Seven spine surgeons answer this question: Would you consider using robotic technology in the OR if cost weren't an obstacle?
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question is: Are there any spine procedures you are having a hard time receiving reimbursement for?
Please send responses to Laura Miller at laura@beckershealthcare.com by Tuesday, Jan. 31 at 5pm CST. Limit responses to five sentences or less.
Dennis Crandall, MD (Medical Director, Sonoran Spine Center, Mesa, Ariz.): Because of the precise tension or retraction tolerated on neural structures, I would be very hesitant to allow a robot to do that. Muscle retraction and other tasks seem more practical. Screw placement is a possibility if the tolerances can be certain and very fine.
Ara Deukmedjian, MD (Founder, Deuk Spine Institute, Melbourne, Fla.): Robotics may play a role in future spine care if payors allow it to. Health insurers are constantly trying to develop new policies and coverage determinations that further restrict access to quality spine care. Every stakeholder in healthcare is losing ground except the insurers because every new policy they adopt further restricts access to established treatments and thwarts new technology.
Insurers routinely refuse to cover new technology, for example artificial spinal discs were FDA approved years ago and there is ample evidence in peer reviewed journals that they are a safe and effective treatment for a common spinal condition (discogenic pain) yet most insurers won't cover the procedure because they are deemed "medically unnecessary or experimental" by the insurer (but not by spine surgeons, hospitals or patients). By denying the procedure the insurance company is guaranteed to keep more of their ever escalating premium dollars for themselves which leads to greater profits for the insurer but diminished healthcare delivered to the insured, which truly is the insurer's modus operandi.
It is a shame that the very organizations that were created to facilitate delivery of quality medical care and new technology are now obstructing it and enriching themselves further with the adoption of endless new policies aimed at further denying care to patients in desperate need of help.
Michael Gleiber, MD (Founder, Michael A. Gleiber, MD, PA, Jupiter, Fla.): I believe a spine surgeon needs to depend on his or her hands, anatomic landmarks and intuition to perform any operation correctly. If cost were not an obstacle, I still would rely on my surgical skill rather than use robotic guidance on routine cases. In areas of extreme deformity or severe trauma, I believe there is a role for guidance.
Purnendu Gupta, MD (Medical Director—Chicago Spine Center at Weiss Memorial Hospital, Associate Professor of Surgery in Orthopedics and Rehabilitation—University of Chicago): Unfortunately, cost is a huge issue right now, even for the technology we currently have. We are just at the point where the development of current technology may be stunted going into the future. One of the things that limited robotics in the past was image guidance. Now technology has advanced so we are seeing additional benefits in our practice. I think there will be some advantage to robotics for spine surgery in the future, but I don't know exactly where the impact will be or if it will add the same value as it has in other specialties, such as cardiology.
Paul Slosar, MD (President, SpineCare Medical Group, San Francisco Spine Institute): Yes, more so for pedicle screw insertion in complex deformity cases.
Brian Subach, MD (Director of Research and Spine Surgeon, Virginia Spine Institute, Reston): Absolutely yes! Having done both laparoscopic and mini-open ALIFs, the biggest problem with the laparoscopic cases was the lack of three dimensional vision. The robot provides both the visualization and the surgical dexterity. Screw fixation in deformity cases would be much simpler with image-guidance fused with robotic technique.
William Tobler, MD (Spine Specialist—Mayfield Clinic, Professor of Neurosurgery—University of Cincinnati College of Medicine): I have evaluated robotic systems but have not used them in the operating room. I would consider using a robotic system if I was convinced that it could be easily integrated into the operating room environment, and at an affordable cost. However, I am not yet convinced that it offers me a better advantage for the improvement of patient care over what I currently do.
Related Articles on Spine Surgeons:
Spine Surgeons: Is An ACO in Your Future?
Where are Spine Surgeons Focusing Research & Development in 2012?
What is your Number One Concern for Spine Surgery in 2012?
Please send responses to Laura Miller at laura@beckershealthcare.com by Tuesday, Jan. 31 at 5pm CST. Limit responses to five sentences or less.
Q: Would you consider using robotic technology in the OR if cost weren't an obstacle?
Dennis Crandall, MD (Medical Director, Sonoran Spine Center, Mesa, Ariz.): Because of the precise tension or retraction tolerated on neural structures, I would be very hesitant to allow a robot to do that. Muscle retraction and other tasks seem more practical. Screw placement is a possibility if the tolerances can be certain and very fine.
Ara Deukmedjian, MD (Founder, Deuk Spine Institute, Melbourne, Fla.): Robotics may play a role in future spine care if payors allow it to. Health insurers are constantly trying to develop new policies and coverage determinations that further restrict access to quality spine care. Every stakeholder in healthcare is losing ground except the insurers because every new policy they adopt further restricts access to established treatments and thwarts new technology.
Insurers routinely refuse to cover new technology, for example artificial spinal discs were FDA approved years ago and there is ample evidence in peer reviewed journals that they are a safe and effective treatment for a common spinal condition (discogenic pain) yet most insurers won't cover the procedure because they are deemed "medically unnecessary or experimental" by the insurer (but not by spine surgeons, hospitals or patients). By denying the procedure the insurance company is guaranteed to keep more of their ever escalating premium dollars for themselves which leads to greater profits for the insurer but diminished healthcare delivered to the insured, which truly is the insurer's modus operandi.
It is a shame that the very organizations that were created to facilitate delivery of quality medical care and new technology are now obstructing it and enriching themselves further with the adoption of endless new policies aimed at further denying care to patients in desperate need of help.
Michael Gleiber, MD (Founder, Michael A. Gleiber, MD, PA, Jupiter, Fla.): I believe a spine surgeon needs to depend on his or her hands, anatomic landmarks and intuition to perform any operation correctly. If cost were not an obstacle, I still would rely on my surgical skill rather than use robotic guidance on routine cases. In areas of extreme deformity or severe trauma, I believe there is a role for guidance.
Purnendu Gupta, MD (Medical Director—Chicago Spine Center at Weiss Memorial Hospital, Associate Professor of Surgery in Orthopedics and Rehabilitation—University of Chicago): Unfortunately, cost is a huge issue right now, even for the technology we currently have. We are just at the point where the development of current technology may be stunted going into the future. One of the things that limited robotics in the past was image guidance. Now technology has advanced so we are seeing additional benefits in our practice. I think there will be some advantage to robotics for spine surgery in the future, but I don't know exactly where the impact will be or if it will add the same value as it has in other specialties, such as cardiology.
Paul Slosar, MD (President, SpineCare Medical Group, San Francisco Spine Institute): Yes, more so for pedicle screw insertion in complex deformity cases.
Brian Subach, MD (Director of Research and Spine Surgeon, Virginia Spine Institute, Reston): Absolutely yes! Having done both laparoscopic and mini-open ALIFs, the biggest problem with the laparoscopic cases was the lack of three dimensional vision. The robot provides both the visualization and the surgical dexterity. Screw fixation in deformity cases would be much simpler with image-guidance fused with robotic technique.
William Tobler, MD (Spine Specialist—Mayfield Clinic, Professor of Neurosurgery—University of Cincinnati College of Medicine): I have evaluated robotic systems but have not used them in the operating room. I would consider using a robotic system if I was convinced that it could be easily integrated into the operating room environment, and at an affordable cost. However, I am not yet convinced that it offers me a better advantage for the improvement of patient care over what I currently do.
Related Articles on Spine Surgeons:
Spine Surgeons: Is An ACO in Your Future?
Where are Spine Surgeons Focusing Research & Development in 2012?
What is your Number One Concern for Spine Surgery in 2012?