Exciting spine and orthopedic innovations from 23 leaders

The executives featured in this article are all speaking at Becker's 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference, at the Swissotel Chicago.

As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at the conference on June 15-17, 2023. The following are answers from our speakers.

To learn more about this event, click here.

If you would like to join as a speaker, contact Zoe McClain at zmcclain@beckershealthcare.com.

Question: What spine and orthopedic innovations are you most excited about?

Adam J. Bruggeman, MD. CEO, Texas Spine Care Center (San Antonio): There are several orthopedic and spine innovations that are intriguing and should help to change the surgical landscape.

The first is the continued improvement and innovation in the space of disc arthroplasty. If you look at the history of orthopedics you see that both hip and knee surgery began with fusions.  Over time arthroplasty was developed and improved to the point where total joint arthroplasty became one of the most successful surgeries performed anywhere in the body. Spine arthroplasty is clearly the next frontier and innovation as well as adoption continues to increase at an exponential pace.

Virtual reality, augmented reality and robotics continue to see significant investment and change. Adoption is particularly high within training programs, which I see permeating now into hospitals across the country as these residents and fellows graduate and join community practices. The field is still being defined and constantly shifting, so the ultimate direction is not fully clear. There is tremendous potential for these technologies to truly change the way we perform surgery as well as improve safety.

Finally, artificial intelligence is becoming a part of every aspect of our lives. It was recently reported that ChatGPT was able to pass parts of the United States Medical Licensing Exam. Artificial intelligence has also been increasingly utilized within healthcare. I foresee further advances leading to changes in the way we interpret imaging, make decisions in our clinics, intraoperatively choose implants, and interact with those outside our organizations such as insurance companies and patients.

Vishal Mehta, MD. President and Managing Partner, Fox Valley Orthopedics (Geneva, Ill.): I am excited to see the potential of our improved digital data collection on patient outcomes intersect with the huge leaps forward in artificial intelligence that have been realized recently. I believe this can tremendously improve our clinical decision making as we try to help our patients reach the best outcomes possible. 

Corey Welchlin, DO. Owner, Center for Specialty Care (Fairmont, Minn.): Outpatient total joints. Patients love having their own home to recover in and control their pain.

Comron Saifi, MD. Orthopedic Spine Surgeon, Houston Methodist: I am excited for breakthroughs in research, specifically in regard to objective functional outcomes research and complex data analytics of spine registries. My research team is currently focusing on both of these fields in collaboration with research teams at Rice University, Texas A&M, and Houston Methodist Research Institute.

Jacob Rodman, CMPE. CEO, Raleigh Neurosurgical Clinic (N.C.): I am most excited about the advances and innovations in minimally invasive spine surgery and robotics. Specifically, how we have seen these innovations directly affect patient outcomes in a positive way. From reduced surgical times, faster recovery and extreme cost savings by being able to perform these in the ASC setting. It seems we have seen innovation happen very quickly over the last few years and I can’t wait to see what the next few years look like. 

Adeel A. Faruki, MD, MBA. Assistant Professor of Anesthesiology and Program Director, Advanced Perioperative Ultrasound and Clinical Training, University of Colorado Anschutz Medical Campus (Aurora, Colo.): I am excited about the advances in motion sparing implants for the cervical spine. These procedures are less invasive than traditional fusions and gaining popularity amongst surgeons. Also, these implants are enabling patients to regain cervical mobility while possibly reducing the risk of adjacent segment disease. The hope is these advances continue to bring more spine surgeries into the ASC setting. 

Troy Morrison, DO, FAOAO. Orthopedic Surgeon, Citizens Memorial Healthcare (Bolivar, Mo.): The most exciting innovations in spine and orthopedics help to drive better care for our patients. Innovations which mitigate risk and optimize patient outcomes like perioperative nutrition and new technologies that reduce postoperative complications through improved materials and biologics are allowing surgeons to better serve our patients. 

John V. Prunskis, MD, FIPP. Medical Director/Principal, DxTx Pain and Spine; CEO, Illinois Pain and Spine Institute (Barrington, Ill.): There are multiple innovations to help people with spine and related area pain. Before talking about innovations, however, a physician must precisely diagnose the source of the pain. Once the precise diagnosis of the pain generator has been done, the innovations right now that excite me the most are advances in both posterior and lateral sacroiliac joint fusion. 

Data indicates that at least 30 percent or more of all back pain is sacroiliac joint related. Also, advanced technologies that can address pain related to Modic changes in the vertebral body. Modic changes are a source of forward flexion back pain. Medicare approval for injection of medication into the disc for disc-related pain, and newer lumbar spinal fusion devices to address lumbar spinal stenosis with neural claudication are exciting as well. 

Last but not least, advances in both spinal and peripheral nerve stimulation to successfully treat multiple conditions now in addition to back pain, such as post laminectomy syndrome, radiculitis complex regional pain syndrome, (otherwise known as reflexive sympathetic dystrophy), painful diabetic neuropathy as well as peripheral neuritis.

Theresa J. C. Pazionis, MD, FRCSC. Spine Surgeon and Orthopedic Oncologist, Temple University Hospital and Fox Chase Cancer Center (Philadelphia): I'm very excited about patient specific implants and radiomics as used to predict patient outcomes and provide better patient specific care.

Jeremy M. Steinberger, MD. Director, Minimally Invasive Spine Surgery, Department of Neurosurgery, Mount Sinai Health System; Assistant Professor, Neurosurgery and Orthopedics, Icahn School of Medicine, Mount Sinai (New York City): I am excited about virtual reality and augmented reality applications in spine surgery, whether in the office explaining spinal pathologies to patients or placing instrumentation with navigated augmented reality. We have come a long way already but there is a lot more work to be done. 

Christopher Cannova, MD. Orthopedic Surgeon, OrthoBethesda; CIO, Aligned Orthopedic Partners (Bethesda, Md.; Arlington, Va.): I am most excited about implantable sensors in orthopedic devices. The cardiovascular field has proven the power of implantable sensor technology. Now orthopedics has brought this power of capturing data to our implants. We hope this information will improve both our current and future patients' outcomes.

Emily Putney, DO, MS. Orthopedic Spine Surgeon, Coastal Orthopaedics and Sports Medicine Center (Port St. Lucie, Fla.): I'm most excited about continued developments in lateral lumbar spine surgery. Specifically, single patient positioning has become possible and allows for lateral and posterior access in the same setting. This innovative positioning allows for ideal psoas and lumbar plexus tension which can reduce neuropraxia after surgery, as well as reduce operative times while obviating the need for additional patient transfers. I'm also ever interested in expanded footprint and lordotic dimension options available in porous titanium interbody cages for both cervical and lumbar fusion.

Brian R. Gantwerker, MD, FAANS, FACS. Neurosurgeon, The Craniospinal Center of Los Angeles: I am most excited by the upcoming entry of the Mako robot being ported into the spine space. Many of my orthopedic colleagues have been using the Mako to revolutionize total knee and hip arthroplasties. The watershed moment when the robot can truly help with decompression and interbody work I believe is coming. This year, I believe that will come to the fore. No two spine surgeries are the same, but a customized, faster operative plan, and not just a fancy screw guide is what I think all of us have been waiting for. 

Robert Tatsumi, MD. Governing Board Member, South Portland Surgical Center (Tualatin, Ore.): Surgeon collaboration with spinal companies in the field of navigation and robotics will continue to grow this year. In regards to navigation, I would like to enhance the wearable heads up display technology to improve surgeon ergonomics and efficiency when performing spinal procedures. I would also like to focus on creating a robotic platform that can accommodate surgeons performing less invasive spine surgeries via a small midline incision. Robotics is a great tool for spinal instrumentation placement via a percutaneous or when making a large incision.

Raymond Hwang, MD. Orthopedic Spine Surgeon, New England Baptist Hospital; Assistant Clinical Professor of Orthopedic Surgery, Tufts University School of Medicine (Boston): I’m excited about three general technologies in spine and orthopedic care:

One, additional robotic capabilities to address high variability components of surgery. Two,

GPT-4 and LLMs in general and their impact on workflow, patient education and communication. And three, the unification of artificial intelligence and enabling technologies like augmented reality and virtual reality navigation and robotics to create end to end ecosystems (pre-op to OR to post-op) that improve clinical decision making, delivery of surgical care and collection and interpretation of data.

I believe we are living through the early stages of an industry-wide shift away from implant focused research and development and towards surgeon support technologies like these that enable better outcomes in ways that were previously not possible.

Daniel Park, MD, FAAOS. Orthopedic Spine Surgeon and Associate Professor of Orthopedic Spine Surgery, Beaumont Hospital-Royal Oak (Mich.): As a minimally invasive spine surgeon, I am most excited about how endoscopic spine surgery will be adopted by more spine surgeons. I believe endoscopic spine surgery can limit the surgical footprint caused by surgery while promoting similar or better clinical outcomes for patients. As technology advances, we will be able to see aspects of the patient's spine that we could not see before so we can specifically treat pathology safely, but also perhaps make our surgical techniques better. 

The challenge will come from cost containment from insurers and hospitals, and from the learning curve. I believe biportal endoscopic spine surgery overcomes the financial barriers for adoption and as more spine surgeons adopt it, the learning curve will be easier to overcome. Reimbursement from insurers will have to be tackled as we demonstrate superior outcomes with more minimally invasive surgery. 

Daniel Mulconrey, MD. Orthopedic Surgeon, Midwest Orthopaedic Center (Peoria, Ill.): Artificial intelligence and its role in spinal surgery is one of the most exciting topics in 2023. Artificial intelligence will eventually aid the surgeon in all aspects of patient care. AI may be employed in preoperative care by aiding in the selection of the appropriate patient, addressing comorbid conditions and optimizing the patient's health prior to surgery. AI has the ability to provide assistance with optimizing the surgical procedure. Lastly, postoperatively AI will continue to track patient outcomes and help us improve care.

Maahir Haque, MD. Spine Surgeon, Spine Group Orlando: I’m most excited about the next generation of enabling technologies for spine surgery. Solutions for stereotactic navigation, intraoperative visualization, robotics and augmented reality are becoming more user friendly while surgeons are also migrating cases to the ASC. If these technologies can become cost effective and insurers realize the value, we will see widespread adoption in the years to come.

Zeeshan Tayeb, MD. Owner, Pain Specialists of Cincinnati: I am truly excited about basivertebral nerve ablation as an option for chronic low back pain. The new intraosseous nerve-ablation procedure, known commercially as the Intercept System, targets the basivertebral nerve of the vertebral endplate, the region that serves as an interface between the vertebrae and the disk.

A multicenter study of 225 patients randomized to treatment (147) or sham (78) interventions reported in the International Journal of Spine Surgery showed sustained clinical benefits on both the Oswestry Disability Index and the Visual Analog Scale as well as high responder rates at 2 years following treatment. Mean percent improvements in ODI and VAS compared to baseline were 54 percent and 53 percent, respectively, in patients who had the procedure.

Suboptimal success rates with conventional treatments for CLBP have led medical researchers to probe whether they have been missing a pain generator. Anatomic studies over the past several years have shown the vertebral endplates to be a significant source of CLBP.

The vertebral endplates contain a rich nerve supply stemming from the basivertebral nerve that transmits pain from the superior and inferior endplates. Studies have found that there are endplate changes associated with disk degeneration. Basivertebral nerve density has been found to be higher in endplate regions that have been damaged, indicating a connection between these nerves and CLBP.

Carmen Quatman, MD, PhD. Orthopedic Surgeon, The Ohio State University Wexner Medical Center (Columbus): I am excited to see the exponential growth in healthcare technology and analytics. The next great innovation must be to design and implement seamless, safe adoption pathways to make these life-saving and transforming tools available bedside.

Albert Wong, MD. Neurosurgeon, Cedars-Sinai Medical Center; Neurosurgeon, DOCS Health (Los Angeles): I am most excited by the integration of robotic navigation with spine surgery. This new technology allows for accurate and reproducible placement of spinal instrumentation in smaller incisions with near 100 percent accuracy.  

Thomas Feldman, MPH. CEO, Center for Health Ambulatory Surgery Center, LLC (Peoria, Ill.): We have seen great success in terms of outcomes for our total joint procedures. We are hopeful that the insurance carriers and CMS will also come to appreciate these outstanding quantifiable results. Having patients receive care in the appropriate setting provides for lower costs to all parties involved. It also allows for greater patient satisfaction with regards to efficiency. Lastly, coming to an ASC prevents the patient from being exposed to the potential of hospital-acquired infections. 

Lorraine Hutzler, MPA. Associate Program Director, The Center for Quality and Patient Safety, Department of Orthopedic Surgery, NYU Langone; Adjunct Assistant Professor of Health Policy and Management, NYU Wagner (New York City): Growing usage of virtual reality for surgical procedures and physician training has been great for residents, and has expanded throughout our department and other hospitals. A lot of companies are now doing that with robotics, which become more precise paired with VR and will improve surgical tools and the way surgeons operate.

Additionally there are a lot of different areas where artificial intelligence comes into account. One that we’re primarily working on is looking at readmission rates or hospital acquired conditions. If we’re able to take data from patients and predict, based on comorbidities, who might be expected to have a readmission or complications ahead of time, then what can we do to prevent that? 

Now, AI is being utilized to figure out different care pathways for patients based on their comorbidities and current state of health, as well as to help with their rehabilitation post-operatively. We’re also using AI on another end to predict different levels of fusion when looking at MRIs and X-rays. There are a lot of different areas where it can be utilized; it’s going to grow rapidly and there are a lot of opportunities.

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