Welcome everyone to the Becker's Healthcare podcast series. I'm Maria Mohammed.
She, her pronouns, a writer and moderator for Becker's Healthcare,
and I am absolutely thrilled to have with me today Dr.
Y Young Bay Medical Director at the Spine Institution Center for Spinal
Restoration. Dr. Bay is so nice to talk with you today. How are you?
Very good.
Wonderful. Well, to begin,
would you mind please introducing yourself and then telling us a bit about your
background?
Sure. Uh, my name is Shun Bay. I practice in Los Angeles. Uh,
and I'm actually co-director of Education and Fellowship here at Cedar Sinai
Spine Center. We believe that we're one of the top spine centers in the country,
uh, as well as I have a private practice called the Spine Institute Center for
Spinal Restoration in Santa Monica. Um, and I've been involved in research for,
gosh, over 20 years, um, involved with, uh,
creating new devices for spine. Um,
also very involved in the cellular and biologics world and have been teaching
fellows for the last 20 years as well.
Wonderful. Thank you so much for that background. Well,
to begin with the real questions of the interview,
the first thing I wanted to ask you, doctor,
is what are the big headwinds you're planning for this year?
Really interesting question. Um,
I think one of the major shifts is, is that, uh, even though I'm,
I'm at Cedars, it's, I'm officially called a private practice physician.
I'm not employed by Cedars. Uh, and it's very interesting,
I think what's happening to the, you know, the private world where, uh,
spine surgeons in, at least in our market, you know,
what's happening in their world, it's, it's kind of changing a little bit.
I think for me, I've joined a, a group of spine physicians recently,
it's called Commons Clinic. Um, and it's really trying to leverage,
uh, very busy spine surgeons,
getting them together in a private practice type of environment and hopefully
being able to compete, uh, in the, uh, ambulatory care center. You know,
obviously everybody's talking about spine surgery, uh,
moving to the ambulatory center.
We certainly have gotten a lot better with minimally invasive surgery. Uh,
but the idea is, is not only to compete on the,
I would say standard surgical fees per se, uh,
but really trying to bring management of bundled care
into the ambulatory care center. So not just managing,
let's say the surgical event,
but really managing the presurgery and post-surgical
event to see if we can manage it and bring quality to the
patient. And then obviously, you know,
have some cost savings that we can all share. Um,
I think that's a very interesting model.
It's kind of trying to bring bundle care into the ambulatory center instead of,
you know,
what we've typically been hearing with bundle care with c M s into the hospital.
It's really bringing that to more of a private payer based,
but bringing it into the ambulatory care center just to, you know,
help with cost savings. Uh, that's a truly interesting venture that, uh,
I'm starting right now. And I think, uh, that, uh,
is basically one of the big headwinds as far as the practice. Um,
obviously in LA we're seeing a lot of movement with private equity. Um,
this is a little bit different. Um, and I think, uh,
I'm looking forward to spearheading that and seeing what,
seeing really how we can move the needle in that regard, both for patient care,
but, uh, both for trying to increase some, um,
leverage in community amongst private practitioners that, uh,
are involved in spine surgery. Um, other than that, if you ask me, you know,
what I think as far as technique, uh,
or procedure based, um, I do think, uh,
a couple things have really moved and we'll move in the next couple years.
One is more kind of endoscopic or arthroscopic, whatever you want to call it,
uh, this type of more minimally invasive surgery.
I think the term minimally invasive surgery is, is kind of overdone now.
We've used it a lot. It's very unclear.
The patient doesn't really know what it is. And I think, uh,
endoscopic surgery definitely helps cuz the word endoscopic defines the
procedure itself and there's no, I don't know,
misconception. It's not like, you know,
mis surgery can be anything from deformity to a one level T lift to a micro
decompression to an A C D F to an anterior cervical disc replacement. Um,
and at least when you say I'm gonna do an endoscopic decompression or endoscopic
discectomy, it's very descriptive and it conveys it, the, the,
the message that, hey,
this will be something that you'll be able to tolerate that is actually
minimally invasive. So, um, I see that in my practice. You know,
we've started some, um, I'm gonna say more kind of arthroscopic assisted,
that's our term for use. Um, cuz it's by portal.
We use two portals and, and I think that that's very interesting. Um,
other than that, I still think that motion preservation,
now that I've been doing motion preservation both lumbar arthroplasty and
cervical arthroplasty for more than 20 years, and I've,
I've been so underwhelmed with the amount of progress,
uh, and where we are with this technology today.
But I do see in the last five years at least, this is truly evolving,
that we certainly are seeing a big uptick of cervical arthro
arthroplasty.
I think that that's great and I think that's probably with the data release of
the longer term studies. Um, and I think, you know,
that's kind of carried along lumbar arthroplasty where I do see,
uh, more surgeons, uh,
around the community starting doing lumbar disc replacements. Um,
I think lumbar disc replacements have a huge impact, uh,
to the patient just as much,
if not more than cervical arthroplasty. Um,
and certainly I think it's more geographically based, uh,
but at least in our geo geography, we're seeing a lot more of that.
And I think hopefully that's, you know, spreading around the country.
Yeah, absolutely.
All those things definitely sound so interesting and sounds like it's a win-win
for everyone, hopefully. Um, for you doctor,
how will the spine and orthopedic field evolve in the next two to three years,
would you think?
I, so as far as, you know, bigger surgeries, I think,
you know, we're expanding both bigger and smaller. Okay.
So I think for the bigger surgeries when we talk about, um,
surgeries that involve, uh, multilevel fixation, deformity correction,
deformity surgery, uh, I do think that that is becoming,
uh, more prescriptive. Um,
we have a lot of tools and I'll think we'll see a lot more tools that will help
bring more reliability and reproducibility to that surgery, including robotics,
um, you know, some type of artificial intelligence,
which I think is more related to surgical planning and what you're gonna
achieve. Uh, I think in the future, probably in the near future, um,
a lot of this is gonna be planned with the help of AI and you won't even have to
bend the rod, the robot will put the screws in and bend the rod for you. Um,
I think that is what's gonna happen to the larger surgeries now, you know,
still it, it, it,
it allows for reproducibility in the surgical procedure
part. Um, but you know, I I still think there's a lot of
innovation, uh, that needs to come about of, of, you know,
is there an alternative to this type of surgery? You know, and not just,
I would say, you know, not just, Hey, can we decrease levels?
Can we change the flexibility of the rod? Can we, you know,
do something with, you know, the amount of fixation?
I think it's really hopefully looking back with more data to see, you know,
how do we get here? Like why do we get here? You know?
And hopefully with the index procedures, you know,
we can change the index procedures to hopefully avoid, uh,
having to do longer term constructs.
Now I think that's probably more of a five to 10 year, uh, project. Um,
but you know, after being here for 23 years, I'm still surprised that,
you know, we seem still to be chasing ourselves with fusion,
you know, that one level to two levels,
to four levels to T 10 the pelvis. And,
and it makes me believe that if we're still chasing ourselves, it,
it's not about, you know, how to do the fusion better or re you know,
or causing reproducibility in the fusion. It's really, you know,
maybe it's the index operation or, uh,
the fact that we're fixating the spine,
which is a non physiologic procedure and maybe we need to look at that
differently to hopefully stop the progression. Also,
if you ask me, you know, other things in the biologic arena,
I do think that there's been a lot of progress. Um,
there's three clinical trials that I know of right now that are looking at,
uh, disc injections. And when I talk about clinical trials,
I'm really talking about phase three FDA clinical trials that are gonna be
randomized against some type of, um, placebo arm,
um, one, two being stem cells,
one being a molecule that will be injected to for, uh,
into the disc for disc degeneration and low back pain.
And I'm eagerly weighting those results, but I think in five years,
or maybe even a little bit longer, that we actually may have
an FDA approved product with the indication
that says the treatment of low back pain for degenerative disc disease. Uh,
and I think, you know, that would be definitely a paradigm shift.
Um, there's also a recent approval, uh,
for a drug that's very similar to camo papine, uh,
which is a drug that, you know, maybe, you know,
the younger surgeons have not heard about, but you know,
it's kind of the molecule from a papaya ab uh,
extract that digests collagen has the ability to digest collagen.
And it was used a long time ago for the treatment of her needed disc for
contained hernia disc.
And I just found out that there's been a recent approval that the FDA has
actually had an approval, uh,
for this medication to treat contained disc
herniations for radiculopathy.
And so I'm interested to see how that rolls out in the next two or three years.
Um, I think, uh, that probably, uh,
gets into your next question.
Yeah, absolutely. Thank you all for that. Uh, the last question, doctor,
that I wanted to ask you is, where do you see the best opportunities for growth?
So I still think making, you know,
the harder and bigger surgeries more reliable,
there's a lot of growth there because there's obviously a lot of invested
dollars there. So, you know, where there's, you know, investment,
you know, you have to get a return. And so I do think that, you know,
big stain in the spine and doing long fur fusion certainly is an expensive
process and therefore there'll be a lot of investment into that field.
So it will be robotics, ai, augmented reality. Um,
I do think that that's still, um,
gonna be a major and progression over the next couple years.
And definitely a lot of people are,
are already experimenting and playing in that field. Um,
but I also think on the minimally invasive side, the smaller side, which,
you know, sometimes gets neglected, um, because you know, it's smaller,
right? And sometimes it doesn't require hardware.
So I still think that endoscopic or arthroscopic or arthroscopic
assisted that these types of surgeries in the US um,
has a tremendous amount of growth opportunity. And I see it now. If you, if you,
if um, if you follow like kind of the endoscopic session at, uh,
society of Minimally Invasive Spine Surgery ESUs,
and if you looked at over the past years, I would say five years ago,
if you went through an arthroscopic or endoscopic spine uh, session,
there's probably two or three people in the room. You couldn't even get faculty.
Okay? But last year at ESUs, the endoscopic spine session,
the room was packed, you know, packed. And you know,
you have tons of faculty to choose from.
And so I do think that that is gonna obviously
start growing here in the us What's fascinating is I just traveled to Korea
about four months ago. Okay. And,
um, you know, they started with endoscopic spine surgery quite early on, um,
and in Korea, what's fascinating is,
is that if you need a decompression or if you need a
um, disc removed,
if you have a herniated disc and you need a laminotomy discectomy or just a
simple decompression,
you are more likely to have that treated endoscopically than you are open.
Okay. So, uh, that has really happened over the last 10 to 15 years in,
in Korea. And I think, you know,
other countries have adopted endoscopic surgery and I think, you know,
the US if we are, you know, the spine leaders that, you know,
we will also start adopting that as well.
Yeah, yeah, totally. Thank you so much for sharing that. Um,
and thank you so much for those final thoughts, doctor.
This has been an amazing, amazing discussion.
So I wanna thank you so much for coming on Peckers Healthcare again,
and I look forward to connecting with you again soon.
Fantastic. Thank you very much, Mariah.