1 00:00:00,320 --> 00:00:02,560 This is Carly Beam with the Becker Spine 2 00:00:02,560 --> 00:00:05,359 and Orthopedic Podcast, and I'm thrilled to be 3 00:00:05,359 --> 00:00:07,919 joined today by doctor Scott Blumenthal of the 4 00:00:07,919 --> 00:00:09,220 Texas Staff Institute. 5 00:00:09,599 --> 00:00:10,500 Doctor Blumenthal, 6 00:00:10,880 --> 00:00:13,265 thank you for joining us. Before we dive 7 00:00:13,265 --> 00:00:15,745 into our main discussion, would you please introduce 8 00:00:15,745 --> 00:00:17,425 yourself and tell us a bit about your 9 00:00:17,425 --> 00:00:17,925 background? 10 00:00:18,545 --> 00:00:19,664 Okay. Yeah. So, 11 00:00:20,385 --> 00:00:22,704 I'm Scott Blumenthal, and I'm a spine surgeon 12 00:00:22,704 --> 00:00:25,185 at the Center for Disc Replacement in Texas 13 00:00:25,185 --> 00:00:25,925 Back Institute. 14 00:00:27,609 --> 00:00:29,689 Main focus of my practice, in fact, is 15 00:00:29,689 --> 00:00:30,429 sole focus, 16 00:00:31,129 --> 00:00:33,850 and of my research is on artificial disc, 17 00:00:33,850 --> 00:00:36,250 both in the neck, the cervical spine, and 18 00:00:36,250 --> 00:00:38,890 then the the low back, the lumbar spine. 19 00:00:38,890 --> 00:00:40,090 And I and I think that's what we're 20 00:00:40,090 --> 00:00:41,229 gonna focus on 21 00:00:41,545 --> 00:00:43,704 today, I I guess, and and some other 22 00:00:43,704 --> 00:00:45,304 subjects as well. So I'm looking forward to 23 00:00:45,304 --> 00:00:45,804 it. 24 00:00:47,225 --> 00:00:49,464 Absolutely. And you've been a reader in total 25 00:00:49,464 --> 00:00:52,024 disc replacement in The US, and I know 26 00:00:52,024 --> 00:00:54,424 we're coming up on twenty five years since 27 00:00:54,424 --> 00:00:56,850 you debut this in The United States. 28 00:00:57,570 --> 00:00:59,409 And I want to hear your perspective on 29 00:00:59,409 --> 00:01:03,009 how total disc replacement has evolved and what 30 00:01:03,009 --> 00:01:05,329 you think the next phase will be for 31 00:01:05,329 --> 00:01:06,150 these procedures. 32 00:01:07,890 --> 00:01:09,969 So that's great. And it's actually pretty good 33 00:01:09,969 --> 00:01:12,229 timing because I I just came from, 34 00:01:12,775 --> 00:01:15,174 seeing patients in my office, and one of 35 00:01:15,174 --> 00:01:17,734 our earliest patients, in fact, patient number two 36 00:01:17,734 --> 00:01:18,635 in The US 37 00:01:19,174 --> 00:01:19,674 from 38 00:01:20,215 --> 00:01:22,795 twenty five years ago came back for follow-up. 39 00:01:22,854 --> 00:01:24,795 And now we've got X rays, 40 00:01:25,650 --> 00:01:28,129 twenty five year follow-up with the patient number 41 00:01:28,129 --> 00:01:29,189 two that we did. 42 00:01:30,290 --> 00:01:31,030 All good. 43 00:01:31,569 --> 00:01:32,549 The the technology 44 00:01:32,930 --> 00:01:33,430 continues 45 00:01:34,849 --> 00:01:37,829 to improve or our technique continues to improve. 46 00:01:38,105 --> 00:01:40,424 It's starting off talking lumbar or low back 47 00:01:40,424 --> 00:01:42,525 because that's what the twenty five year anniversary 48 00:01:42,584 --> 00:01:43,084 is. 49 00:01:43,704 --> 00:01:45,165 It's one of the most studied 50 00:01:45,625 --> 00:01:46,125 operations, 51 00:01:46,745 --> 00:01:48,984 not only in spine, but in in medicine. 52 00:01:48,984 --> 00:01:50,525 There's over a thousand 53 00:01:51,150 --> 00:01:52,290 peer reviewed publications, 54 00:01:53,150 --> 00:01:55,230 in the time that that this technology has 55 00:01:55,230 --> 00:01:57,630 been out, as well as some very, very 56 00:01:57,630 --> 00:01:58,130 high 57 00:01:58,510 --> 00:02:02,370 quality data, high quality research that that almost 58 00:02:02,430 --> 00:02:03,170 no other 59 00:02:03,549 --> 00:02:07,125 devices, except maybe for cervical artificial disc, have 60 00:02:07,125 --> 00:02:07,865 gone through. 61 00:02:08,405 --> 00:02:09,784 It's changed my practice. 62 00:02:10,324 --> 00:02:11,465 It's allowed people 63 00:02:12,405 --> 00:02:14,805 to treat to have their pain treated and 64 00:02:14,805 --> 00:02:17,525 return to to more normal function and more 65 00:02:17,525 --> 00:02:18,504 normal function 66 00:02:18,805 --> 00:02:19,305 quicker 67 00:02:19,764 --> 00:02:22,025 than than the previous standard, 68 00:02:22,849 --> 00:02:25,650 which was fusion surgery. So it's it's been 69 00:02:25,650 --> 00:02:26,629 a real boon, 70 00:02:27,650 --> 00:02:28,469 for patients. 71 00:02:29,969 --> 00:02:33,109 And doctor Blumenthal, one of the big obstacles 72 00:02:33,329 --> 00:02:34,870 for this first technology 73 00:02:35,329 --> 00:02:37,810 and adoption in The US has been payer 74 00:02:37,810 --> 00:02:38,264 coverage. 75 00:02:39,064 --> 00:02:42,025 What can spine surgeons and patients expect in 76 00:02:42,025 --> 00:02:44,044 the next five years in this area? 77 00:02:44,425 --> 00:02:46,365 Will it get easier to have these cases 78 00:02:46,425 --> 00:02:48,844 covered, or could it remain an uphill battle? 79 00:02:50,824 --> 00:02:53,340 That's that's a superb question because that 80 00:02:53,739 --> 00:02:55,759 may be my number one cause celeb 81 00:02:56,379 --> 00:02:57,840 at this point. Because 82 00:02:58,780 --> 00:03:00,239 coverage has been a problem, 83 00:03:00,539 --> 00:03:01,039 and 84 00:03:01,739 --> 00:03:02,959 even more so, 85 00:03:03,659 --> 00:03:06,699 not just coverage, because we're at about 90% 86 00:03:06,699 --> 00:03:07,199 now. 87 00:03:08,034 --> 00:03:09,175 But it's the 88 00:03:09,715 --> 00:03:10,215 restrictions 89 00:03:10,594 --> 00:03:14,375 that the insurance industry places upon us using 90 00:03:14,835 --> 00:03:16,534 an FDA approved device. 91 00:03:17,074 --> 00:03:17,574 And 92 00:03:17,875 --> 00:03:18,855 never before 93 00:03:20,699 --> 00:03:21,680 in my career 94 00:03:22,379 --> 00:03:24,400 has there been so much scrutiny, 95 00:03:25,819 --> 00:03:28,080 and in a in fact, 96 00:03:28,539 --> 00:03:31,340 just oversight in in a in a, you 97 00:03:31,340 --> 00:03:31,840 know, 98 00:03:32,539 --> 00:03:35,039 the analogy would be like a helicopter parent. 99 00:03:35,794 --> 00:03:37,655 And and then we've talked about it before. 100 00:03:37,875 --> 00:03:40,034 And just because an insurance company says they 101 00:03:40,034 --> 00:03:40,854 cover something, 102 00:03:42,194 --> 00:03:44,455 if certain companies, if if you've 103 00:03:44,914 --> 00:03:46,455 not checked one box 104 00:03:46,835 --> 00:03:49,289 appropriately or the patient just doesn't fit the 105 00:03:49,370 --> 00:03:51,069 the perfect FDA criteria, 106 00:03:51,769 --> 00:03:53,229 they'll turn down the procedure. 107 00:03:53,849 --> 00:03:56,030 And very little is left 108 00:03:56,569 --> 00:03:57,469 to the discretion 109 00:03:57,930 --> 00:03:58,430 of, 110 00:03:59,049 --> 00:03:59,789 a competent, 111 00:04:00,729 --> 00:04:01,229 surgeon. 112 00:04:01,905 --> 00:04:04,164 And we've seen a lot written about this, 113 00:04:04,305 --> 00:04:07,044 you know, most recently in in Becker's, 114 00:04:07,584 --> 00:04:09,824 but the whole peer to peer process is 115 00:04:09,824 --> 00:04:11,525 just a joke. It's a farce. 116 00:04:11,905 --> 00:04:14,884 And, you know, oftentimes, you have 117 00:04:15,250 --> 00:04:16,610 physicians that are not, 118 00:04:17,009 --> 00:04:19,730 practicing. They're not in your same specialty. They're 119 00:04:19,730 --> 00:04:21,110 just reading off a list, 120 00:04:21,410 --> 00:04:23,329 and the whole peer to peer in many 121 00:04:23,329 --> 00:04:23,829 cases, 122 00:04:24,689 --> 00:04:25,509 is a misnomer. 123 00:04:26,529 --> 00:04:28,129 Now if you asked what it's gonna be 124 00:04:28,129 --> 00:04:30,069 like in the next five years or so, 125 00:04:30,935 --> 00:04:32,855 I'm a bit discouraged because I would have 126 00:04:32,855 --> 00:04:33,995 thought with the recent, 127 00:04:35,014 --> 00:04:36,634 scrutiny placed upon 128 00:04:37,335 --> 00:04:38,074 health care, 129 00:04:39,014 --> 00:04:39,514 insurers 130 00:04:40,615 --> 00:04:43,975 denying coverage, particularly with the the unfortunate death 131 00:04:43,975 --> 00:04:44,795 of the United, 132 00:04:45,449 --> 00:04:47,689 or murder, I should say, of the United 133 00:04:47,689 --> 00:04:48,189 CEO, 134 00:04:48,649 --> 00:04:49,949 that there would be more, 135 00:04:50,889 --> 00:04:53,769 light placed on that process that makes people 136 00:04:53,769 --> 00:04:56,009 so frustrated that someone would do such an 137 00:04:56,009 --> 00:04:56,509 illegal 138 00:04:56,889 --> 00:04:57,709 and and 139 00:04:58,410 --> 00:05:00,750 immoral and terrible thing to another 140 00:05:01,185 --> 00:05:01,925 human being. 141 00:05:02,865 --> 00:05:04,245 But having said that, 142 00:05:04,785 --> 00:05:05,764 the insurers 143 00:05:06,865 --> 00:05:08,085 do terrible things, 144 00:05:09,024 --> 00:05:11,345 to the patients that when they're in their 145 00:05:11,345 --> 00:05:13,605 worst place, which is needing care. 146 00:05:14,129 --> 00:05:16,870 And it's gotten taken out of the the 147 00:05:17,490 --> 00:05:19,509 realm of the judgment 148 00:05:19,810 --> 00:05:20,550 of competent, 149 00:05:21,330 --> 00:05:23,730 and caring physician that are trying to help 150 00:05:23,730 --> 00:05:26,290 people, and not every patient fits into a 151 00:05:26,290 --> 00:05:27,830 little box or a little checklist. 152 00:05:28,634 --> 00:05:31,354 And will AI help that or hurt that? 153 00:05:31,354 --> 00:05:33,675 I don't know. AI may make it worse. 154 00:05:33,675 --> 00:05:35,914 And, you know, the the earliest adopters of 155 00:05:35,914 --> 00:05:38,875 AI are gonna be the carriers, and you 156 00:05:38,875 --> 00:05:41,995 can program AI to set whatever barometer you 157 00:05:41,995 --> 00:05:43,214 want. And I suspect 158 00:05:44,069 --> 00:05:46,389 that that barometer will be set to the 159 00:05:46,389 --> 00:05:46,889 advantage, 160 00:05:47,990 --> 00:05:51,189 of the shareholders of of big insurance companies, 161 00:05:51,189 --> 00:05:52,169 not to the patients. 162 00:05:53,829 --> 00:05:54,490 And so 163 00:05:55,029 --> 00:05:56,409 bouncing off of this, 164 00:05:57,024 --> 00:05:58,324 what you're talking about 165 00:05:58,704 --> 00:05:59,845 in terms of 166 00:06:00,305 --> 00:06:01,604 AI and algorithms 167 00:06:03,185 --> 00:06:05,604 and all these concerns in general, 168 00:06:06,625 --> 00:06:07,925 what kind of advocacy 169 00:06:08,785 --> 00:06:12,270 measures do you wanna see from spine surgeons 170 00:06:12,410 --> 00:06:16,029 and physicians in general to, you know, hopefully, 171 00:06:16,970 --> 00:06:19,790 the flash these, you know, concerns you have? 172 00:06:21,129 --> 00:06:23,595 Well, you know, it it's I mean, it's 173 00:06:23,595 --> 00:06:25,214 gonna have to come from 174 00:06:25,754 --> 00:06:29,935 big societies, the academies, the orthopedic academies, neurosurgical 175 00:06:30,235 --> 00:06:32,334 academies, the the big spine, 176 00:06:33,194 --> 00:06:33,694 societies. 177 00:06:34,394 --> 00:06:35,855 And, you know, unfortunately 178 00:06:36,875 --> 00:06:38,495 what do they say? Money talks? 179 00:06:38,930 --> 00:06:40,949 And we'll always be 180 00:06:41,409 --> 00:06:41,909 outspent 181 00:06:42,849 --> 00:06:44,389 from a lobbying standpoint. 182 00:06:45,329 --> 00:06:45,829 And 183 00:06:46,370 --> 00:06:49,889 maybe, you know, if the new administration puts 184 00:06:49,889 --> 00:06:52,129 in somebody who who's in, you know, a 185 00:06:52,129 --> 00:06:55,064 new age thinker like RFK Jr, maybe we 186 00:06:55,064 --> 00:06:56,204 can get that on 187 00:06:56,664 --> 00:06:58,044 on on his schedule, 188 00:06:58,584 --> 00:07:00,104 of things to do after he gets done 189 00:07:00,104 --> 00:07:02,204 with the vaccines and food additives, 190 00:07:03,305 --> 00:07:05,644 may maybe reforming the entire, 191 00:07:06,345 --> 00:07:08,584 insurance industry in The United States. It's it's 192 00:07:08,584 --> 00:07:09,724 a fairly unregulated, 193 00:07:10,790 --> 00:07:11,290 industry. 194 00:07:12,790 --> 00:07:15,350 Oh, definitely let's see, how this all plays 195 00:07:15,350 --> 00:07:18,230 out. And then circling back to total disc 196 00:07:18,230 --> 00:07:20,230 replacement, I know you and your colleagues have 197 00:07:20,230 --> 00:07:22,170 done a lot of interesting research 198 00:07:22,995 --> 00:07:24,995 in this area. And I was wanting to 199 00:07:24,995 --> 00:07:27,475 share more about some of your findings and 200 00:07:27,475 --> 00:07:29,714 if there's anything new that you're planning to 201 00:07:29,714 --> 00:07:31,014 investigate this year. 202 00:07:32,595 --> 00:07:33,095 So, 203 00:07:33,634 --> 00:07:35,875 you know, and we've talked about this before. 204 00:07:35,875 --> 00:07:36,774 Over the past 205 00:07:37,579 --> 00:07:38,879 year or so, we've published, 206 00:07:39,819 --> 00:07:43,019 some studies both on cervical and lumbar disc 207 00:07:43,019 --> 00:07:45,259 replacements and and kind of how long they 208 00:07:45,259 --> 00:07:46,240 last. I mean, 209 00:07:47,180 --> 00:07:49,740 we're a few decades behind hip and knee 210 00:07:49,740 --> 00:07:52,584 replacements, and there's a robust literature on a 211 00:07:52,584 --> 00:07:55,564 certain percentage of them need to be revised. 212 00:07:55,865 --> 00:07:57,865 So we want to answer that question for 213 00:07:57,865 --> 00:07:58,925 cervical and lumbar, 214 00:07:59,305 --> 00:07:59,805 and 215 00:08:00,504 --> 00:08:02,365 both incidences of revision 216 00:08:02,824 --> 00:08:05,384 are well below what they are for hip 217 00:08:05,384 --> 00:08:06,125 and knee. 218 00:08:06,569 --> 00:08:07,069 And 219 00:08:07,370 --> 00:08:10,569 particularly in the cervical spine, now we've developed 220 00:08:10,569 --> 00:08:11,629 some treatment algorithms 221 00:08:11,930 --> 00:08:13,709 for when when 222 00:08:14,169 --> 00:08:14,669 patients, 223 00:08:15,370 --> 00:08:17,389 do need additional treatment, 224 00:08:18,329 --> 00:08:20,430 for their cervical disc replacement. 225 00:08:21,225 --> 00:08:23,464 And some of them can be revised to 226 00:08:23,464 --> 00:08:26,504 another disc. Some of them need to to 227 00:08:26,504 --> 00:08:27,324 be converted 228 00:08:27,625 --> 00:08:30,024 to a fusion, but hopefully, they'll have had 229 00:08:30,024 --> 00:08:32,044 many years of motion that that 230 00:08:32,919 --> 00:08:35,259 will help, the health of the other disc, 231 00:08:35,720 --> 00:08:36,620 in the spine. 232 00:08:37,160 --> 00:08:39,160 But that's that that's really the newest thing 233 00:08:39,160 --> 00:08:41,399 is now that there's hundreds of thousands of 234 00:08:41,399 --> 00:08:42,299 these out there, 235 00:08:42,600 --> 00:08:44,059 how do we take care of somebody, 236 00:08:44,919 --> 00:08:47,100 you know, that are a small percent, fortunately, 237 00:08:47,644 --> 00:08:49,804 that aren't doing well, and that need more 238 00:08:49,804 --> 00:08:52,044 help. And and that's what we're kind of 239 00:08:52,044 --> 00:08:54,705 pioneering at at, Center for Disc Replacement 240 00:08:55,164 --> 00:08:57,164 at at Texas Back is how to treat 241 00:08:57,164 --> 00:08:59,264 those patients. And, you know, fortunately, 242 00:09:00,709 --> 00:09:03,110 it seems to be a relatively rare occurrence 243 00:09:03,110 --> 00:09:05,769 and a relatively treatable condition. 244 00:09:07,509 --> 00:09:09,690 Awesome. Well, I'm looking forward to seeing, 245 00:09:10,070 --> 00:09:11,990 the results of those studies. And, 246 00:09:12,629 --> 00:09:14,149 those are all the questions I have for 247 00:09:14,149 --> 00:09:16,434 you today. Thank you for joining us on 248 00:09:16,434 --> 00:09:19,075 the podcast, doctor Blumenthal. It's been a pleasure 249 00:09:19,075 --> 00:09:21,235 speaking with you, and I look forward to 250 00:09:21,235 --> 00:09:22,695 connecting again in the future. 251 00:09:23,315 --> 00:09:23,815 Absolutely. 252 00:09:24,754 --> 00:09:25,634 Look forward to, 253 00:09:26,195 --> 00:09:28,615 to seeing and talking with you again.