This is Carly Beam with the Becker Spine
and Orthopedics podcast.
I'm thrilled to be joined today by doctor
Craig McMains of OrthoIndy.
Doctor McMains, thank you so much for being
here today.
Hey. Thank you. I really appreciate you having
me on the the podcast.
Absolutely.
And before we get started into our main
discussion, could you share a little bit about
your background and introduce yourself for us? Yeah.
Sure. So I'm an orthopedic spine surgeon. I
work out of Indianapolis, Indiana at OrthoIndy.
We're a
physician owned group that, has our own hospital.
And,
for the last, you know, almost,
I think, fifty years from the founding of
the group and then twenty years from the
founding of the hospital or so, We've, kind
of been a forefront leader in, orthopedic care
in the Midwest here and,
really trying to make patient centered care our
focus.
And, historically, the group's been very, focused on,
kind of driving forward
newer technologies and, treatment algorithms and pathways and,
proud to be a part of that discussion.
Thank you. And,
you know, you're I know you're currently involved
in a study focused on spine biologics.
Can you talk about that study and the
outcomes that you're hoping to see?
Yeah.
Absolutely.
So
we were the first site to participate with
a company called Theradaptive. They have a new
product called OsseoDAP
SP.
And,
basically, this is, you know, really one of
the first, what we call,
osteogenic biologics in the market since, Infuse came
out,
you know, a decade or so ago.
And so,
this is kind of an exciting
product because there's really been no development in
the space. There was,
one one product, a handful of years ago
that looked at what we call BMP seven.
There's these different kind of bioactive proteins,
and that that product didn't do very well.
But, BMP two, which is what this other
product called Infuse has been, has been, you
know, kind of a mainstay for many, many
years, but has some really narrow,
FDA indications.
And there's been some issues,
kinda clinically with the use of it,
about,
particularly its its,
kind of diffusion. Right? So the substance, this
bioactive
molecule, which generates bone, can leach into the
surrounding tissues.
And so this company has come up with
a newer technique to,
kind of more directly bind that bioactive molecule
to, whatever substance that we're using as the
bone graft.
And, you know, the benefit of that would
be, a, it doesn't leach into the surrounding
tissues or cause all these other kind of
side effects.
And by doing that, we might be able
to use a a much, much lower dose
potentially
to get the same clinical fusion. So it's
a it's fairly exciting, and,
it's it's a it's, great to be a
part of that,
trial.
Yeah. And, you know, I know biologics and
especially in spine. It's an area where
it could stand to be more deeply researched.
Are there any applications that you wanna see
spine surgeons explore more with biologics, any
other interesting research that you're doing as well
in this area?
Yeah. So
we,
you know, as spine surgeons, you know, our
our gold standard is what we call autograft.
Right? So in other words, it's it's bone
taken from,
the patient's own body and used in their
spinal fusion.
And,
that,
obviously, you know, works really well, but the
concern is that, you know, if you had
to get enough bone to lay
in the spine, you usually were harvesting it
from somewhere else, what we call donor site
morbidity. It causes
pain and, you know, issues from the place
you harvested it. So these other options, whether
it's what we call an allograft coming from
a a cadaveric source or from a synthetic
source like OsteoDAP,
you know, are really promising because then we
can potentially
get a fusion result as good as autograft
without causing further harm to the patient.
I I think that the opportunity to
expand upon synthetic use where we don't have
to
come you know, complicate the,
the the procedure by having the risk of
an of a cadaveric sourced product
that maybe could be as good if maybe
not even better than auto you know, autograft
is, like, kinda the the pie in the
sky gold, you know, dream that we all
achieve or striving for. So
anything that can make the surgical experience easier
and faster is always the goal.
And,
doing some of these studies as part of
that.
We're, you know, we're constantly looking at all
kinds of other biologics. We I've looked at
some other synthetic products, and
the thing I'm excited about is not just
getting a solid fusion. Right?
Maybe a year out, which is kind of
our historical
standard, but
getting to that fusion faster.
Because if you can keep the patient if
you get the patient back to their normal
life quicker,
it's a win for everybody.
Yeah. So it sounds like really just
making recovery
faster and easier for the patient.
And, you know, we think about the role
of spine biologics in five years. What does
that look like? Are we gonna see
more people taking advantage of these products? Are
we gonna see more innovation?
I I think absolutely. There's just a
a a crazy amount of interest in the
space.
So I think more people as we kinda
get better products will utilize those other products,
like synthetics, like I mentioned earlier.
And then the innovation's gonna come from
you know, everybody talks about personalized medicine. You're
gonna have personalized biologics. You're gonna have a
biologic that knows how to go into your
body
and stimulate it to lay down bone,
in the most effective,
and the most efficient manner possible.
And so as we kind of,
expand forward, we're gonna get to those
solid fusions faster, which is one goal. Right?
But then we're also gonna
apply that learning of
biologics, not just a bone graph. We're gonna
expand it into
the implants themselves because right now, you know,
we're we we put in
pieces of metal or pieces of biologic plastic,
you know, or, bio biocompatible
plastic into the body,
and the body doesn't like to have foreign
substances in it. Right? You know? Everybody, when
they get a splinter, it the body tries
to spit it out. Mhmm. So,
if we can somehow tell the body that,
hey. This is
it's coated in a bioactive substance and, you
know, the body recognizes whatever implant you put
in as part of itself.
It'll heal
speed up that healing process and get a
a better outcome. And,
you know, that's just on the the kind
of the chemistry side of things.
We've even touched upon, like, the digital side.
Right? Where
how do we know that we're getting faster
fusions and better fusions? You know? We're we're
starting to
kinda leverage,
our learnings in the digital space to get
real time feedback maybe with how solid fusions
are becoming and how quickly they're becoming that
way. And then also,
you know, getting information about when they when
they were just giving us a real time
monitoring of the healing process.
Yeah. And then, obviously, you can't talk about
the digital space in health care without touching
on
AI. So, can you talk about how you're
using AI in your practice right now?
Yeah. So, you know, AI, it's a it's
a catchall phrase. Right? But this
is modern medicine's inflection point. Right? We had,
you know, the discovery of anisepsis, antibiotics. Right?
And then the AI here is gonna completely
change the paradigm of how we approach health
care because,
we're gonna take
you know, our ability to diagnose is gonna
be enhanced by it. Our ability to then,
from, like, a surgical perspective,
preoperatively plan will be changed. We're we're doing
work at OrthoIndy right now
leveraging,
you know, our, our imaging platform. We have
an Eos Edge scanner, and, it gives us,
like, this head to toe, high quality, low
low radiation dose image.
And we're learning,
how to integrate an AI to give us
automated
pre you know, pre preoperative measurements.
We're planning our surgeries on it, and then
it's feeding
a a,
an algorithm, a machine learning,
model to then,
determine, you know, which of these plans that
we're doing are getting us the best results
and kind of matching our preoperative templates the
best. So
and and and that's just on the surgical
side. Like, we're not even talking about leveraging
it for
knowing what type of bio biologic
to give a patient if they have osteoporosis
or if they have good bone quality.
And then on top of that, you know,
it's little things even
just, like,
you know, I I used to have a
a remote scribe in clinic. Right? I I
can I can type and write pretty fast,
but my scribe could always do it faster
than me? So they were always in the
clinic with me typing up my notes.
Now I use an AI scribing platform. And,
you know, the quality is surprisingly good, and
it's getting better, you know, month to month
that we're using it because it learns continually
from itself.
Yeah. And along with, you know, image analysis
and note taking,
are there any uses for AI in spine
surgery that you think are underrated
that more
physicians should get on top of?
Yeah. So I think,
you know, the low hanging fruit right now,
like I mentioned, like, using an AI for
your
transcription is something that like, it's it's it's
already out there. There's platforms that are available
for it. Utilize it because that means you
spend more time with your patient and,
get to talk to them more versus taking
notes and doing documentation.
I think, surgical planning software is out there,
whether it's using a image based platform, like,
that's specific like Eos
or, you know, some of the other, surgical
planning software that's that's gonna make you better
if, you know, if you measure twice, cut
once as the old, Carpenter,
adage goes. I'm an orthopedic surgeon. We like
to we like our carpentry,
analogies.
And then, you know, the other thing is
you can
utilize AI even if it's,
you know, something just commercially available, like like,
say, chat GPT. Right? Mhmm. Because these patients
that you're coming and talking to, you know,
you understand this high level of knowledge knowledge
medically, but their patient doesn't. And that that
mismatch of translation between your knowledge base and
their knowledge base causes a lot of friction
sometimes.
You'd be surprised without giving it any kind
of, obviously, protected health information. You can ask
an AI, hey. Help me explain something to
a patient or to somebody that doesn't have
a medical background, and they will give you
this template of of of of, responses or
talking points to
help bring the patient along on that health
care journey and make them a truly informed
partner in their care.
I really like the way you're describing
AI as like a tool to enhance, you
know, the face to face communication that you
do
with your patients.
And, you know, we've we've been talking about
Biologics. We've been talking about AI and their
future.
Are there any particular challenges that stand out
to you that could hinder their growth or
just make it harder for physicians to adopt?
Yeah. So,
something that is gonna be, a,
as a surgical field, we're very,
dogmatic, and we're very
entrenched in our ways. Right? We like to
make sure that everything is evidence based. We
we are resistant to sudden change for change
sake.
And that's good. Right? We don't wanna make
unnecessary changes that jeopardize patient care.
Mhmm. But
AI
and to a degree, biologics because they they're
kinda feeding into each other, frankly, at this
point.
These are things that are rapidly evolving.
And
if we don't
have a willingness
to embrace some of these
newer methods of interacting with patients and improving
patient care,
it's gonna be a detriment to our our
our product as surgeons and physicians.
And
so, you know,
it it it does take time to learn
how to utilize these tools effectively. Because like
you said, they they are tools. Right? And,
like, any tool, you get the most out
of it when you become a master of
it. And so taking the time to
understand how AI works and and utilize it
is really important. And understanding
why maybe a synthetic product
can generate
a personalized healing response that's as good as
AutoGraph.
You know, taking the time to kind of
leverage those tools in your own practice will
help,
help you in the end. But if we
don't do that, that's the biggest barrier for,
patient care and adoption of these techniques.
Very well said.
And,
thank you, doctor McMains, for joining the podcast
today. I look forward to connecting again in
the future.
Absolutely. Thank you so much.