Minimally Invasive Spine Surgery: What You Need to Know

In this video, Dr. Rita Roy, CEO of the National Spine Health Foundation, and a panel of the leaders of the Society for Minimally Invasive Spine Surgery (SMISS) discuss the benefits and advancements in minimally invasive spine surgery. 

The experts highlight how....
Minimally invasive surgery reduces tissue damage, speeding up recovery and improving outcomes.
It uses advanced technologies like robotics and imaging for precise, effective surgery.
Patients benefit from smaller incisions, less pain, and quicker return to normal activities.
Choosing the right treatment involves shared decision-making between patient and surgeon.
It’s important to find a trusted surgeon and ask about their experience with minimally invasive techniques.

Join us for an in-depth discussion on this revolutionary approach to spine care, and the hope it brings to patients dealing with neck and back pain.

Transcript

SPEAKER_02 0:06

Hello, welcome to Spine Talks. I'm Dr. Rita Roy, CEO of the National Spine Health Foundation, and I am delighted to be joined today with a panel of experts. We're here to talk about minimally invasive spine surgery. And it's a real honor to be joined by leaders from the Society for Minimally Invasive Spine Surgery. It's the professional society that looks at the science and the techniques around the discovery of bringing this modern spine technique to patients. I am honored to be joined by our panelists.

SPEAKER_04 0:40

Hi, I'm Mike Wei. I'm a neurosurgeon. I specialize in spine surgery in Miami, Florida.

SPEAKER_00 0:45

I'm Frank Phillips. I'm an orthopedic spine surgeon. I practice as part of Midwest Orthopedics at Rush University in Chicago.

SPEAKER_01 0:54

Hi, I'm Neil Alund. I'm in Los Angeles, spine surgeon, and been practicing there about 25 years now.

SPEAKER_03 1:00

Hi, I'm Shiraz Kureshi, and I'm uh orthopedic spine surgeon and I practice at the hospital for special surgery in New York.

SPEAKER_02 1:07

One of the exciting things about being joined by these tremendous physicians today is that each of them have taken a leadership role in the Society for Minimally Invasive Spine Surgery. Each of these surgeons has served as a president of this organization and or is an incoming president to this organization. And the reason why that matters is because to have the leadership of an organization like this joining us to be able to educate the public about what we're talking about at spine surgery is really our way of bringing unparalleled access to these incredible experts. So I'm going to kick off our conversation by asking the first question of defining what is minimally invasive spine surgery? What do we mean when we say that? I'm going to just start down the panel here with Dr. Wang.

SPEAKER_04 1:56

Minimally invasive surgery can be a philosophy. It could be a principle of saying, well, when we look at the spine, because the spine's so vast, I'm going to do the least amount to the spine that will get the job done and make the patient better. It can also be technically oriented. For example, there are specific techniques and methodologies used that make that more possible, right? But the reality is that it is a concept where you're trying to reduce the amount of collateral damage in the process of doing surgery.

SPEAKER_00 2:21

Traditional spine surgery was done through large incisions through the back. It involved typically stripping the muscles off the spine to get access to the spinal structures and then doing delicate work around the spine and around the nerve structures. The downside of that was a lot of the post-operative or after surgery, pain, discomfort, recovery was related to that extensive muscle dissection we would do. And really we were only doing that to access the spine. So minimally invasive surgery really evolved around finding ways to access the spine, do an equally good job as we had done with open surgery, but as Mike said, without all the collateral damage. So some patients like the idea of very small incisions, which we do. But to me, much more important than the small incisions, which are sexy, is the fact that we really preserve the structures around the spine. And with minimum invasive access, we can really do exactly what we need to the spine without damaging structures that just happen to be in our way. So that's really how I see minimum invasive surgery and how it's evolved over the last 20 or so years.

SPEAKER_02 3:26

Yeah, that's really incredible. And that idea, Dr. Phillips, of having a small incision is really what the patient sees, and the patient doesn't see, you know, the tremendous amount of technology that goes into making it really small and the amount of work that goes in that's been shrunken down to just result in just that one little scar that a patient is gonna have. It's it's really quite remarkable. Dr. Anand, um give us your description of minimally invasive spine surgery.

SPEAKER_01 4:01

I know we get fixated on an incision, and I think Frank sort of alluded to that. To me, it's not the incision. The incision, skin heals end to end and side to side. If anyone's at a facial list, it is a very big incision, but nobody knows that, right? So I think it's the tissue damage that matters. To me, minimal invasive was about trying to do as little tissue damage as possible, maintain your muscles, as little collateral damage as alluded to before. And so what that means is fine tissue planes. We don't have to operate through muscles. Find a plane between the muscles, get down to the do it. We have technology to help us. We have robots, we have tubes, that allows us to access that. So I think we work together with the philosophical way of approaching the spine and then use technology to help us get there. But I I would just take the tuition that we should not focus only on the incision. But just because you've got a quarter-inch incision, you do a horrible job, that's probably ten times worse than having a two-inch incision and doing a good job.

SPEAKER_03 5:01

So I usually define minimally invasive surgery as sort of a toolbox of various techniques where we can use those techniques to optimize decompression, spinal stabilization, and spinal reconstruction, but at the same time limit the collateral damage like you've heard everybody talk about, so that we're preserving soft tissues to reduce risk, complication, and improve uh the recovery period.

SPEAKER_02 5:30

Yeah, that's fascinating. And what we've heard our experts tell us today is that minimally invasive surgery is not only a philosophy, it's also a series of techniques with different kinds of technologies that can be utilized. But before we get into those techniques, the first thing that needs to happen is a patient needs to understand if they are a candidate for minimally invasive spine surgery. And one of the first things that happens when you go to see one of the doctors is that they're gonna want to get uh an imaging study, so a CAT scan or an MRI or an X-ray. And I'd like to ask our experts, what is the purpose of getting those those imaging studies and how does it help you as a spine surgeon?

SPEAKER_03 6:15

The imaging studies that you described are the ones that we utilize. I think they're very complementary. So it's it's not that one replaces another, but uh in any patient where we're trying to formulate a surgical plan, we use an X-ray, a CAT scan, and an MRI to understand different uh things about the pathology and also the best way to access the pathology for uh minimally invasive or traditional surgical techniques. Um but really it's to help a surgeon identify the pathology, figure out which part of the pathology that you're seeing correlates most closely with the person's symptoms, and then what surgical plan may work best in your hands to be able to deliver the best outcome.

SPEAKER_02 6:59

That is a lot that you've said there. That is huge. And so if I'm translating that correctly, um it's the imaging studies help the surgeons make the right diagnosis to help identify the right technique. Um did I get that right, Dr. Wang, or not quite?

SPEAKER_04 7:20

Yes, it's absolutely correct because the spot is so complicated, you need that roadmap not only to make the diagnosis, but to formulate a plan on how to it attack the problem or rectify it. But let me just take a slightly different twist to it because the imaging is so sophisticated now, and sometimes patients obsess about imaging, but the imaging always exists in a context I think Dr. Cresci alluded to that as well, which is that what does the patient really need or want? There are many roads to Rome, right? So over-reliance on imaging can be dangerous too because people could have unnecessarily large surgeries, and our imaging is so refined now that we're gonna pick up all kinds of crazy stuff that may not even have any relevance to what the patient really wants to get out of surgery. And there, again, I think is where MIS surgery aminently invasive is a philosophy where we're not trying to fix a patient's MRI, right? We're trying to fix their problems that limit their function or create pain or keep them from sleeping or participating in life. And so I think you're absolutely right, Rita. The imaging is critical. It is so advanced now, but it can it can lead to overtreatment also.

SPEAKER_00 8:20

Yeah, I agree with what everybody said. Each of those imaging modalities, X-rays, CT, MRI, give us different information. Because in spine, part of what we do is focus on nerves. MRI is very good for nerves and soft tissue. Other parties, structural issues, deformity, and x-rays and CTs are helpful. But to echo what other others have said, the secret is correlating clinical findings with what you see on the MRI. Because I've had many patients, as of all of us, who get an MRI, they come in, they're freaked out. It says you've got herniated discs at every level, arthritis at every level, and they may have very little pain, but now they're sort of in the mindset. This is the beginning of the end. If not now, in the next five years, I'm going to need spine surgery. So a lot of the time it's explaining to the patient uh that the imaging findings are perhaps part of aging, not necessarily the source of their symptoms. And obviously, when you go in that drought, the more information you have, which is why you need m all or most of those modalities, HOCT MRI, uh that you brought up.

SPEAKER_02 9:23

Yeah, that's that's so fascinating. We think that um when you look at an imaging study, you're looking at a flat picture, but you all as spine surgeons are dealing with a 3D, you know, object, which is the spine, it's three-dimensional and it moves, and there's a lot going on with it. It's complicated, and that's why we're here to talk about it, is to help patients understand. Dr. Anand, what are what are your um, you know, sort of best um comments on the kinds of imaging and what the information that gives you as a surgeon and what patients should know about that?

SPEAKER_01 9:57

To me, the two things. The images have to fit the symptoms the patient is saying. The patient's like tell you something, there's gotta be a correlation. In the words of most people, though, if it doesn't fit, you have to quit. Don't operate on that patient. I think it's really, really important. And we and Dr. Phillips said that, we see it so many times. You see all these crazy things going on on MRI or a CT scan, and very rarely do they fit. It has to fit the patient's symptoms, that's one. And two is what Dr. Wang said, to me, it's a roadmap. It's a really finite, 3D GPS roadmap of what we are gonna now do surgically or technically to take care of the problem as long as the symptoms fit. For example, if someone's got stenosis, got leg pain going down one nerve, you know, that's the only nerve that needs to be decompressed. You don't have to operate the entire spine. So I think for me that's really important. You use imaging a lot to make that, to plan it. It's more for planning and uh rather than just diagnosis.

SPEAKER_02 10:57

Yeah. So that that is so interesting that the imaging studies are so important as tools to help the surgeons figure out an approach to solving the problem. And and I think what we're hearing today is that figuring out exactly what the problem is and making that right diagnosis and then determining the way to solve that is the art and the science of what these experts do every day with their patients. Um let's talk a little bit about the science around minimally invasive spine surgery. And what is it that patients need to know about the various techniques that exist? Uh again, minimally invasive spine surgery, as you've all pointed out, it's a philosophy as well as an approach. And at the Society for Minimally Invasive Spine Surgery, there's a lot of research, there's a lot of discussion and a lot of science around new technologies that are available for addressing various problems that patients have when they come to see you. Um Let's talk a little bit about what those techniques are and what it is that patients need to know. Should they care about what approach their surgeon uses or leave that up to their doctor uh to make that decision for them? Or is there a shared decision-making um opportunity that that ought to be as part of that uh discussion? And um I'll ask you first, Dr. Cresci, to comment on that.

SPEAKER_03 12:23

Sure. So I think um for most of what we do in spine surgery, shared decision making is critical uh because in general there are multiple approaches and multiple thought processes in terms of determining the best treatment plan, surgical or non-surgical. Um with regards to the technological advances that are helping us, I think that um there's a lot of opportunity there, but we happen to live in a time where we have benefited from a lot of advances that have helped surgeons as well as our patients. Um I think some of the ones that are very recent and top of mind are the advances in robotics and uh and imaging technology in the operating room that help us to really deliver a product that perhaps in the past could only be done through open techniques but provide it in a minimally invasive manner.

SPEAKER_02 13:20

And do you talk about that approach with your patient when you're evaluating an approach? Is that something that when patients come to see you, is a discussion um that they have? And how do they know what to ask you about it?

SPEAKER_03 13:33

Aaron Powell How do they know? I think, you know, I happen to be in a practice environment where uh patients I think do a lot of research. Um so I'm always really impressed with the questions that they're asking. Um and again it's a conversation in general. Uh I start by talking about the symptoms, and I always ask if I'm gonna tell you that you should have surgery done, what is it that you would like to get better from that surgery? Because that will help me understand what a person's goals are and whether they're realistic and whether surgery is gonna be the right thing for them.

SPEAKER_02 14:08

Yeah, that's great. I'm gonna send it down to Dr. Wang to comment on that.

SPEAKER_04 14:13

We've Yeah, it's very it's interesting. We're all from different cities, right? Big cities in America, so the patient population is a little different. South Florida, very old patient population. Uh my default mode is always to sort of offer what's least uh first. But I think if a patient were to think about the spine, one of the ways it differs from other types of surgeries is you could think along three dimensions, okay? Three dimensions of care for a surgical procedure. The first is geography, like how much of the spine, how many levels? People want to know is it one level, two levels, three levels, seven levels, and that's the numbers, right? The numbering of the vertebrae. The second part is about um what you're really gonna do there. What's the intent? Are you gonna do a fusion? Are you gonna do a realignment? Are you just decompressing a nerve? And that is sort of like purpose-built, like what are we really trying to accomplish at those geographical areas? And the third is really where where you're where we're alluding to is the technical approach. In other words, you're coming through the front of the body, the side of the body, the back of the body, how big an incision, as Dr. Anod said, muscle splitting versus muscle cutting. And then those are the more tactical pieces. But if you put those three dimensions together, you end up with uh a large number of permutations of types of surgeries, which is why spine can be so mystifying because there's so many different ways to do surgery or fix a problem. They all have pros and cons.

SPEAKER_00 15:29

Yeah, so sort of two comments. Um, agreeing with others about the patient being very involved in this surgical decision making. And part of that gets down to, you know, many other conditions uh in medicine are absolute. There's a solution, and this is how it's done. In spine, every decision, every procedure is a compromise, right? Like you say to a patient, for example, the main problem is a pensioner if they also have instability, which could in five or ten years become symptomatic. So then there's a discussion: do you just want to take care of the problem that you have today with a high likelihood of success with a minimum invasive surgery, or should you do a larger surgery, which maybe is quote, overkill today, but it sort of takes away that risk of progressive symptoms over years. And that's very individualized. Like some patients, maybe it's their age, maybe it's their mindset, they just want to play golf next week. So you just do the small procedure, we'll deal with it later. So it's very important because there's always some compromise. We're never really fixing the spine, we're managing the spine, is how I look at it. And then the other part of your question, which I think is very important, is the science you asked about. Because many of the minimum invasive techniques we all use are very well validated with years of science and studies and confirming their effectiveness, their safety, the patient benefit. What patients have to really be careful of about is there's a lot of marketing out there, there are a lot of minimally, quote, minimally invasive procedures touted as the next greatest thing that have very little science behind them. And I think you know it's a difficult field for patients to navigate. They feel kind of lost because the guy they're seeing says, oh, this is the greatest thing ever. But we're all saying there's no data around it. So I think it's really important for the patient to kind of get involved, ask your doctor about that. Is there science? Is this what your procedure you're proposing? Actually, a reasonable, validated, safe procedure. I think it's really important that the the clinical decision making has to be driven by the studies and the science that we have.

SPEAKER_02 17:27

I love that our surgeons are saying um that it kind of depends on what the patient wants. Um and I think that that is oftentimes the challenge is that patients don't know what they want. They're not sure how to make that decision. Um, Dr. Nand, can you comment on that?

SPEAKER_01 17:45

No, you raise a really important topic. I think the thing I see the most, and I feel sorry for the patients, it's so confusing for them. They go see three, maybe four, five doctors. They literally land up with ten opinions. And nothing wrong with that. The problem is that every surgeon is evaluating that patient or him or her in their own mind and their own way, and they come to a certain conclusion. And then I think they design or a treatment plan that works best for them. And there's nothing wrong with that. There's nothing wrong with that there really is no one surgery that fixes everything. And I think most surgeons are comfortable doing what they feel is the best for that particular problem. I think we see that a lot, and that becomes a big issue. And I usually tell patients at the end of the day, go to your comfortable. You like it, it makes sense, go to your comfortable day. It's not that this surgery is right for you or that surgery is right for you. I think that's one really important point. But the other point is I I say this too, for the right patient for the right diagnosis, the right technique in that surgeon's hand will always work. But all three matter. The patient needs to have the symptoms to be treated correctly. The the diagnosis gotta be dead on, but what are you treating? And then you do the right technique in your hands. I think you'll do very well with spine surgery. The problem with spine surgery, unfortunately, one of the three goes wrong, and we see problems, and then yes, you sort of get, oh my god, I'm having spine surgery. Uh, you know, too. I really need spine surgery. Uh I I think that's that's not the way the way to look at it is get the right surgery done, find the right person, uh, ask questions the right way, educate yourselves. I agree with Dr. Kouishi. I'm lucky to have very educated patients, very savvy today. It's all available online. In fact, many of your patients sometimes know more than I do. They ask me questions, Frank, do you see that? Okay, great. And I picked things. So I think it's it's not it's not in a win. I love it. A patient should be educated.

SPEAKER_02 19:42

How do you find the right surgeon for you? And um when a surgeon is talking about a minimally invasive approach, what should patients ask about that? And let's let's I'd love to hear our experts say, you know, I wish my patients would ask me X.

SPEAKER_03 19:58

Yeah, it's a great question. I mean, how how do you find the right surgeon? I think at least how how my patients find me is primarily word of mouth through other patients, and I think that that's always the biggest compliment for any of us as surgeons is that if you have happy patients who, you know, feel that they can trust you, they've had a good outcome, or that you've just been there for them through the process, uh, I think is just so important for you know, it's human nature. Um and then in terms of the questions, you know, that patients should ask when somebody's recommending minimally invasive surgery, I think you just there there's probably no one particular question. Um, but I think you just want to make sure that you have an understanding of a technique that a surgeon is going to use and that you feel comfortable with what they're describing to you. At some point it's a relationship where you just have to give up control and hand it to somebody else, and that's the scariest thing, having gone through not a spine surgery but a a knee surgery, you know, we're all control freaks, and you know, you need to just kind of hand the control and have trust. And I I always tell patients, whoever does your surgery in whatever manner they do it, if you trust that person and you'd go out to dinner with them, then they're probably the right surgeon for you.

SPEAKER_02 21:20

That's wonderful. That's a that's a great way of describing that. If a patient asks you the question of, how many of these have you done, does that um does that upset you in any way? In other words, we want to encourage patients to ask surgeons, do you do this often? How many of these do you do? But I think oftentimes people are afraid of offending their surgeon or they're they're afraid to ask that question or they're shy to ask that question. How do you feel about that?

SPEAKER_01 21:47

Well no, I would I would strongly encourage that. I have no problem with that. Tell them right up front what's being done. If it's a new technique, we tell them it's a new technique. Discuss the whole thing with them. I'm also a very strong believer of patients talking to other Patients. I give patients names and numbers out. They can go talk to them, discuss with them. Whereas like Dr. Kurishis, there's nothing like word of mouth. There's absolutely nothing like word of mouth. And most patients really have no idea or very hard for them to understand what they're really going to go through. But I can say it's easy and two hours you're going to get up and go home. But there's a whole lot more than that. What happened later? How do you experience it? How do you go through a few days? I think I found really good when they speak to another patient and they really get tremendous information. They're much happier. They come back and no, I strongly encourage that. I tell them exactly how we have done. I mean, uh, and and if I haven't done it, tell them that I haven't done it. If I haven't done it, then but I think it's a great technique, and I've done many clubs to it. But this may be a better way to approach it, and I'm confident I can do it. But that's okay. I think that should be discussed.

SPEAKER_02 22:48

Yeah, that's wonderful for both Dr. Cresci and Dr. Anand talking about the power of the patient testimonial being so important. That's that's awesome. We at the National Spine Health Foundation tell a lot of these spinal champion stories, people who've successfully overcome a spine condition through a treatment that got them back to their lives. Um, Dr. Phillips, I want to ask you um, you know, help patients understand what kinds of questions they should ask of their surgeon.

SPEAKER_00 23:17

Yeah, I mean, I agree with what others have said. I mean, there's not a specific question. I think the most important thing is for the patient to feel that their surgeon is skilled, has done it before, hence the question about how many have you done, how frequently have you done this. And also feel like the surgeon will be with them through the journey and they'll be there if they have a complication. And I think that's important. And it's hard to assess that. It's sort of a feeling you get when you're in the room with a patient. So I think, you know, the questions we've talked about are asking the obvious questions, how many have you done? Are you comfortable doing this? Those are very reasonable questions. And if a surgeon gets offended by that, you should probably realize that there's a reason that I want to get into that and maybe walk out of the office. Um, but the other piece is much harder to kind of define with a few questions, you know, like the patient's not going to ask me, you know, what are you doing for dinner tonight? But you know, you get into a conversation, the patient says, My goal is to get back to golf. Oh, where do you play? That sort of thing. They don't feel like you're part of their life, their team, you're gonna be there for them. But it's a hard your question, it's a hard question, and it's even harder to sort of define what questions they should the patient should ask. It's more about the technical stuff. And even then, I mean, a lot of it is like word of mouth. I mean, most practices now collect sort of complication rates we do, and we can share that with patients. Because every surgeon's going to sound very experienced. I do it better than anybody else. So you've got to kind of weed through some of that. But those are reasonable questions, at least to get a feel for how the surgeon reacts.

SPEAKER_02 24:50

Yeah, that's great. Dr. Wang.

SPEAKER_04 24:52

Yeah, you know, it's it's interesting because this panel, we're all like in our 50s, probably, right? So we're all like at the peak performance of surgical skill and wisdom almost. Uh, and we're all at major academic centers in giant cities. So it it's it's a little difficult because I think to Dr. Anand's point about, you know, he feels bad for the patient, I'm not suggesting that people can't get good care in more rural places, but we're exposed to a very large plethora of patients, and um, we probably all get most of our patients through word of mouth. In other words, other patients referring patients. Certainly the bulk of my practice is that. So it puts the patient in a difficult position because if one were to say only see one surgeon, they're presented one option, or if they saw 10 and got 20 options, right? What does a what does a patient really do with either scenario? I would suggest that because spine has this very complex diagnostic and treatment-oriented perspective, meaning different people are going to look at you differently. They're going to say, oh, this is the problem or that's the problem, you need to fix all of this or part of this, and then how the technique is going to be offered to the patient. I would suggest that it's beyond a typical patient's abilities to really sift through what they really need. So I would rather take a more strategic view and say, find a surgeon that you're philosophically aligned with. For example, I'm a kind of doctor that I don't want to sit around and talk a lot to the patient about all kinds of things and explain things on the model. But on the other hand, to Dr. Phillips' point, they're my patients for life. It doesn't matter what happens to them. I'm going to be there for them if I can. I'm going to take them to whatever journey. As Dr. Phillips said, it's like you don't fix a spine, you're taking care of their spine for the rest of their lives. So that's my philosophy. Some patients don't like that. They want to be one and done, they don't want to see the doctor afterwards, uh, or they want a lot of explanation. I think for a patient to understand that philosophy, and so all of us are minimally invasive surgeons, we're by default gonna do as little as possible to the patient. And if that's the patient's philosophy, and they're okay with that and they understand there there may be less durability with that over time, that's a good doctor for you, right? And so I think that finding that alignment, just like in a marriage, you have to align on the big picture, not the details. The details let us work out, but if you find a doctor that's aligned with you in that sense, um, then I think you're gonna make better choices and have better outcomes.

SPEAKER_02 27:15

That's great. Beautifully said. Um so talking about the minimally invasive surgical techniques, um, I'd like to hear from our experts today what it is that excites them about MIS now and into the future. And our experts are leaders in the professional societies, they are presidents, past presidents, upcoming presidents of this particular Society for Minimally Invasive Spine Surgery. That means they are at the forefront of the thinking and the and the championing of these new technologies. Um I'd like to hear from you, Dr. Cresci. I believe you are currently the president of the society. What are you most excited about?

SPEAKER_03 27:59

I think what probably brings me the greatest joy in what we do is that it's been a journey initially just to get legitimacy. Um it was often viewed that minimally invasive spine surgery, as you've heard um our the others on the panel say, w could was more marketing than it was actual care. Uh and I think we're finally at the point now where p nobody can really argue about the uh benefits of of minimally invasive spine surgery in the right hands and and done for the right reasons. And what's really exciting to me is that the next generation of spine surgeons, I think, aren't going to have to worry about getting over that battle, but really thinking about how now to maximally use minimally invasive surgery to benefit the patient.

SPEAKER_01 28:51

I think it's been an amazing time in life where to Dr. Kurachi's point, it's society such as ours that's discussed it, bought the data out, published it out. I think it's here to stay. There's no question in my mind minimally invasive surgery is here to stay. Now, is it going to expand over time it will? It is technically more difficult than traditional open surgery. But I go back to the 70s and laparoscopic surgery came in. It was the same thing. We had the same discussions went on on open appendectomy compared to laparoscopic appendectomy. It went over 10, 15, 20 years. Till it became commonplace. So that only anybody who has an open appendix remote is all done laparoscopically. So I think at some point we'll get there. It'll take time to get to that point as people get more technically savvy in it. I think as more the junior doctors learn more and more about it. So yeah, it's an extremely exciting field. And they were, we are going to get much better 20 years from now than we are today with further technology. And I think the technology has actually enhanced immensely what we do. So there's a simultaneous growth of industry, technology, talents, techniques, and data. And today we're doing the most complex procedures minimally invasively. And it it's it's completely revolutionized what we do. But it's it's about patient experience because of Yes. I think the patient is having, it has to be patient-centric. The patient's having a much better experience, hopefully, far less complications, less blood loss, quicker recovery, get up and walk quickly, not going to the ICU. At so many levels, that's where the change is. It's not in one and two years, in one and two years they're going to be sick. But that immediate recovery is what matters. And to me, that's what that's what I'm exciting about in my minimum invasive surgery. Big, big change.

SPEAKER_00 30:37

You know, I've been involved in minimum invasive since the earliest days, and it's really progressed dramatically over that time. Early on, there were a few techniques for a few pathologies. Now we can address much more uh many, many more pathologies than we did early on. Uh, the techniques have evolved to enable us to do it, which has been uh very exciting and gratifying to see. We used to have approaches from the back only, now we have minimally involved now. We have minimally invasive approaches from the back, the front, and the side, which allows us to do many more path treatment, many more pathologies we couldn't otherwise. But we're also seeing now our world is evolving just like the rest of the world. We have augmented reality technologies, we have robotic technologies, all of those really play towards a minimally invasive surgery. And the real goal behind all of those is to make the surgery completely reproducible. So it doesn't matter if Mike Wang does it or Frank Phillips does it, or a surgeon in a rural country, a rural area in America does it. It will the enabling technology should be the equalizer so a patient can feel comfortable, they get the same good outcome. And I think that's an exciting part of the future. It sort of gets rid of that variability, that surgeon-to-surgeon variability. We'll never quite get there, but it certainly evens the playing field so the patient's getting a more reliable outcome. The other thing that excites me, which is what your question was, you know, we've done historically spine surgery in these big hospitals, and patients are in the hospital for days. I do a lot of my fusions, my minimally invasive surgery in the outpatient setting, which I'm really passionate about. I think it's a better patient experience. It costs the system less, and there's a lot of studies showing equally good outcomes. So I think the evolution towards outpatient surgery from a patient perspective is something that's to me really exciting.

SPEAKER_02 32:27

That's that's amazing. Um, just in the last six years, from the time that I had my fusion surgery and stayed in the hospital for five days to now, um, it's it's incredible. And um, we're seeing so much of that um evolution happening in medicine, as Dr. Anand pointed out. You know, appendectomy and you know, and and appendix surgery is uh is never a big open sharp bite, right? It's a small laparoscopic puncture wound, and we're seeing that happening in spine as well. And and again, just to underscore, the experts who are joining me today are people at the forefront of making these technologies happen and bringing them to people. Um, Dr. Wing.

SPEAKER_04 33:10

Yeah, that's a great question, Reed. All your questions have been great, and I agree with uh all the panelists are obviously correct about that. I'll I'll take a slightly different perspective on this. If you think about what the problem is with spine care writ large in the first world, it's America and all this all the most industrialized nations. We we have a very peculiar job because we're faced, probably more than any other specialty, with two things. One is the fairly common situation that we all see where someone is having a surgery and maybe it's not so clear they really need that surgery. I'm not saying it's the wrong thing to do, but it's it's certainly not a consensus and it's unclear. And that that can be a problem. And we all represent spine writ large beyond just our personal practices. And the second, which is the converse of that, which is people really need a surgery, but they're so scared and terrified they're not going to do it. And maybe they let themselves go so far that it becomes an unrecoverable situation, where some people just suffer in silently and people even commit suicide because they're more afraid of surgery. And maybe this is the reason why the National Spine Health Foundation exists, right? That you you see this rubric being so difficult. Now, where does minimally invasive fit in? Well, maybe minimally invasive treats the second part of that problem, which is that if patients weren't so terrified of spine surgery, maybe millions more people would get the care they really need. Right? And that, and I'm not ignoring the first problem because there's real parallel issues within our field. But I think that if if you ask me what I would want to see, I'd want to see our techniques, our technologies, our abilities being used on the right people, um you know, without the intense fear and reluctance to undergo a spide surgery.

unknown 34:56

Yeah.

SPEAKER_02 34:57

Comments on that?

SPEAKER_00 35:00

Yeah, I think I mean Mike is always spot on. I think one of the problems, which is where your this foundation can be so effective, is, and we talked a little bit about what patients asking the right questions, there's so much misinformation out there on the internet, and that many times adds to the fear. When patients ask me, they say, well, fusion's terrible, and if I have a fusion, it's guaranteed in the next five years, I'm gonna need all the other levels fused. And my answer to them is, you know, they look on the internet, the patients that did not have a good outcome, often for the first reason, Mike explained they didn't probably need surgery, are on the internet saying spine surgery is terrible. The people who have surgery get on with their lives. They don't talk about I have patients that had surgery 10 years ago that did great, and I'd say, Who did your surgery? And you'd think it's a big event, and they actually don't remember their surgeons though, which is good, right? Because it means they just got into the life it was in the thick. So I think that's really important. I think there's so much misinformation on the internet that adds to that fear that Mike's talking about, and you know, getting the right questions answered is key, and the right questions have to come from a place of understanding and knowledge. And so hopefully by doing what we're doing today and what you do day in, day out, is giving the patients those tools to be able to make the right choices.

SPEAKER_02 36:19

Great. So well said, and and that is what the National Spine Health Foundation is here to do is to give knowledge and hope. And that power of hope, that hope, I don't have to live like this, I can get better. Um, that hope comes from knowledge, knowing that you can get better, that there are ways out of the pain or or out of the suffering. Um, for sure. Doc Dr. Anand.

SPEAKER_01 36:44

No, I love it. It this discussion is so important because for me, one of the most disappointing things is you have a patient who's been suffering from pain for four, five, seven, eight years. They had 20 injections, done physical therapy five times, seen somebody else and got a pain stimulator. And the sad part is we follow that story. If they had come to see us within that three months, one year, we could have really, really make them better. Now we reach the point where unfortunately they have chronic pain, you're depressed, a lot of things have gone on, sometimes lost your job, you reach this point, you're hypersensitized, and you live with this pain. And truly it's really hard for us to make that better. Whatever we do, even with the greatest surgical techniques we have, that patient is not going to be the same. So I think one of the greatest things we can teach out there is if you're hurting and you continue to hurt beyond three to six months, please go see the spine specialist who can then tell you what exactly needs to happen. Maybe a diagnosis was missed, maybe go the right path, and not just flip around trying weird remedies to make you better when you're not getting better. If you're getting better, great. But I think that's a huge problem in spine. People are scared of getting surgery. They try every alternative. And this is really true. I have someone who gives life goldfish to his patients to swallow. You see, remedies are completely off the books. But people know it. And this is important. This is not right. You have it treated right. And so it's one thing to get scared about spine surgery, that's fair. Ask the right questions. But it's symptomatic beyond three and six months, and you're not getting better. Please, please, please, see spine splestions wherever you are, and you probably go down the right track at least and get treated earlier rather than later.

SPEAKER_03 38:31

Yeah, I mean, I think everybody's brought up great points. I mean, to me, why do patients avoid seeing a spine surgeon? There's the recovery is scary, um, complication can be severe, uh, and there's an uncertainty of whether you're going to get better or worse. And when you think about minimally invasive surgery and the technological advances that are happening and marry those together, they're addressing all of those problems. We're in minimally invasive procedures, like Dr. Phillips was referring to, oftentimes fusions can be done and you can go home the same day. What a what a major change that makes that recovery sound so much better. And it's not just a old wives' tale, it's happening every day. Uh, in terms of the complication profile, technological advances like robotics, navigation, um, and it's just to name a few, really improve the accuracy and precision of what we're doing. And then ultimately the sphere of am I really gonna get better with this? I think that's the part where you just have to find a surgeon that's only gonna operate when you need it and is willing to say, you know what, I don't think you're gonna get better with surgery. And that's where it's so important to find the right surgeon is really somebody's gonna tell you when you don't need it, as opposed to worrying about too much of the detail of how they're gonna fix your problem.

SPEAKER_02 39:57

Yeah, that's that's so beautifully said. And you know, a lot of times people will say, Well, I'm not gonna go see a spine surgeon because he's just gonna want to cut because he's a surgeon. Um, but I think what we're hearing today is that spine is unique in that way, that spine surgeons see the gamut in the range of treatment modalities that are available and finding the right diagnosis and the right treatment to solve that problem is is the art and science of of what you do. And that is true for just about every well-trained, whether they're an orthopedic or neurosurgery trained spine specialist, that they are here and they're here to get you better, um, and that there is hope.

SPEAKER_04 40:40

I think that uh what NSHF is doing is really phenomenal because you know, there are so few resources that are reliable, that have veracity. Most of what people see on the internet is marketing. There's so much misinformation of as we've heard already. Um, you know, find people you trust, talk to other patients, talk to your doctor. Um spine surgery works. It absolutely works in the vast, vast majority of people when the selection process is right, when the execution is correct. There are some variants, and that's important to understand. But, you know, we exist here for a reason. Surgery is there to fix the things your body cannot fix.

SPEAKER_00 41:17

I think one of the most important things as a patient is to have realistic expectations about what the surgery is going to accomplish, what it's not. And I think that's an important discussion with the physician, with a surgeon. I think overpromising is not right because it's never going to live up to your expectations. I'm never telling a patient who has back pain, if I do a fusion, I'm 100% sure they'll never have a day of back pain in their life. I'll tell them that they may still have some intermittent pain. They'll probably be happy they did the surgery, uh, but they may need anti-inflammatories every six weeks. So I think setting expectations when you go into the surgery, understanding what your surgeons' goals are, what your goals are, seeing where those marry is really the most critical part of what the of the success of the surgery.

SPEAKER_01 42:02

Don't let your neck or back pain get the better of you. Get on top of it, deal with it, get the right opinions. Don't let it, you know, really start affecting physically, mentally. I know you're starting taking narconics. I have red lines. If someone's taking narconics with a back or neck pain to me, there's a big no-no. It's reached a point where you probably really need a good opinion. You're getting neurological problems, go see a doctor. And you it's affecting your work mentally, physically. You're not that you gotta get this treated. Don't sit there vacillating on that. I think that's really, really important. And and the other side was, and Frank alluded to, Dr. Phillips alluded to that. Back problems, neck problems, are degenerative aging problems predominantly. And there's no cure. It's not you got a broken bone, you fix it, you're perfectly normal. I took patients all day was a diabetes. We absolutely control diabetes. When you're gonna have a cake pinch, you're gonna suffer. Similarly, your back, we can control it. But you want to do crazy stuff, your back being won't come back. So we have to you have to live through a new normal, but yes, we can get you to that new normal. And I think most spine solutions do a great job. Just get a good opinion. Don't wait on it.

SPEAKER_03 43:13

I agree with everything that's been said, and I just I want to congratulate you guys for what you're doing. Um because you brought up that you know you had this concept because you said, where is the American Health Association for spine problems? And it never hit me until I heard that. And I think um the value of information that's unbiased uh around spine surgery and and spine care is invaluable. So thanks for what you're doing.

SPEAKER_02 43:42

Thank you. We can't do our work without the input and volunteerism and enthusiasm of the experts like the surgeons who join me today. The National Spine Health Foundation is here to give knowledge, to give hope, to give expert insight to everyone who's struggling with a neck or back condition. We know that's millions and millions of people, and these surgeons see that every day. Um, we've heard that they are excited about minimally invasive spine surgery for all the reasons that they can do complicated procedures with less disruption to your life and get you back to your life like never before in history. So I want to thank these healthcare heroes who put the best of science into practice every day for their patience and have taken their time to help you understand what minimally invasive spine surgery is, maybe what it is not, and how to approach deciding whether or not that might be something for you. Thank you for watching.