1 00:00:00,080 --> 00:00:02,080 This is Carly Beam with the Becker Spine 2 00:00:02,080 --> 00:00:04,559 and Orthopedics podcast, and I'm thrilled to be 3 00:00:04,559 --> 00:00:07,759 joined today by doctor Rachel Protesco with George 4 00:00:07,759 --> 00:00:09,539 Washington University Hospital. 5 00:00:10,160 --> 00:00:12,160 Rachel, thank you so much for being here 6 00:00:12,160 --> 00:00:12,660 today. 7 00:00:13,144 --> 00:00:14,664 Thank you. Thanks so much for having me. 8 00:00:14,664 --> 00:00:15,324 I'm thrilled. 9 00:00:15,785 --> 00:00:17,945 Absolutely. And before we dive into our discussion, 10 00:00:17,945 --> 00:00:19,785 could you introduce yourself and tell us a 11 00:00:19,785 --> 00:00:20,844 bit about your background? 12 00:00:21,464 --> 00:00:23,484 Yeah. So my name is Rachel Bortescu. 13 00:00:23,864 --> 00:00:26,660 I'm an orthopedic spine surgeon in the department 14 00:00:26,660 --> 00:00:29,859 of orthopedic surgery at George Washington University where 15 00:00:29,859 --> 00:00:30,519 I'm faculty 16 00:00:30,980 --> 00:00:32,200 in Washington, DC. 17 00:00:32,820 --> 00:00:36,100 And, doctor Botescu, what are your top three 18 00:00:36,100 --> 00:00:36,600 goals, 19 00:00:37,060 --> 00:00:38,920 in your work this year? 20 00:00:39,625 --> 00:00:41,625 Yeah. I would say great question to kick 21 00:00:41,625 --> 00:00:43,784 off the new year. Number one, my number 22 00:00:43,784 --> 00:00:45,885 one goal I would say is incorporating endoscopy 23 00:00:46,024 --> 00:00:46,924 in my practice. 24 00:00:47,385 --> 00:00:49,225 Mhmm. So if you're not familiar or those 25 00:00:49,225 --> 00:00:51,465 who are not familiar, spinal endoscopy is a 26 00:00:51,465 --> 00:00:51,965 technique 27 00:00:52,679 --> 00:00:54,280 that a lot of people are more familiar 28 00:00:54,280 --> 00:00:56,699 with in the context of other joints. 29 00:00:57,000 --> 00:00:59,079 Right? So the shoulder, the knee, and the 30 00:00:59,079 --> 00:01:00,059 hip, for example. 31 00:01:00,519 --> 00:01:02,439 It's the idea of doing the work that 32 00:01:02,439 --> 00:01:04,200 you need to do as a surgeon through 33 00:01:04,200 --> 00:01:06,119 one portal while viewing and seeing what you're 34 00:01:06,119 --> 00:01:07,259 doing in another portal. 35 00:01:07,954 --> 00:01:10,755 What's really exciting is that this technique can 36 00:01:10,755 --> 00:01:13,174 also be translated to spine surgery. 37 00:01:13,555 --> 00:01:15,635 This was a technique I trained in, during 38 00:01:15,635 --> 00:01:17,715 one of my fellowships in my orthopedic spine 39 00:01:17,715 --> 00:01:18,935 fellowship at NYU. 40 00:01:19,314 --> 00:01:21,174 I was trained in by portal endoscopy. 41 00:01:22,115 --> 00:01:22,739 What makes 42 00:01:23,219 --> 00:01:25,479 this unique is that it is essentially 43 00:01:25,780 --> 00:01:28,040 doing ultra minimally invasive spine surgery. 44 00:01:28,500 --> 00:01:30,659 This is incredibly important when we are looking 45 00:01:30,659 --> 00:01:31,719 to offer patients 46 00:01:32,099 --> 00:01:34,680 less invasive forms of surgery that can 47 00:01:34,984 --> 00:01:36,984 get them out of surgery with less pain 48 00:01:36,984 --> 00:01:39,144 in the acute postoperative period and get them 49 00:01:39,144 --> 00:01:40,424 back to the things that they love to 50 00:01:40,424 --> 00:01:40,924 do. 51 00:01:41,224 --> 00:01:43,545 Whether that's working, whether that's spending time with 52 00:01:43,545 --> 00:01:46,364 your family, or any other recreational activities that 53 00:01:46,825 --> 00:01:49,165 patients wanna get back into, whether that's sports 54 00:01:49,305 --> 00:01:52,079 or just staying active throughout your life. So 55 00:01:52,079 --> 00:01:54,500 this is a really amazing technique in particular 56 00:01:54,560 --> 00:01:57,379 for spinal surgeries such as decompressions and microdiscectomies, 57 00:01:58,399 --> 00:01:59,619 but it's also being 58 00:02:00,239 --> 00:02:00,739 utilized, 59 00:02:01,200 --> 00:02:02,979 as well in some fusion surgeries. 60 00:02:03,435 --> 00:02:05,515 I'm currently in the process of having this 61 00:02:05,515 --> 00:02:07,995 approved at our hospital. I'm hopeful in the 62 00:02:07,995 --> 00:02:09,514 next few months that that will be the 63 00:02:09,514 --> 00:02:11,514 case and then I can start employing this 64 00:02:11,514 --> 00:02:12,814 technique with my patients. 65 00:02:13,514 --> 00:02:15,754 That's awesome to hear. And, you know, so 66 00:02:15,754 --> 00:02:18,469 sound it sounds like things are looking pretty 67 00:02:18,469 --> 00:02:20,650 good. Can you dive into sort of your, 68 00:02:20,710 --> 00:02:23,050 I guess, sales pitch to the hospital to, 69 00:02:23,189 --> 00:02:25,290 you know, have them thinking about this? 70 00:02:26,069 --> 00:02:26,969 Yeah. I think 71 00:02:27,349 --> 00:02:29,990 when we consider what goes into patients having 72 00:02:29,990 --> 00:02:32,490 spine surgery, there's a lot of things. There's, 73 00:02:33,425 --> 00:02:35,365 not only from a hospital standpoint, 74 00:02:35,905 --> 00:02:38,784 think considering things like length of stay, length 75 00:02:38,784 --> 00:02:39,525 of surgery, 76 00:02:39,824 --> 00:02:40,324 anesthesia, 77 00:02:41,344 --> 00:02:44,224 efficiency of surgery, OR time, staffing, and things 78 00:02:44,224 --> 00:02:45,044 of that nature. 79 00:02:45,360 --> 00:02:48,340 Really doing these surgeries in less invasive manners 80 00:02:48,400 --> 00:02:50,560 allows us to be more efficient to help 81 00:02:50,560 --> 00:02:52,560 more patients and also consider doing things on 82 00:02:52,560 --> 00:02:55,139 more of an outpatient basis or ambulatory surgery. 83 00:02:55,280 --> 00:02:56,500 So it's really advantageous 84 00:02:57,120 --> 00:02:58,419 from a hospital standpoint, 85 00:02:59,264 --> 00:03:01,125 and also from a patient standpoint. 86 00:03:01,585 --> 00:03:03,025 And I I think that's one of the 87 00:03:03,025 --> 00:03:05,605 the greatest advantages of doing surgery this way. 88 00:03:05,905 --> 00:03:08,465 Sounds like an absolute win win. And what 89 00:03:08,465 --> 00:03:10,405 were some of your other goals, besides, 90 00:03:10,784 --> 00:03:13,044 this? If you wanna say two more? 91 00:03:13,745 --> 00:03:15,549 Sure. So I I think the next one 92 00:03:15,549 --> 00:03:17,310 that I'm really excited about, which is also 93 00:03:17,310 --> 00:03:18,209 founded in 94 00:03:18,590 --> 00:03:20,829 in my training as a spine surgeon, having 95 00:03:20,829 --> 00:03:23,969 done both orthopedic and neurosurgical spine fellowships, 96 00:03:24,509 --> 00:03:25,969 is creating a comprehensive 97 00:03:26,509 --> 00:03:27,810 spine center at GW. 98 00:03:28,254 --> 00:03:30,655 And what that means is merging both the 99 00:03:30,655 --> 00:03:31,875 orthopedic and neurosurgery 100 00:03:32,655 --> 00:03:33,474 spine departments. 101 00:03:34,014 --> 00:03:35,875 I am fortunate that I have a great 102 00:03:36,014 --> 00:03:38,335 relationship with the neurosurgeons here, and this is 103 00:03:38,335 --> 00:03:41,294 really the future of spine surgery, especially at 104 00:03:41,294 --> 00:03:43,629 many large academic centers in The United States 105 00:03:43,629 --> 00:03:45,949 and around the world that employ this model. 106 00:03:45,949 --> 00:03:47,549 And what that really means is that you 107 00:03:47,549 --> 00:03:48,769 have orthopedic 108 00:03:49,069 --> 00:03:50,049 and neurosurgeons 109 00:03:50,509 --> 00:03:53,250 who are spine surgeons collaborating and working together 110 00:03:53,310 --> 00:03:55,090 instead of being two separate departments. 111 00:03:55,549 --> 00:03:58,034 You're working under the same department, the Department 112 00:03:58,034 --> 00:04:00,914 of Spine Surgery, and a comprehensive spine center 113 00:04:00,914 --> 00:04:02,674 isn't just about the surgeons. It's also about 114 00:04:02,674 --> 00:04:05,794 everything else that we can offer patients, whether 115 00:04:05,794 --> 00:04:07,414 that is pain management, 116 00:04:08,034 --> 00:04:08,534 injections, 117 00:04:08,914 --> 00:04:09,894 physical therapy. 118 00:04:10,539 --> 00:04:12,860 These are other departments and other providers that 119 00:04:12,860 --> 00:04:14,879 I work very closely with who take care 120 00:04:14,939 --> 00:04:17,420 of my patients, and there's often multiple steps 121 00:04:17,420 --> 00:04:18,079 that happen 122 00:04:18,379 --> 00:04:20,379 before a patient even goes to surgery in 123 00:04:20,379 --> 00:04:21,360 addition to patients 124 00:04:21,660 --> 00:04:23,420 for whom surgery is not in their best 125 00:04:23,420 --> 00:04:23,920 interest. 126 00:04:24,274 --> 00:04:26,355 So it really makes sense to have all 127 00:04:26,355 --> 00:04:28,355 of these offerings under the same roof and 128 00:04:28,355 --> 00:04:29,335 in the same place. 129 00:04:30,035 --> 00:04:32,435 At the same time, this promotes better patient 130 00:04:32,435 --> 00:04:32,935 care, 131 00:04:33,235 --> 00:04:34,935 better access, streamlining 132 00:04:35,235 --> 00:04:35,735 of 133 00:04:36,274 --> 00:04:36,774 appointments 134 00:04:37,074 --> 00:04:37,814 of staffing, 135 00:04:38,149 --> 00:04:39,930 and having everything in one place, 136 00:04:40,470 --> 00:04:42,250 both figuratively, but also 137 00:04:42,629 --> 00:04:44,470 in many cases under the same roof like 138 00:04:44,470 --> 00:04:46,790 sharing clinic space. When you can walk down 139 00:04:46,790 --> 00:04:48,310 the hallway and speak to one of your 140 00:04:48,310 --> 00:04:50,149 colleagues about a mutual patient or come up 141 00:04:50,149 --> 00:04:50,889 with a plan 142 00:04:51,264 --> 00:04:53,345 or even see that same patient both in 143 00:04:53,345 --> 00:04:54,004 the same 144 00:04:54,464 --> 00:04:57,025 day or have their intervention done, whether that's 145 00:04:57,025 --> 00:04:59,904 an injection, an ablation, etcetera, and then go 146 00:04:59,904 --> 00:05:02,404 check-in and see how they're doing. It's just 147 00:05:02,865 --> 00:05:05,264 better involvement in your patient's care and and 148 00:05:05,264 --> 00:05:07,790 can also contribute to better patient outcomes. So 149 00:05:07,790 --> 00:05:10,529 that makes a a lot of sense. Mhmm. 150 00:05:11,069 --> 00:05:13,089 Obviously, these things can take some time, 151 00:05:13,389 --> 00:05:15,310 but I'm hopeful that that by the end 152 00:05:15,310 --> 00:05:16,829 of this year, that that's another thing that 153 00:05:16,829 --> 00:05:18,769 will be on our horizon and both 154 00:05:19,095 --> 00:05:21,335 from a neurosurgery and an orthopedic standpoint here 155 00:05:21,335 --> 00:05:21,915 at GW, 156 00:05:22,935 --> 00:05:25,254 we both agree that that this is the 157 00:05:25,254 --> 00:05:25,754 future, 158 00:05:26,055 --> 00:05:27,975 and and we look forward to offering this 159 00:05:27,975 --> 00:05:28,714 to our patients. 160 00:05:29,175 --> 00:05:30,574 Yeah. Absolutely. No. I mean, I've heard from 161 00:05:30,574 --> 00:05:32,395 a lot of other spine surgeons and orthopedic 162 00:05:32,535 --> 00:05:33,514 surgeons about 163 00:05:34,370 --> 00:05:35,029 the importance 164 00:05:35,649 --> 00:05:37,270 of having more, interdisciplinary 165 00:05:38,850 --> 00:05:39,350 multidisciplinary 166 00:05:39,970 --> 00:05:40,470 collaborations. 167 00:05:40,930 --> 00:05:42,069 Exactly. Yeah. 168 00:05:42,449 --> 00:05:44,129 And so what are some other exciting things 169 00:05:44,129 --> 00:05:46,704 going on with, the spine program out here? 170 00:05:46,704 --> 00:05:49,264 Obviously, you mentioned this comprehensive spine center you're 171 00:05:49,264 --> 00:05:50,404 working on, endoscopy 172 00:05:51,185 --> 00:05:52,004 spine surgery. 173 00:05:52,544 --> 00:05:54,004 But what else is going on? 174 00:05:54,464 --> 00:05:56,625 Yeah. I would say that probably the most 175 00:05:56,625 --> 00:05:59,839 important thing is is creating the comprehensive spine 176 00:05:59,839 --> 00:06:00,339 center. 177 00:06:01,040 --> 00:06:02,660 We're also working on collaboration, 178 00:06:04,160 --> 00:06:07,120 by educating other providers in our referral base. 179 00:06:07,120 --> 00:06:08,800 So that's not just things that are very 180 00:06:08,800 --> 00:06:10,100 spine adjacent like 181 00:06:10,454 --> 00:06:11,194 pain management, 182 00:06:11,574 --> 00:06:13,574 and spine surgeons in general, but this also 183 00:06:13,574 --> 00:06:14,714 includes our primary 184 00:06:15,175 --> 00:06:18,634 care physicians. This includes other disciplines like endocrinology 185 00:06:18,854 --> 00:06:21,194 and rheumatology, people that we work with, 186 00:06:21,814 --> 00:06:24,454 very closely as well or have common patients 187 00:06:24,454 --> 00:06:24,810 with. 188 00:06:25,290 --> 00:06:26,169 And right now, they're 189 00:06:26,889 --> 00:06:28,810 in most cases for spine surgery, there's a 190 00:06:28,810 --> 00:06:31,149 process by which patients are seen. 191 00:06:31,529 --> 00:06:33,689 In many cases, you require six weeks of 192 00:06:33,689 --> 00:06:35,709 physical therapy in order to get an MRI. 193 00:06:36,569 --> 00:06:38,750 In other cases, we're looking to get patients 194 00:06:39,024 --> 00:06:40,485 treated for things like osteoporosis. 195 00:06:40,865 --> 00:06:42,084 We're looking to get, 196 00:06:42,865 --> 00:06:44,724 before spinal fusions, for example. 197 00:06:45,504 --> 00:06:47,985 And just looking to have patients worked up 198 00:06:47,985 --> 00:06:49,985 by by other means for other medical conditions 199 00:06:49,985 --> 00:06:51,444 to get optimized for surgery. 200 00:06:51,850 --> 00:06:52,589 And so 201 00:06:52,889 --> 00:06:54,589 really facilitating that communication, 202 00:06:54,889 --> 00:06:57,290 educating other providers about how this process works 203 00:06:57,290 --> 00:06:58,730 and how we can better take care of 204 00:06:58,730 --> 00:06:59,389 our patients, 205 00:06:59,850 --> 00:07:01,290 I would say is another thing that's on 206 00:07:01,290 --> 00:07:03,310 my list of goals for the upcoming year, 207 00:07:03,529 --> 00:07:05,884 but it is an exciting thing that's happening 208 00:07:05,884 --> 00:07:08,444 at GW so that we can all work 209 00:07:08,444 --> 00:07:10,785 on collaborating and taking better care of patients. 210 00:07:11,324 --> 00:07:13,084 Yeah. And I'd love to also pick your 211 00:07:13,084 --> 00:07:14,865 brain a bit on, the faculty 212 00:07:15,404 --> 00:07:17,164 work you've been doing. What are some of 213 00:07:17,164 --> 00:07:18,660 the most important, 214 00:07:19,680 --> 00:07:20,180 lessons, 215 00:07:20,639 --> 00:07:22,639 themes that you're instilling in, 216 00:07:23,519 --> 00:07:25,459 residents, fellows, students, etcetera? 217 00:07:26,639 --> 00:07:28,419 I think one of the most important 218 00:07:28,879 --> 00:07:29,939 things is mentorship, 219 00:07:30,694 --> 00:07:32,455 And that's something that you and I may 220 00:07:32,455 --> 00:07:34,074 even have spoken about previously. 221 00:07:34,775 --> 00:07:36,395 It's such an important thing 222 00:07:36,935 --> 00:07:39,415 as a resident. Not that that was terribly 223 00:07:39,415 --> 00:07:41,014 long ago for me, but as a resident, 224 00:07:41,014 --> 00:07:42,535 when you think back to the people who 225 00:07:42,535 --> 00:07:44,535 influenced your choice in the field you go 226 00:07:44,535 --> 00:07:46,240 into and into your sub specialty. 227 00:07:47,500 --> 00:07:49,500 And you you think about it like not 228 00:07:49,500 --> 00:07:51,660 every orthopedic resident that comes to work with 229 00:07:51,660 --> 00:07:53,600 me is gonna be a spine surgeon, but 230 00:07:53,740 --> 00:07:55,420 there are people who want to be. So 231 00:07:55,420 --> 00:07:57,120 whether I'm serving as a mentor, 232 00:07:57,740 --> 00:07:59,500 for somebody who is interested in in the 233 00:07:59,500 --> 00:08:00,639 field of spine surgery, 234 00:08:01,395 --> 00:08:03,895 from someone from a research standpoint or academics, 235 00:08:04,355 --> 00:08:06,855 a medical student who's trying to decide what 236 00:08:06,915 --> 00:08:09,235 subspecialty they might want to go into, whether 237 00:08:09,235 --> 00:08:11,634 that's orthopedics or not. This is one of 238 00:08:11,634 --> 00:08:14,035 the reasons that I really enjoy being in 239 00:08:14,035 --> 00:08:16,680 in academic side of things because I do 240 00:08:16,680 --> 00:08:19,720 get to to mentor and teach and really 241 00:08:19,720 --> 00:08:21,420 guide people and figure out, 242 00:08:22,199 --> 00:08:24,620 from both a medical student and a resident 243 00:08:24,680 --> 00:08:25,180 standpoint, 244 00:08:25,639 --> 00:08:27,639 what makes them happy and what might provide 245 00:08:27,639 --> 00:08:29,180 them with a fulfilling career. 246 00:08:29,894 --> 00:08:30,394 Absolutely. 247 00:08:30,694 --> 00:08:31,814 And, you know, what are some of the 248 00:08:31,814 --> 00:08:35,754 biggest headwinds you're bracing yourself for in 2026? 249 00:08:36,375 --> 00:08:38,215 Yeah. I I would imagine that there are 250 00:08:38,215 --> 00:08:40,774 a number of other spine surgeons who have 251 00:08:40,774 --> 00:08:41,995 some of the same feelings, 252 00:08:42,375 --> 00:08:43,975 on these issues, but one of the main 253 00:08:43,975 --> 00:08:46,110 concerns for for me for the upcoming year 254 00:08:46,110 --> 00:08:47,970 is really the continued challenges 255 00:08:48,509 --> 00:08:50,210 that we have and whether or not insurance 256 00:08:50,269 --> 00:08:52,750 companies are going to continue increasing things like 257 00:08:52,750 --> 00:08:54,129 denials and peer to peers. 258 00:08:54,509 --> 00:08:55,410 The the authorization 259 00:08:55,789 --> 00:08:58,190 process, this is goes for imaging, but also 260 00:08:58,190 --> 00:09:00,985 surgeries in general has just been incredibly time 261 00:09:00,985 --> 00:09:03,625 consuming. It's challenging, and we really noticed a 262 00:09:03,625 --> 00:09:04,684 drastic increase 263 00:09:05,544 --> 00:09:07,804 in the peer to peers required not just 264 00:09:07,865 --> 00:09:09,884 to get things like MRIs done, 265 00:09:10,424 --> 00:09:13,199 but also for denials related to surgeries. And 266 00:09:13,199 --> 00:09:15,079 a lot of these patients are really well 267 00:09:15,079 --> 00:09:15,579 indicated, 268 00:09:16,600 --> 00:09:17,899 and really suffering, 269 00:09:18,440 --> 00:09:20,679 leading into their spine surgeries. And it's something 270 00:09:20,679 --> 00:09:22,679 that we we fight for, and almost every 271 00:09:22,679 --> 00:09:24,279 spine surgeon that I know is fighting for 272 00:09:24,279 --> 00:09:25,259 on a daily basis. 273 00:09:25,720 --> 00:09:28,125 So that's one of the challenges that we 274 00:09:28,205 --> 00:09:30,524 kind of brace ourselves as the years progressed 275 00:09:30,524 --> 00:09:32,764 for in the upcoming year, but we will 276 00:09:32,764 --> 00:09:34,625 continue to fight it for our patients. 277 00:09:35,325 --> 00:09:36,684 Yeah. Can you just kind of dive into 278 00:09:36,684 --> 00:09:38,205 just kind of your strategy when it comes 279 00:09:38,205 --> 00:09:39,485 to dealing with, 280 00:09:40,205 --> 00:09:42,225 insurers, these peer to peers? 281 00:09:43,199 --> 00:09:45,120 I think that one of the most important 282 00:09:45,120 --> 00:09:46,899 things, number one, is 283 00:09:47,279 --> 00:09:49,759 just the foundation of this indicating your patients 284 00:09:49,759 --> 00:09:50,740 well for surgery, 285 00:09:51,279 --> 00:09:53,120 doing the right surgery for the right patient 286 00:09:53,120 --> 00:09:54,179 at the right time, 287 00:09:54,720 --> 00:09:57,220 as well as documenting. I mean, your documentation 288 00:09:58,254 --> 00:10:00,735 supports your clinical decision making. You can look 289 00:10:00,735 --> 00:10:03,214 back at your note or your your office 290 00:10:03,214 --> 00:10:05,214 visits, and you can say, this is why 291 00:10:05,294 --> 00:10:07,054 you know, this is what this patient's symptoms 292 00:10:07,054 --> 00:10:09,615 were. This is, from an imaging standpoint, what 293 00:10:09,615 --> 00:10:09,650 I believe the pathology is, and this is 294 00:10:09,650 --> 00:10:09,686 why these are the things that they've tried 295 00:10:09,686 --> 00:10:10,850 and why I believe things 296 00:10:12,269 --> 00:10:14,509 that they've tried and why I believe they're 297 00:10:14,509 --> 00:10:16,669 indicated for this specific surgery, and you can 298 00:10:16,669 --> 00:10:20,110 demonstrate that that's your logical mode of thinking. 299 00:10:20,110 --> 00:10:21,949 I think that's one of the most important 300 00:10:21,949 --> 00:10:22,365 things, 301 00:10:22,924 --> 00:10:24,924 as well as it being a medical legal 302 00:10:24,924 --> 00:10:26,304 document. So I think 303 00:10:26,684 --> 00:10:29,644 having really tight and strong indications as well 304 00:10:29,644 --> 00:10:30,945 as documenting, 305 00:10:31,964 --> 00:10:33,504 in the medical record appropriately 306 00:10:33,964 --> 00:10:36,610 and providing very objective evidence for for what 307 00:10:36,610 --> 00:10:38,529 has been done and why you are recommending 308 00:10:38,529 --> 00:10:40,690 this are probably the most important things going 309 00:10:40,690 --> 00:10:42,050 in because then you have a leg to 310 00:10:42,050 --> 00:10:42,870 stand on. 311 00:10:43,410 --> 00:10:45,570 Yeah. So, like, really having that paper trail 312 00:10:45,570 --> 00:10:47,889 to back you up. Exactly. Yeah. Yeah. And 313 00:10:47,889 --> 00:10:49,970 then, doctor Protesco, the last question I had 314 00:10:49,970 --> 00:10:52,184 for you is, how else are you thinking 315 00:10:52,184 --> 00:10:54,264 about growth in your practice? I know you 316 00:10:54,264 --> 00:10:56,584 touched on wanting to, you know, expand their 317 00:10:56,584 --> 00:10:57,084 endoscopy 318 00:10:57,704 --> 00:10:59,144 work. But, you know, what are some other 319 00:10:59,144 --> 00:11:01,084 areas of growth that you're envisioning? 320 00:11:02,345 --> 00:11:04,840 Yeah. I think on on the along the 321 00:11:04,840 --> 00:11:08,120 lines of incorporating less invasive options for patients, 322 00:11:08,120 --> 00:11:09,500 which we touched on already, 323 00:11:09,800 --> 00:11:12,379 another thing that is very exciting as far 324 00:11:12,519 --> 00:11:14,920 as spine surgery goes is the incorporation of 325 00:11:14,920 --> 00:11:15,899 advanced technology. 326 00:11:16,279 --> 00:11:18,735 So these are things like not only robotics, 327 00:11:19,674 --> 00:11:22,254 in in navigation, which I use very frequently, 328 00:11:22,314 --> 00:11:22,814 but, 329 00:11:23,434 --> 00:11:26,095 additional things in the pipeline like augmented reality. 330 00:11:26,794 --> 00:11:28,475 I I mean, the the goal is to 331 00:11:28,475 --> 00:11:29,454 be able to 332 00:11:29,919 --> 00:11:31,940 do a less invasive spine surgery 333 00:11:32,559 --> 00:11:33,700 through a microscope 334 00:11:34,080 --> 00:11:36,160 where you can see an overlay of the 335 00:11:36,160 --> 00:11:38,259 pathology without actually looking 336 00:11:38,639 --> 00:11:40,799 at it. Right? There are companies here that 337 00:11:40,799 --> 00:11:43,360 are working on these technologies and so these 338 00:11:43,360 --> 00:11:45,815 are these are things that other companies I'm 339 00:11:45,815 --> 00:11:47,434 talking to, things we're exploring, 340 00:11:48,215 --> 00:11:50,375 and we're always looking for ways. The bottom 341 00:11:50,375 --> 00:11:51,975 line is not just that these things are 342 00:11:51,975 --> 00:11:53,815 cool and exciting, but we are looking for 343 00:11:53,815 --> 00:11:54,955 ways to make surgery 344 00:11:55,335 --> 00:11:58,055 safer and incorporate them into our workflow and 345 00:11:58,055 --> 00:11:58,715 our practice 346 00:11:59,095 --> 00:12:00,634 so that we can take care of patients 347 00:12:00,799 --> 00:12:02,720 better and for them to have better outcomes. 348 00:12:02,720 --> 00:12:04,559 That's the goal. Yeah. And then I just 349 00:12:04,559 --> 00:12:06,799 had a quick follow-up. I mean, obviously, without, 350 00:12:06,799 --> 00:12:09,600 like, naming names, but are there any any 351 00:12:09,600 --> 00:12:10,100 particular, 352 00:12:10,959 --> 00:12:13,139 types of spine technologies that you think will 353 00:12:13,360 --> 00:12:16,995 really soar, really develop in the next twelve 354 00:12:16,995 --> 00:12:17,495 months? 355 00:12:18,754 --> 00:12:20,995 I think in in terms of what I 356 00:12:20,995 --> 00:12:22,595 know is available and what I know is 357 00:12:22,595 --> 00:12:23,254 out there, 358 00:12:23,794 --> 00:12:24,294 there 359 00:12:25,075 --> 00:12:26,455 are navigation systems 360 00:12:27,235 --> 00:12:28,054 that are 361 00:12:28,500 --> 00:12:31,639 vendor agnostic, meaning you can use any implants 362 00:12:31,700 --> 00:12:33,879 that that you would like from any company 363 00:12:34,340 --> 00:12:35,639 in addition to having 364 00:12:36,820 --> 00:12:37,399 the accuracy 365 00:12:38,019 --> 00:12:40,500 that is incredible. Right? So what that means 366 00:12:40,500 --> 00:12:41,000 is 367 00:12:41,334 --> 00:12:41,834 submillimeter 368 00:12:42,134 --> 00:12:44,695 accuracy when you're placing a screw in the 369 00:12:44,695 --> 00:12:46,214 pedicle of the spine when you're doing a 370 00:12:46,214 --> 00:12:48,534 spinal fusion, for example, that's very close to 371 00:12:48,534 --> 00:12:50,634 the nerves or the spinal canal. I mean, 372 00:12:50,855 --> 00:12:52,534 these are things that are real and that 373 00:12:52,534 --> 00:12:54,134 are out there and that are gaining in 374 00:12:54,134 --> 00:12:54,634 popularity. 375 00:12:55,100 --> 00:12:57,279 So I I wouldn't be surprised, especially 376 00:12:57,899 --> 00:13:00,160 at the rate that this type of technology 377 00:13:00,620 --> 00:13:02,639 is developing and being utilized, 378 00:13:03,019 --> 00:13:04,779 that it doesn't come to a head and 379 00:13:04,779 --> 00:13:06,800 become even more popular in the next year. 380 00:13:06,940 --> 00:13:08,620 Yeah. So it sounds like that versatility is 381 00:13:08,620 --> 00:13:11,215 probably just especially important, I imagine, for, 382 00:13:11,754 --> 00:13:12,575 spine surgeons. 383 00:13:13,434 --> 00:13:15,754 Yeah. Well, doctor Portescu, thank you again for 384 00:13:15,754 --> 00:13:17,674 joining us on today's podcast. I hope you 385 00:13:17,674 --> 00:13:19,595 enjoy the rest of your evening, and I 386 00:13:19,595 --> 00:13:21,695 look forward to connecting again in the future. 387 00:13:21,754 --> 00:13:23,514 Yeah. Likewise. Thank you so much for having 388 00:13:23,514 --> 00:13:24,391 me. It's been great.