Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Hyun Bae, Medical Director of the Spine Institute at Center for Spinal Restoration

Transcript

Dr. Hyun Bae, Medical Director of the Spine Institute at Center for Spinal Restoration · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  Welcome everyone to the Becker's Healthcare podcast series. I'm Maria Mohammed.
• 0:04
  She, her pronouns, a writer and moderator for Becker's Healthcare,
• 0:08
  and I am absolutely thrilled to have with me today Dr.
• 0:10
  Y Young Bay Medical Director at the Spine Institution Center for Spinal
• 0:14
  Restoration. Dr. Bay is so nice to talk with you today. How are you?
• 0:19
  Very good.
• 0:20
  Wonderful. Well, to begin,
• 0:22
  would you mind please introducing yourself and then telling us a bit about your
• 0:25
  background?
• 0:27
  Sure. Uh, my name is Shun Bay. I practice in Los Angeles. Uh,
• 0:32
  and I'm actually co-director of Education and Fellowship here at Cedar Sinai
• 0:37
  Spine Center. We believe that we're one of the top spine centers in the country,
• 0:41
  uh, as well as I have a private practice called the Spine Institute Center for
• 0:45
  Spinal Restoration in Santa Monica. Um, and I've been involved in research for,
• 0:50
  gosh, over 20 years, um, involved with, uh,
• 0:54
  creating new devices for spine. Um,
• 0:57
  also very involved in the cellular and biologics world and have been teaching
• 1:02
  fellows for the last 20 years as well.
• 1:06
  Wonderful. Thank you so much for that background. Well,
• 1:08
  to begin with the real questions of the interview,
• 1:10
  the first thing I wanted to ask you, doctor,
• 1:12
  is what are the big headwinds you're planning for this year?
• 1:17
  Really interesting question. Um,
• 1:21
  I think one of the major shifts is, is that, uh, even though I'm,
• 1:26
  I'm at Cedars, it's, I'm officially called a private practice physician.
• 1:31
  I'm not employed by Cedars. Uh, and it's very interesting,
• 1:34
  I think what's happening to the, you know, the private world where, uh,
• 1:38
  spine surgeons in, at least in our market, you know,
• 1:41
  what's happening in their world, it's, it's kind of changing a little bit.
• 1:46
  I think for me, I've joined a, a group of spine physicians recently,
• 1:50
  it's called Commons Clinic. Um, and it's really trying to leverage,
• 1:55
  uh, very busy spine surgeons,
• 1:57
  getting them together in a private practice type of environment and hopefully
• 2:01
  being able to compete, uh, in the, uh, ambulatory care center. You know,
• 2:06
  obviously everybody's talking about spine surgery, uh,
• 2:09
  moving to the ambulatory center.
• 2:10
  We certainly have gotten a lot better with minimally invasive surgery. Uh,
• 2:13
  but the idea is, is not only to compete on the,
• 2:17
  I would say standard surgical fees per se, uh,
• 2:20
  but really trying to bring management of bundled care
• 2:26
  into the ambulatory care center. So not just managing,
• 2:30
  let's say the surgical event,
• 2:32
  but really managing the presurgery and post-surgical
• 2:37
  event to see if we can manage it and bring quality to the
• 2:41
  patient. And then obviously, you know,
• 2:44
  have some cost savings that we can all share. Um,
• 2:47
  I think that's a very interesting model.
• 2:50
  It's kind of trying to bring bundle care into the ambulatory center instead of,
• 2:54
  you know,
• 2:55
  what we've typically been hearing with bundle care with c M s into the hospital.
• 3:00
  It's really bringing that to more of a private payer based,
• 3:03
  but bringing it into the ambulatory care center just to, you know,
• 3:07
  help with cost savings. Uh, that's a truly interesting venture that, uh,
• 3:11
  I'm starting right now. And I think, uh, that, uh,
• 3:13
  is basically one of the big headwinds as far as the practice. Um,
• 3:18
  obviously in LA we're seeing a lot of movement with private equity. Um,
• 3:22
  this is a little bit different. Um, and I think, uh,
• 3:25
  I'm looking forward to spearheading that and seeing what,
• 3:28
  seeing really how we can move the needle in that regard, both for patient care,
• 3:32
  but, uh, both for trying to increase some, um,
• 3:36
  leverage in community amongst private practitioners that, uh,
• 3:39
  are involved in spine surgery. Um, other than that, if you ask me, you know,
• 3:44
  what I think as far as technique, uh,
• 3:48
  or procedure based, um, I do think, uh,
• 3:52
  a couple things have really moved and we'll move in the next couple years.
• 3:56
  One is more kind of endoscopic or arthroscopic, whatever you want to call it,
• 4:01
  uh, this type of more minimally invasive surgery.
• 4:04
  I think the term minimally invasive surgery is, is kind of overdone now.
• 4:08
  We've used it a lot. It's very unclear.
• 4:10
  The patient doesn't really know what it is. And I think, uh,
• 4:13
  endoscopic surgery definitely helps cuz the word endoscopic defines the
• 4:17
  procedure itself and there's no, I don't know,
• 4:21
  misconception. It's not like, you know,
• 4:23
  mis surgery can be anything from deformity to a one level T lift to a micro
• 4:28
  decompression to an A C D F to an anterior cervical disc replacement. Um,
• 4:33
  and at least when you say I'm gonna do an endoscopic decompression or endoscopic
• 4:38
  discectomy, it's very descriptive and it conveys it, the, the,
• 4:42
  the message that, hey,
• 4:43
  this will be something that you'll be able to tolerate that is actually
• 4:46
  minimally invasive. So, um, I see that in my practice. You know,
• 4:50
  we've started some, um, I'm gonna say more kind of arthroscopic assisted,
• 4:55
  that's our term for use. Um, cuz it's by portal.
• 4:58
  We use two portals and, and I think that that's very interesting. Um,
• 5:06
  other than that, I still think that motion preservation,
• 5:10
  now that I've been doing motion preservation both lumbar arthroplasty and
• 5:14
  cervical arthroplasty for more than 20 years, and I've,
• 5:17
  I've been so underwhelmed with the amount of progress,
• 5:23
  uh, and where we are with this technology today.
• 5:25
  But I do see in the last five years at least, this is truly evolving,
• 5:30
  that we certainly are seeing a big uptick of cervical arthro
• 5:35
  arthroplasty.
• 5:36
  I think that that's great and I think that's probably with the data release of
• 5:39
  the longer term studies. Um, and I think, you know,
• 5:42
  that's kind of carried along lumbar arthroplasty where I do see,
• 5:47
  uh, more surgeons, uh,
• 5:49
  around the community starting doing lumbar disc replacements. Um,
• 5:53
  I think lumbar disc replacements have a huge impact, uh,
• 5:56
  to the patient just as much,
• 5:59
  if not more than cervical arthroplasty. Um,
• 6:03
  and certainly I think it's more geographically based, uh,
• 6:06
  but at least in our geo geography, we're seeing a lot more of that.
• 6:10
  And I think hopefully that's, you know, spreading around the country.
• 6:13
  Yeah, absolutely.
• 6:14
  All those things definitely sound so interesting and sounds like it's a win-win
• 6:19
  for everyone, hopefully. Um, for you doctor,
• 6:22
  how will the spine and orthopedic field evolve in the next two to three years,
• 6:27
  would you think?
• 6:30
  I, so as far as, you know, bigger surgeries, I think,
• 6:35
  you know, we're expanding both bigger and smaller. Okay.
• 6:38
  So I think for the bigger surgeries when we talk about, um,
• 6:41
  surgeries that involve, uh, multilevel fixation, deformity correction,
• 6:45
  deformity surgery, uh, I do think that that is becoming,
• 6:50
  uh, more prescriptive. Um,
• 6:53
  we have a lot of tools and I'll think we'll see a lot more tools that will help
• 6:57
  bring more reliability and reproducibility to that surgery, including robotics,
• 7:03
  um, you know, some type of artificial intelligence,
• 7:05
  which I think is more related to surgical planning and what you're gonna
• 7:09
  achieve. Uh, I think in the future, probably in the near future, um,
• 7:13
  a lot of this is gonna be planned with the help of AI and you won't even have to
• 7:17
  bend the rod, the robot will put the screws in and bend the rod for you. Um,
• 7:22
  I think that is what's gonna happen to the larger surgeries now, you know,
• 7:26
  still it, it, it,
• 7:27
  it allows for reproducibility in the surgical procedure
• 7:32
  part. Um, but you know, I I still think there's a lot of
• 7:38
  innovation, uh, that needs to come about of, of, you know,
• 7:42
  is there an alternative to this type of surgery? You know, and not just,
• 7:46
  I would say, you know, not just, Hey, can we decrease levels?
• 7:51
  Can we change the flexibility of the rod? Can we, you know,
• 7:55
  do something with, you know, the amount of fixation?
• 7:58
  I think it's really hopefully looking back with more data to see, you know,
• 8:03
  how do we get here? Like why do we get here? You know?
• 8:05
  And hopefully with the index procedures, you know,
• 8:08
  we can change the index procedures to hopefully avoid, uh,
• 8:12
  having to do longer term constructs.
• 8:14
  Now I think that's probably more of a five to 10 year, uh, project. Um,
• 8:19
  but you know, after being here for 23 years, I'm still surprised that,
• 8:24
  you know, we seem still to be chasing ourselves with fusion,
• 8:29
  you know, that one level to two levels,
• 8:32
  to four levels to T 10 the pelvis. And,
• 8:36
  and it makes me believe that if we're still chasing ourselves, it,
• 8:39
  it's not about, you know, how to do the fusion better or re you know,
• 8:43
  or causing reproducibility in the fusion. It's really, you know,
• 8:48
  maybe it's the index operation or, uh,
• 8:51
  the fact that we're fixating the spine,
• 8:53
  which is a non physiologic procedure and maybe we need to look at that
• 8:57
  differently to hopefully stop the progression. Also,
• 9:02
  if you ask me, you know, other things in the biologic arena,
• 9:06
  I do think that there's been a lot of progress. Um,
• 9:10
  there's three clinical trials that I know of right now that are looking at,
• 9:15
  uh, disc injections. And when I talk about clinical trials,
• 9:18
  I'm really talking about phase three FDA clinical trials that are gonna be
• 9:22
  randomized against some type of, um, placebo arm,
• 9:27
  um, one, two being stem cells,
• 9:30
  one being a molecule that will be injected to for, uh,
• 9:33
  into the disc for disc degeneration and low back pain.
• 9:37
  And I'm eagerly weighting those results, but I think in five years,
• 9:41
  or maybe even a little bit longer, that we actually may have
• 9:47
  an FDA approved product with the indication
• 9:52
  that says the treatment of low back pain for degenerative disc disease. Uh,
• 9:57
  and I think, you know, that would be definitely a paradigm shift.
• 10:02
  Um, there's also a recent approval, uh,
• 10:06
  for a drug that's very similar to camo papine, uh,
• 10:10
  which is a drug that, you know, maybe, you know,
• 10:12
  the younger surgeons have not heard about, but you know,
• 10:15
  it's kind of the molecule from a papaya ab uh,
• 10:18
  extract that digests collagen has the ability to digest collagen.
• 10:23
  And it was used a long time ago for the treatment of her needed disc for
• 10:27
  contained hernia disc.
• 10:29
  And I just found out that there's been a recent approval that the FDA has
• 10:33
  actually had an approval, uh,
• 10:35
  for this medication to treat contained disc
• 10:40
  herniations for radiculopathy.
• 10:42
  And so I'm interested to see how that rolls out in the next two or three years.
• 10:47
  Um, I think, uh, that probably, uh,
• 10:51
  gets into your next question.
• 10:54
  Yeah, absolutely. Thank you all for that. Uh, the last question, doctor,
• 10:57
  that I wanted to ask you is, where do you see the best opportunities for growth?
• 11:04
  So I still think making, you know,
• 11:06
  the harder and bigger surgeries more reliable,
• 11:08
  there's a lot of growth there because there's obviously a lot of invested
• 11:12
  dollars there. So, you know, where there's, you know, investment,
• 11:17
  you know, you have to get a return. And so I do think that, you know,
• 11:21
  big stain in the spine and doing long fur fusion certainly is an expensive
• 11:24
  process and therefore there'll be a lot of investment into that field.
• 11:29
  So it will be robotics, ai, augmented reality. Um,
• 11:34
  I do think that that's still, um,
• 11:36
  gonna be a major and progression over the next couple years.
• 11:40
  And definitely a lot of people are,
• 11:41
  are already experimenting and playing in that field. Um,
• 11:45
  but I also think on the minimally invasive side, the smaller side, which,
• 11:49
  you know, sometimes gets neglected, um, because you know, it's smaller,
• 11:54
  right? And sometimes it doesn't require hardware.
• 11:57
  So I still think that endoscopic or arthroscopic or arthroscopic
• 12:02
  assisted that these types of surgeries in the US um,
• 12:07
  has a tremendous amount of growth opportunity. And I see it now. If you, if you,
• 12:12
  if um, if you follow like kind of the endoscopic session at, uh,
• 12:15
  society of Minimally Invasive Spine Surgery ESUs,
• 12:19
  and if you looked at over the past years, I would say five years ago,
• 12:22
  if you went through an arthroscopic or endoscopic spine uh, session,
• 12:27
  there's probably two or three people in the room. You couldn't even get faculty.
• 12:31
  Okay? But last year at ESUs, the endoscopic spine session,
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  the room was packed, you know, packed. And you know,
• 12:40
  you have tons of faculty to choose from.
• 12:42
  And so I do think that that is gonna obviously
• 12:48
  start growing here in the us What's fascinating is I just traveled to Korea
• 12:53
  about four months ago. Okay. And,
• 12:59
  um, you know, they started with endoscopic spine surgery quite early on, um,
• 13:02
  and in Korea, what's fascinating is,
• 13:04
  is that if you need a decompression or if you need a
• 13:09
  um, disc removed,
• 13:10
  if you have a herniated disc and you need a laminotomy discectomy or just a
• 13:14
  simple decompression,
• 13:16
  you are more likely to have that treated endoscopically than you are open.
• 13:22
  Okay. So, uh, that has really happened over the last 10 to 15 years in,
• 13:27
  in Korea. And I think, you know,
• 13:29
  other countries have adopted endoscopic surgery and I think, you know,
• 13:32
  the US if we are, you know, the spine leaders that, you know,
• 13:36
  we will also start adopting that as well.
• 13:39
  Yeah, yeah, totally. Thank you so much for sharing that. Um,
• 13:42
  and thank you so much for those final thoughts, doctor.
• 13:45
  This has been an amazing, amazing discussion.
• 13:47
  So I wanna thank you so much for coming on Peckers Healthcare again,
• 13:50
  and I look forward to connecting with you again soon.
• 13:52
  Fantastic. Thank you very much, Mariah.