Here are seven spine surgeon responses to the question: Where should spine surgeons focus their research efforts in the future?
Neel Anand, MD, Director of Orthopedic Spine Surgery, Cedars-Sinai Spine Center, Los Angeles: The biggest place we need to focus our research today is in patient-directed outcomes. We have wonderful procedures and techniques that make people's lives significantly better, but we need to definitively prove that our clinical outcomes are worth the cost and efforts being practiced. In terms of treatment paradigms, we have to focus on cost-efficient technology and the overall delivery of spine care. Finally, and most importantly, it is imperative for us as surgeons to continue researching minimally invasive techniques designed to effectively treat spinal pathology.
Ara Deukmedjian, MD, Founder, Deuk Spine Institute, Melbourne, Fla.: Designing and completing high quality clinical studies to demonstrate the effectiveness of particular treatments. Then the results need to be analyzed and published. Degenerative spine conditions are the most common issues seen in private practice and optimal treatment requires a trial of conservative management. Most patients with chronic back or neck pain will respond very well to appropriate rehabilitative and interventional pain modalities however about 10 percent will need to pursue surgery for palliation or cure of symptoms. As the population ages (10,000 Americans retiring daily) we will see more people with spine derived pain syndromes and they will be desperate for a cure. It is our responsibility to provide them with the best treatment known and it should be their insurance company's responsibility to pay for their care.
Walter Eckman, MD, Founder, Aurora Spine Center, Tupelu, Miss.: It is critical that spine surgeons are committed to long-term outcome studies related to spine fusion. Many procedures are going to be denied and many patients with chronic pain are going to suffer from typical pain management when in fact they could have better results from a definitive fusion procedure. The most glaring example of this is in lumbar stenosis but there are many other conditions which are highly treatable by fusion procedures.
J. Brian Gill, MD, Spine Surgeon, Nebraska Spine Center, Omaha: Research needs to be focused on outcome data to provide further justification of the care that we provide to our patients. All surgeons have anecdotal evidence that a particular treatment works, but that is not objective information that validates our treatment algorithms. Outcome data can only make "us" (surgeons) better and improve the quality of care that we provide.
Michael Gleiber, MD, Founder, Michael A. Gleiber, MD, PA, Jupiter, Fla.: Stem cell research and osteo-biologics. I also believe that the field of minimally invasive spine surgery continues to evolve every year.
Khawar Siddique, MD, Spine Surgeon, Beverly Hills Spine Surgery, Calif: Controlled clinical studies comparing on treatment method versus another.
Paul Slosar, MD, President, SpineCare Medical Group, San Francisco Spine Institute: I think we should start focusing on the interbody implant surface/ bone interface. Our dental and total joint replacement colleagues know that it is essential to get the implant and the bone to interact physiologically. Spine surgeons have become complacent as BMP makes most of our fusions heal regardless of the material we place into the disc space. As access to BMP becomes more restricted we too will have to focus more on the implant surface and how it interacts with the host bone.
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Neel Anand, MD, Director of Orthopedic Spine Surgery, Cedars-Sinai Spine Center, Los Angeles: The biggest place we need to focus our research today is in patient-directed outcomes. We have wonderful procedures and techniques that make people's lives significantly better, but we need to definitively prove that our clinical outcomes are worth the cost and efforts being practiced. In terms of treatment paradigms, we have to focus on cost-efficient technology and the overall delivery of spine care. Finally, and most importantly, it is imperative for us as surgeons to continue researching minimally invasive techniques designed to effectively treat spinal pathology.
Ara Deukmedjian, MD, Founder, Deuk Spine Institute, Melbourne, Fla.: Designing and completing high quality clinical studies to demonstrate the effectiveness of particular treatments. Then the results need to be analyzed and published. Degenerative spine conditions are the most common issues seen in private practice and optimal treatment requires a trial of conservative management. Most patients with chronic back or neck pain will respond very well to appropriate rehabilitative and interventional pain modalities however about 10 percent will need to pursue surgery for palliation or cure of symptoms. As the population ages (10,000 Americans retiring daily) we will see more people with spine derived pain syndromes and they will be desperate for a cure. It is our responsibility to provide them with the best treatment known and it should be their insurance company's responsibility to pay for their care.
Walter Eckman, MD, Founder, Aurora Spine Center, Tupelu, Miss.: It is critical that spine surgeons are committed to long-term outcome studies related to spine fusion. Many procedures are going to be denied and many patients with chronic pain are going to suffer from typical pain management when in fact they could have better results from a definitive fusion procedure. The most glaring example of this is in lumbar stenosis but there are many other conditions which are highly treatable by fusion procedures.
J. Brian Gill, MD, Spine Surgeon, Nebraska Spine Center, Omaha: Research needs to be focused on outcome data to provide further justification of the care that we provide to our patients. All surgeons have anecdotal evidence that a particular treatment works, but that is not objective information that validates our treatment algorithms. Outcome data can only make "us" (surgeons) better and improve the quality of care that we provide.
Michael Gleiber, MD, Founder, Michael A. Gleiber, MD, PA, Jupiter, Fla.: Stem cell research and osteo-biologics. I also believe that the field of minimally invasive spine surgery continues to evolve every year.
Khawar Siddique, MD, Spine Surgeon, Beverly Hills Spine Surgery, Calif: Controlled clinical studies comparing on treatment method versus another.
Paul Slosar, MD, President, SpineCare Medical Group, San Francisco Spine Institute: I think we should start focusing on the interbody implant surface/ bone interface. Our dental and total joint replacement colleagues know that it is essential to get the implant and the bone to interact physiologically. Spine surgeons have become complacent as BMP makes most of our fusions heal regardless of the material we place into the disc space. As access to BMP becomes more restricted we too will have to focus more on the implant surface and how it interacts with the host bone.
More Articles on Spine Surgery:
4 Spine Surgeons on Opportunities for Expanding Ancillary Revenue
5 Spine Surgeons Responding to Coverage Denials
20 Statistics on Spine Pain Patient Office Visits