Shifting Trends in Spine Surgery

"The power to question is the basis of all human progress." - Indra Gandhi

The promise of outpatient minimally invasive spine surgery today is enveloped by the notion that the way things have “always been done” can be done better. So much of progress in our world is based on this idea, I suppose. But spine surgery is my world and here is what I know to be true about it – outpatient minimally invasive (MIS) techniques have increasingly become a strong trend in the way that surgical spine care is delivered in the U.S.

hospital outpatient entryThis trend toward outpatient MIS didn’t happen overnight. In fact, it is decades in the making. But what we have now that we didn’t have in the trend’s early beginnings is actual, research-based evidence of its worth. Be it a minimally invasive outpatient approach to interbody fusion or to disc replacement surgery, long-term studies comparing their effectiveness to that of their open surgery counterparts have shown reduced operating room times, minimal blood loss and fewer complications.

Additionally, these minimally invasive procedures typically offer lower costs overall than open surgery. This has made them more attractive to insurance companies, many of which now cover at least some minimally invasive versions of procedures that have historically been performed via open access. There are multiple reasons for this including the elimination of a hospital stay and a reduced risk of complications that could result in further hospitalization or reoperation. 

But if we set all of the evidence and research aside, there is another reason that outpatient minimally invasive techniques have become more popular – patient choice. Across all specialties, today’s patients are savvy and they’re searching. Not only do they compare the procedures available to treat their conditions, they compare the providers who treat those conditions. They research – extensively. And the world of spine surgery is better for it – especially when it comes to minimally invasive techniques. As a specialized field of medicine, we’re steadily improving at educating the public and that is driving their demand. Patients today are searching for physicians who can treat them using less invasive procedures. Most of them know they have a choice – and many of them, which may include their caregivers and loved ones – exercise that choice.

No matter where outpatient minimally invasive technology takes us, one thing is certain: physician expertise is critical to the safety and efficacy of this emerging trend. It isn’t enough to simply have the technology at our finger tips. It must be employed by specialized experts and those experts have a strong obligation to teach the next generation of surgeons how to operate the tools of the trade. When we can harness the technological advances and cultivate a stellar supply of experts to use it, our patients will wholly benefit. Perhaps, in another decade, we’ll be talking less about this as an emerging trend and more about it as the standard of care – for the health and well-being of patients all over the world.