Latest / Becker’s Healthcare Podcast / Redefining Success in Spine Surgery with Dr. Aqib Zehri

Transcript

Redefining Success in Spine Surgery with Dr. Aqib Zehri · Becker’s Healthcare Podcast

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  - a clear sense of where you stand and
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  - what comes next.
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  - So join us November second through the fifth
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  - at the Hyatt Regency in Chicago, and come
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  - ready to do the hard thinking.
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  - Hi, everyone, and welcome to the Becker Spine
• 1:01
  - and Orthopedic
• 1:02
  - podcast.
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  - I am Sophie Ades, assistant editor
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  - of Becker Spine Review.
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  - And today, we're pleased to be joined by
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  - doctor Akhbzary,
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  - neurosurgeon
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  - practicing in Portland, Oregon
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  - specializing in complex and revision spine surgery,
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  - spinal deformity,
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  - and minimally invasive spine surgery.
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  - Doctor Zairey brings advanced fellowship training in complex
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  - spinal surgery and a patient centered approach to
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  - some of the most challenging cases
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  - in spine care.
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  - And a recent conversation with doctor Zaire raised
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  - a fascinating question.
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  - When can we actually call a spine surgery
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  - successful?
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  - Doctor Zeri shared that he now follows fusion
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  - patients for one to two years or until
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  - a durable fusion is confirmed,
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  - something he says wasn't emphasized as much during
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  - his training. So today,
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  - we're going beyond the operation itself. We'll talk
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  - about what doctor Zaire has learned from following
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  - patients longer,
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  - how those lessons have changed his thinking, and
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  - whether spine surgery needs to reconsider how it
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  - defines success. So, doctor Zaire, thank you get
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  - right
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  - into
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  - it.
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  - I know that you've said,
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  - again, following fusion patients this long wasn't really
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  - emphasized as much during your training. So
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  - what really made you start questioning the old
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  - approach?
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  - Thank you for having me on this podcast.
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  - Glad to be
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  - contributing to this, work and
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  - improving
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  - spine care
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  - for patients.
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  - So in in training,
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  - I think our focus was
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  - on
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  - focused on indications,
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  - implementing
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  - the
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  - the technically
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  - appropriate surgery and focused on
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  - short term outcomes,
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  - and preventing,
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  - complications
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  - within a ninety day global period,
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  - and, focused on decreasing length of stay,
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  - and
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  - avoiding readmission rates, things like that. I mean,
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  - those are all important,
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  - but they're not the full outcome of
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  - some spine surgeries, especially spinal fusions.
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  - So a patient can technically have a successful
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  - operation and look well,
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  - as six weeks out, but we do not
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  - know how they're doing one year out,
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  - or two years out. And I think that
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  - longitudinal
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  - follow-up,
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  - and feedback with the surgeon is very valuable,
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  - because it forces us to evaluate our own
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  - decision making
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  - and how we can continue improving
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  - the care we provide to the next patient.
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  - And so that's something that I'm focused on
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  - with my practice
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  - is having this longer term follow-up
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  - that I then use to then improve my
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  - current practice.
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  - It's such an important,
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  - conversation because I think there is so much
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  - emphasis on the short term, you know, outcomes,
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  - which are super important. But I feel like,
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  - to your point, the long term,
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  - you know, really hasn't maybe been focused on
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  - as much.
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  - So now that you're seeing these patients one
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  - or two years later,
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  - what are you learning
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  - that you maybe would have never seen earlier?
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  - I think the most important thing that I'm
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  - learning,
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  - one or two years out at follow-up
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  - is that durability
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  - in spinal fusions matters a lot.
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  - And durability
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  - can be in the form of a construct
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  - length.
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  - It could be
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  - the metal density in a construct, meaning,
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  - how much screws are put in,
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  - in scoliosis surgery to support,
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  - the spinal fusion,
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  - what type of biologics
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  - are used,
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  - what type of technology is used at the
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  - time of surgery
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  - to make the surgery more efficient.
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  - And so all these factors,
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  - can be tracked long term in these patients
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  - if you follow them one or two years
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  - out, and that can justify the use of
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  - using some of these more expensive technologies, some
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  - of these more expensive biologics,
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  - that actually do make an impact on on
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  - patients.
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  - I think there is some pushback
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  - on hospital systems
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  - and leadership on using some of these
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  - these, technologies
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  - and improvements in biologics that are coming out
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  - because of cost. But I do see value
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  - in that,
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  - when I'm seeing these patients one or two
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  - years out because
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  - I do see, better outcomes.
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  - Yeah. That's an interesting
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  - point. I guess,
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  - has anything you've discovered really made you change
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  - how
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  - you operate today or think about operating?
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  - One thing that I implemented
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  - in my practice is,
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  - doing sacroiliac
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  - joint fusion in my
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  - long segment constructs for spinal fusions.
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  - I've seen that patients,
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  - one or two years out,
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  - really have minimal back pain,
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  - even after large deformity surgery
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  - that could be
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  - related to correcting them to the,
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  - their natural spine alignment that they need to
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  - have. But it it can also be related
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  - to
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  - prophylaxis
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  - treating
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  - any sacroiliac
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  - joint dysfunction that may develop
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  - after, doing a long segment fusion.
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  - So I've had great outcomes,
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  - utilizing this technique
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  - on my spine deformity patients.
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  - And even though,
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  - the implant cost is really high,
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  - for this type of additional surgery.
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  - I do see value in that.
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  - Additionally,
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  - I do use,
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  - expensive biologics
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  - at the index surgery,
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  - And, I see value in using biologics that
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  - have shown...
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  - I have good data in showing long term
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  - fusion rates. Mhmm.
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  - Even though the cost may be high in
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  - using these biologics, I do see the benefit
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  - of them Mhmm. In the long run.
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  - And I think it's important to
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  - minimize revision rates in these patients.
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  - I think that's more important,
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  - and valuable rather than trying to
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  - lower cost of property surgeries.
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  - Right. I think there's a lot of talk
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  - about, you know, maybe
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  - there is a more minimally invasive option or
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  - whatever, you know, that might be chosen. But
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  - at the end of the day, that might
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  - not really be what's right for the patient
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  - and then it becomes into a much bigger
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  - surgery when it's a revision surgery.
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  - But let me challenge the idea of success
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  - a little bit.
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  - When you see a patient a year or
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  - two after surgery, what makes you personally say
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  - this was truly a successful operation?
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  - So I track their patient related outcomes. So
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  - it could be their,
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  - pain scores.
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  - It's something that I monitor.
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  - I also track their their walking distance.
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  - Subjectively,
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  - I see what hobbies they're,
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  - doing again after a major spine surgery.
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  - I also get CT scans of their spine,
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  - to confirm infusion rates. So that... Those are
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  - the markers that I use to confirm,
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  - whether a
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  - clinically meaningful
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  - outcome has been achieved.
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  - And I compare that to all the pre
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  - op data that I that I've already collected.
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  - And Mhmm. And so this is mainly just
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  - for myself,
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  - feedback from myself on how I can continue
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  - to improve the work that I do. And
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  - then once I have enough data, I'm happy
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  - to share that with other surgeons or other
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  - hospital systems on what works and what doesn't
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  - work. Mhmm. I think that as surgeons, we
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  - should constantly collect our own data and see
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  - what what
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  - is working and what doesn't and how we
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  - can save cost. Because, ultimately, that does matter
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  - is how can we provide
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  - sustainable spine surgery to a growing and aging
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  - population.
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  - And so I I see I see the
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  - value in that as well. Mhmm.
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  - Yeah. It's it's so important. And I'm wondering
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  - too, like, is most of that information that
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  - you're gathering coming from
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  - those patient reported outcomes rather than the imaging?
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  - Yes. I I see more value in the
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  - patient reported outcomes.
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  - I think that's that's more important.
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  - Sometimes
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  - it's challenging to get CT scans done
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  - on some patients,
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  - because of insurance,
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  - authorization.
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  - And so it does... Some insurances deny getting
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  - CT scans,
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  - and it requires extra steps to get them
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  - approved.
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  - And so
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  - not all patients can get CT scans to
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  - confirm fusion rates, and so the patient reported
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  - outcomes,
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  - are a kinda secondary way
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  - of confirming if they've achieved a fusion.
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  - And that's by tracking their pain scores. Mhmm.
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  - Yeah.
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  - So important.
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  - And I think too, at the same time,
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  - spine surgeons are definitely being asked to do
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  - more with less.
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  - So what have you changed about the way
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  - you practice to make
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  - high quality spine care more sustainable?
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  - One thing that I've done is try to
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  - standardize
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  - the stuff that I do. Mhmm. That includes
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  - the pre optimization pathway, what type of imaging
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  - they get pre op, the labs,
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  - the equipments that I use during surgeries,
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  - the pain protocols pre and post op,
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  - having standardized mobilization
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  - protocols,
• 11:10
  - and having,
• 11:11
  - standard follow-up
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  - for my patients.
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  - So
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  - when all of that is standardized,
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  - it's predictable.
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  - I think that
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  - you can really,
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  - have successful,
• 11:24
  - surgeries and successful outcomes.
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  - This becomes really important,
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  - especially at the time of surgery,
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  - because,
• 11:32
  - the surgeon can focus on the surgery itself,
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  - and everyone around you
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  - knows what their what their role is.
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  - Because I don't want the team spending energy
• 11:42
  - figuring out routine logistics,
• 11:45
  - especially while we're dealing with the most difficult
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  - part of the case.
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  - And so standardization
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  - is is the one thing.
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  - And then,
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  - having
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  - staff that are familiar
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  - with,
• 11:57
  - these types of cases,
• 11:59
  - in the clinic and the operating rooms is
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  - important.
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  - I believe that spine surgery, like any other
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  - surgeries, that team support.
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  - So that's really important.
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  - And,
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  - all all this stuff is related to improving,
• 12:15
  - patient outcomes. Yeah.
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  - Absolutely.
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  - And,
• 12:20
  - obviously,
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  - you're building your practice at a time when
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  - spine care itself is changing very quickly.
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  - Ten years from now, which seems like
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  - always a way,
• 12:31
  - at pace we're moving. But what do you
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  - hope you'll be doing differently
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  - than than you are today?
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  - I do see a role for,
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  - artificial intelligence making its way
• 12:45
  - into
• 12:46
  - spine
• 12:47
  - spine surgery,
• 12:48
  - also advanced imaging,
• 12:51
  - improvements in navigation and robotics.
• 12:54
  - I do feel like a lot of the
• 12:55
  - repetitive parts of surgical planning and how we
• 12:58
  - execute it will become more technology
• 13:02
  - assisted and driven.
• 13:03
  - I think that the role of the surgeon
• 13:05
  - is still gonna be very important,
• 13:08
  - and the surgeon's judgment is still gonna be
• 13:11
  - emphasized.
• 13:13
  - But it's gonna be
• 13:15
  - more important for the surgeon to choose the
• 13:18
  - right patient, the right surgery,
• 13:21
  - understanding when to operate.
• 13:24
  - And so I think that having,
• 13:28
  - artificial intelligence
• 13:30
  - and,
• 13:31
  - models that can help us,
• 13:33
  - come up with these,
• 13:36
  - these answers is gonna be important. So I
• 13:38
  - think ten years from now, we'll have,
• 13:42
  - these types of
• 13:43
  - technology available to surgeons,
• 13:46
  - so that we can,
• 13:48
  - have better decision making tools.
• 13:50
  - Mhmm.
• 13:52
  - Yeah. AI will definitely be huge. And as
• 13:55
  - you know, we're already seeing such great advances
• 13:58
  - in that area, and things are changing, it
• 14:01
  - seems like, day by day,
• 14:03
  - hour by hour.
• 14:05
  - You know? But like we've kind of been
• 14:08
  - saying, I mean, it truly is an exciting
• 14:10
  - time for spine surgery.
• 14:12
  - But thank you again. I think this has
• 14:14
  - been a really fascinating conversation,
• 14:16
  - and I appreciate you sharing your perspective and
• 14:19
  - for giving us sort of a deeper look
• 14:21
  - at what happens
• 14:22
  - when we think beyond the operation itself and
• 14:25
  - ask
• 14:26
  - what long term success really means for spine
• 14:28
  - patients.
• 14:30
  - Is there anything else we didn't touch on
• 14:32
  - that you wanted to make sure we did?
• 14:35
  - For me, I think
• 14:37
  - in the future,
• 14:39
  - I think my practice will be more data
• 14:41
  - driven,
• 14:42
  - and I think most surgeons' practice will be
• 14:44
  - more technology assisted,
• 14:47
  - in the future.
• 14:48
  - A lot of it's gonna be supported by
• 14:50
  - the industry,
• 14:52
  - and where things are headed. Mhmm. But, ultimately,
• 14:55
  - I don't think
• 14:56
  - the goal of the surgeon is to,
• 14:59
  - replace their decision making to technology
• 15:02
  - or AI. I think that our
• 15:05
  - focus
• 15:06
  - just should still be,
• 15:08
  - using our own judgment,
• 15:10
  - to provide the best patient care.
• 15:13
  - But we can use this technology to help
• 15:15
  - us make better decisions around surgery.
• 15:18
  - So I see
• 15:20
  - these tools supplementing
• 15:21
  - our own knowledge,
• 15:23
  - and not necessarily replacing it. So I do
• 15:25
  - just wanna make a remark on that. Yes.
• 15:27
  - It's definitely
• 15:28
  - a tool and a resource.
• 15:31
  - So thank you for for bringing that up.
• 15:33
  - But
• 15:34
  - that is all for today's episode of the
• 15:37
  - Becker Spine and Orthopedic podcast. A huge thank
• 15:40
  - you to doctor Akhivzari
• 15:42
  - for joining us and sharing his insights on
• 15:44
  - long term patient outcomes,
• 15:46
  - surgical decision making,
• 15:48
  - and how the definition of success in spine
• 15:51
  - surgery may be evolving.
• 15:53
  - So thanks for listening, and we will see
• 15:56
  - you next time.