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This is Carly Beam with the Becker Spine

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and Orthopedics podcast.

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I'm thrilled to be joined today by doctor

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Craig McMains of OrthoIndy.

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Doctor McMains, thank you so much for being

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here today.

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Hey. Thank you. I really appreciate you having

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me on the the podcast.

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Absolutely.

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And before we get started into our main

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discussion, could you share a little bit about

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your background and introduce yourself for us? Yeah.

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Sure. So I'm an orthopedic spine surgeon. I

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work out of Indianapolis, Indiana at OrthoIndy.

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We're a

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physician owned group that, has our own hospital.

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And,

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for the last, you know, almost,

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I think, fifty years from the founding of

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the group and then twenty years from the

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founding of the hospital or so, We've, kind

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of been a forefront leader in, orthopedic care

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in the Midwest here and,

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really trying to make patient centered care our

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focus.

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And, historically, the group's been very, focused on,

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kind of driving forward

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newer technologies and, treatment algorithms and pathways and,

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proud to be a part of that discussion.

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Thank you. And,

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you know, you're I know you're currently involved

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in a study focused on spine biologics.

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Can you talk about that study and the

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outcomes that you're hoping to see?

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Yeah.

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Absolutely.

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So

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we were the first site to participate with

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a company called Theradaptive. They have a new

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product called OsseoDAP

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SP.

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And,

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basically, this is, you know, really one of

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the first, what we call,

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osteogenic biologics in the market since, Infuse came

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out,

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you know, a decade or so ago.

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And so,

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this is kind of an exciting

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product because there's really been no development in

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the space. There was,

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one one product, a handful of years ago

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that looked at what we call BMP seven.

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There's these different kind of bioactive proteins,

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and that that product didn't do very well.

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But, BMP two, which is what this other

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product called Infuse has been, has been, you

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know, kind of a mainstay for many, many

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years, but has some really narrow,

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FDA indications.

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And there's been some issues,

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kinda clinically with the use of it,

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about,

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particularly its its,

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kind of diffusion. Right? So the substance, this

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bioactive

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molecule, which generates bone, can leach into the

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surrounding tissues.

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And so this company has come up with

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a newer technique to,

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kind of more directly bind that bioactive molecule

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to, whatever substance that we're using as the

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bone graft.

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And, you know, the benefit of that would

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be, a, it doesn't leach into the surrounding

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tissues or cause all these other kind of

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side effects.

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And by doing that, we might be able

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to use a a much, much lower dose

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potentially

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to get the same clinical fusion. So it's

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a it's fairly exciting, and,

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it's it's a it's, great to be a

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part of that,

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trial.

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Yeah. And, you know, I know biologics and

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especially in spine. It's an area where

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it could stand to be more deeply researched.

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Are there any applications that you wanna see

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spine surgeons explore more with biologics, any

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other interesting research that you're doing as well

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in this area?

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Yeah. So

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we,

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you know, as spine surgeons, you know, our

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our gold standard is what we call autograft.

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Right? So in other words, it's it's bone

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taken from,

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the patient's own body and used in their

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spinal fusion.

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And,

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that,

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obviously, you know, works really well, but the

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concern is that, you know, if you had

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to get enough bone to lay

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in the spine, you usually were harvesting it

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from somewhere else, what we call donor site

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morbidity. It causes

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pain and, you know, issues from the place

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you harvested it. So these other options, whether

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it's what we call an allograft coming from

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a a cadaveric source or from a synthetic

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source like OsteoDAP,

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you know, are really promising because then we

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can potentially

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get a fusion result as good as autograft

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without causing further harm to the patient.

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I I think that the opportunity to

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expand upon synthetic use where we don't have

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to

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come you know, complicate the,

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the the procedure by having the risk of

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an of a cadaveric sourced product

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that maybe could be as good if maybe

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not even better than auto you know, autograft

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is, like, kinda the the pie in the

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sky gold, you know, dream that we all

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achieve or striving for. So

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anything that can make the surgical experience easier

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and faster is always the goal.

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And,

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doing some of these studies as part of

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that.

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We're, you know, we're constantly looking at all

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kinds of other biologics. We I've looked at

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some other synthetic products, and

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the thing I'm excited about is not just

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getting a solid fusion. Right?

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Maybe a year out, which is kind of

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our historical

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standard, but

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getting to that fusion faster.

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Because if you can keep the patient if

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you get the patient back to their normal

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life quicker,

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it's a win for everybody.

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Yeah. So it sounds like really just

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making recovery

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faster and easier for the patient.

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And, you know, we think about the role

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of spine biologics in five years. What does

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that look like? Are we gonna see

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more people taking advantage of these products? Are

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we gonna see more innovation?

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I I think absolutely. There's just a

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a a crazy amount of interest in the

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space.

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So I think more people as we kinda

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get better products will utilize those other products,

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like synthetics, like I mentioned earlier.

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And then the innovation's gonna come from

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you know, everybody talks about personalized medicine. You're

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gonna have personalized biologics. You're gonna have a

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biologic that knows how to go into your

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body

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and stimulate it to lay down bone,

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in the most effective,

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and the most efficient manner possible.

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And so as we kind of,

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expand forward, we're gonna get to those

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solid fusions faster, which is one goal. Right?

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But then we're also gonna

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apply that learning of

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biologics, not just a bone graph. We're gonna

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expand it into

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the implants themselves because right now, you know,

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we're we we put in

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pieces of metal or pieces of biologic plastic,

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you know, or, bio biocompatible

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plastic into the body,

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and the body doesn't like to have foreign

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substances in it. Right? You know? Everybody, when

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they get a splinter, it the body tries

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to spit it out. Mhmm. So,

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if we can somehow tell the body that,

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hey. This is

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it's coated in a bioactive substance and, you

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know, the body recognizes whatever implant you put

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in as part of itself.

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It'll heal

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speed up that healing process and get a

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a better outcome. And,

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you know, that's just on the the kind

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of the chemistry side of things.

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We've even touched upon, like, the digital side.

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Right? Where

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how do we know that we're getting faster

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fusions and better fusions? You know? We're we're

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starting to

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kinda leverage,

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our learnings in the digital space to get

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real time feedback maybe with how solid fusions

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are becoming and how quickly they're becoming that

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way. And then also,

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you know, getting information about when they when

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they were just giving us a real time

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monitoring of the healing process.

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Yeah. And then, obviously, you can't talk about

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the digital space in health care without touching

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on

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AI. So, can you talk about how you're

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using AI in your practice right now?

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Yeah. So, you know, AI, it's a it's

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a catchall phrase. Right? But this

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is modern medicine's inflection point. Right? We had,

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you know, the discovery of anisepsis, antibiotics. Right?

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And then the AI here is gonna completely

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change the paradigm of how we approach health

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care because,

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we're gonna take

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you know, our ability to diagnose is gonna

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be enhanced by it. Our ability to then,

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from, like, a surgical perspective,

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preoperatively plan will be changed. We're we're doing

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work at OrthoIndy right now

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leveraging,

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you know, our, our imaging platform. We have

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an Eos Edge scanner, and, it gives us,

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like, this head to toe, high quality, low

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low radiation dose image.

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And we're learning,

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how to integrate an AI to give us

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automated

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pre you know, pre preoperative measurements.

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We're planning our surgeries on it, and then

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it's feeding

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a a,

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an algorithm, a machine learning,

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model to then,

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determine, you know, which of these plans that

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we're doing are getting us the best results

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and kind of matching our preoperative templates the

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best. So

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and and and that's just on the surgical

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side. Like, we're not even talking about leveraging

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it for

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knowing what type of bio biologic

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to give a patient if they have osteoporosis

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or if they have good bone quality.

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And then on top of that, you know,

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it's little things even

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just, like,

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you know, I I used to have a

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a remote scribe in clinic. Right? I I

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can I can type and write pretty fast,

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but my scribe could always do it faster

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than me? So they were always in the

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clinic with me typing up my notes.

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Now I use an AI scribing platform. And,

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you know, the quality is surprisingly good, and

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it's getting better, you know, month to month

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that we're using it because it learns continually

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from itself.

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Yeah. And along with, you know, image analysis

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and note taking,

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are there any uses for AI in spine

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surgery that you think are underrated

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that more

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physicians should get on top of?

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Yeah. So I think,

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you know, the low hanging fruit right now,

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like I mentioned, like, using an AI for

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your

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transcription is something that like, it's it's it's

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already out there. There's platforms that are available

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for it. Utilize it because that means you

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spend more time with your patient and,

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get to talk to them more versus taking

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notes and doing documentation.

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I think, surgical planning software is out there,

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whether it's using a image based platform, like,

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that's specific like Eos

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or, you know, some of the other, surgical

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planning software that's that's gonna make you better

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if, you know, if you measure twice, cut

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once as the old, Carpenter,

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adage goes. I'm an orthopedic surgeon. We like

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to we like our carpentry,

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analogies.

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And then, you know, the other thing is

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you can

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utilize AI even if it's,

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you know, something just commercially available, like like,

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say, chat GPT. Right? Mhmm. Because these patients

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that you're coming and talking to, you know,

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you understand this high level of knowledge knowledge

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medically, but their patient doesn't. And that that

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mismatch of translation between your knowledge base and

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their knowledge base causes a lot of friction

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sometimes.

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You'd be surprised without giving it any kind

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of, obviously, protected health information. You can ask

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an AI, hey. Help me explain something to

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a patient or to somebody that doesn't have

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a medical background, and they will give you

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this template of of of of, responses or

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talking points to

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help bring the patient along on that health

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care journey and make them a truly informed

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partner in their care.

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I really like the way you're describing

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AI as like a tool to enhance, you

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know, the face to face communication that you

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do

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with your patients.

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And, you know, we've we've been talking about

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Biologics. We've been talking about AI and their

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future.

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Are there any particular challenges that stand out

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to you that could hinder their growth or

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just make it harder for physicians to adopt?

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Yeah. So,

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something that is gonna be, a,

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as a surgical field, we're very,

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dogmatic, and we're very

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entrenched in our ways. Right? We like to

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make sure that everything is evidence based. We

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we are resistant to sudden change for change

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sake.

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And that's good. Right? We don't wanna make

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unnecessary changes that jeopardize patient care.

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Mhmm. But

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AI

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and to a degree, biologics because they they're

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kinda feeding into each other, frankly, at this

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point.

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These are things that are rapidly evolving.

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And

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if we don't

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have a willingness

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to embrace some of these

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newer methods of interacting with patients and improving

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patient care,

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it's gonna be a detriment to our our

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our product as surgeons and physicians.

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And

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so, you know,

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it it it does take time to learn

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how to utilize these tools effectively. Because like

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you said, they they are tools. Right? And,

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like, any tool, you get the most out

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of it when you become a master of

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it. And so taking the time to

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understand how AI works and and utilize it

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is really important. And understanding

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why maybe a synthetic product

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can generate

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a personalized healing response that's as good as

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AutoGraph.

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You know, taking the time to kind of

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leverage those tools in your own practice will

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help,

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help you in the end. But if we

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don't do that, that's the biggest barrier for,

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patient care and adoption of these techniques.

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Very well said.

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And,

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thank you, doctor McMains, for joining the podcast

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today. I look forward to connecting again in

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the future.

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Absolutely. Thank you so much.