Speaker 0: This is where health care leadership comes together. Becker's sixteenth annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April. This series event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former president George w Bush. For the agenda and event details, visit beckershospitalreview.com and click on the events tab in the upper right. We're looking forward to hosting you in Chicago.

Speaker 1: This is Carly Beam with the Becker Spine and Orthopedics podcast, and I'm thrilled to be joined today by doctor Rory Murphy, a spine surgeon with Barrow Neurological Institute. Doctor Murphy, thank you for being here today.

Speaker 2: Thank you very much for the invite today, and thank you for setting this podcast up.

Speaker 1: Absolutely. So before we dive into our questions, could you just introduce yourself and share a bit more about your background?

Speaker 2: Yes. My name is Rory Murphy. I'm a neurosurgeon, and I'm a neurosurgeon with the Barrow Brain and Spine Group, and I practice here in Phoenix, Arizona. Been here for over eight years. And, did my Irish, did my medical school in Ireland, came over here, did my training and my residency in WashU in Saint Louis, fellowship in San Francisco, and then moved here.

And, here, I do have a a busy neurosurgical practice, and I really one of my main areas I'm really interested in is helping people move, especially after, cervical injuries, so cervical spinal cord injuries or helping people with cervical degenerative cervical myelopathy. And so, really working on different ways to help diagnose, treat, better surgical options for those conditions and also better research opportunities and working with companies and setting up companies to try and commercialize and get solutions out into the the real world to help people.

Speaker 1: Absolutely. That's all very fascinating. And, doctor Murphy, I wanted to touch on something that you had mentioned in the conversation that, we had earlier, last year. I know there's been some interesting conversations about cervical disc replacement infusions around, especially at, like, three levels. And I want to hear your perspective on this debate and what you've been hearing from the spine community.

Speaker 2: Yeah. And and it's it's very topical. I had, two or three people in clinic today. We discussed, they had three symptomatic areas with radiculopathy or myelopathy, attributable to three levels. And we had a long discussion with people.

And some of the people today would have been, one patient who's a neurologist and, one patient who's an athlete. So we're going through the ins and outs and nuances, and there's no exact right answer. I always discuss with people, try and match you'll find out what they hope to achieve and improve, then try and give them the options and potentially match their goals the best. Ultimately, disc replacement arthroplasty versus fusion, currently, the data says that they are about the same. Mhmm.

We have perspective information and in data from Norway and Sweden saying that there's no difference between them and the disrobeisement is not better nor worse than the fusion. And similarly, a fusion is not better nor worse than the disreplacement. Other data from The US and especially industry sponsored studies, suggests that disc replacements may have some benefits over fusions. You know, ultimately, it's down to what a patient's goals are and probably what a person's what challenges a person's willing to deal with in the future.

Speaker 1: Yeah. Because I can imagine, your patient who's, neurologist versus an athlete, they might have very different goals on what they want in their healing.

Speaker 2: Yeah. Age, stage in life, their other medical challenges. These are very important things to take into account. So this is a very topical conversation. We're gonna be debating this of the spine somewhat, in a month's time here in Phoenix in Desert Ridge.

So myself and doctor Alvesh Patel from Northwestern will be, as part of the CSRS and WNS special courses. We'll be debating the pros and cons of three level arthroplasty versus fusion. And, I've been nominated to be the proponent of three level arthroplasty. So I'm gonna go through, the data, the most up to date data, gather information from the registries, and data from, industry sources on two versus three levels. And doctor Patel would do the same for three level fusions.

So we'll go through the different, pros and cons of both. So it's I think everyone agrees that there is a rule for three level art capacity in some people.

Speaker 1: Mhmm.

Speaker 2: There's, three level fusions better than other people. And we just have to try and match the best solution to the person.

Speaker 1: Absolutely. And that sounds like a really, exciting opportunity you have ahead. And doctor Murphy, I was wondering if you could dive into some of the research that you'll be, doing this year at Beryl, whether it is, you know, into fusion or arthroplasty or is any other interesting areas of spine and neurosurgery?

Speaker 2: Yeah. So another, you know, I spent a long time with the insurance company this morning. I have a, you know, 50 year old athletic, dancer, and, she has a two level arthroplasty at four or five and five and six. And, she is developing symptoms, severe symptoms in radiculopathy, c seven radiculopathy, changes c six, c seven.

Speaker 1: Mhmm.

Speaker 2: So, her preference after extensive discussion is to have another arthroplasty because she did so well after the other two, but her insurance will not approve, or cover a third disc replacement or third arthroplasty. So I think there's a lot of information we need to get out there. We need to they their reasonable or their, logical, reason to deny it is they have to has already approved it for two levels. So I think there's a couple of things we need to do. We need to probably show that in in certain people, three level arthroplasty is safe and effective and have the FDA acknowledge that.

And the the other thing we need to look into more is hybrid. So when you have somebody who has primarily disc degeneration that you can do an arthroplasty on very well, but maybe another level where they would do better with the fusion, what's the long term data from a hybrid, approach? And I know High Ridge and, are looking at, doing a study where they're doing assessing long term outcomes after a hybrid approach, I. E, doing a disc replacement and a the continuous level infusion. So that's one study we're looking forward to being part of this year.

Speaker 1: That's awesome. And then I was wondering, you know, what are some of the top trends that you're following in health care today?

Speaker 2: Well, couple of things. I am a trustee for an excellent charity called myelopathy.org, which is set up by people with ser degenerative cervical myelopathy to help advocate for them, help with diagnosis, and help educate people with degenerative cervical myel myelopathy. So I that, group has primarily came out of The United Kingdom. And now, interestingly, the website is growing in popularity in The US. So more and more people in, The US and North America are logging on to the website because they they recognize the value.

So I think the patient education and giving people options, is really improving. And, if you have people with myelopathy in your clinic, I definitely recommend that you direct them to the myelopathy.org website where you can get very balanced, informative information for your patients. And it's a great resource for anyone who tries to help people with degenerative cervical myelopathy or who has their family member with degenerative cervical myelopathy. Mhmm. So the myelopathy.org, charity is really growing in The US this year.

I think there's gonna be a lot of work helping with people with spinal cord injuries, using different techniques. I'm looking forward to hopefully more data. We're part of the doctor Alan Levi from University of Miami is, hypothermia trial where people with acute cervical spinal cord injuries will be randomized to cooling or standard of care treatment. And, that has been running now for a number of years. We're one of the sites along with, three or four four or five other sites.

So, hopefully, the data from that will come out in the next twelve to eighteen months. So we're really looking forward to that data, because we really need better ways to help people with severe cervical spinal cord injuries. And then for people who you know, once we've decompressed the spinal cord straight away, maybe done cooling, maybe used different medications. If they don't improve after twelve to eighteen months, what options do we have? And there's a huge growth in, neuroprosthetics.

So brain computer interfaces, basically trying to bridge the gap between the brain and the extremities. And you can see a number of excellent companies really pushing to move this forward, including, Neuralink, Paradromix, Phantom Neuro. It's really an exciting time for neuroprosthetics and helping people respond with injuries or strokes or other neurological injuries.

Speaker 1: Yeah. And I'm curious, you know, with that technology, particularly the brain computer in interfaces, your neurolink chips, What's your outlook for this technology, let's say, as soon as even in the next five years?

Speaker 2: Well, I think every time you know, we always see kind of a cycle. So there usually, it takes five to ten years for the new technology comes along. The first few years, we're learning about it. We're gaining familiarity with it. And it takes, you know, five to ten years before we really, get comfortable with it and we really see the benefits.

Examples being the stereotype and navigation for spine, robotic use, arthroplasty. All these things, we we gain knowledge over time. So, endoscopy as well. You know, we so I think the neuroprosthetics will be quite different in five to ten years, and, we'll be using them in ways that we didn't quite expect. So I'm looking forward to that.

Speaker 1: Great. And then couple other questions. What do you think will be the biggest headwind that you'll be facing in 2026?

Speaker 2: It's really hard for people to navigate the health care system. You're unwell. You have a a severe brain or spine problem. You're in pain. Navigating the system is very trippy.

It's hard to get to your primary care doctor. It's hard to get the preventative care. And when you do get seen and assessed, it's hard to get the imaging. And then subsequently, if you do need a procedure to help you, the insurance company to approve it. So that's my main concern for my patients.

How do they get to the get assessed, diagnosed, and treated correctly in a pragmatic, holistic way? So, you know, that's my concern. A reduction in care because of, insurance and rationing of care.

Speaker 1: Got it. And then just the last question I had for you is, how are you thinking about growth over the next twelve to twenty four months?

Speaker 2: Well, there's different areas to grow. You know, I'm always trying to, make sure that my patients are better educated because the better educated they are, the better they do. The more they understand their condition, the more they understand the options, the better they do. Practice wise, we're always trying to refine our practice and make it better. Growth research wise, hoping to add more new help options to help people with cervical menopause and spinal cord injuries.

And, you know, on the entrepreneurial side, we're looking forward to hopefully first in human trials for smart implants and connected implants in the next, you know, twelve to eighteen months. So I think that'll be a big growth area.

Speaker 1: Great. Well, doctor Murphy, thank you so much for joining us today. Look forward to connecting down the line.

Speaker 2: Excellent. Thank you very much.