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This is Carly Beam with the Becker Spine
and Orthopedics podcast.
I'm thrilled to be joined today by doctor
Alok Charan of Spine and Performance Institute.
Doctor Charan, thank you so much for being
here today. Thank you, Carly. I'm really looking
forward to our conversation today.
Likewise.
Before we dive into our conversation, could you
introduce yourself and tell us a bit about
your background?
Absolutely. Sure. Well, my name is, as you
mentioned earlier, is Alok Sharan. I'm an orthopedic
spine surgeon.
I have my own solo practice in the
state of New Jersey, which is called the
Spine and Performance Institute.
I've been practicing
spine surgery now for almost twenty years, and
I've had a a great career so far
starting off in,
a major
academic medical center. I took a little detour
and got a health care MBA
and went into private practice. And, eventually,
a couple years ago, I started my own
practice, which is now called the Spine and
Performance Institute.
Great.
And, you know, you said you got a
health care MBA and that you started your
own practice. Can you talk about,
you know,
what have been the benefits of having this
this business education,
and what
what opportunities and challenges do you see with
running your own practice in 2025?
That's a great question.
I I'll say that it's been very professionally
fulfilling to start my own practice, but no
question,
very challenging.
We're in a tough environment right now.
There are a lot of pressures on
reimbursement,
for the solo physician, but
I started my own practice because
I realized that health care is in a
very dynamic state now, and I'm sure we'll
get into it later on in the podcast.
But health care is in a very dynamic
state now. It requires a lot of agility,
a lot of entrepreneurial thinking.
After I finished up my health care MBA
at Dartmouth, I realized that I just don't
wanna be part of just doing the same
thing.
And I needed to sort of break away
from, if you will, like, the ivory towers
of the academic centers and really start my
own thing. And I've been really excited to
sort of execute on what my vision is
of where health care is going and also
have the ability to be agile and change
if I need to.
Absolutely. And, you know, you're a huge leader
in awake spine surgery.
Can you talk about the state of that
at your practice and then just within the
spine specialty overall?
Absolutely. Yeah. So, you know, awake spine surgery
initially came out of desire of just doing
spine surgery without general anesthesia.
That's how it started because I had a
patient who had actually requested that. This is
ten plus years ago now.
At this point now, awake spine surgery has
really evolved into
the development of what we call a rapid
recovery protocol.
Meaning at this point now, when someone comes
to me for a spinal fusion,
we're able to do their surgery in a
minimally invasive fashion through a small incision
using local anesthesia and sedation
and discharge them home on the same day
on just Motrin and Tylenol.
So at this point now,
a week spine surgery for us is an
opioid free
same day spine procedure, which has just been
really exciting to work on over the past
few years.
And what and the truth is actually is
that what's been great is that as
as we've been able to do more and
more patients using this rapid recovery at o
x spine surgery,
protocol, more patients are coming to us because
they're appreciating
the vulnerability
and sort of, quote, the collateral damage
of general anesthesia.
So it's been nice that we've had many
patients come to us, not just from our
local region, but also from out of state
Texas, DC,
Chicago,
because they realize that they wanna have spine
surgery. They need to have spine surgery because
of the pain,
but they're slowly beginning to realize that,
general anesthesia does have some side effects.
And if it's possible to have a surgery
without the general anesthesia,
they're going for it. What's been exciting for
me to see
as the field evolves is the number of
practitioners throughout the country
who are also observing the same issues and
reaching out to me and asking me about
our protocol.
I think originally you had asked me about,
the state of oblique spine surgery throughout the
country.
What's what I'm really excited about now is
that,
my colleague, Mohammed Abdelbar, he's a spine surgeon
at Duke. He's been spearheading the publication of
a book. So this fall, we're actually coming
out with our first book on awake spine
surgery. It should be published by this fall.
That's really exciting. Can you dive in a
bit deeper into these rapid recovery protocols? So
any
specifics and if if you think any of
these could be applied to
other types of spine cases, you know, whether
it's, you know,
outpatient, minimally invasive, etcetera.
Yeah. Absolutely. For sure. You know, what's interesting
for me is this.
I've I've come to a couple different conclusions
as we continue to develop our protocol.
It's pretty clear to me that a patient
has a problem, a spine problem. They wanna
come to you and in the least invasive
fashion, have their problem fixed and be able
to go to work as soon as possible
or be independent as soon as possible.
So initially, when we started doing awake spine
surgery,
we noticed that if you go from
using general anesthesia to just spinal anesthesia,
that your length of stay goes down by
50%.
As we started adding in other items such
as, like, a regional block and,
marking that lasts for about twenty four to
forty eight hours,
we noticed that patients were mobilizing quicker after
surgery and requiring less pain meds. And we
got to a pretty efficient point where we
were doing spinal fusion surgery,
and sending them home the same day. So
once we achieved a same day discharge after
spinal fusion surgery, we thought, okay. What's the
next big challenge that we can go after?
The next big challenge we thought was to
go after the opioid problems. We all know
about the problems of opioids and spinal fusion
surgery.
And, you know, I've heard about multimodal analgesia
and different kind of protocols people are using.
But,
in speaking to my colleagues who do orthopedic
sports medicine,
I appreciated from them the value of nutrition
and nutritional optimization
prior to surgery. Now they're doing it for
their athletes,
but I thought, how can we transpose that
knowledge to our spine patients?
And what we started doing, which has been
absolutely incredible to work on and and see
the results of is,
prior to surgery, we have,
a protocol where we sort of nutritionally optimize
the patients
using an anti inflammatory amino acid along with
an amino acid supplementation.
What we're seeing now is that by sort
of, quote, reducing the inflammation prior to surgery
and to some degree helping build up their
muscles,
the patients require less pain meds after surgery.
And when we started realizing that, we realized
that these patients actually don't need opioids.
So by using knowledge
of the, the work that my colleagues are
doing on athletes and bringing it over to
spine surgery, we saw that, basically, we can
do opioid free spinal fusion surgery and send
them home the same day.
That's really cool. And I imagine, you know,
this holistic approach, it also
I imagine it helps with, you know, cost
for practice,
the patients, etcetera.
Absolutely. It's you know, it it's it's very
satisfying because it kind of opens up
who you could do spinal surgery on. So
I'll give you an example. We just operated
on a gentleman. He's, late seventies, early eighties,
a physician, A practicing physician who truly I
mean, at 80 years old, if you're seeing
patients, I mean, you truly enjoy what you're
doing.
He needed a spinal fusion surgery, and our
goal was basically to figure out how we
can do the proper surgery for him while
minimizing any kind of collateral damage.
He went through our whole protocol, and about
a week or two after surgery, he's like,
can I go back to can I go
back to work now?
So from my perspective, what I think is
so interesting about that is, first of all,
it's obviously gratifying to be able to take
care of someone, take care of the pain.
But then the ability to bring them back
into doing what they enjoy, which is working
in this situation, or just giving them back
to society
is absolutely amazing. Right? We're doing that quicker.
And so there's a whole sort of class
of patients so we can sort of offer
this to who probably would have been, let's
say,
rejected from having spine surgery from others. Now
there's gonna be, a whole class of people
that it opens up the world to who
we who we can take care of.
How much do you see awake spine surgery
growing in prevalence? You talk about all these
benefits and, you know, how much do you
think this will
expand to just the wider population?
You know, it's a it's a very patient
driven, outcomes driven approach.
And I believe that as more publication
public education goes on about this, more patients
will be demanding it. Right? That's why patients
are coming to me right now. And then
eventually, they'll be seeking out surgeons who are
doing this.
We're seeing in other fields like, the one
field where I think this has really been
really interesting is in, hand surgery.
In hand surgery, they do, what's called Wallant,
w a l a n t, which is
wide awake low local incision, no tourniquet hand
surgery, where patients are literally coming into an
office, rolling up their sleeves, having hand surgery,
and and driving home the same day.
They've been leaders in the field of trying
to avoid the whole notion of general anesthesia
and really just using local anesthesia.
As more and more public education,
happens around this whole notion of avoiding general
anesthesia,
you're gonna see, patients demanding it. I think
in your parts of the world in Chicago,
I believe they just did a kidney transplant
or a kidney harvest
using spinal anesthesia. And so we're seeing it
in other fields of medicine. People are realizing
that. So then I think when patients begin
to understand that this is a very safe
and reasonable option,
that demand will force, more and more providers
to change the way they do spine surgery.
But then in addition, I think what's gonna
be really interesting and really where I'm really
excited about
is, being able to educate the insurance companies
on this. So we're in the process of
pulling our data together and looking at it
from a cost effective point of view, and
there's no question, as you can imagine, that
it's very cost effective.
And so in due time, it'll be interesting
to see how the insurance companies engage us
and perhaps even incentivize,
doing awake spine surgery.
Are you
optimistic about the the payer reception to this?
Because I know, like, disc replacement, for instance,
it's been proven to be safe and effective
for, you know, decades before
the some of the big private insurers, you
know, became keen on covering it.
I think so. You know, these things are
very complicated.
It's,
you know, perhaps we need to study the
the disc replacement world a little bit to
understand what worked and didn't work in terms
of their discussions with insurance companies.
But, you know, my belief has always been
is that if you can truly show with
data
that what you're doing is better and meaningful,
it's not gonna happen overnight. It's gonna be
a series of conversations.
But over time, I am hopeful
that the insurance companies will realize that this
is this is a very good, predictable,
avenue
for rapid recovery.
And, you know, what other spine innovations
excite you besides
awake spine surgery?
Yeah. I mean, you know, the what I
think is really exciting, and I think it's
maybe the sort of standard, but everyone's probably
seeing this as a the notion of artificial
intelligence right now.
AI is is prevalent in so many different
aspects of what we do. But what I'm
really excited about is the integration of AI.
And just our really common workflows. Now I
I know that's not maybe the most catchy
thing out there, but the reason why I'm
so excited about it is because it's gonna
help us
collect data, process data really quickly, and then
be able to improve our ability to predict
what needs to be. What I mean by
that is this. You know, many patients
right now, I'm I'm lucky that patients, they
seek me out,
because they want a weak spline surgery. Right?
So we just had a guy from Texas
fly up. He did his research and came
to see me. Okay. So that's fine. He
was a pretty healthy guy. Didn't really have
any medical problems.
During his surgery, it was great. Opioid free.
Flew back to Texas the following week. But
let's say you had a patient like the
80 year old gentleman who I just operated
on who wasn't as,
optimized, if you will, prior to surgery.
Mhmm. Now if you had the ability to
sort of collect data on him,
not just medical data, but but even nutritional
data and even psychological data, what I'm excited
about is the ability to collect the data
and perhaps use AI
to come up with a personalized algorithm to
optimize him prior to surgery.
So for right now, like, we're using a
weak spine surgery and discharging people home same
day for fairly healthy people. But let's say
they're not so healthy. Let's say they're sort
of class two or class three.
Then AI is gonna be great because it
will since it'll be so integrated into our
workflows,
gathering the data and analyzing and then predicting
will become even easier. So that's what really
excites me about, the use of AI in
spine surgery.
Yeah. So it sounds like AI could be
a real a real tool in just kind
of widening
accessibility to health care.
Absolutely. Absolutely. And we're in the process now
of, collecting step data
on our patients. And I think there's a
lot to be said about your sort of,
gate signature. I think that, soon enough, we'll
have good data about how your gait has
a particular signature, and it could tell us
a lot. They already know that, you know,
they can predict the progression of Parkinson's, for
example, based off of your gait data. So
in due time, as we study this more,
we'll be able to use your,
gait data
as a predictor for disease and then being
able to monitor treatment. So that's what we're
working on right now, and I'm really excited
about that.
That's really that's really fascinating.
And my last question for you, doctor Sharron,
what are some other health care trends that
you're following closely today, whether it's in spine
or just in health care overall?
Yeah. I think that's a great question. Well,
there's two there's two main trends that I'm
really,
curious about, if you will.
One is that I'm seeing a greater move
towards, independent spine practitioners.
I think that there was this pinnacle that
we reached where,
spine doctors or spine surgeons were joining health
care systems or large groups.
And,
for a variety of different reasons, they're perhaps
you're getting a little frustrated
and they're breaking away. And the reason why
I hear about it is because many people
are beginning to call me asking me about
how to set up your own practice and
the challenges. So
I'm curious to see if this is just
sort of a blip right now or if
this is truly a trend
away where we've reached the pinnacle of these
large groups and now towards the independent groups.
And then the other trend, which I think
is gonna be really interesting, is this.
You know, as the as you know, president
Trump just
nominated and confirmed the new secretary of health
and human services.
Mhmm. And there's this huge effort,
to look for inefficiencies and payments at both
the Medicaid level and perhaps not Medicare, but
I'm sure there is.
And so so much so many of the
hospitals in this country depend upon government funding.
If they truly start to pull back on
that funding,
it's gonna cause a really like, a a
seismic shift
in the way hospitals behave. Right? And so
the trend that I'm really curious to see
is that what I I know that president
Trump wants to be a transformer of president,
and so we're gonna see over time over
these next four years how much of health
care you can truly transform and fund and
the change in funding, of course, will lead
to that major transformation. So it's gonna be
really interesting to see what happens there.
Well, this has been a great conversation, doctor
Charon. Thank you for joining us on the
podcast today. It's been a pleasure talking, and
I look forward to connecting again down the
line. Absolutely. Thank you again. It's always a
pleasure.