Orthopedic spine surgeon Alex Cruz, MD recently shared his expertise on the latest advancements in minimally invasive spine surgery and the lasting effects of the pandemic on orthopedics on Becker’s Healthcare Spine and Orthopedic Podcast.
Read the entire interview below or listen to the podcast here.
What can a patient expect when they visit you in the office?
Normally when I see a patient for their initial consultation, I go through what their images show, and I go through their history from top to bottom. I tell most folks that have pain – back pain, leg pain, pinching of nerves, or instability of their back – that there are solutions for them. As a spine surgeon, I can offer surgery as an option for a lot of folks, but I try to seek out non-surgical solutions first. I think that’s what differentiates me, and Texas Orthopedics in general. I like to treat patients with as little surgery as possible. When you come to my office, I really engage, show your MRIs results, and get an understanding of your anatomical problem. When folks go through all conservative care options (injections, therapy, medications), and at the end of the day, if surgery is indicated, I offer it. I offer both open procedures and minimally invasive spine surgeries. I think when it is appropriate, patients do well with minimally invasive surgery, and they are happy with the results and getting back to the level of activity that they want to be at a quicker pace and with less pain.
What do you hope to focus on in your practice over the next few years?
As I’ve gotten acclimated in the Austin market, I’ve gotten to know what the culture is like here. And I’ve gotten to develop a lot of relationships with many patients and other providers (primary care physicians, pain management, and physiatrists) throughout the city. I think building rapport with the community is vital to the success of any practice, but just the engagement of the patients is for me, the reason why I wanted to do medicine in the first place. In terms of where I see my practice going over the next several years, I’m honing in more on performing minimally invasive spine surgery.
My practice is leaning towards doing fusions from a minimally invasive standpoint and trying to get patients out of the hospital within 23 hours for single level or multi-level fusions. I’ve worked a lot on pain management protocols and making sure that patients are treated appropriately, for their pain immediately after surgery with what we call multimodal regimens. That means that you tackle the pain from different aspects, so that you’re not just providing narcotic medications to patients, but you’re really trying to treat the source of their symptoms and trying to alleviate things without having long term narcotic use. For me, that that’s really important and I want to continue to develop that over the next several years.
What new technologies and platforms in spine surgery are most interesting to you?
We’re kind of living in a golden age of spine surgery right now. It’s a cool time to be alive. We really went from 20 years ago, where there was controversy as to whether even putting in screws was necessary for fusion procedures. Nowadays we know screw techniques, putting in implants and using X-rays is beneficial because you’re putting them in safely and you know exactly where you’re putting them in. But as time has gone by and as technology has evolved, we’ve gone through CAT scan navigation or CT navigation, [meaning] we are able to use a real-time cat scan in the operating room to really take a look at the anatomy of a patient, and we’re able to place screws and any other instrumentation very safely for patients, and it minimizes the risk of any complication down the line. Now there’s an advent over the last three or four years of robotics in spine surgery. Robotics is really cool because, kind of like with the Mako robot with knee surgeries, there’s a Mako equivalent to spine surgeries where you really do a lot of planning at the time of surgery and you’re really working with an artificially intelligent robot that’s able to pinpoint and map out where screws should be placed. That’s where technology has gotten us so far and that minimizes complications, makes patients happier, fewer returns to the operating room, makes operations a lot quicker and they’re all done in a minimally invasive manner, which is really cool for the patients.
What movement are you seeing with orthopedic surgeries in the outpatient setting?
There’s been a large shift throughout the country doing surgeries from the hospital setting into the ambulatory surgical center, where patients are done essentially as an outpatient, or if not within 23-hour observations and discharge. Part of that is it saves in healthcare costs, but also we’ve gone to a point where these procedures that we’re doing now that are similar to what we used to do before are a lot safer. They’re more efficient. They’re done in a way that minimizes pain in a postoperative period. So patients are able to really get home in a safe manner within 23 hours for a fusion procedure, which was unheard of 10 years ago. That’s where we are going now. I think that’s where my practice will end up going as well. It makes everybody happier, including patients considering it saves a substantial amount of money in healthcare costs.
What kind of lasting legacy will COVID-19 have on orthopedic and spine surgery?
I hope we can get past COVID-19 and you never have to think about it again, but from the spine standpoint, we’ve really learned to work on pushing toward more outpatient elective procedures. People would have surgery done and you’d be in the hospital for a while. And then you’re predisposed to getting COVID-19 while you’re in the hospital, which was a real thing at the height of the pandemic. People being the hospital for four or five days after a large surgery, and they come in communication with healthcare providers who have been exposed with COVID-19. Patients would end up getting COVID-19, they would stay in the hospital for even longer. Having that push toward doing outpatient [procedures], that was once unheard of and unthought of. So there’s been a large drive toward doing more outpatient surgeries because of COVID-19.
If you have questions about back or neck pain, or would like to schedule an appointment with our spine care team, book an appointment online or call (512) 439-1001. Keep up with Texas Orthopedics news by following us on Facebook and Instagram.
Dr. Alex Cruz is an orthopedic surgeon with fellowship training in spine surgery. He specializes in minimally invasive surgical techniques and sees patients in Northwest Austin, Central Austin, and Round Rock.