What surgeons must know before adding a new spine procedure

Alan Condon -   Print  |

As surgical technologies continue to develop in spine, many surgeons are diving deeper into minimally invasive techniques, which are increasingly being performed in the outpatient setting.

Endoscopic spine surgery, vertebral body tethering for scoliosis and single-position spine surgery such as the prone transpsoas technique are some of the minimally invasive options that are attracting significant interest from surgeons.

Proper research is the first and most important step before adding a new procedure, according to Vladimir Sinkov, MD, of Sinkov Spine Center in Las Vegas.

"Make sure the new procedure makes scientific sense and will provide benefits to our patients above and beyond your current techniques," Dr. Sinkov said. "Make sure you clearly understand the indications and limitations of the procedure."

The next step is to determine whether the procedure is financially feasible for your practice. A lot of questions need to be asked: Does it require significant capital investment or use a lot of expensive disposables? Does insurance reimburse for the procedure? If not, will you find enough cash-paying patients to make this worth purchasing the equipment?

Implementing a new procedure can be both exciting and scary, but these are "necessary steps on the pathway of innovation," according to Grant Shifflett, MD, of DISC Sports & Spine Center in Newport Beach, Calif.

Dr. Shifflett recommends surgeons engage in research and speak to surgeons who are experts in the particular technique you are looking to learn.  

"You cannot overstate the value of training labs where you can practice new techniques on models, sawbones or cadavers," Dr. Shifflett said. "Make the mistakes and avoid the steepest part of the learning curve by developing comfortability when nothing is on the line. When you translate that technique to a live patient, you will have greater confidence that you can perform the procedure successfully."

Attending courses are popular ways for surgeons to get to grips with new technologies and surgical procedures, but surgeons shouldn't be bashful about leaning on those who are experienced in a new technology, especially in the initial cases.  

"Often experts will provide critical information and clinical pearls that will reduce the learning curve," Jeffrey Deckey, MD, of Hoag Orthopedic Institute told Becker's. "If possible, having a visiting expert present for your first case can be extremely valuable. Educating the OR staff is also important in order to avoid the unexpected."

The preparation and preoperative planning stages are the most important tools to ensure success. Choose a relatively straightforward case for the first surgical attempt, but always have a plan B laid out in case of complications.

"If the procedure cannot be performed, or if a complication occurs, you must be able to handle it and have the appropriate equipment available," Dr. Sinkov said.

"All of this may sound overwhelming, and unwillingness to go through this process is what holds many surgeons back from embracing new procedures," he added. "But I would encourage every spine surgeon to keep abreast of the new and emerging procedures and embrace the ones that make sense to you to provide the greatest benefit for your patients."

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