The most important health care decisions don't happen
in isolation.
They happen when leaders come together.
Becker's sixteenth annual meeting brings together more than
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hospital and health system executives this April in
Chicago.
With 800 speakers from Ascension, Cleveland Clinic, CommonSpirit
and more, the conversations get real. Leaders will
share how their scenario planning for policy shifts,
breaking through value based care barriers, and building
clinical teams that translate new ideas into real
world care.
Join top decision makers in the room April
13 through the sixteenth.
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This is Carly Beam with the Becker Spine
and Orthopedics podcast.
And today, I'm thrilled to be joined by
doctor Mauricio
Avila,
director of neurosurgery
spine at,
Saint Louis University
SSM Health. Doctor Avila, thanks so much for
joining us today. Thank you, Carly, for having
me. So before we dive into some questions,
I'd love if you could just introduce yourself
and tell us more about your background.
Yeah. So as you said, I'm Mauricio Avila.
I'm I'm currently an assistant professor at Saint
Louis University. I'm director of the,
sparring part of the of our neurosurgery program.
Been here now for three years. Did my
residency at University of Arizona.
Had to do my fellowship in Seattle with,
Jan Chapman in Radovskoubian.
And then, I came to St. Louis to,
start my practice. So So I've been here
for a couple of years.
Awesome. And I'd love to hear how you're
thinking about,
you know, the neurosurgery
spine program and just kind of growth over
the next twelve to twenty four months.
Yeah. I mean, I've been very, very excited
here. In particular, I think we've been able
to achieve something that has always been in
my mind is first creating a bridge between
neurosurgery and ortho. You know, I think as
we all evolve, we've now come to understand
that spine is a shared world.
And besides very few procedures, we basically can
do the same thing. So my philosophy was
orthoneuro. So then when I came here, that's
the first thing I did. And and the
growth has been similar. Right? We're we're growing
at different
institutions. And and, personally, I'm growing the endoscopic
spine program,
which I think has been has been very
interesting for me because I was not exposed
to that during, runs this year fellowship,
but it's it's one of the techniques that
because I'm a I'm a big believer in
minimally invasive surgery, it was very easy for
me to understand the value of endoscopic spine.
Definitely. And I I wanna well, first, I
wanna hone in on what you're saying about,
you know, bridging between spine and orthopedic spine
and narrow spine.
What does that kind of look like in
practice?
What kinds of
actions,
strategies are you thinking about?
What I did here is my ortho colleagues,
they had, basically, some a spine conference, a
spine round. So I asked if I could
join them, and then I start joining them.
And I think, as surgeons,
the way you kinda, in a way, show
humility is start showing your cases. Right? So
they're showing my own cases, you know, my
successes and my maybe not as perfect cases.
And I think that showed them that I
was willing to to do that, and that
really helped,
get us all in the same room. And
then I'll tell you, it has helped tremendously
to try to, you know, especially as a
as a much bigger group, basically, two departments
go to,
go to, some of our c suite people
and in the hospital and be like, hey.
This is something we both want in terms
of teams.
So that helps tremendously,
because now we have lines of communication.
I'll tell you for patient care, like, when
I'm on call, you know, if one of
their patients comes in, you know, I'll take
care of them and then just literally call
them and be like, hey. Your patient came
in this and that. There's none of that.
Like, oh, not my problem. You figure it
out type of thing, which also provides, I
will say, more peace of mind and and
also some quality of life.
That's really cool. So just kind of learning
from each other, actually seeing what's going on
the other side of the curtain, so to
speak.
Basically. Basically. Yeah. And I'm curious. Is endoscopic
spine one of those one of those areas
that that, you know, you really were able
to,
kinda showcase?
Yeah. Yeah. Basically. So I'm I'm I think
I'm I'm the, the one with the flag
and and trying to push it as much
as I can. But definitely a couple of
my ortho colleagues have also already done a
few cases just because we're able to get
the equipment. But as as as you probably
know, talking with many spine surgeons, he does
have a steep learning curve. So Yeah. Not
not everybody wants to, you know, do the
ten, fifteen, 20 cases for when you can
do, like, an open lunch much quicker. So
it just required that that commitment. But, yeah,
we both have used it, and,
and I think it's one of those that
we were able to bridge that that that
gap. Oh, what I'm curious. What advice do
you have for surgeons who,
they wanna learn endoscopic spine, but, you know,
again, that ten, fifteen, twenty case learning curve
seem I am sure that's definitely pretty daunting.
What advice would you have for those surgeons
who
want to get over that, mountain?
The first thing is you have to believe
in it. Right? And and I think for
me, because I'm a big, tubular decompression person.
Right? Minimally invasive. So it makes sense. Right?
No question. And I think all the companies
have done a great job in getting you
into labs, cadaver labs, and
and practice just because it's a different instrument.
And I think, you know, for example, the
microscope is more, useful for us in nurse
surgery less for the ortho, but I think
the endoscope,
because the my ortho colleagues, the shoulders, knees,
different things, they're probably more comfortable with the
endoscope versus us in neurosurgery when, you know,
we do some brain endoscopy, but it's not
the same. So you have to get familiar
with the instruments and then just have to
find that perfect case,
to start. But but it's not gonna be
easy because if let's say, you know, your
one level microdose takes you an hour and
a half, this may take three. Right? Right.
You know, you just have to have that
commitment, and then, you know, don't give up
and keep doing them because, truly, it's it's
amazing to see, you know, the visualization through
the endoscope and then, of course, patients going
home basically the same day with a tiny
incision.
Definitely. And can you talk about just this
kind of value proposition that you presented to
SSM Health when,
you know, you're saying, hey. You know, I
wanna bring this technology
to our patients, to our surgeons here.
I mean, the the key is
what what we all want is, of course,
taking care of patients and good patient outcomes,
but it is always helpful if you have
this at the same time. We can do
these cases, and people will have to stay
in the hospital. Right? So I think that's
a big valid proposition there. It's like, we
can do this
ultra minimally invasive procedure
and, you know, get good outcomes, which is
number one. But at the same time, we
can prevent people staying overnight, prevent blood loss,
prevent all these other ancillary things, you know,
pain, etcetera, that definitely will help on length
of stay. Right? So I think that's where,
most of the leadership in hospitals will see
the value of that. Because, of course, if
there's any technology, there's always gonna be some
capital
investment needed.
And I I think that's that's where it
comes, I for most of the leadership in
hospitals that they understand that part when you
you tell those
numbers. Absolutely. And, you know, besides the endoscope,
what other spine innovations are exciting you the
most?
I think that the the robotics in general,
and I know a lot of people say
that, but but, truly, I've been I've been
able to see some behind the scenes of
some of the what companies are working on.
And and I think
it's it's here to stay. Right? I think
it's not gonna go anywhere.
Of course, I think for spine, the big
thing was navigation. Once we got navigation, that
was a before and after.
But I think robotics
is not just the actual robot, but definitely
the software that gets attached to it and
all the things we can do plan with
it, which I think is there's no question
is gonna be is gonna be the future.
And as as we continue to develop these
machines and
and getting us in targets
and places and and potentially, you know, start
doing some decompression and things like that,
I think it's gonna be the new frontier.
As always, it'll be time, position, and, of
course,
good patient outcomes because it's not worth it
if laminectomy takes three hours doing it with
a robot.
Right? But but if if it's helping you
get to places or anatomy that is distorted,
then I think does provide an added value.
And you raise a good point about the
software itself. Yeah. You can have a really
good robot, but it's, you know, it's the
software that is really kind of the meat
and potatoes of the hardware itself. So what
do you wanna see in the next generation
of
spine robotics software?
It's all about, to me, planning. Right?
And I I think I went over a
planner.
It started residency and then shout out to
doctor Chaben. You know, we plan every screw.
You know, we measure every pedicle, etcetera, etcetera,
and I just keep doing the same thing.
So if I'm able to put an X-ray,
put a CT of a patient, get my
my pelvic parameters, my sagittal parameters, and etcetera,
and then plan it, and then potentially see
I hope then, hey. If I do this
here, what will happen? If I do this
here, what will happen? And, again, as as
I was saying and you mentioned is beyond
the robot. Is is that software?
And what I wanna see is me be
able to be in my office, potentially at
home in a in a cloud based
type of platform. And then, you know, the
weekend before a couple of cases during the
week, then I can do by planning. And
then if I need to modify, I can
modify it because I think that's where this
is coming from. And then
I know some companies may already be working
on this, but sharing the data in in
potentially anonymized or nonautomized because, of course, surgeons
were competitive. So I also wanna see how
much, you know, my next door surgeon is
getting on his till if he's getting the
two, you know, five degrees, 10 degrees, or
or why are we doing? And then I
think that that's where the software will come.
It's like, you know what? You wanna do
a T lift at this level. However,
based on this, you know, 150 other cases,
you probably need an ALIF. And I think
that will be very exciting for the software
as they continue to develop them.
Yeah. It's a fascinating picture you're painting here
as well. And then I was wondering,
you know, headwinds. What do you think will
be the biggest challenge that you'll face this
year, and how are you getting ahead of
it now?
Listen. A big one beyond, of course, the
cost of all this technology
is
people, personnel. I mean, here, I've been blessed
to have very good staff, and all of
a sudden, you know, they disappear.
And and you you talk with them, and
it's like, listen. I wanted to stay, but,
you know, this other place offered me, I
don't know, 2 more dollars an hour or
they offered me an extra day off. Things
like that that,
you know,
it's hard because
most sometimes we do simple cases, but some
do very complex cases, and every minute matters.
If you have a good trained, reliable staff,
it's gonna make my life easier. No question.
I don't have to think, but just to
think about the patient and the kinda critical
points of the surgery, not to think about
it. Okay. This tech or this nurse, I've
never seen a spine case. I've never seen
the navigation software, etcetera, etcetera.
I'll tell you that's been beyond, of course,
having the capital to buy all the new
technology is is having
leadership in hospitals
to understand that the value of well trained
people
who makes, and particularly my life as a
surgeon, easier because they know what they're doing,
they're trained,
and they're great people to work with. So
that's I'll tell you is one of the
big ones.
Got it. And then just my last question
I had for you, doctor Avila, is what
are three other big health care trends that
you're following closely this year?
Definitely,
in terms of the companies, I'll I'll tell
you. It all started with the VB brothers,
you know, getting the the Stryker spine part
and then, you know, the PU
separating from J and J. So that's one
trend I wanna see if there's any other
one of the big companies that are gonna
try to separate their spine business because I
think in that realm,
that can bring competition, and competition, I think,
is good, because that will probably have room
for innovation and and and new things.
Another one, of course, is reimbursement. Right? They've
been changing some reimbursement. They've been trying to,
you know, pay us less because we're more
efficient, which to me makes completely the opposite
sense.
It's like, okay. We're trained. We're getting better,
and then we're gonna get paid less. It's
like, well, you should pay more because we're
getting better.
I I will say those those are those
are the big ones that I'm I'm looking
in the in the in the upcoming year.
Great. Well, doctor Avila, thank you so much
again for taking the time to walk us
through all these
trends, ideas,
on our podcast today. It's a great conversation,
and I look forward to connecting again in
the future.
Sounds good, Carly. Thanks for having me. This
was great.