This is Carly Beam with the Becker Spine
and Orthopedics podcast. And today, I'm thrilled to
be joined by doctor Scott Blumenthal at the
Texas Back Institute.
Doctor Blumenthal,
welcome back to the podcast, and thanks for
being here today.
Oh, it's good to be back, Carly.
Absolutely. And, to start off, can you introduce
yourself and tell us a bit about your
background?
Okay.
As mentioned, I'm Scott Blumenthal. I am a
orthopedic spinal surgeon at
the Texas Back Institute or more specifically the
Center for Disc Replacement
at, TBI, which we started over
a decade ago,
kind of building on our focus
on disc replacement, which,
you know, we pioneered in The US now
over twenty five years ago.
That's that's incredible. More than twenty five years,
more than half a century of disc replacement
in The US. And, you know, with Texas
back and also, you know, the disc, replacement
institute,
Where do you see the best opportunities for
growth in 2026?
Well, I mean, I I think what we're
going to see is continued expansion
of indications for motion preservation. I I think
a lot of it's patient driven that,
patients seem to,
try to look for an alternative to fusion
because they've all had they've all had a
negative story about someone or someone in their
family,
with a fusion, and they they,
are always asking for an alternative. And, you
know, with the data that we have with
both cervical and lumbar disc replacement,
it's pretty favorable.
Yeah. And I'd love to hear more about
the research that you're doing at Texas Biag,
both in the disc replacement realm and then
otherwise.
Well, the the the newest,
project that we've got going on is pertains
to cervical disc replacement, which has been very,
very popular and gaining popularity, not only US,
but worldwide.
And it was really to answer the question,
by our patients.
They all know that if you have a
hip or knee replacement,
they've got about a five to ten percent
chance of knee revision
at ten or twenty years. So So that
same question was asked about disc replacement.
We did a paper in the lumbar spine
and found it about to be about one
and a half percent,
but we also did a paper in the
cervical spine and really found about that same
number, which compares very favorably,
to hips and knees, which is a a
very established, multi decade,
technology.
So we we kind of built on on
that particular finding, at least for the cervical
spine to look for the the the most
common reasons of failure. And then how do
we how do we revise disc? Do you
always have to take a disc out and
turn it into a fusion, or can you
two truly do a revision,
disc to disc, which we found we were
able to do in about a fourth to
a third of those patients,
that did require revision.
Yeah. And, you know, what are some of
the and I was used against a very,
very small, risk of complications, cervical and lumbar
disc replacement, but what are the kind of
the most common reasons you do see those
small
instances
of complication?
The,
the two most common reasons we see
is,
a condition called osteolysis,
which again is something we learned from our
hip and knee and shoulder replacement colleagues,
which is an,
a cyst formation around a prosthesis that's felt
to be due to,
wear of components. And and every every every
disc has components that can that can wear,
and if they cause wear particles that the
body reacts unfavorably to,
they create a situation
where you get these progressive cysts,
and then it requires,
revision just, you know, much like we we
see in our peripheral joint.
The second most common reason
really is
more of a a learning curve or technical
issue, and that is failure to address
all the pathology.
In other words, we take the disc out,
we put a new disc in, but you
also have to do a more meticulous decompression
of of the spinal cord and nerve roots,
And persistent
posterior pathology, which,
will mean something to the physicians, but maybe
less so to the the non physicians listening,
is is probably the second most common,
reason for needing revisions.
Got it. And you mentioned earlier, you know,
seeing these expanded indications,
for
disc replacement. And I'm wondering, you know, what
is, what are some of these indications that
might be, underutilized
right now, underrated that you want to see,
gain more prominence?
I will tell you that,
your question is very timely because we just
had a conference on this a couple weeks
ago in in
in LA.
And
we originally and initially thought that in the
cervical spine,
the disc replacement was for younger patients and
fusions were for older.
As we've gained more experience both in The
US and outside The US, we have found
that we can increase the age for patients
to get disc replacements,
more arthritic,
spines,
spines that may have lost the normal curvature
in the cervical spine,
much more,
you know, as we're in our third decade
of doing this. And and that's helped a
lot of our older patients, you know, into
their sixties and seventies even being potential candidates
for disc replacement.
That's really exciting. It sounds like, you know,
also a huge,
quality of life update upgrade for the patients
as well.
No question about it. I mean, preserving motion
is kinda where it's at, and motion equals
function.
Definitely.
And, you know, besides disc replacement,
how else do you see the spine orthopedic
field evolve the next two to three years,
whether it's with innovations
or how practices
are run, etcetera, etcetera?
Well, I'm I'm I'm gonna pivot, and and
this is more into,
because everybody likes talking about robots and image
guidance and things like that. I'm gonna talk
about,
patient access to care and that being the
private insurance world.
We have seen such
headwinds,
particularly with this particular technology,
such that anything that doesn't fit a very
strict protocol,
and that's
something in the real world that just doesn't
exist all that commonly.
Because patients are you know, we've we've always
treated patients individually
as we've learned again about these,
more expanded indications
for disc replacement.
We've run into
resistance from the insurance industry in
in getting approvals for these things. And,
you know, they they send these,
robotic
peer to peer doctors, and peer to peer
is such a misnomer because all they're doing
is regurgitating
policy. They're they're not trying to to,
figure out the best strategy for for helping
a patient. In fact, for example, today, I
was doing a peer to peer, and
and the the doc on the other side
was listing CPT codes and what their policies
and protocols are.
And,
I said, hey.
Why don't we just play doctor for a
little bit and talk about the patient and
what's best for the patient?
And, unfortunately, it didn't register because,
you know, the the most of the peer
to peers are not there to help the
patient. They're there just to regurgitate,
these very restrictive policies.
And I think that's something that we're gonna
have to deal with,
globally as an entity
because it's it's basically,
number one, corporate practice of medicine, which, at
least in the state of Texas, is illegal.
And, you know, and that's at the very
best. At the very worst, it's just unethical
and rationing patient care.
Yeah. So and so, doctor Blumenthal, it sounds
like a lot of your
frustrations lie within these conversations you're having with
other physicians like yourself.
And I don't really you know, that's what
they're hired to do. So, you know, I'm
not necessarily,
necessarily criticizing them as as people.
Mhmm. They're hired to regurgitate the policy. It's
truly
the suits
behind
the,
the who hide behind
these
really not well thought out,
protocols.
And, you know, the reality is we talk
about the cost of health care, it's a
big political issue now in The United States.
Last estimate I heard, 60 to 70%
of health care costs are administrative,
you know, middle management,
c suite type things and really don't, go
to the people that are either delivering the
care or receiving the care, and that's just
gotta change.
And how are you strategizing, miss, kind of
your own day to day work
within these systems?
You know, the
on a micro level, you know, they're trying
to outsmart us, and we're trying to outsmart
them. On a macro level, it just it
it needs to go back to, you know,
not getting in the middle of the doctor
patient relationship, which is exactly,
the strategy that of of these insurance companies.
Even using the word provider,
which is a very derogatory term,
to a physician,
it just dehumanizes
what we were trained to do, which was
be in a,
advocating relationship with our patients.
Got it.
And then I wanna pivot things a little
bit again. I want to hear what you
think will be, you know, the number one
key disruptor to spine surgery in 2026.
I think it's exactly that. I I think
it's going to be more restrictions
to,
to advanced technology. We got these great technologies
that come out, and if they don't fit
the protocols,
they're they're gonna restrict patients' access to it,
you know, much like,
pharmaceuticals
that come up with these great new drugs,
and it takes years to get on the
formularies
of of of these insurance companies. So patients
don't have access unless they wanna pay thousands
of dollars.
And, you know, practice like ours, the the
center of disc replacement
at Texas Back Institute, we've stayed, you know,
within the insurance networks, whereas a lot of
the disc replacement surgeons
opt for an out of network,
strategy so they don't have to deal with,
I'll use your term, these headwinds,
that we've been having to deal with. But
for the most part, most patients can't really
afford,
to do out of network,
cash pay models for for disc replacements because,
it's tens of thousands of dollars.
Yeah.
And, you know, I wanna ask also just
what are some other health care trends besides
what we discussed
that you've been following closely?
Yeah. You know,
I I don't know that I that I'm
so focused on on this particular one in
advancing our technologies.
You know, I think the trends
that
that we see and and
and that other people are talking about and
if I'm a young surgeon, it's it's putting
the instruments where they need to go without,
utilizing radiation. So it's it's robotics and navigation,
I think. I think that's where it's at.
Unfortunately, you know, people love to to throw
on the term AI, but AI is gonna
work more against us than for us, at
least in the short term,
because of because of access.
Yeah. Now can you dive deeper into that?
Just kind of your own experience working with
AI in your practice, and what do you
what you think it will take for it
to,
get out of, this kind of rut you're
describing and to,
work better long term?
The early AI, which which I think is
pretty cool,
is the the concept of having
this third person, your AI, in the room
with you and your patient. You basically can
just have a conversation, do a history and
physical, and the AI generates the the medical
record. I think that's really, really cool.
And that's not in any decision making realm.
That's basically just documenting,
you know, patient's problems
and, you know, what your findings are when
you're, you know, in the room doing an
exam taking a history.
The the next level AI, I think, will
go into surgical planning and indications and and,
you know, where to stop your fusions if
you're doing long scoliosis fusions,
when maybe motion might be better than fusion.
That we're not there yet, but I think
that's that's the next step from our point
of view.
That's really exciting to think about, and it
does seem like there's a lot of a
lot of potential with AI and where it
can go.
And that's all the time we do have
for today. Doctor Blumenthal, thank you for,
joining us again. And it's been a pleasure
speaking, and I hope to connect again down
the line.
Always. Anytime, Carly.
Thank you.