houle: The future of spinal fusions and what device has dramatically improved OR efficiency

Written by Alan Condon | May 23, 2019 | Print  | Email

Paul Houle, MD, is a board-certified neurosurgeon with Cape Cod Healthcare Neurosurgery in Hyannis, Mass.

He earned his medical degree at Boston University School of Medicine and completed his residency in neurosurgery at Medical College of Georgia in Augusta.

Here, Dr. Houle discusses the future of spinal fusions and what modern device has substantially improved OR efficiency for him.

Question: How do you see spinal fusions evolving in the future?

Dr. Paul Houle: I think the trend for spinal fusions is towards more minimally invasive approaches. It has been clearly demonstrated that simple one and two level lumbar fusions can be safely performed in both the acute care and ambulatory setting. Advances in multimodal therapies to control postoperative pain in conjunction with endoscopic spine techniques will make outpatient spinal fusions under conscious sedation common. In fact, in the very near future, cage technology will be introduced that will allow for true endoscopic transforaminal lumbar interbody fusions.

Spinal endoscopy has evolved to such a degree that direct visualization of the neural structures as well as the ability to visually confirm the effectiveness of the disc space preparation is possible via an incision not much larger than a number two pencil. While artificial intelligence and robotics are currently garnering all of the press, I am not convinced of their utility and cost effectiveness for simple one or two segment fusions which accounts for the majority of lumbar spinal fusions in the U.S. What I do see is the wave of enthusiasm for endoscopic spine surgery as a platform to decompress and deploy expandable cages with minimal tissue destruction.

Q: What modern technology has dramatically improved efficiency in the OR?

PH: The modern technology that has dramatically improved efficiency in the operating room is the O-Arm. In our hands, the time to obtain images and place pedicle screws for a single or two level lumbar fusion has dropped to under 15 minutes. This technology has eliminated the return to OR for mal-positioned screws for our past 3,500 cases.

To participate in future Becker's Q&As, contact Alan Condon at acondon@beckershealthcare.com.

Learn more about key trends in spine surgery at the Becker's 17th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference, June 13-15 in Chicago. Click here to learn more and register. For more information about exhibitor and sponsor opportunities, contact Maura Jodoin at mjodoin@beckershealthcare.com.

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