Reimbursements have been a pain point for many spine and orthopedic surgeons in recent years, and their changes have affected how care and business is done.
Here is how three surgeons are thinking about disc replacements:
1. Spine surgery will shift more in favor towards motion-preservation over fusion, and many will wish the transformation happens sooner, Todd Lanman, MD, said.
"In 10 years, I believe spine surgeons will look back at the current state of the field and shake their heads at the number of fusions performed instead of disc replacements," Dr. Lanman said. "The same thing happened in 1958 when John Charley invented the artificial hip. Most surgeons at the time laughed at him and said his device would not work. That hip replacement was a fad. Instead, knee and hip fusion were standard of care. In 10 years the field will have shifted dramatically to motion preservation surgery — artificial disc replacement, facet joint replacement — to the point that we may see the ability to partially correct 20 degree to 25 degree scoliosis curves with motion sparing devices. Just like arthroplasty is now commonplace for hip and knee and fusion is rare, the same will be true of spine devices; cervical and lumbar artificial discs will be the mainstay of treatment and spinal fusion will be the rare exception."
2. Disc replacements can be beneficial for ASCs' bottom lines, according to Issada Thongtrangan, MD.
"The most profitable surgeries in my practice are cervical disc replacements and minimally invasive spinal fusions in the ASC as they can control the cost and expenses, especially the implants and biologic cost," Dr. Thongtrangan said. "The least profitable is revision decompression lumbar surgery as it takes longer than usual and there is potential risk of complications, which may require transferring the patient to the hospital."
3. Payer coverage will play an important role in growing disc replacements, Jack Zigler, MD, said.
"The payers of the future, whoever they are, whether it's a single payer in the government, or a consolidation of insurance companies or hospital systems, whoever is controlling the healthcare dollar is ultimately going to see a significant decrease in the need for expensive spinal reoperations is in the public good," Dr. Zigler said. "Reoperation is one of the largest drivers of healthcare economics, so by cutting down the necessity for additional surgery, with the data that we've been able to generate, I think it's going to be a no-brainer for the powers who are controlling the healthcare dollar to recommend disc replacement over fusion. So I think in the future there's going to be even a bigger role for disc replacement than we've seen before."