This is Carly Beam with the Becker Spine
and Orthopedic Podcast, and I'm thrilled to be
joined today by doctor Scott Blumenthal of the
Texas Staff Institute.
Doctor Blumenthal,
thank you for joining us. Before we dive
into our main discussion, would you please introduce
yourself and tell us a bit about your
background?
Okay. Yeah. So,
I'm Scott Blumenthal, and I'm a spine surgeon
at the Center for Disc Replacement in Texas
Back Institute.
Main focus of my practice, in fact, is
sole focus,
and of my research is on artificial disc,
both in the neck, the cervical spine, and
then the the low back, the lumbar spine.
And I and I think that's what we're
gonna focus on
today, I I guess, and and some other
subjects as well. So I'm looking forward to
it.
Absolutely. And you've been a reader in total
disc replacement in The US, and I know
we're coming up on twenty five years since
you debut this in The United States.
And I want to hear your perspective on
how total disc replacement has evolved and what
you think the next phase will be for
these procedures.
So that's great. And it's actually pretty good
timing because I I just came from,
seeing patients in my office, and one of
our earliest patients, in fact, patient number two
in The US
from
twenty five years ago came back for follow-up.
And now we've got X rays,
twenty five year follow-up with the patient number
two that we did.
All good.
The the technology
continues
to improve or our technique continues to improve.
It's starting off talking lumbar or low back
because that's what the twenty five year anniversary
is.
It's one of the most studied
operations,
not only in spine, but in in medicine.
There's over a thousand
peer reviewed publications,
in the time that that this technology has
been out, as well as some very, very
high
quality data, high quality research that that almost
no other
devices, except maybe for cervical artificial disc, have
gone through.
It's changed my practice.
It's allowed people
to treat to have their pain treated and
return to to more normal function and more
normal function
quicker
than than the previous standard,
which was fusion surgery. So it's it's been
a real boon,
for patients.
And doctor Blumenthal, one of the big obstacles
for this first technology
and adoption in The US has been payer
coverage.
What can spine surgeons and patients expect in
the next five years in this area?
Will it get easier to have these cases
covered, or could it remain an uphill battle?
That's that's a superb question because that
may be my number one cause celeb
at this point. Because
coverage has been a problem,
and
even more so,
not just coverage, because we're at about 90%
now.
But it's the
restrictions
that the insurance industry places upon us using
an FDA approved device.
And
never before
in my career
has there been so much scrutiny,
and in a in fact,
just oversight in in a in a, you
know,
the analogy would be like a helicopter parent.
And and then we've talked about it before.
And just because an insurance company says they
cover something,
if certain companies, if if you've
not checked one box
appropriately or the patient just doesn't fit the
the perfect FDA criteria,
they'll turn down the procedure.
And very little is left
to the discretion
of,
a competent,
surgeon.
And we've seen a lot written about this,
you know, most recently in in Becker's,
but the whole peer to peer process is
just a joke. It's a farce.
And, you know, oftentimes, you have
physicians that are not,
practicing. They're not in your same specialty. They're
just reading off a list,
and the whole peer to peer in many
cases,
is a misnomer.
Now if you asked what it's gonna be
like in the next five years or so,
I'm a bit discouraged because I would have
thought with the recent,
scrutiny placed upon
health care,
insurers
denying coverage, particularly with the the unfortunate death
of the United,
or murder, I should say, of the United
CEO,
that there would be more,
light placed on that process that makes people
so frustrated that someone would do such an
illegal
and and
immoral and terrible thing to another
human being.
But having said that,
the insurers
do terrible things,
to the patients that when they're in their
worst place, which is needing care.
And it's gotten taken out of the the
realm of the judgment
of competent,
and caring physician that are trying to help
people, and not every patient fits into a
little box or a little checklist.
And will AI help that or hurt that?
I don't know. AI may make it worse.
And, you know, the the earliest adopters of
AI are gonna be the carriers, and you
can program AI to set whatever barometer you
want. And I suspect
that that barometer will be set to the
advantage,
of the shareholders of of big insurance companies,
not to the patients.
And so
bouncing off of this,
what you're talking about
in terms of
AI and algorithms
and all these concerns in general,
what kind of advocacy
measures do you wanna see from spine surgeons
and physicians in general to, you know, hopefully,
the flash these, you know, concerns you have?
Well, you know, it it's I mean, it's
gonna have to come from
big societies, the academies, the orthopedic academies, neurosurgical
academies, the the big spine,
societies.
And, you know, unfortunately
what do they say? Money talks?
And we'll always be
outspent
from a lobbying standpoint.
And
maybe, you know, if the new administration puts
in somebody who who's in, you know, a
new age thinker like RFK Jr, maybe we
can get that on
on on his schedule,
of things to do after he gets done
with the vaccines and food additives,
may maybe reforming the entire,
insurance industry in The United States. It's it's
a fairly unregulated,
industry.
Oh, definitely let's see, how this all plays
out. And then circling back to total disc
replacement, I know you and your colleagues have
done a lot of interesting research
in this area. And I was wanting to
share more about some of your findings and
if there's anything new that you're planning to
investigate this year.
So,
you know, and we've talked about this before.
Over the past
year or so, we've published,
some studies both on cervical and lumbar disc
replacements and and kind of how long they
last. I mean,
we're a few decades behind hip and knee
replacements, and there's a robust literature on a
certain percentage of them need to be revised.
So we want to answer that question for
cervical and lumbar,
and
both incidences of revision
are well below what they are for hip
and knee.
And
particularly in the cervical spine, now we've developed
some treatment algorithms
for when when
patients,
do need additional treatment,
for their cervical disc replacement.
And some of them can be revised to
another disc. Some of them need to to
be converted
to a fusion, but hopefully, they'll have had
many years of motion that that
will help, the health of the other disc,
in the spine.
But that's that that's really the newest thing
is now that there's hundreds of thousands of
these out there,
how do we take care of somebody,
you know, that are a small percent, fortunately,
that aren't doing well, and that need more
help. And and that's what we're kind of
pioneering at at, Center for Disc Replacement
at at Texas Back is how to treat
those patients. And, you know, fortunately,
it seems to be a relatively rare occurrence
and a relatively treatable condition.
Awesome. Well, I'm looking forward to seeing,
the results of those studies. And,
those are all the questions I have for
you today. Thank you for joining us on
the podcast, doctor Blumenthal. It's been a pleasure
speaking with you, and I look forward to
connecting again in the future.
Absolutely.
Look forward to,
to seeing and talking with you again.