As spine surgery continues to evolve with technological advances and a push toward value-based care, more procedures are shifting to ASCs.
Amid new minimally invasive techniques, improved pain management protocols and surgical innovations, procedures once exclusively done in hospitals are increasingly performed safely and effectively in outpatient settings. Several spine surgeons joined Becker’s recently to discuss the procedures they believe are poised for growth in ASCs.
Spinal endoscopy
Several surgeons pointed to spinal endoscopy as the most promising area for growth in ASCs.
“Hands-down the most growth will be in spinal endoscopy,” said Brandon Hirsch, MD, of DISC Sports & Spine Center in Newport Beach, Calif. “The technology is advancing rapidly, and patients are always seeking less and less invasive methods of surgery.”
Mohammed Khan, MD, of New Jersey Brain & Spine, also highlighted the rapid rise of ultraminimally invasive endoscopic spine surgery, including discectomies, foraminotomies and fusions. These procedures allow for same-day discharge, faster recovery and reduced postoperative pain.
Many leaders hope this trend will shift the new generations.
“After many years of struggling with adoption, I see the new generation of spine surgeons embracing this technology,” Choll Kim, MD, PhD, of Excel Spine in San Diego, said. “It will not be long before we have two types of spine surgeons — one working primarily in ASCs and the other in hospitals.”
Outpatient lumbar fusion
Outpatient lumbar fusion is another procedure gaining traction, particularly when performed with minimally invasive techniques.
“With lateral and oblique lumbar approaches, minimally invasive [transforaminal lumbar interbody fusion], and even endoscopic fusion, surgeons can now perform lumbar fusion with much less pain and faster recovery,” Don Park, MD, of UCI Health in Orange, Calif., told Becker’s. He also noted that enhanced recovery protocols and advanced technologies such as computer navigation and augmented reality are making outpatient lumbar fusions increasingly viable.
Lateral lumbar interbody fusions
Leaders are also seeing a rising volume of lateral lumbar interbody fusions in ASCs.
“These procedures offer a very delicate exposure with reduced tissue disruption, minimal blood loss and faster recovery,” Jeff Lehmen, MD, of SSM Health Spine Surgery Center in Jefferson City, Mo., said.
Brian Fiani, DO, based in Birmingham, Mich., highlighted anterior lumbar interbody fusions as another fusion type likely to grow in ASCs, thanks to benefits like reduced blood loss and improved postoperative pain scores.
Cervical disc replacement
Surgeons also pointed to cervical disc replacement as also gaining popularity in the outpatient setting.
“I do believe that cervical disc replacement will continue to see growth as surgeons increase their comfort with anterior cervical exposures,” Dr. Hirsch said.
Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles, pointed to sacroiliac joint fusion as another procedure already well established in ASCs. “As we get better at diagnosing this smaller subset of patients, the volume will increase,” he said. With more centers equipped with frameless navigation hardware, he anticipates an uptick in cases.
There also could be a growth in artificial disc replacements, transforaminal interbody fusions, and [lateral lumbar interbody fusions] as technique refinements and efficiency gains continue, according to Scott Raffa, MD, of Cantor Spine Center in Fort Lauderdale, Fla.
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