The spine tech, procedures moving to ASCs

The development of spine technology has increasingly pushed procedures to ASCs, and many spine leaders expect the trend to continue.

Frank Phillips, MD, director of the division of spine surgery at Chicago-based Midwest Orthopaedics at Rush, spoke with Becker's ASC Review about what's pushing these procedures outpatient. 

Editor's note: This piece was edited lightly for clarity and brevity. 

Question: What spine procedures and technologies are moving from hospitals to ASCs?

Dr. Frank Phillips: The rapid trajectory of migration of joint replacement surgery to ASCs over the past few years has not been seen in spine surgery nationally. The economics and value of ASC spine surgeons, however, remain compelling, and we will continue to see ASC spine case volumes grow.

Currently, the majority of ASC spine volume across the country involves 'simple' decompression and [anterior cervical discectomy and fusion] surgery. I currently perform most of my single-level lumbar fusions in the ASC, and this trend will continue as surgeons gain confidence in their ability to perform these cases in an ASC setting. This requires proficiency and efficiency with the surgical procedure as well as with the nuances of spine perioperative anesthesia-analgesia management. Using these principles, in my own experience of outpatient lumbar fusion of over five years years, I have not had any patient require postoperative hospital admission. The cost of devices and biologics used in complex spine cases remains a challenge to spine cases migrating to ASCs.

Q:  What innovations do we still need to move more cases into the ASC?

FP: Currently, advanced enabling technologies, including intraoperative 2D imaging, navigation, robotics and augmented reality, are cost-prohibitive in the ASCs. Many younger spine surgeons are dependent on these technologies to perform more complex spinal procedures. Evolution of these platforms with an eye on the ASC will undoubtedly allow for migration of more complex cases to ASCs. Implant manufacturers have been reluctant to embrace ASCs for fear of cannibalizing their hospital margins on products. By using procedural bundled payments, we have made this a win-win at our ASCs. As less-invasive fusion techniques advance, these will facilitate further ASC migration.


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