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Spine & Neck Service Line Requires Planned Growth

Joe Cantlupe, for HealthLeaders Media, November 15, 2010
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"The thing about SpineZone is, when someone comes in saying they have a bad disc, that they have had chiropractic treatment or injections, and say, 'You have to operate on me'—that's not necessarily the case," Raiszadeh says, pointing to minimally invasive therapies.

"When you look at the cost savings, that's tremendously successful," says Raiszadeh. A key element was extending time for the process over a period of three months, not six weeks, for the exercise program to build up strength for the patient. At the end of the day, for the patient, there is better quality of life.
In development of the SpineZone, the group of physicians "came up with the comprehensive idea and brought the 'zone' to the hospital," Raiszadeh says. "The hospital provides the strengthening machines; we can refer [patients] to primary physicians at the hospital." Referrals and exchanges of patients make good business sense for both the hospital and the group of physicians, he says.

"In essence, we are managing the whole disease. Coordination with hospitals and physicians is a model that has been around for cardiology, but it is new for orthopedics," Raiszadeh says. "The whole concept is to improve function of the patient."

Success Key No. 2: Robotic surgery

Texas Health Presbyterian Hospital Plano is counting on a spine robot procedure to improve patient outcomes and produce more business for the hospital. While there has been much debate nationwide over costly spine surgeries, executives at the Texas hospital believe the robot technique is the forerunner of future minimally invasive surgery techniques, and also has growth potential for years to come.

Overall, minimally invasive spine fusion in the United States has historically been limited by difficulty associated with the techniques, a lack of clinical data, and a lack of surgeon awareness or confidence in associated devices, according to the Millinneum Research Group of Toronto. Despite these obstacles, in recent years the market for spinal fusion surgery devices has flourished, primarily due to patient demand for minimally invasive options, which in turn has compelled surgeons to educate themselves about the techniques, according to the group. Despite questions over reimbursement issues, revenues are expected to be buoyed in the overall market for invasive spinal fusion devices, according to Millennium.

"Patient demand, a growing foundation of clinical data, and increasing competition will serve to push revenues" from $670 million in 2009 to more than $1.2 billion in 2014, the group stated.

Yet there is concern about unnecessary and costly spinal surgeries or injections. About 1.2 million spinal surgeries are performed in the U.S. each year, with about 300,000 as spinal fusions.

The Plano hospital is opting for improved patient outcomes and revenues with its robotic procedures, linked to minimally invasive surgery. The SpineAssist surgical robot is one of three such robots in the United States, and the only one in Texas designed specifically to operate on the spine. Accurate to less than half a millimeter, it enables surgeons to plan the optimal surgery ahead of time using a computer tomography-based 3-D simulation of the patient's spine.

Isador Lieberman, MD, an orthopedic and spinal surgeon at the hospital, says the robot essentially maps out the patient's anatomy and allows the operating physician to consider the entire procedure before surgery is started. Using the robot, Lieberman says he can be more precise in his surgeries and anticipate complications quicker.

The technology can be used in biopsies, to treat thoracic-lumbar fusion and vertebra compression fractures, and to correct scoliosis. The surgery is much less invasive; as a result, small incisions mean less pain for the patient, shorter stays, and faster recovery.

"The surgeon plans in a virtual environment, just like a pilot plans his flight," says Lieberman, noting that "an autopilot on an airplane follows the pilot's instructions." Of the robot, "it's more precise and efficient during surgery," he says.

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