Charla Fischer, MD: Discussing the Future of Orthopedics


How has technology changed the way orthopedic specialists practice and what is driving advances such as minimally invasive spine surgery?

As the US population continues to age, orthopedic specialists and surgeons continue to adapt technology to help treat their patients. With minimally invasive spine surgery becoming more mainstream and the use of stem cells being considered to treat certain conditions, orthopedics has been advancing rapidly to meet the needs of patients.

Charla Fischer, MD, associate professor of orthopedic surgery at NYU Langone Spine Center, discusses how these advancements are used in her practice and what is driving the push behind incorporating new technology and techniques into the field.

MD Mag: How have advances in technology and minimally invasive spine surgery changed how orthopedic specialists practice?

Fischer: I would say in the past 5 to 10 years, we've seen a lot of advances in minimally invasive surgery as well as recently we've been seeing more advances in robotics and navigation and that really allows us to do what we need to do surgically with minimal soft tissue disruption and less pain afterwards. So, we've done some studies here looking at opioid use we're very concerned about opioid use making sure we're not contributing to the opioid epidemic helping patients and being cognizant of that. So, we looked at a lot of factors around surgery to see you know if we can minimize opioid use so long-term. We saw that there was a difference between traditional open surgery and minimally invasive surgery, in terms of prolonged opioid use in the long run at six months.

So, I think that's really sort of key showing that patients do well after surgery, they get back to their activities faster, they're in the hospital shorter period of time, and overall whenever I can apply minimally invasive techniques, I do, because I really believe that it helps the patient.

What is the future of stem cells for treating degenerative disc disease?

Fischer: So, the use of stem cells in degenerative disc disease is a really exciting concept. We haven't seen a lot of good outcomes yet and that's because back pain is multifactorial. So, you're looking at one part of a bigger picture so maybe you can help one part but then so if you can help the disc pain then you still have facet joint pain, you still have paraspinal muscle pain, you still have stenosis, or nerve pain. So, it's an area of interest to a lot of people, which I think is good, and if we can help decrease pain that way that would be great. I haven't seen a lot of stuff that is conclusive and would warrant me adding that to my practice or offering that to patients.

What is driving advances in orthopedic surgery and orthopedics in general?

Fischer: So, as with most things in medicine what drives the advance and the staying power of an advance or technology or anything is the benefit to the patient. So, if you really see a benefit to the patient then most people get on board really quickly. Additionally, there are other benefits such as being able to having more technology that helps ramp up the adaptation or the implementation of these techniques in your OR but, overall it's just if you see patients do

better you're gonna want to continue to do that.

Around that we've seen instrumentation companies come up with systems that are easier to use in a minimally invasive fashion, we've seen the advancement of navigation and robotics, and as well as sort of administrative support around these surgeries. So, I think everything is sort of coming together in the perfect storm to really push this to the forefront and make it more mainstream. I would say it's fairly mainstream at this point and in the future, it will probably be more gold standard. There's some stat about the first lap chole was done in France and I believe 1987 and within 3 years every lap chole in the US was done, every cholecystectomy was done laparoscopic and we're just a little bit slower to adapt the technology because we kind of need or this the minimally invasive technique because we needed some technology to really apply that to spine but once we got that we saw a rapid switch in surgical technique just like the cholecystectomy.

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