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The most important health care decisions don't happen

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in isolation.

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They happen when leaders come together.

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Becker's sixteenth annual meeting brings together more than

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3,500

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hospital and health system executives this April in

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Chicago.

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With 800 speakers from Ascension, Cleveland Clinic, CommonSpirit

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and more, the conversations get real. Leaders will

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share how their scenario planning for policy shifts,

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breaking through value based care barriers, and building

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clinical teams that translate new ideas into real

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world care.

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Join top decision makers in the room April

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13 through the sixteenth.

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For the agenda and event details, visit beckers

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hospital review dot com and click on the

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events tab in the upper right.

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This is Carly Beam with the Becker Spine

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and Orthopedics podcast.

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And today, I'm thrilled to be joined by

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doctor Mauricio

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Avila,

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director of neurosurgery

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spine at,

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Saint Louis University

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SSM Health. Doctor Avila, thanks so much for

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joining us today. Thank you, Carly, for having

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me. So before we dive into some questions,

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I'd love if you could just introduce yourself

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and tell us more about your background.

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Yeah. So as you said, I'm Mauricio Avila.

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I'm I'm currently an assistant professor at Saint

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Louis University. I'm director of the,

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sparring part of the of our neurosurgery program.

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Been here now for three years. Did my

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residency at University of Arizona.

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Had to do my fellowship in Seattle with,

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Jan Chapman in Radovskoubian.

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And then, I came to St. Louis to,

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start my practice. So So I've been here

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for a couple of years.

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Awesome. And I'd love to hear how you're

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thinking about,

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you know, the neurosurgery

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spine program and just kind of growth over

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the next twelve to twenty four months.

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Yeah. I mean, I've been very, very excited

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here. In particular, I think we've been able

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to achieve something that has always been in

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my mind is first creating a bridge between

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neurosurgery and ortho. You know, I think as

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we all evolve, we've now come to understand

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that spine is a shared world.

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And besides very few procedures, we basically can

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do the same thing. So my philosophy was

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orthoneuro. So then when I came here, that's

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the first thing I did. And and the

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growth has been similar. Right? We're we're growing

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at different

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institutions. And and, personally, I'm growing the endoscopic

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spine program,

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which I think has been has been very

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interesting for me because I was not exposed

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to that during, runs this year fellowship,

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but it's it's one of the techniques that

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because I'm a I'm a big believer in

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minimally invasive surgery, it was very easy for

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me to understand the value of endoscopic spine.

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Definitely. And I I wanna well, first, I

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wanna hone in on what you're saying about,

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you know, bridging between spine and orthopedic spine

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and narrow spine.

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What does that kind of look like in

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practice?

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What kinds of

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actions,

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strategies are you thinking about?

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What I did here is my ortho colleagues,

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they had, basically, some a spine conference, a

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spine round. So I asked if I could

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join them, and then I start joining them.

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And I think, as surgeons,

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the way you kinda, in a way, show

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humility is start showing your cases. Right? So

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they're showing my own cases, you know, my

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successes and my maybe not as perfect cases.

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And I think that showed them that I

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was willing to to do that, and that

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really helped,

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get us all in the same room. And

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then I'll tell you, it has helped tremendously

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to try to, you know, especially as a

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as a much bigger group, basically, two departments

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go to,

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go to, some of our c suite people

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and in the hospital and be like, hey.

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This is something we both want in terms

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of teams.

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So that helps tremendously,

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because now we have lines of communication.

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I'll tell you for patient care, like, when

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I'm on call, you know, if one of

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their patients comes in, you know, I'll take

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care of them and then just literally call

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them and be like, hey. Your patient came

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in this and that. There's none of that.

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Like, oh, not my problem. You figure it

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out type of thing, which also provides, I

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will say, more peace of mind and and

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also some quality of life.

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That's really cool. So just kind of learning

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from each other, actually seeing what's going on

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the other side of the curtain, so to

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speak.

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Basically. Basically. Yeah. And I'm curious. Is endoscopic

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spine one of those one of those areas

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that that, you know, you really were able

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to,

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kinda showcase?

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Yeah. Yeah. Basically. So I'm I'm I think

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I'm I'm the, the one with the flag

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and and trying to push it as much

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as I can. But definitely a couple of

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my ortho colleagues have also already done a

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few cases just because we're able to get

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the equipment. But as as as you probably

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know, talking with many spine surgeons, he does

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have a steep learning curve. So Yeah. Not

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not everybody wants to, you know, do the

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ten, fifteen, 20 cases for when you can

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do, like, an open lunch much quicker. So

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it just required that that commitment. But, yeah,

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we both have used it, and,

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and I think it's one of those that

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we were able to bridge that that that

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gap. Oh, what I'm curious. What advice do

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you have for surgeons who,

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they wanna learn endoscopic spine, but, you know,

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again, that ten, fifteen, twenty case learning curve

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seem I am sure that's definitely pretty daunting.

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What advice would you have for those surgeons

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who

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want to get over that, mountain?

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The first thing is you have to believe

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in it. Right? And and I think for

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me, because I'm a big, tubular decompression person.

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Right? Minimally invasive. So it makes sense. Right?

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No question. And I think all the companies

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have done a great job in getting you

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into labs, cadaver labs, and

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and practice just because it's a different instrument.

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And I think, you know, for example, the

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microscope is more, useful for us in nurse

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surgery less for the ortho, but I think

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the endoscope,

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because the my ortho colleagues, the shoulders, knees,

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different things, they're probably more comfortable with the

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endoscope versus us in neurosurgery when, you know,

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we do some brain endoscopy, but it's not

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the same. So you have to get familiar

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with the instruments and then just have to

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find that perfect case,

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to start. But but it's not gonna be

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easy because if let's say, you know, your

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one level microdose takes you an hour and

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a half, this may take three. Right? Right.

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You know, you just have to have that

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commitment, and then, you know, don't give up

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and keep doing them because, truly, it's it's

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amazing to see, you know, the visualization through

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the endoscope and then, of course, patients going

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home basically the same day with a tiny

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incision.

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Definitely. And can you talk about just this

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kind of value proposition that you presented to

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SSM Health when,

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you know, you're saying, hey. You know, I

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wanna bring this technology

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to our patients, to our surgeons here.

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I mean, the the key is

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what what we all want is, of course,

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taking care of patients and good patient outcomes,

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but it is always helpful if you have

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this at the same time. We can do

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these cases, and people will have to stay

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in the hospital. Right? So I think that's

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a big valid proposition there. It's like, we

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can do this

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ultra minimally invasive procedure

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and, you know, get good outcomes, which is

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number one. But at the same time, we

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can prevent people staying overnight, prevent blood loss,

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prevent all these other ancillary things, you know,

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pain, etcetera, that definitely will help on length

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of stay. Right? So I think that's where,

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most of the leadership in hospitals will see

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the value of that. Because, of course, if

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there's any technology, there's always gonna be some

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capital

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investment needed.

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And I I think that's that's where it

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comes, I for most of the leadership in

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hospitals that they understand that part when you

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you tell those

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numbers. Absolutely. And, you know, besides the endoscope,

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what other spine innovations are exciting you the

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most?

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I think that the the robotics in general,

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and I know a lot of people say

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that, but but, truly, I've been I've been

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able to see some behind the scenes of

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some of the what companies are working on.

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And and I think

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it's it's here to stay. Right? I think

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it's not gonna go anywhere.

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Of course, I think for spine, the big

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thing was navigation. Once we got navigation, that

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was a before and after.

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But I think robotics

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is not just the actual robot, but definitely

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the software that gets attached to it and

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all the things we can do plan with

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it, which I think is there's no question

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is gonna be is gonna be the future.

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And as as we continue to develop these

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machines and

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and getting us in targets

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and places and and potentially, you know, start

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doing some decompression and things like that,

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I think it's gonna be the new frontier.

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As always, it'll be time, position, and, of

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course,

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good patient outcomes because it's not worth it

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if laminectomy takes three hours doing it with

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a robot.

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Right? But but if if it's helping you

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get to places or anatomy that is distorted,

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then I think does provide an added value.

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And you raise a good point about the

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software itself. Yeah. You can have a really

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good robot, but it's, you know, it's the

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software that is really kind of the meat

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and potatoes of the hardware itself. So what

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do you wanna see in the next generation

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of

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spine robotics software?

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It's all about, to me, planning. Right?

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And I I think I went over a

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planner.

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It started residency and then shout out to

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doctor Chaben. You know, we plan every screw.

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You know, we measure every pedicle, etcetera, etcetera,

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and I just keep doing the same thing.

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So if I'm able to put an X-ray,

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put a CT of a patient, get my

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my pelvic parameters, my sagittal parameters, and etcetera,

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and then plan it, and then potentially see

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I hope then, hey. If I do this

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here, what will happen? If I do this

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here, what will happen? And, again, as as

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I was saying and you mentioned is beyond

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the robot. Is is that software?

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And what I wanna see is me be

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able to be in my office, potentially at

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home in a in a cloud based

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type of platform. And then, you know, the

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weekend before a couple of cases during the

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week, then I can do by planning. And

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then if I need to modify, I can

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modify it because I think that's where this

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is coming from. And then

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I know some companies may already be working

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on this, but sharing the data in in

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potentially anonymized or nonautomized because, of course, surgeons

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were competitive. So I also wanna see how

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much, you know, my next door surgeon is

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getting on his till if he's getting the

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two, you know, five degrees, 10 degrees, or

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or why are we doing? And then I

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think that that's where the software will come.

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It's like, you know what? You wanna do

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a T lift at this level. However,

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based on this, you know, 150 other cases,

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you probably need an ALIF. And I think

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that will be very exciting for the software

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as they continue to develop them.

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Yeah. It's a fascinating picture you're painting here

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as well. And then I was wondering,

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you know, headwinds. What do you think will

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be the biggest challenge that you'll face this

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year, and how are you getting ahead of

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it now?

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Listen. A big one beyond, of course, the

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cost of all this technology

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is

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people, personnel. I mean, here, I've been blessed

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to have very good staff, and all of

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a sudden, you know, they disappear.

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And and you you talk with them, and

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it's like, listen. I wanted to stay, but,

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you know, this other place offered me, I

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don't know, 2 more dollars an hour or

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they offered me an extra day off. Things

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like that that,

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you know,

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it's hard because

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most sometimes we do simple cases, but some

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do very complex cases, and every minute matters.

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If you have a good trained, reliable staff,

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it's gonna make my life easier. No question.

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I don't have to think, but just to

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think about the patient and the kinda critical

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points of the surgery, not to think about

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it. Okay. This tech or this nurse, I've

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never seen a spine case. I've never seen

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the navigation software, etcetera, etcetera.

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I'll tell you that's been beyond, of course,

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having the capital to buy all the new

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technology is is having

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leadership in hospitals

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to understand that the value of well trained

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people

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who makes, and particularly my life as a

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surgeon, easier because they know what they're doing,

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they're trained,

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and they're great people to work with. So

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that's I'll tell you is one of the

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big ones.

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Got it. And then just my last question

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I had for you, doctor Avila, is what

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are three other big health care trends that

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you're following closely this year?

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Definitely,

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in terms of the companies, I'll I'll tell

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you. It all started with the VB brothers,

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you know, getting the the Stryker spine part

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and then, you know, the PU

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separating from J and J. So that's one

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trend I wanna see if there's any other

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one of the big companies that are gonna

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try to separate their spine business because I

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think in that realm,

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that can bring competition, and competition, I think,

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is good, because that will probably have room

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for innovation and and and new things.

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Another one, of course, is reimbursement. Right? They've

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been changing some reimbursement. They've been trying to,

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you know, pay us less because we're more

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efficient, which to me makes completely the opposite

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sense.

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It's like, okay. We're trained. We're getting better,

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and then we're gonna get paid less. It's

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like, well, you should pay more because we're

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getting better.

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I I will say those those are those

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are the big ones that I'm I'm looking

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in the in the in the upcoming year.

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Great. Well, doctor Avila, thank you so much

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again for taking the time to walk us

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through all these

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trends, ideas,

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on our podcast today. It's a great conversation,

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and I look forward to connecting again in

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the future.

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Sounds good, Carly. Thanks for having me. This

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was great.