1 00:00:00,080 --> 00:00:02,000 This is Carly Beam with the Becker Spine 2 00:00:02,000 --> 00:00:04,639 and Orthopedics podcast. And today, I'm thrilled to 3 00:00:04,639 --> 00:00:07,359 be joined by doctor Scott Blumenthal at the 4 00:00:07,359 --> 00:00:08,500 Texas Back Institute. 5 00:00:08,880 --> 00:00:09,619 Doctor Blumenthal, 6 00:00:09,919 --> 00:00:12,080 welcome back to the podcast, and thanks for 7 00:00:12,080 --> 00:00:13,059 being here today. 8 00:00:13,794 --> 00:00:15,175 Oh, it's good to be back, Carly. 9 00:00:15,554 --> 00:00:18,435 Absolutely. And, to start off, can you introduce 10 00:00:18,435 --> 00:00:20,114 yourself and tell us a bit about your 11 00:00:20,114 --> 00:00:20,614 background? 12 00:00:21,394 --> 00:00:21,875 Okay. 13 00:00:22,355 --> 00:00:24,855 As mentioned, I'm Scott Blumenthal. I am a 14 00:00:24,994 --> 00:00:27,175 orthopedic spinal surgeon at 15 00:00:27,559 --> 00:00:30,199 the Texas Back Institute or more specifically the 16 00:00:30,199 --> 00:00:31,500 Center for Disc Replacement 17 00:00:32,039 --> 00:00:34,539 at, TBI, which we started over 18 00:00:34,920 --> 00:00:35,899 a decade ago, 19 00:00:36,840 --> 00:00:38,619 kind of building on our focus 20 00:00:39,479 --> 00:00:41,100 on disc replacement, which, 21 00:00:41,445 --> 00:00:43,364 you know, we pioneered in The US now 22 00:00:43,364 --> 00:00:44,825 over twenty five years ago. 23 00:00:45,284 --> 00:00:47,765 That's that's incredible. More than twenty five years, 24 00:00:47,765 --> 00:00:50,484 more than half a century of disc replacement 25 00:00:50,484 --> 00:00:52,725 in The US. And, you know, with Texas 26 00:00:52,725 --> 00:00:55,545 back and also, you know, the disc, replacement 27 00:00:56,004 --> 00:00:56,504 institute, 28 00:00:57,210 --> 00:00:59,770 Where do you see the best opportunities for 29 00:00:59,770 --> 00:01:01,310 growth in 2026? 30 00:01:02,090 --> 00:01:03,770 Well, I mean, I I think what we're 31 00:01:03,770 --> 00:01:06,030 going to see is continued expansion 32 00:01:06,730 --> 00:01:10,189 of indications for motion preservation. I I think 33 00:01:10,534 --> 00:01:12,454 a lot of it's patient driven that, 34 00:01:13,094 --> 00:01:14,634 patients seem to, 35 00:01:16,375 --> 00:01:18,375 try to look for an alternative to fusion 36 00:01:18,375 --> 00:01:19,894 because they've all had they've all had a 37 00:01:19,894 --> 00:01:21,894 negative story about someone or someone in their 38 00:01:21,894 --> 00:01:22,394 family, 39 00:01:22,950 --> 00:01:24,650 with a fusion, and they they, 40 00:01:25,109 --> 00:01:27,270 are always asking for an alternative. And, you 41 00:01:27,270 --> 00:01:28,790 know, with the data that we have with 42 00:01:28,790 --> 00:01:30,730 both cervical and lumbar disc replacement, 43 00:01:31,189 --> 00:01:32,250 it's pretty favorable. 44 00:01:32,870 --> 00:01:34,230 Yeah. And I'd love to hear more about 45 00:01:34,230 --> 00:01:36,814 the research that you're doing at Texas Biag, 46 00:01:36,814 --> 00:01:39,295 both in the disc replacement realm and then 47 00:01:39,295 --> 00:01:39,795 otherwise. 48 00:01:40,974 --> 00:01:43,474 Well, the the the newest, 49 00:01:44,015 --> 00:01:46,754 project that we've got going on is pertains 50 00:01:46,814 --> 00:01:49,134 to cervical disc replacement, which has been very, 51 00:01:49,134 --> 00:01:52,299 very popular and gaining popularity, not only US, 52 00:01:52,299 --> 00:01:53,040 but worldwide. 53 00:01:53,819 --> 00:01:56,159 And it was really to answer the question, 54 00:01:56,939 --> 00:01:57,840 by our patients. 55 00:01:58,299 --> 00:01:59,579 They all know that if you have a 56 00:01:59,579 --> 00:02:00,640 hip or knee replacement, 57 00:02:01,020 --> 00:02:02,780 they've got about a five to ten percent 58 00:02:02,780 --> 00:02:04,000 chance of knee revision 59 00:02:04,380 --> 00:02:06,355 at ten or twenty years. So So that 60 00:02:06,355 --> 00:02:08,694 same question was asked about disc replacement. 61 00:02:09,474 --> 00:02:11,155 We did a paper in the lumbar spine 62 00:02:11,155 --> 00:02:12,675 and found it about to be about one 63 00:02:12,675 --> 00:02:13,574 and a half percent, 64 00:02:14,115 --> 00:02:15,794 but we also did a paper in the 65 00:02:15,794 --> 00:02:18,514 cervical spine and really found about that same 66 00:02:18,514 --> 00:02:20,534 number, which compares very favorably, 67 00:02:21,449 --> 00:02:23,610 to hips and knees, which is a a 68 00:02:23,610 --> 00:02:25,629 very established, multi decade, 69 00:02:26,250 --> 00:02:26,750 technology. 70 00:02:27,449 --> 00:02:30,969 So we we kind of built on on 71 00:02:30,969 --> 00:02:34,025 that particular finding, at least for the cervical 72 00:02:34,025 --> 00:02:36,025 spine to look for the the the most 73 00:02:36,025 --> 00:02:38,344 common reasons of failure. And then how do 74 00:02:38,344 --> 00:02:40,104 we how do we revise disc? Do you 75 00:02:40,104 --> 00:02:42,025 always have to take a disc out and 76 00:02:42,025 --> 00:02:43,944 turn it into a fusion, or can you 77 00:02:43,944 --> 00:02:45,564 two truly do a revision, 78 00:02:46,259 --> 00:02:48,180 disc to disc, which we found we were 79 00:02:48,180 --> 00:02:50,099 able to do in about a fourth to 80 00:02:50,099 --> 00:02:51,479 a third of those patients, 81 00:02:52,099 --> 00:02:53,400 that did require revision. 82 00:02:54,180 --> 00:02:55,780 Yeah. And, you know, what are some of 83 00:02:55,780 --> 00:02:58,340 the and I was used against a very, 84 00:02:58,340 --> 00:03:01,784 very small, risk of complications, cervical and lumbar 85 00:03:02,165 --> 00:03:03,844 disc replacement, but what are the kind of 86 00:03:03,844 --> 00:03:06,645 the most common reasons you do see those 87 00:03:06,645 --> 00:03:07,145 small 88 00:03:07,525 --> 00:03:08,025 instances 89 00:03:08,485 --> 00:03:09,305 of complication? 90 00:03:10,405 --> 00:03:10,724 The, 91 00:03:11,685 --> 00:03:13,860 the two most common reasons we see 92 00:03:14,259 --> 00:03:14,759 is, 93 00:03:15,620 --> 00:03:17,080 a condition called osteolysis, 94 00:03:17,699 --> 00:03:20,199 which again is something we learned from our 95 00:03:20,340 --> 00:03:22,680 hip and knee and shoulder replacement colleagues, 96 00:03:23,060 --> 00:03:24,020 which is an, 97 00:03:24,580 --> 00:03:27,675 a cyst formation around a prosthesis that's felt 98 00:03:27,675 --> 00:03:28,935 to be due to, 99 00:03:29,635 --> 00:03:32,455 wear of components. And and every every every 100 00:03:32,915 --> 00:03:35,655 disc has components that can that can wear, 101 00:03:35,715 --> 00:03:37,715 and if they cause wear particles that the 102 00:03:37,715 --> 00:03:39,814 body reacts unfavorably to, 103 00:03:40,275 --> 00:03:41,735 they create a situation 104 00:03:42,370 --> 00:03:44,310 where you get these progressive cysts, 105 00:03:44,770 --> 00:03:45,990 and then it requires, 106 00:03:46,770 --> 00:03:49,170 revision just, you know, much like we we 107 00:03:49,170 --> 00:03:50,950 see in our peripheral joint. 108 00:03:51,569 --> 00:03:53,189 The second most common reason 109 00:03:53,650 --> 00:03:54,550 really is 110 00:03:54,974 --> 00:03:57,215 more of a a learning curve or technical 111 00:03:57,215 --> 00:03:59,955 issue, and that is failure to address 112 00:04:00,254 --> 00:04:01,235 all the pathology. 113 00:04:01,615 --> 00:04:03,534 In other words, we take the disc out, 114 00:04:03,534 --> 00:04:05,134 we put a new disc in, but you 115 00:04:05,134 --> 00:04:08,354 also have to do a more meticulous decompression 116 00:04:08,495 --> 00:04:10,680 of of the spinal cord and nerve roots, 117 00:04:11,719 --> 00:04:12,379 And persistent 118 00:04:12,680 --> 00:04:14,299 posterior pathology, which, 119 00:04:14,919 --> 00:04:17,160 will mean something to the physicians, but maybe 120 00:04:17,160 --> 00:04:19,579 less so to the the non physicians listening, 121 00:04:20,680 --> 00:04:22,519 is is probably the second most common, 122 00:04:22,919 --> 00:04:24,379 reason for needing revisions. 123 00:04:25,175 --> 00:04:27,574 Got it. And you mentioned earlier, you know, 124 00:04:27,574 --> 00:04:29,274 seeing these expanded indications, 125 00:04:29,975 --> 00:04:30,475 for 126 00:04:30,855 --> 00:04:32,774 disc replacement. And I'm wondering, you know, what 127 00:04:32,774 --> 00:04:35,274 is, what are some of these indications that 128 00:04:35,735 --> 00:04:37,035 might be, underutilized 129 00:04:37,495 --> 00:04:40,279 right now, underrated that you want to see, 130 00:04:40,519 --> 00:04:41,579 gain more prominence? 131 00:04:42,599 --> 00:04:43,959 I will tell you that, 132 00:04:44,599 --> 00:04:46,360 your question is very timely because we just 133 00:04:46,360 --> 00:04:47,959 had a conference on this a couple weeks 134 00:04:47,959 --> 00:04:48,939 ago in in 135 00:04:49,319 --> 00:04:50,060 in LA. 136 00:04:50,599 --> 00:04:51,099 And 137 00:04:51,415 --> 00:04:54,134 we originally and initially thought that in the 138 00:04:54,134 --> 00:04:55,115 cervical spine, 139 00:04:55,415 --> 00:04:58,134 the disc replacement was for younger patients and 140 00:04:58,134 --> 00:04:59,514 fusions were for older. 141 00:04:59,895 --> 00:05:02,134 As we've gained more experience both in The 142 00:05:02,134 --> 00:05:04,535 US and outside The US, we have found 143 00:05:04,535 --> 00:05:07,279 that we can increase the age for patients 144 00:05:07,339 --> 00:05:08,959 to get disc replacements, 145 00:05:09,659 --> 00:05:10,479 more arthritic, 146 00:05:11,099 --> 00:05:11,599 spines, 147 00:05:12,300 --> 00:05:14,479 spines that may have lost the normal curvature 148 00:05:14,779 --> 00:05:16,159 in the cervical spine, 149 00:05:16,699 --> 00:05:17,519 much more, 150 00:05:17,899 --> 00:05:19,759 you know, as we're in our third decade 151 00:05:19,865 --> 00:05:21,865 of doing this. And and that's helped a 152 00:05:21,865 --> 00:05:23,944 lot of our older patients, you know, into 153 00:05:23,944 --> 00:05:26,904 their sixties and seventies even being potential candidates 154 00:05:26,904 --> 00:05:27,884 for disc replacement. 155 00:05:28,504 --> 00:05:30,584 That's really exciting. It sounds like, you know, 156 00:05:30,584 --> 00:05:31,705 also a huge, 157 00:05:32,599 --> 00:05:35,879 quality of life update upgrade for the patients 158 00:05:35,879 --> 00:05:36,539 as well. 159 00:05:37,240 --> 00:05:39,319 No question about it. I mean, preserving motion 160 00:05:39,319 --> 00:05:41,959 is kinda where it's at, and motion equals 161 00:05:41,959 --> 00:05:42,459 function. 162 00:05:42,919 --> 00:05:43,419 Definitely. 163 00:05:44,039 --> 00:05:46,220 And, you know, besides disc replacement, 164 00:05:46,925 --> 00:05:49,745 how else do you see the spine orthopedic 165 00:05:49,964 --> 00:05:52,444 field evolve the next two to three years, 166 00:05:52,444 --> 00:05:53,904 whether it's with innovations 167 00:05:54,205 --> 00:05:55,745 or how practices 168 00:05:56,365 --> 00:05:57,824 are run, etcetera, etcetera? 169 00:05:58,990 --> 00:06:01,889 Well, I'm I'm I'm gonna pivot, and and 170 00:06:02,110 --> 00:06:03,569 this is more into, 171 00:06:04,269 --> 00:06:07,469 because everybody likes talking about robots and image 172 00:06:07,469 --> 00:06:09,949 guidance and things like that. I'm gonna talk 173 00:06:09,949 --> 00:06:10,449 about, 174 00:06:11,625 --> 00:06:13,944 patient access to care and that being the 175 00:06:13,944 --> 00:06:15,324 private insurance world. 176 00:06:16,025 --> 00:06:17,645 We have seen such 177 00:06:18,264 --> 00:06:18,764 headwinds, 178 00:06:20,345 --> 00:06:22,764 particularly with this particular technology, 179 00:06:23,625 --> 00:06:26,680 such that anything that doesn't fit a very 180 00:06:26,680 --> 00:06:27,579 strict protocol, 181 00:06:28,199 --> 00:06:29,339 and that's 182 00:06:29,800 --> 00:06:31,879 something in the real world that just doesn't 183 00:06:31,879 --> 00:06:33,579 exist all that commonly. 184 00:06:33,959 --> 00:06:36,599 Because patients are you know, we've we've always 185 00:06:36,599 --> 00:06:37,899 treated patients individually 186 00:06:38,314 --> 00:06:40,414 as we've learned again about these, 187 00:06:41,435 --> 00:06:42,894 more expanded indications 188 00:06:43,354 --> 00:06:44,495 for disc replacement. 189 00:06:45,435 --> 00:06:46,495 We've run into 190 00:06:47,034 --> 00:06:49,615 resistance from the insurance industry in 191 00:06:49,995 --> 00:06:52,850 in getting approvals for these things. And, 192 00:06:53,310 --> 00:06:54,990 you know, they they send these, 193 00:06:55,709 --> 00:06:56,209 robotic 194 00:06:56,589 --> 00:06:58,610 peer to peer doctors, and peer to peer 195 00:06:58,670 --> 00:07:00,830 is such a misnomer because all they're doing 196 00:07:00,830 --> 00:07:01,490 is regurgitating 197 00:07:02,110 --> 00:07:04,910 policy. They're they're not trying to to, 198 00:07:06,305 --> 00:07:08,464 figure out the best strategy for for helping 199 00:07:08,464 --> 00:07:11,425 a patient. In fact, for example, today, I 200 00:07:11,425 --> 00:07:13,285 was doing a peer to peer, and 201 00:07:14,064 --> 00:07:16,064 and the the doc on the other side 202 00:07:16,064 --> 00:07:19,365 was listing CPT codes and what their policies 203 00:07:19,584 --> 00:07:20,879 and protocols are. 204 00:07:21,439 --> 00:07:21,839 And, 205 00:07:22,639 --> 00:07:23,620 I said, hey. 206 00:07:24,000 --> 00:07:25,520 Why don't we just play doctor for a 207 00:07:25,520 --> 00:07:27,120 little bit and talk about the patient and 208 00:07:27,120 --> 00:07:28,339 what's best for the patient? 209 00:07:28,720 --> 00:07:31,060 And, unfortunately, it didn't register because, 210 00:07:32,000 --> 00:07:33,759 you know, the the most of the peer 211 00:07:33,759 --> 00:07:35,040 to peers are not there to help the 212 00:07:35,040 --> 00:07:36,580 patient. They're there just to regurgitate, 213 00:07:37,415 --> 00:07:39,115 these very restrictive policies. 214 00:07:39,495 --> 00:07:41,975 And I think that's something that we're gonna 215 00:07:41,975 --> 00:07:43,035 have to deal with, 216 00:07:43,735 --> 00:07:45,194 globally as an entity 217 00:07:45,895 --> 00:07:47,835 because it's it's basically, 218 00:07:48,295 --> 00:07:50,535 number one, corporate practice of medicine, which, at 219 00:07:50,535 --> 00:07:52,314 least in the state of Texas, is illegal. 220 00:07:53,480 --> 00:07:56,120 And, you know, and that's at the very 221 00:07:56,120 --> 00:07:58,600 best. At the very worst, it's just unethical 222 00:07:58,600 --> 00:08:00,060 and rationing patient care. 223 00:08:00,600 --> 00:08:02,600 Yeah. So and so, doctor Blumenthal, it sounds 224 00:08:02,600 --> 00:08:03,740 like a lot of your 225 00:08:04,675 --> 00:08:07,715 frustrations lie within these conversations you're having with 226 00:08:07,715 --> 00:08:09,254 other physicians like yourself. 227 00:08:11,555 --> 00:08:13,155 And I don't really you know, that's what 228 00:08:13,155 --> 00:08:15,475 they're hired to do. So, you know, I'm 229 00:08:15,475 --> 00:08:16,215 not necessarily, 230 00:08:17,970 --> 00:08:20,629 necessarily criticizing them as as people. 231 00:08:21,170 --> 00:08:23,810 Mhmm. They're hired to regurgitate the policy. It's 232 00:08:23,810 --> 00:08:24,310 truly 233 00:08:24,850 --> 00:08:25,589 the suits 234 00:08:26,370 --> 00:08:26,870 behind 235 00:08:27,569 --> 00:08:28,069 the, 236 00:08:28,930 --> 00:08:30,470 the who hide behind 237 00:08:31,089 --> 00:08:31,589 these 238 00:08:32,254 --> 00:08:33,934 really not well thought out, 239 00:08:34,335 --> 00:08:34,835 protocols. 240 00:08:35,455 --> 00:08:37,774 And, you know, the reality is we talk 241 00:08:37,774 --> 00:08:39,215 about the cost of health care, it's a 242 00:08:39,215 --> 00:08:41,394 big political issue now in The United States. 243 00:08:41,934 --> 00:08:44,595 Last estimate I heard, 60 to 70% 244 00:08:44,960 --> 00:08:46,740 of health care costs are administrative, 245 00:08:47,279 --> 00:08:48,660 you know, middle management, 246 00:08:49,200 --> 00:08:52,160 c suite type things and really don't, go 247 00:08:52,160 --> 00:08:53,919 to the people that are either delivering the 248 00:08:53,919 --> 00:08:56,240 care or receiving the care, and that's just 249 00:08:56,240 --> 00:08:57,059 gotta change. 250 00:08:57,774 --> 00:09:00,014 And how are you strategizing, miss, kind of 251 00:09:00,014 --> 00:09:01,475 your own day to day work 252 00:09:01,855 --> 00:09:03,235 within these systems? 253 00:09:05,215 --> 00:09:06,174 You know, the 254 00:09:07,134 --> 00:09:09,215 on a micro level, you know, they're trying 255 00:09:09,215 --> 00:09:11,215 to outsmart us, and we're trying to outsmart 256 00:09:11,215 --> 00:09:13,669 them. On a macro level, it just it 257 00:09:13,669 --> 00:09:15,769 it needs to go back to, you know, 258 00:09:16,230 --> 00:09:18,069 not getting in the middle of the doctor 259 00:09:18,069 --> 00:09:19,850 patient relationship, which is exactly, 260 00:09:20,709 --> 00:09:23,529 the strategy that of of these insurance companies. 261 00:09:23,669 --> 00:09:25,414 Even using the word provider, 262 00:09:25,875 --> 00:09:27,894 which is a very derogatory term, 263 00:09:28,195 --> 00:09:29,095 to a physician, 264 00:09:29,554 --> 00:09:30,615 it just dehumanizes 265 00:09:30,995 --> 00:09:32,995 what we were trained to do, which was 266 00:09:32,995 --> 00:09:33,714 be in a, 267 00:09:34,195 --> 00:09:36,294 advocating relationship with our patients. 268 00:09:37,039 --> 00:09:37,699 Got it. 269 00:09:38,240 --> 00:09:40,480 And then I wanna pivot things a little 270 00:09:40,480 --> 00:09:42,659 bit again. I want to hear what you 271 00:09:42,720 --> 00:09:45,059 think will be, you know, the number one 272 00:09:45,120 --> 00:09:48,899 key disruptor to spine surgery in 2026. 273 00:09:51,075 --> 00:09:52,835 I think it's exactly that. I I think 274 00:09:52,835 --> 00:09:55,415 it's going to be more restrictions 275 00:09:56,355 --> 00:09:56,855 to, 276 00:09:58,355 --> 00:10:00,934 to advanced technology. We got these great technologies 277 00:10:01,075 --> 00:10:03,154 that come out, and if they don't fit 278 00:10:03,154 --> 00:10:03,815 the protocols, 279 00:10:05,579 --> 00:10:07,980 they're they're gonna restrict patients' access to it, 280 00:10:07,980 --> 00:10:09,600 you know, much like, 281 00:10:10,059 --> 00:10:10,559 pharmaceuticals 282 00:10:10,940 --> 00:10:12,720 that come up with these great new drugs, 283 00:10:12,860 --> 00:10:14,539 and it takes years to get on the 284 00:10:14,539 --> 00:10:15,039 formularies 285 00:10:15,500 --> 00:10:18,059 of of of these insurance companies. So patients 286 00:10:18,059 --> 00:10:20,485 don't have access unless they wanna pay thousands 287 00:10:20,485 --> 00:10:21,144 of dollars. 288 00:10:21,764 --> 00:10:23,924 And, you know, practice like ours, the the 289 00:10:23,924 --> 00:10:25,144 center of disc replacement 290 00:10:25,524 --> 00:10:28,165 at Texas Back Institute, we've stayed, you know, 291 00:10:28,165 --> 00:10:30,485 within the insurance networks, whereas a lot of 292 00:10:30,485 --> 00:10:31,865 the disc replacement surgeons 293 00:10:32,325 --> 00:10:33,785 opt for an out of network, 294 00:10:34,320 --> 00:10:36,580 strategy so they don't have to deal with, 295 00:10:36,960 --> 00:10:38,660 I'll use your term, these headwinds, 296 00:10:39,279 --> 00:10:41,279 that we've been having to deal with. But 297 00:10:41,279 --> 00:10:43,680 for the most part, most patients can't really 298 00:10:43,680 --> 00:10:44,180 afford, 299 00:10:44,720 --> 00:10:46,259 to do out of network, 300 00:10:46,720 --> 00:10:49,700 cash pay models for for disc replacements because, 301 00:10:50,154 --> 00:10:51,774 it's tens of thousands of dollars. 302 00:10:52,554 --> 00:10:53,054 Yeah. 303 00:10:53,754 --> 00:10:55,674 And, you know, I wanna ask also just 304 00:10:55,674 --> 00:10:57,835 what are some other health care trends besides 305 00:10:57,835 --> 00:10:58,575 what we discussed 306 00:10:58,955 --> 00:11:00,575 that you've been following closely? 307 00:11:02,490 --> 00:11:03,950 Yeah. You know, 308 00:11:04,889 --> 00:11:06,649 I I don't know that I that I'm 309 00:11:06,649 --> 00:11:09,129 so focused on on this particular one in 310 00:11:09,129 --> 00:11:10,350 advancing our technologies. 311 00:11:12,090 --> 00:11:13,389 You know, I think the trends 312 00:11:13,929 --> 00:11:14,429 that 313 00:11:14,754 --> 00:11:16,294 that we see and and 314 00:11:16,674 --> 00:11:18,674 and that other people are talking about and 315 00:11:18,674 --> 00:11:21,074 if I'm a young surgeon, it's it's putting 316 00:11:21,074 --> 00:11:23,414 the instruments where they need to go without, 317 00:11:24,034 --> 00:11:27,495 utilizing radiation. So it's it's robotics and navigation, 318 00:11:27,634 --> 00:11:29,730 I think. I think that's where it's at. 319 00:11:30,289 --> 00:11:32,209 Unfortunately, you know, people love to to throw 320 00:11:32,209 --> 00:11:34,370 on the term AI, but AI is gonna 321 00:11:34,370 --> 00:11:36,289 work more against us than for us, at 322 00:11:36,289 --> 00:11:37,589 least in the short term, 323 00:11:39,009 --> 00:11:41,110 because of because of access. 324 00:11:42,004 --> 00:11:44,084 Yeah. Now can you dive deeper into that? 325 00:11:44,084 --> 00:11:46,325 Just kind of your own experience working with 326 00:11:46,325 --> 00:11:48,325 AI in your practice, and what do you 327 00:11:48,404 --> 00:11:49,845 what you think it will take for it 328 00:11:49,845 --> 00:11:50,345 to, 329 00:11:51,205 --> 00:11:53,365 get out of, this kind of rut you're 330 00:11:53,365 --> 00:11:54,745 describing and to, 331 00:11:55,845 --> 00:11:57,144 work better long term? 332 00:11:58,649 --> 00:12:00,649 The early AI, which which I think is 333 00:12:00,649 --> 00:12:01,470 pretty cool, 334 00:12:01,929 --> 00:12:04,429 is the the concept of having 335 00:12:04,809 --> 00:12:07,049 this third person, your AI, in the room 336 00:12:07,049 --> 00:12:09,129 with you and your patient. You basically can 337 00:12:09,129 --> 00:12:11,049 just have a conversation, do a history and 338 00:12:11,049 --> 00:12:14,024 physical, and the AI generates the the medical 339 00:12:14,024 --> 00:12:17,004 record. I think that's really, really cool. 340 00:12:17,625 --> 00:12:20,664 And that's not in any decision making realm. 341 00:12:20,664 --> 00:12:22,205 That's basically just documenting, 342 00:12:22,745 --> 00:12:24,044 you know, patient's problems 343 00:12:24,585 --> 00:12:27,459 and, you know, what your findings are when 344 00:12:27,459 --> 00:12:29,139 you're, you know, in the room doing an 345 00:12:29,139 --> 00:12:30,440 exam taking a history. 346 00:12:31,139 --> 00:12:33,299 The the next level AI, I think, will 347 00:12:33,299 --> 00:12:37,139 go into surgical planning and indications and and, 348 00:12:37,139 --> 00:12:38,899 you know, where to stop your fusions if 349 00:12:38,899 --> 00:12:40,759 you're doing long scoliosis fusions, 350 00:12:41,225 --> 00:12:44,285 when maybe motion might be better than fusion. 351 00:12:44,985 --> 00:12:46,904 That we're not there yet, but I think 352 00:12:46,904 --> 00:12:48,665 that's that's the next step from our point 353 00:12:48,665 --> 00:12:49,245 of view. 354 00:12:49,705 --> 00:12:52,185 That's really exciting to think about, and it 355 00:12:52,185 --> 00:12:53,705 does seem like there's a lot of a 356 00:12:53,705 --> 00:12:55,705 lot of potential with AI and where it 357 00:12:55,705 --> 00:12:56,445 can go. 358 00:12:57,089 --> 00:12:59,089 And that's all the time we do have 359 00:12:59,089 --> 00:13:01,990 for today. Doctor Blumenthal, thank you for, 360 00:13:02,370 --> 00:13:04,129 joining us again. And it's been a pleasure 361 00:13:04,129 --> 00:13:05,970 speaking, and I hope to connect again down 362 00:13:05,970 --> 00:13:06,629 the line. 363 00:13:07,009 --> 00:13:08,389 Always. Anytime, Carly. 364 00:13:08,850 --> 00:13:09,589 Thank you.