← Becker’s Healthcare Podcast
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- [00:00]
A
This is Carly Beam with the Becker's Spine and Orthopedics Podcast. And today I'm thrilled to be joined by Dr. Scott Blumenthal at the Texas Back Institute. Dr. Blumenthal, welcome back to the podcast and thanks for being here today.
- [00:14]
B
It's good to be back, Carly.
- [00:16]
A
Absolutely. And to start off, can you introduce yourself and tell us a bit about your background?
- [00:21]
B
Okay. As mentioned, I'm Scott Blumenthal. I am a orthopedic spinal surgeon at the Texas Back Institute or more specifically the center for Disc Replacement at tbi, which we started over a decade ago, kind of building on our focus on disc replacement, which we pioneered in the US now over 25 years ago.
- [00:46]
A
That's incredible. More than 25 years, more than half a century of disc replacement in the US and with Texas Back and also the Disc Replacement Institute, where do you see the best opportunity for growth in 2026?
- [01:02]
B
Well, I mean, I, I think what we're going to see is continued expansion of indications for motion preservation. I, I think a lot of it's patient driven that patients seem to try to look for an alternative to fusion because they've all had, they've all had a negative story about someone or someone in their family with a fusion and they, they are always asking for an alternative. And, you know, with the data that we have with both cervical and lumbar disc replacement, it's pretty favorable.
- [01:33]
A
Yeah. And I'd love to hear more about the research that you're doing at Texas Back, both in the disc replacement realm and otherwise.
- [01:41]
B
Well, the newest project that we've got going on pertains to cervical disc replacement, which has been very, very popular and gaining popularity, not only us, but worldwide. And it was really to answer the, by our patients, they all know that if you have a hip or knee replacement, they've got about a 5 to 10% chance of knee revision at 10 or 20 years. That same question was asked about disc replacement. We did a paper in the lumbar spine and found it to be about one and a half percent. But we also did a paper in the cervical spine and really found about that same number, which compares very favorably to hips and knees, which is a very established multi decade technology. So we kind of built on that particular finding, at least for the cervical spine to look for the most common reasons of failure. And then how do we revise disc? Do you always have to take a disc out and turn it into a fusion or can you truly do a revision disc to disc, which we found we were able to do in about a fourth to a third of those patients that did require revision.
- [02:54]
A
Yeah. And what are some of the. I know, again, so very, very small risk of complications. Cervical lumbar disc replacement. But what are the most common reasons you do see those small instances of complication?
- [03:12]
B
The two most common reasons we see is a condition called osteolysis, which again is something we learned from our hip and knee and shoulder replacement colleagues, which is a cyst form around a prosthesis that's felt to be due to wear of components. And every disc has components that can wear. And if they cause wear particles that the body reacts unfavorably to, they create a situation where you get these progressive cysts and then it requires revision, just much like we see in our peripheral joint. The second most common reason really is more of a learning curve or technical issue, and that is failure to address all the pathology. In other words, we take the disc out, we put a new disc in. But you also have to do a more meticulous decompression of the spinal cord and nerve roots and persistent posterior pathology, which will mean something to the physicians, but maybe less so to the non physicians listening to is probably the second most common reason for needing revisions.
- [04:25]
A
Got it. And you mentioned earlier, you know, seeing these expanded indications for disk replacement, and I'm wondering, you know, what is. What are some of these indications that might be underutilized right now, underrated that you want to see gain more prominence?
- [04:42]
B
I will tell you that your question is very timely because we just had a conference on this a couple of weeks ago in, in la, and we originally and initially thought that in the cervical spine, the disc replacement was for younger patients and fusions were for older. As we've gained more experience both in the US and outside the US we have found that we can increase the age for patients to get disc replacements. More arthritic spines, spines that may have lost the normal curvature in the cervical spine. Much more. As we're in our third decade of doing this, and that's helped a lot of our older patients into their 60s and 70s even being potential candidates for disc replacement.
- [05:29]
A
That's really exciting. It sounds like also huge quality of life upgrade for the patients as well.
- [05:37]
B
No question about it. I mean, preserving motion is kind of where it's at. And motion equals function.
- [05:43]
A
Definitely. And besides disc replacement, how else do you see the spine orthopedic field evolve the next two to three years, whether it's with innovations or how practices are run, et cetera, et cetera.
- [05:59]
B
Well, I'm going To pivot. And this is more into, because everybody likes talking about robots and image guidance and things like that. I'm going to talk about patient access to care. And that being the private insurance world, we have seen such headwinds, particularly with this particular technology, such that anything that doesn't fit a very strict protocol, and that's something in the real world that just doesn't exist all that commonly because patients are, we've always treated patients individually. As we've learned again about these more expanded indications for disc replacement, we've run into resistance from the insurance industry in getting approvals for these things. And they send these robotic peer to peer doctors. And peer to peer is such a misnomer because all they're doing is regurgitating policy. They're not trying to figure out the best strategy for helping a patient. In fact, for example, today I was doing a peer to peer and the doc on the other side was listing CPT codes and what their policies and protocols are. And I said, hey, why don't we just play doctor for a little bit and talk about the patient and what's best for the patient? And unfortunately it didn't register because most of the peer to peers are not there to help the patient. They're there just to regurgitate these very restrictive policies. And I think that's something that we're going to have to deal with globally as an entity because it's basically number one corporate practice of medicine which at least in the state of Texas is illegal. And that's at the very best, at the very worst, it's just unethical and rationing patient care.
- [08:01]
A
Yeah, so. And so, Dr. Blumenthal, it sounds like a lot of your frustrations lie within these conversations you're having with other physicians like yourself.
- [08:12]
B
And I don't really, you know, that's what they're hired to do. So you know, I'm not necessarily, necessarily criticizing them as, as people they're hired to regurgitate the policy. It's truly the suits behind the, the who hide behind these really not well thought out protocols. And you know, the reality is we, we talk about the cost of healthcare. It's a big political issue. Now in last estimate, I heard 60 to 70% of healthcare costs are administrative, you know, middle management, C suite type things and really don't go to the people that are either delivering the care or receiving the care. And that's just got to change.
- [08:58]
A
Yeah. And how are you strategizing this kind of your own day to day work within these systems?
- [09:05]
B
You Know, on a micro level, you know, they're trying to outsmart us and we're trying to outsmart them. On a macro level, it just, it needs to go back to, you know, not getting in the middle of the doctor patient relationship, which is exactly the strategy that of, of these insurance companies. Even using the word provider, which is a very derogatory term to a physician, it just dehumanizes what we were trained to do, which was be in a advocating relationship with our patients.
- [09:37]
A
Got it. And then I want to pivot things a little bit again. I want to hear what you think will be the number one key disruptor to spine surgery in 2026.
- [09:51]
B
I think it's exactly that. I think it's going to be more restrictions to advanced technologies. We got these great technologies that come out and if they don't fit the protocols, they're going to restrict patients access to it. You know, much like pharmaceuticals that come up with these great new drugs. And it takes years to get on the formularies of these insurance companies. So patients don't have access unless they want to pay thousands of dollars. And a practice like ours, the center of Disc Replacement at Texas Back Institute, we've stayed within the insurance networks, whereas a lot of the disc replacement surgeons opt for an out of network strategy so they don't have to deal with, I'll use your term, these headwinds that we've been having to deal with. But for the most part, most patients can't really afford to do out of network cash pay models for, for disc replacements because it's tens of thousands of dollars.
- [10:52]
A
Yeah. And you know, I want to ask also, just what are some other healthcare trends besides what we've discussed that you've been following closely?
- [11:03]
B
You know, you know, I don't know that I, that I'm so focused on, on this particular one and advancing our technologies. You know, I think the trends that, that we see and, and that other people are talking about, and if I'm a young surgeon, it's, it's putting the instruments where they need to go without utilizing radiation. So it's, it's robotics and navigation. I think, I think that's where it's at. Unfortunately, people love to throw around the term AI, but AI is going to work more against us than for us, at least in the short term. Because of access.
- [11:42]
A
Yeah. Can you dive deeper into that? Just kind of your own experience working with AI in your practice and what you think it will take for it to get out this kind of rut you're describing? And to work better long term.
- [11:58]
B
The early AI, which, which I think is pretty cool, is the, the concept of having this third person, your AI in the room with you and your patient. You basically can just have a conversation, do a history and physical, and the AI generates the, the medical record. I think that's really, really cool. And that's not in any decision making realm. That's basically just documenting what, you know, patients problems and you know, what your findings are when you're, you know, in the room doing an exam, taking a history. The, the next level AI, I think, will go into surgical planning and indications and, and you know, where to stop your fusions if you're doing long scoliosis fusions, when maybe motion might be better than fusion, that we're not there yet. But I think that's, that's the next step from our point of view.
- [12:50]
A
That's really exciting to think about. And it does seem like there's a lot of potential with AI and where it can go. And that's all the time we do have for today. Dr. Blumenthal, thank you for joining us again and it's been a pleasure speaking and I hope to connect again down the line. Always.
- [13:07]
B
Anytime, Carly.
- [13:09]
A
Thank you, Sam.