Outpatient spine procedures have seen explosive growth over the last 10 years — a pattern that could continue as technology rapidly advances in the industry.
Outpatient spine procedures grew among Medicare patients between 2010 and 2021, with significant yearly growth at ASCs. According to the March 2024 issue of the North American Spine Society Journal, the total number of outpatient spine procedures rose about 193% from 2010 to 2021. The compound annual growth rate for outpatient cases per year was 9.9% for hospital outpatient departments and 15.7% for ASCs.
A critical factor in this continued growth will be a more widespread understanding and embrace of endoscopic spinal procedures, Sanjay Konakondla, MD, an assistant professor of neurosurgery at Geisinger Health System in Scranton, Pa., told Becker's.
"I would argue that surgeons or sponsors of America, we're still sort of mentioning what this thing can do and what it actually is," Dr. Konakondla said. "I would say we're not only a super early hockey stick in the adoption of the technique, but in the professional understanding of the technique, [among] the expert panels, committees and national organizations."
Achieving more widespread understanding and adoption of endoscopic spinal procedures, particularly in an outpatient setting, faces both headwinds and tailwinds.
Supportive factors for endoscopic spine procedures include a more general reframing of care for spine issues that lends itself to the outpatient setting, Dr. Konakondla said.
"I think what we're realizing pretty quickly here is that quality-of-life procedures demand smaller surgeries" he continued. "The surgery has to match that sort of drive for even getting the procedure in the first place. When people are not going to be immediately paralyzed or lose function … and they just want their pain to get better, surgery has to leave them in less pain than they're currently in now."
This shift in approach to spinal procedures is challenging because pain is deeply personal and subjective, Dr. Konakondla said. But the introduction of endoscopy into outpatient and minimally invasive spinal procedures "forces us to revisit this," he said.
"It's an interesting dynamic or shift here, because the world where patients are demanding what they want," he said. "They're going to come in and say, 'I want the smallest surgery.' And if a guy's not able to offer that, they have the option to look for other places."
This is heightened by the fact that patients now have access to more information than ever before.
"Giving the option or the luxury of choice to patients on what's out there is going to be the next big drive to, I think, stepping to the next level," Dr. Konakondla said.
Payer policies are one of the significant barriers to scaling up endoscopic spinal procedures — particularly given that, per Dr. Konakondla's approach, clinical decision-making for spinal treatments can be more subjective and less clear-cut than in other specialties or procedures.
"[For] most insurance companies right now, [spinal endoscopy is] all experimental to them," he said. He added that there is a "multifactorial" problem with current CPT coding for spine procedures with endoscopy.
"There's a CPT code for endoscopic lumbar procedures, which is 60380," he said. "It talks about a lumbar decompression with a camera. And unfortunately, that's in the percutaneous family of codes, No. 1. No. 2, it's a little bit short-sighted, because an endoscope is not used only to take out a lumbar disc or do a decompression on the lumbar spine.
"Right now we're using it for synovial cysts, bilateral dorsal decompressions, thoracic disc herniation, cervical stenosis … none of these surgeries have codes for the endoscope I see," he continued. "The only code that exists is that decompression for the disc and lumbar spine. And it's sort of unfortunate because it's super specific, and it's closed off so we don't have any leg to stand on.
Dr. Konakondla also noted that the capital costs remain relatively high for these procedures, which could fall as they are more widely adopted, particularly by larger health systems or other big players in healthcare.
"When Teslas came out, they were super expensive. Now they're like the most widely used [electric vehicle] in the country. I think that that's the necessary steps of any progressive technology," he said. "It's a complex system. There's a number of incentives. Some people want to pay for it. Some people don't. Some people think that this is experimental regardless of the positive, robust research for endoscopies. But I think again, it's going to come down to patient demand."