Embedded Files
becomes more common, do you see a more standardized approach arising? WT: No, I still think you are going to see a minimally invasive procedure variation. The variation will depend on the diagnosis and surgeon preference. Additionally, where the surgeon was trained, patient population and practice location will all impact this decision. Q: Despite the variation, is there an umbrella definition surgeons can use to describe a procedure as ‘minimally invasive’? WT: “Minimally invasive” is a definition we have struggled with for a long time. Our definition for SMISS is an approach to the spine which satisfies the physician requirements for outcomes and complications but utilizes normal tissue plans that may avoid unnecessary tissue destruction and allows for outcomes that may be superior to traditional open surgery. Depending on your technique, the definition could include using an endoscope or other tools to achieve the same goals, as long as the surgeon is minimizing approach related tissue disruption. Q: There is a big push within healthcare right now to practice evidence-based medicine. Where is minimally invasive spine surgery in terms of proving effectiveness in the literature? WT: You have to divide that into what we think minimally invasive surgery is now and where we think it will go in the future. It wasn’t until the past few years that we knew surgery was better than conservative treatment for spinal stenosis. The Spine Patient Outcomes Research Trial showed, for the first time, this outcome as well as the idea that fusion for spondylolisthesis is better than decompression in the long run. These points have been argued back and forth, but SPORT gave us a foundation for our argument. We can point to is less blood loss for minimally invasive procedures. There are some studies that don’t show this outcome, but the weight of them indicate decreased blood loss, hospital stays, decrease in infection, faster return to work and fewer blood transfusions than with open procedures. In the future, we are hoping to find that outcomes are better for minimally invasive surgery, pain rates are less and patients have a lower risk for adjacent level disc disease. Q: What are your goals for SMISS over the next few years? WT: There are three main goals we are focused on: 1. Research — we are trying to prove the effectiveness of minimally invasive spine surgery and creating a database for those procedures. Surgeons who use it aren’t conducting prospective, randomized, controlled studies, but they can mine the database for their research. 2. Education — we try to provide validated training courses for surgeons who would like to learn the minimally invasive technique. Many surgeons are taught by device companies to use their instrumentation; we want to better understand and validate the types and method of the education currently in use and how we can do a better job maximizing these efforts to produce better trained physicians. SMISS also provides educational courses. We have the largest minimally invasive spine surgery meeting every year and at the meeting we have separate courses developed to teach minimally invasive spine surgery techniques, along with the development of our CORE Curriculum and CME lecture series. 3. Advocacy — some surgeons have difficulty receiving reimbursement for minimally invasive procedures. Some procedures don’t have CPT codes. Our goal as a society is to make sure surgeons have minimally invasive procedures available in their armamentarium when they are appropriate — which should be available to the patient and the surgeon, not a decision made by the insurance company. For example, the AxiaLIF procedure from TranS1 was developed 10 years ago and has been done 14,000 times — 10,000 times in the United States — it won’t have a CPT code until 2013. The idea that a procedure that has been done thousands of times over the past decade and proven in the literature still has difficulty getting approvals and reimbursement is disappointing. It means we are not doing enough as a society to ensure options for all patients. n Spine 13 8 Pillars of Success at Sonoran Spine Center By Laura Miller Spine practices can follow one of several different business models with a focus on either surgical cases, non-surgical cases or a mix of both. When founding his group, Sonoran Spine Center, Dennis Crandall, MD, chose a model that emphasized treating all different types of patients. “We have chosen a model on purpose that embraces all spine disease in adults and children — operative and non-operative,” says Dr. Crandall, who now serves as the practice president and CEO. “We don’t want our referral physicians to think about whether their patients would fit our treatment style; we want them to send patients to us regardless of their condition and we can guide them to the best treatment.” Here, Dr. Crandall discusses the challenges and opportunities presented by this practice model and how his group has remained successful despite changes in the healthcare environment. 1. Make it easy for patients to come through the door. Sonoran Spine Center is a patient-driven practice, which means the surgeons depend upon a high volume of cases to keep the practice running. Since there are specialists in several different spine-related areas, the group can accept most patients coming their way; however, they must also
Google Sites
Report abuse