*This article appeared in Becker’s Spine Review.
Written by Jessica Kim Cohen | September 20, 2016
Nitin Khanna, MD, a spine care specialist at Orthopaedic Specialists of Northwest Indiana in Munster, discusses the importance of personalized medicine in the spinal care field.
Question: What led to your interest in nonsurgical techniques?
Dr. Nitin Khanna: While I am a surgeon, I believe that the vast majority of patients can do better without having a surgical intervention. I'm a big believer in holistic care when dealing with any patient. I think this concept of personalized medicine has actually been around for a long time, but with recent changes in healthcare, such as consolidation, there has been a drive to have everything be protocol driven. The challenge is that sometimes you have a square peg and a round hole, and it doesn't fit, so having individualized treatment plans is important. You can have the same MRIs of two patients, but their ages might be different, their bone quality might be different; you need to have different ways of treating those patients. I think everything from diet, to exercise, to physical therapy, to medications — both allopathic medications and treatments like acupuncture, herbs, et cetera — all of these things have a role and should be part of spinal care.
Q: Are you working on any research projects?
NK: We recently published on a procedure called MAS-PLIF [Maximum Access Surgery Posterior Lumbar Interbody Fusion], which is a medialized approach to lumbar spinal fusion. I think it's the next step in the evolutions of MIS lumbar degenerative surgery. The advances made with MIS have data to support the fact that costs are better, length of stay is better, complication rates are better, but the challenge is that there's not a lot of great data on transition syndromes, ability to maintain alignment and some of these other long-term parameters, which have been better established with open procedures. MAS-PLIF, which is a minimally invasive procedure, aims to address those issues. Our paper looks at sagittal alignment correction after the procedure. I think that's where minimally invasive spine surgery has to go: to prove durability and longevity. It needs good short-term, mid-term as well as long-term data, and I think this is a step in the direction of proving long-term outcomes.
Q: What is the biggest challenge facing the orthopedic surgery field today?
NK: In general, I think it's consolidation. Insurance companies are consolidating and driving healthcare decisions, and also hospital consolidation, in which hospitals basically own patients and are driving patients to their employed physicians. I think that really hurts a free-market environment; it really hurts choice. I do not believe the net effect is going to be a net benefit, either in terms of clinical outcomes for patients or in terms of cost savings for the healthcare system.