1 00:00:00,220 --> 00:00:04,320 Welcome everyone to the Becker's Healthcare podcast series. I'm Maria Mohammed. 2 00:00:04,320 --> 00:00:08,160 She, her pronouns, a writer and moderator for Becker's Healthcare, 3 00:00:08,460 --> 00:00:10,840 and I am absolutely thrilled to have with me today Dr. 4 00:00:10,960 --> 00:00:14,920 Y Young Bay Medical Director at the Spine Institution Center for Spinal 5 00:00:14,920 --> 00:00:18,040 Restoration. Dr. Bay is so nice to talk with you today. How are you? 6 00:00:19,450 --> 00:00:20,283 Very good. 7 00:00:20,850 --> 00:00:22,540 Wonderful. Well, to begin, 8 00:00:22,540 --> 00:00:25,780 would you mind please introducing yourself and then telling us a bit about your 9 00:00:25,780 --> 00:00:26,613 background? 10 00:00:27,780 --> 00:00:32,550 Sure. Uh, my name is Shun Bay. I practice in Los Angeles. Uh, 11 00:00:32,850 --> 00:00:36,990 and I'm actually co-director of Education and Fellowship here at Cedar Sinai 12 00:00:37,160 --> 00:00:40,790 Spine Center. We believe that we're one of the top spine centers in the country, 13 00:00:41,450 --> 00:00:45,350 uh, as well as I have a private practice called the Spine Institute Center for 14 00:00:45,350 --> 00:00:50,070 Spinal Restoration in Santa Monica. Um, and I've been involved in research for, 15 00:00:50,340 --> 00:00:54,230 gosh, over 20 years, um, involved with, uh, 16 00:00:54,790 --> 00:00:57,350 creating new devices for spine. Um, 17 00:00:57,740 --> 00:01:02,070 also very involved in the cellular and biologics world and have been teaching 18 00:01:02,100 --> 00:01:04,030 fellows for the last 20 years as well. 19 00:01:06,030 --> 00:01:08,640 Wonderful. Thank you so much for that background. Well, 20 00:01:08,940 --> 00:01:10,840 to begin with the real questions of the interview, 21 00:01:10,840 --> 00:01:12,320 the first thing I wanted to ask you, doctor, 22 00:01:12,500 --> 00:01:15,640 is what are the big headwinds you're planning for this year? 23 00:01:17,780 --> 00:01:20,040 Really interesting question. Um, 24 00:01:21,280 --> 00:01:26,160 I think one of the major shifts is, is that, uh, even though I'm, 25 00:01:26,220 --> 00:01:31,000 I'm at Cedars, it's, I'm officially called a private practice physician. 26 00:01:31,220 --> 00:01:34,400 I'm not employed by Cedars. Uh, and it's very interesting, 27 00:01:34,600 --> 00:01:38,880 I think what's happening to the, you know, the private world where, uh, 28 00:01:38,890 --> 00:01:41,760 spine surgeons in, at least in our market, you know, 29 00:01:41,900 --> 00:01:45,400 what's happening in their world, it's, it's kind of changing a little bit. 30 00:01:46,000 --> 00:01:50,040 I think for me, I've joined a, a group of spine physicians recently, 31 00:01:50,070 --> 00:01:54,280 it's called Commons Clinic. Um, and it's really trying to leverage, 32 00:01:55,100 --> 00:01:57,200 uh, very busy spine surgeons, 33 00:01:57,200 --> 00:02:01,520 getting them together in a private practice type of environment and hopefully 34 00:02:01,530 --> 00:02:06,120 being able to compete, uh, in the, uh, ambulatory care center. You know, 35 00:02:06,120 --> 00:02:09,160 obviously everybody's talking about spine surgery, uh, 36 00:02:09,160 --> 00:02:10,520 moving to the ambulatory center. 37 00:02:10,580 --> 00:02:13,960 We certainly have gotten a lot better with minimally invasive surgery. Uh, 38 00:02:13,960 --> 00:02:16,720 but the idea is, is not only to compete on the, 39 00:02:17,160 --> 00:02:20,800 I would say standard surgical fees per se, uh, 40 00:02:20,860 --> 00:02:25,600 but really trying to bring management of bundled care 41 00:02:26,190 --> 00:02:30,240 into the ambulatory care center. So not just managing, 42 00:02:30,450 --> 00:02:31,840 let's say the surgical event, 43 00:02:32,140 --> 00:02:36,880 but really managing the presurgery and post-surgical 44 00:02:37,010 --> 00:02:41,800 event to see if we can manage it and bring quality to the 45 00:02:41,800 --> 00:02:44,280 patient. And then obviously, you know, 46 00:02:44,310 --> 00:02:47,240 have some cost savings that we can all share. Um, 47 00:02:47,360 --> 00:02:50,640 I think that's a very interesting model. 48 00:02:50,830 --> 00:02:54,560 It's kind of trying to bring bundle care into the ambulatory center instead of, 49 00:02:54,820 --> 00:02:55,160 you know, 50 00:02:55,160 --> 00:02:59,780 what we've typically been hearing with bundle care with c M s into the hospital. 51 00:03:00,210 --> 00:03:03,180 It's really bringing that to more of a private payer based, 52 00:03:03,600 --> 00:03:07,180 but bringing it into the ambulatory care center just to, you know, 53 00:03:07,180 --> 00:03:11,300 help with cost savings. Uh, that's a truly interesting venture that, uh, 54 00:03:11,300 --> 00:03:13,700 I'm starting right now. And I think, uh, that, uh, 55 00:03:13,920 --> 00:03:18,100 is basically one of the big headwinds as far as the practice. Um, 56 00:03:18,100 --> 00:03:22,020 obviously in LA we're seeing a lot of movement with private equity. Um, 57 00:03:22,020 --> 00:03:25,340 this is a little bit different. Um, and I think, uh, 58 00:03:25,480 --> 00:03:28,900 I'm looking forward to spearheading that and seeing what, 59 00:03:28,900 --> 00:03:32,540 seeing really how we can move the needle in that regard, both for patient care, 60 00:03:32,640 --> 00:03:36,220 but, uh, both for trying to increase some, um, 61 00:03:36,540 --> 00:03:39,420 leverage in community amongst private practitioners that, uh, 62 00:03:39,420 --> 00:03:44,260 are involved in spine surgery. Um, other than that, if you ask me, you know, 63 00:03:44,260 --> 00:03:48,250 what I think as far as technique, uh, 64 00:03:48,350 --> 00:03:52,290 or procedure based, um, I do think, uh, 65 00:03:52,490 --> 00:03:55,810 a couple things have really moved and we'll move in the next couple years. 66 00:03:56,470 --> 00:04:00,690 One is more kind of endoscopic or arthroscopic, whatever you want to call it, 67 00:04:01,110 --> 00:04:03,930 uh, this type of more minimally invasive surgery. 68 00:04:04,170 --> 00:04:08,050 I think the term minimally invasive surgery is, is kind of overdone now. 69 00:04:08,060 --> 00:04:09,930 We've used it a lot. It's very unclear. 70 00:04:10,310 --> 00:04:13,250 The patient doesn't really know what it is. And I think, uh, 71 00:04:13,250 --> 00:04:17,410 endoscopic surgery definitely helps cuz the word endoscopic defines the 72 00:04:17,410 --> 00:04:21,930 procedure itself and there's no, I don't know, 73 00:04:21,930 --> 00:04:23,850 misconception. It's not like, you know, 74 00:04:23,990 --> 00:04:28,690 mis surgery can be anything from deformity to a one level T lift to a micro 75 00:04:28,690 --> 00:04:33,650 decompression to an A C D F to an anterior cervical disc replacement. Um, 76 00:04:33,950 --> 00:04:38,010 and at least when you say I'm gonna do an endoscopic decompression or endoscopic 77 00:04:38,020 --> 00:04:42,010 discectomy, it's very descriptive and it conveys it, the, the, 78 00:04:42,030 --> 00:04:43,530 the message that, hey, 79 00:04:43,530 --> 00:04:46,410 this will be something that you'll be able to tolerate that is actually 80 00:04:46,410 --> 00:04:50,450 minimally invasive. So, um, I see that in my practice. You know, 81 00:04:50,450 --> 00:04:55,130 we've started some, um, I'm gonna say more kind of arthroscopic assisted, 82 00:04:55,130 --> 00:04:58,890 that's our term for use. Um, cuz it's by portal. 83 00:04:58,950 --> 00:05:03,890 We use two portals and, and I think that that's very interesting. Um, 84 00:05:06,110 --> 00:05:09,340 other than that, I still think that motion preservation, 85 00:05:10,680 --> 00:05:14,380 now that I've been doing motion preservation both lumbar arthroplasty and 86 00:05:14,380 --> 00:05:17,740 cervical arthroplasty for more than 20 years, and I've, 87 00:05:17,850 --> 00:05:22,060 I've been so underwhelmed with the amount of progress, 88 00:05:23,000 --> 00:05:25,740 uh, and where we are with this technology today. 89 00:05:25,840 --> 00:05:30,340 But I do see in the last five years at least, this is truly evolving, 90 00:05:30,530 --> 00:05:35,020 that we certainly are seeing a big uptick of cervical arthro 91 00:05:35,100 --> 00:05:35,933 arthroplasty. 92 00:05:36,340 --> 00:05:39,180 I think that that's great and I think that's probably with the data release of 93 00:05:39,200 --> 00:05:42,100 the longer term studies. Um, and I think, you know, 94 00:05:42,120 --> 00:05:47,060 that's kind of carried along lumbar arthroplasty where I do see, 95 00:05:47,960 --> 00:05:49,260 uh, more surgeons, uh, 96 00:05:49,260 --> 00:05:53,100 around the community starting doing lumbar disc replacements. Um, 97 00:05:53,500 --> 00:05:56,620 I think lumbar disc replacements have a huge impact, uh, 98 00:05:56,620 --> 00:05:58,980 to the patient just as much, 99 00:05:59,720 --> 00:06:02,900 if not more than cervical arthroplasty. Um, 100 00:06:03,080 --> 00:06:06,900 and certainly I think it's more geographically based, uh, 101 00:06:06,900 --> 00:06:09,980 but at least in our geo geography, we're seeing a lot more of that. 102 00:06:10,000 --> 00:06:12,220 And I think hopefully that's, you know, spreading around the country. 103 00:06:13,990 --> 00:06:14,880 Yeah, absolutely. 104 00:06:14,940 --> 00:06:19,560 All those things definitely sound so interesting and sounds like it's a win-win 105 00:06:19,580 --> 00:06:22,600 for everyone, hopefully. Um, for you doctor, 106 00:06:22,820 --> 00:06:27,080 how will the spine and orthopedic field evolve in the next two to three years, 107 00:06:27,080 --> 00:06:27,913 would you think? 108 00:06:30,300 --> 00:06:35,150 I, so as far as, you know, bigger surgeries, I think, 109 00:06:35,170 --> 00:06:38,230 you know, we're expanding both bigger and smaller. Okay. 110 00:06:38,330 --> 00:06:41,670 So I think for the bigger surgeries when we talk about, um, 111 00:06:41,950 --> 00:06:45,390 surgeries that involve, uh, multilevel fixation, deformity correction, 112 00:06:45,420 --> 00:06:49,230 deformity surgery, uh, I do think that that is becoming, 113 00:06:50,290 --> 00:06:53,150 uh, more prescriptive. Um, 114 00:06:53,570 --> 00:06:57,550 we have a lot of tools and I'll think we'll see a lot more tools that will help 115 00:06:57,880 --> 00:07:02,430 bring more reliability and reproducibility to that surgery, including robotics, 116 00:07:03,290 --> 00:07:05,710 um, you know, some type of artificial intelligence, 117 00:07:05,760 --> 00:07:09,070 which I think is more related to surgical planning and what you're gonna 118 00:07:09,070 --> 00:07:13,910 achieve. Uh, I think in the future, probably in the near future, um, 119 00:07:13,990 --> 00:07:17,670 a lot of this is gonna be planned with the help of AI and you won't even have to 120 00:07:17,670 --> 00:07:22,350 bend the rod, the robot will put the screws in and bend the rod for you. Um, 121 00:07:22,830 --> 00:07:26,110 I think that is what's gonna happen to the larger surgeries now, you know, 122 00:07:26,120 --> 00:07:27,630 still it, it, it, 123 00:07:27,770 --> 00:07:32,350 it allows for reproducibility in the surgical procedure 124 00:07:32,500 --> 00:07:36,550 part. Um, but you know, I I still think there's a lot of 125 00:07:38,100 --> 00:07:42,170 innovation, uh, that needs to come about of, of, you know, 126 00:07:42,350 --> 00:07:46,370 is there an alternative to this type of surgery? You know, and not just, 127 00:07:46,610 --> 00:07:51,160 I would say, you know, not just, Hey, can we decrease levels? 128 00:07:51,460 --> 00:07:55,200 Can we change the flexibility of the rod? Can we, you know, 129 00:07:55,900 --> 00:07:58,240 do something with, you know, the amount of fixation? 130 00:07:58,760 --> 00:08:03,280 I think it's really hopefully looking back with more data to see, you know, 131 00:08:03,420 --> 00:08:05,840 how do we get here? Like why do we get here? You know? 132 00:08:05,840 --> 00:08:08,840 And hopefully with the index procedures, you know, 133 00:08:08,940 --> 00:08:12,560 we can change the index procedures to hopefully avoid, uh, 134 00:08:12,560 --> 00:08:14,400 having to do longer term constructs. 135 00:08:14,420 --> 00:08:19,280 Now I think that's probably more of a five to 10 year, uh, project. Um, 136 00:08:19,420 --> 00:08:23,840 but you know, after being here for 23 years, I'm still surprised that, 137 00:08:24,500 --> 00:08:28,640 you know, we seem still to be chasing ourselves with fusion, 138 00:08:29,140 --> 00:08:32,770 you know, that one level to two levels, 139 00:08:32,990 --> 00:08:35,890 to four levels to T 10 the pelvis. And, 140 00:08:36,230 --> 00:08:39,770 and it makes me believe that if we're still chasing ourselves, it, 141 00:08:39,920 --> 00:08:43,930 it's not about, you know, how to do the fusion better or re you know, 142 00:08:43,950 --> 00:08:48,010 or causing reproducibility in the fusion. It's really, you know, 143 00:08:48,020 --> 00:08:51,730 maybe it's the index operation or, uh, 144 00:08:51,730 --> 00:08:53,530 the fact that we're fixating the spine, 145 00:08:53,530 --> 00:08:57,300 which is a non physiologic procedure and maybe we need to look at that 146 00:08:57,300 --> 00:09:02,040 differently to hopefully stop the progression. Also, 147 00:09:02,140 --> 00:09:06,000 if you ask me, you know, other things in the biologic arena, 148 00:09:06,360 --> 00:09:10,360 I do think that there's been a lot of progress. Um, 149 00:09:10,360 --> 00:09:14,520 there's three clinical trials that I know of right now that are looking at, 150 00:09:15,220 --> 00:09:18,320 uh, disc injections. And when I talk about clinical trials, 151 00:09:18,460 --> 00:09:22,240 I'm really talking about phase three FDA clinical trials that are gonna be 152 00:09:22,250 --> 00:09:26,600 randomized against some type of, um, placebo arm, 153 00:09:27,380 --> 00:09:29,240 um, one, two being stem cells, 154 00:09:30,060 --> 00:09:33,800 one being a molecule that will be injected to for, uh, 155 00:09:33,870 --> 00:09:36,680 into the disc for disc degeneration and low back pain. 156 00:09:37,460 --> 00:09:41,000 And I'm eagerly weighting those results, but I think in five years, 157 00:09:41,300 --> 00:09:45,320 or maybe even a little bit longer, that we actually may have 158 00:09:47,190 --> 00:09:51,290 an FDA approved product with the indication 159 00:09:52,120 --> 00:09:57,090 that says the treatment of low back pain for degenerative disc disease. Uh, 160 00:09:57,110 --> 00:10:00,890 and I think, you know, that would be definitely a paradigm shift. 161 00:10:02,110 --> 00:10:06,450 Um, there's also a recent approval, uh, 162 00:10:06,510 --> 00:10:10,450 for a drug that's very similar to camo papine, uh, 163 00:10:10,450 --> 00:10:12,970 which is a drug that, you know, maybe, you know, 164 00:10:12,970 --> 00:10:15,530 the younger surgeons have not heard about, but you know, 165 00:10:15,530 --> 00:10:18,410 it's kind of the molecule from a papaya ab uh, 166 00:10:18,560 --> 00:10:22,690 extract that digests collagen has the ability to digest collagen. 167 00:10:23,350 --> 00:10:27,570 And it was used a long time ago for the treatment of her needed disc for 168 00:10:27,570 --> 00:10:28,730 contained hernia disc. 169 00:10:29,110 --> 00:10:33,410 And I just found out that there's been a recent approval that the FDA has 170 00:10:33,610 --> 00:10:35,450 actually had an approval, uh, 171 00:10:35,630 --> 00:10:40,130 for this medication to treat contained disc 172 00:10:40,130 --> 00:10:41,850 herniations for radiculopathy. 173 00:10:42,550 --> 00:10:46,050 And so I'm interested to see how that rolls out in the next two or three years. 174 00:10:47,070 --> 00:10:51,630 Um, I think, uh, that probably, uh, 175 00:10:51,630 --> 00:10:52,990 gets into your next question. 176 00:10:54,390 --> 00:10:57,880 Yeah, absolutely. Thank you all for that. Uh, the last question, doctor, 177 00:10:57,880 --> 00:11:01,200 that I wanted to ask you is, where do you see the best opportunities for growth? 178 00:11:04,430 --> 00:11:06,570 So I still think making, you know, 179 00:11:06,830 --> 00:11:08,770 the harder and bigger surgeries more reliable, 180 00:11:08,770 --> 00:11:11,850 there's a lot of growth there because there's obviously a lot of invested 181 00:11:12,040 --> 00:11:16,970 dollars there. So, you know, where there's, you know, investment, 182 00:11:17,230 --> 00:11:20,890 you know, you have to get a return. And so I do think that, you know, 183 00:11:21,790 --> 00:11:24,890 big stain in the spine and doing long fur fusion certainly is an expensive 184 00:11:24,890 --> 00:11:29,090 process and therefore there'll be a lot of investment into that field. 185 00:11:29,470 --> 00:11:34,330 So it will be robotics, ai, augmented reality. Um, 186 00:11:34,410 --> 00:11:36,210 I do think that that's still, um, 187 00:11:36,210 --> 00:11:40,050 gonna be a major and progression over the next couple years. 188 00:11:40,270 --> 00:11:41,810 And definitely a lot of people are, 189 00:11:41,870 --> 00:11:45,490 are already experimenting and playing in that field. Um, 190 00:11:45,870 --> 00:11:49,290 but I also think on the minimally invasive side, the smaller side, which, 191 00:11:49,350 --> 00:11:54,060 you know, sometimes gets neglected, um, because you know, it's smaller, 192 00:11:54,310 --> 00:11:56,500 right? And sometimes it doesn't require hardware. 193 00:11:57,160 --> 00:12:01,820 So I still think that endoscopic or arthroscopic or arthroscopic 194 00:12:02,260 --> 00:12:06,860 assisted that these types of surgeries in the US um, 195 00:12:07,320 --> 00:12:11,540 has a tremendous amount of growth opportunity. And I see it now. If you, if you, 196 00:12:12,080 --> 00:12:15,940 if um, if you follow like kind of the endoscopic session at, uh, 197 00:12:15,940 --> 00:12:18,820 society of Minimally Invasive Spine Surgery ESUs, 198 00:12:19,360 --> 00:12:22,420 and if you looked at over the past years, I would say five years ago, 199 00:12:22,420 --> 00:12:26,140 if you went through an arthroscopic or endoscopic spine uh, session, 200 00:12:27,660 --> 00:12:31,190 there's probably two or three people in the room. You couldn't even get faculty. 201 00:12:31,860 --> 00:12:36,310 Okay? But last year at ESUs, the endoscopic spine session, 202 00:12:36,650 --> 00:12:40,550 the room was packed, you know, packed. And you know, 203 00:12:40,550 --> 00:12:42,390 you have tons of faculty to choose from. 204 00:12:42,850 --> 00:12:47,390 And so I do think that that is gonna obviously 205 00:12:48,280 --> 00:12:51,990 start growing here in the us What's fascinating is I just traveled to Korea 206 00:12:53,640 --> 00:12:58,480 about four months ago. Okay. And, 207 00:12:59,020 --> 00:13:02,840 um, you know, they started with endoscopic spine surgery quite early on, um, 208 00:13:02,860 --> 00:13:04,760 and in Korea, what's fascinating is, 209 00:13:04,780 --> 00:13:09,320 is that if you need a decompression or if you need a 210 00:13:09,820 --> 00:13:10,720 um, disc removed, 211 00:13:10,720 --> 00:13:14,640 if you have a herniated disc and you need a laminotomy discectomy or just a 212 00:13:14,640 --> 00:13:15,640 simple decompression, 213 00:13:16,780 --> 00:13:21,440 you are more likely to have that treated endoscopically than you are open. 214 00:13:22,730 --> 00:13:27,620 Okay. So, uh, that has really happened over the last 10 to 15 years in, 215 00:13:27,640 --> 00:13:29,540 in Korea. And I think, you know, 216 00:13:29,540 --> 00:13:32,900 other countries have adopted endoscopic surgery and I think, you know, 217 00:13:32,900 --> 00:13:36,540 the US if we are, you know, the spine leaders that, you know, 218 00:13:36,540 --> 00:13:38,420 we will also start adopting that as well. 219 00:13:39,520 --> 00:13:42,570 Yeah, yeah, totally. Thank you so much for sharing that. Um, 220 00:13:42,790 --> 00:13:44,930 and thank you so much for those final thoughts, doctor. 221 00:13:45,000 --> 00:13:46,970 This has been an amazing, amazing discussion. 222 00:13:47,190 --> 00:13:49,930 So I wanna thank you so much for coming on Peckers Healthcare again, 223 00:13:50,070 --> 00:13:52,050 and I look forward to connecting with you again soon. 224 00:13:52,970 --> 00:13:55,830 Fantastic. Thank you very much, Mariah.