Friday, November 9, 2012

Loveland's Spine Institute to Build Surgery Center

New 15,000-square-foot facility will open next summer in Johnstown's 2534 development

By Craig Young, Reporter-Herald Staff Writer           Read the original story in the Loveland Reporter-Herald

A Loveland medical clinic specializing in spine surgery and research has bought land for a new surgery center in Johnstown.

The Spine Institute at Rocky Mountain Associates in Orthopedic Medicine purchased property in the 2534 development southeast of the Interstate 25-U.S. 34 interchange. The 1.8 acres sold Oct. 16 for $385,000.

The company moved its office to a building in 2534 a month ago, according to practice manager Dee Goodman, and then bought the adjacent property for its new Spine and Orthopedic Surgery Center.

"Our goal is to be breaking ground soon," she said, with plans to open the surgery center in July 2013.

"We'll be specializing in research, pain management, spine surgeries and biologics (adult stem cell treatments)," she said.

The nearly 15,000-square-foot surgery center will have three operating rooms and six convalescent rooms allowing patients to stay up to 72 hours after surgery, Goodman said.

Drs. Kenneth Pettine and Jeffrey Donner formed Rocky Mountain Associates in Orthopedic Medicine in 1991 and the Spine Institute in 2004. The practice recently moved from North Grant Avenue in Loveland to 4795 Larimer Parkway in the 2534 development.

Rocky Mountain Associates employs about 25 people, including six physicians, according to Goodman, and plans to add another doctor in the near future.

The practice's owners speak nationally and internationally on innovative noninvasive spine technologies, according to the company's website, and Pettine is the co-inventor of an artificial replacement disc.

Goodman said the company chose the 2534 location because of the growth occurring there and the easy access to the interstate. "We have patients who come from all over," she said, including Denver, Colorado Springs, Wyoming and other states.

"They've heard of our spine surgeons and that they specialize in different spine cases," she said, "and we're involved in several different research studies."

The Spine Institute's new locations are directly south of Northern Colorado Long Term Acute Hospital, Northern Colorado Rehabilitation Hospital and Gonyon Cosmetic and Plastic Surgery and about a mile east of the new Kaiser Permanente clinic.

Ryan Schaefer, president of Chrisland Commercial Real Estate, which represented the seller of the land to the Spine Institute, said developers in 2534 have a goal of attracting medical facilities.

"Once the rehab hospital located there, that really created a catalyst for other medical practices to locate there," he said.

He said the Spine Institute's move to 2534 is indicative of the resurgence in the commercial and residential real estate industry that's taking hold in Northern Colorado.

"We're starting to see a rebound," Schaefer said. "It's fairly widespread."

He said the 542-acre 2534 development also is attracting the attention of retailers and primary employers, and he predicted being able to make announcements by the middle of next year.

Craig Young can be reached at 635-3634 or Follow him on Twitter: @CraigYoungRH.

Thursday, November 1, 2012

The coflex® Device Receives FDA Premarket Approval

Note: The Spine Institute participated in the coflex® study and Dr. Pettine backs its ability to help patients with moderate to severe spinal stenosis. To learn more about coflex®, please contact us.

Paradigm Spine Announces U.S. FDA PMA Approval of its Landmark coflex® Interlaminar Technology:
The First Comparative Effectiveness Study for the Treatment of Spinal Stenosis

Read this story online

New York, NY, October 17, 2012 - Paradigm Spine LLC, a provider of innovative spinal implant technologies, announces the U.S. Food and Drug Administration (“FDA”) has granted a Premarket Approval (“PMA”) Order for coflex®, a minimally invasive, Motion Preserving Interlaminar Stabilization™ device for the treatment of Moderate To Severe Stenosis With Or Without Back Pain™.

Key Points:

  • First PMA for the treatment of Moderate To Severe Stenosis With Or Without Back Pain™
  • First prospectively randomized comparative effectiveness Investigational Device Exemption (IDE) study that evaluated pedicle screw fusion following surgical decompression, the current standard of care for the treatment of moderate to severe spinal stenosis, as the control. This study is unique in spine because it prospectively collected Level 1 clinical, radiographic, safety and healthcare economic data. The coflex® device demonstrated better or equivalent outcomes in all major primary and secondary endpoints.
  • The coflex® patients spent 40% less time in the hospital compared to fusion (1.90 vs. 3.19 days), and coflex® surgeries were 36% faster compared to fusion (98 vs. 153 minutes)
  • At 2 years follow-up, 85.8% of coflex® patients showed clinically significant improvement in pain and function (measured by Oswestry Disability Index), compared to 76.7% of fusion patients
  • At 2 years follow-up, coflex® patients retained their pre-operative range of motion (within 10%) and translation (within 5%) at the treated level and maintained normal adjacent level motion. In contrast, fusion patients experience 62% motion reduction at the treated level, and 52% increase in range of motion at the superior adjacent level.
  • First PMA to collect healthcare economic data for spinal stenosis. The study data and resulting analyses demonstrate that coflex® saves the healthcare system an average of $5,000 to $8,700 per case when used as an alternative to pedicle screw fusion1.
  • The coflex® study included a significant Medicare-aged patient population.
  • The coflex® device, now available in the United States, has more than 18 years of clinical history with regulatory approval in over 40 countries throughout 6 continents.

The coflex® clinical trial supporting the PMA represents the most comprehensive Level 1 comparative effectiveness study for the treatment of spinal stenosis. The rigorous six year clinical trial proves coflex® as the first and only motion-preserving alternative to fusion for the treatment of moderate to severe spinal stenosis, by demonstrating better or equivalent outcomes in all major primary and secondary clinical and radiologic assessments, while maintaining natural motion at both treated and adjacent spinal levels. The study results are based on data evaluated from 322 patients, at 21 sites throughout the United States, who presented with a history of spinal stenosis that failed over 6 months of conservative therapy. The patients enrolled in the study were prospectively randomized to receive a surgical decompression and either coflex® Interlaminar Stabilization™ or pedicle screw fusion. The coflex® device outperformed fusion in nearly all clinical, radiographic, and perioperative outcomes, supplemented with healthcare economic data measured through 589 data points evaluated for each individual study subject over a 2 year follow-up period. The data compiled for this study comprised more than 55,000 patient-completed case report form pages, more than 375,000 clinical and radiographic data points, more than 12,000 patient x-rays and prospective health insurance, reimbursement payment and claims data. The rigor of the clinical trial and the robustness of its results are supported by over a 95% follow-up through two years postoperatively, among the highest follow-up rate for any PMA approved device in spine.

According to a Wall Street Journal analysis of data compiled by the Centers for Medicare & Medicaid Services, it is estimated that fusion costs the United States government Medicare system more than $2.2 billion annually2. The coflex® study is the first and only to quantify actual cost savings based on prospective Level 1 data, compared to the current standard of care, posterolateral fusion. On average, coflex® saved $5,000 to $8,700 per case compared to fusion1. These substantial cost savings were achieved through significantly shorter operating room time, faster patient recovery, less blood loss, less narcotics usage by patients, and shorter hospital stay, while producing faster and more sustained clinically successful outcomes as compared to fusion in the treatment of spinal stenosis.

The PMA process is the most stringent FDA regulatory pathway for medical devices, where approval is based on a determination by the FDA that the PMA contains sufficient valid scientific evidence to ensure that the device is safe and effective for its intended use, and that the benefits of the procedure and device outweigh its risks. The FDA’s Summary of Safety and Effectiveness Data, states “Based on the clinical study results, it is reasonable to conclude that a significant portion of the indicated patient population will achieve clinically significant results. In conclusion, the coflex® device represents a reasonable alternative to posterolateral fusion for the treatment of spinal stenosis.”

Marc Viscogliosi, Chairman and CEO, stated “This study provides the evidence insurance companies, surgeons and patients have been demanding. Insurance companies, surgeons and patients finally have an alternative to fusion which, based on independent study data, has demonstrated that coflex® produces better outcomes, a faster recovery, preserves motion and may be performed on an outpatient basis. For patients, the ability to walk without back pain and the progressive symptoms of stenosis is one of the most cherished functions of the aging population.”

Hal Mathews, M.D., Executive Vice President and Chief Medical Officer, stated “The coflex® study results represent a celebration of evidence for surgeons, their patients and the insurance community. We now have objective evidence of the detrimental clinical effects and relatively expensive costs of pedicle screw fusion on spinal stenosis patients. Although outcomes for pedicle screw-based fusions have been historically acceptable, it was the only option surgeons had for the last 25 years to provide stabilization when indicated, along with the decompression procedure. Importantly, coflex® was able to deliver better outcomes at a significantly lower cost to the healthcare system, which we believe is an important mandate of the current healthcare reform law.”

Reginald Davis, M.D.3, Principal Investigator for the coflex® study, stated “This is the first time a new spinal technology is proven to be better and more effective than the historical gold standard, and is still actually lower cost. I am excited to be able to provide coflex® to my patients without the need for fusion through a simple, motion preserving, and minimally invasive bone-saving surgical technique.”
For additional information on Paradigm Spine LLC, the coflex® interlaminar technology and the coflex® procedure, please visit our new website at

About Paradigm Spine LLC
Paradigm Spine LLC, founded by Viscogliosi Bros., LLC in 2004, is a privately held company focused on the design, development and marketing of solutions for the treatment of spinal conditions and diseases. The company's signature product is the coflex® Interlaminar Stabilization™ device, which has more than 18 years of clinical history with regulatory approval in more than 40 countries throughout 6 continents.
About Lumbar Spinal Stenosis

According to the American Association of Neurological Surgeons (AANS), lumbar spinal stenosis is defined as the narrowing of the spinal canal that compresses the nerves traveling through the lower back and into the legs. While it may affect younger patients due to developmental causes, spinal stenosis is a condition most commonly caused by degenerative changes of the spine in people age 60 and older. Its symptoms include pain, weakness, or numbness in the legs, calves or buttocks and are often associated with low back pain. More than 400,000 Americans, most over the age of 60, may be suffering from the symptoms of lumbar spinal stenosis, and as many as 1.2 million Americans have back and leg pain related to any type of spinal stenosis.

As stated by Katz et al. in the New England Journal of Medicine (February 2008), lumbar spinal stenosis is the most frequent indication for spinal surgery in patients older than 65 years of age.

Forward-Looking Statements
This news release contains forward-looking statements as defined in the U.S. Private Securities Litigation Reform Act of 1995. Readers are cautioned not to place undue reliance on these forward-looking statements. Actual results may differ materially from those indicated by these forward-looking statements as a result of risks and uncertainties impacting Paradigm Spine LLC’s business including increased competition; the ability of Paradigm Spine LLC to expand its operations and to attract and retain qualified professionals; technological obsolescence; general economic conditions; and other risks.

1 These results were obtained from analyses of intraoperative, postoperative, perioperative, narcotics and supply costs, and were derived from actual costs reported by study sites, supplemented by estimates or assumptions where actual numbers were not or could not be obtained.
2 Carreyrou, J, & McGinty, T. Top Spine Surgeons Reap Royalties, Medicare Bounty. Wall Street Journal. Retrieved October 12, 2012 from
3 Dr. Davis provides training and education services for Paradigm Spine LLC. Dr. Davis does not receive any royalty income from, and is not an investor in, Paradigm Spine LLC.

Thursday, September 6, 2012

The Promise of Regenerative Medicine

Kenneth A. Pettine, MD
Co-founder of The Spine Institute and founder of the Orthopedic Stem Cell Institute

Dr. Kenneth Pettine of the Orthopedic Stem Cell Institute provides a preliminary but promising report on allogeneic mesenchymal precursor cells.

Administering undifferentiated stem cells to an injured disc has made adult stem cell regenerative medicine in spine a reality. Adult stem cell regenerative medicine holds the promise of stabilizing or even reversing the degenerative changes associated with aging or following traumatic injury. Current clinical use of stem cells is very limited, in part by the cumbersome approval process. The use of concentrated bone marrow aspirate (BMC) as a “stem cell” preparation is currently the simplest and safest way of utilizing the regenerative potential for mesenchymal stem cells (MSCs) to promote tissue regeneration. In fact, stem cells concentrated from bone marrow have been shown to stimulate the formation of bone, cartilage, ligament and tendon, and dermal tissues.

Conservative treatment options for lumbar and cervical pain associated with discogenic disc disease (Pfirrmann Grades 3-6) are limited. Treatment options include pain medication, steroids, physical therapy, and chiropractic care. Reversal of disc pathology has not been achieved with current available treatment modalities. Failure of these nonoperative treatments may leave surgical intervention as a treatment option.

The goal of utilizing MSCs is to not only potentially provide pain relief from the painful degenerative disc, but to reverse the degenerative process. There are three methods for placing MSCs into the painful nucleus pulposus.

The use of allogeneic mesenchymal precursor cells (MPCs) is currently being evaluated as a part of an FDA Phase I clinical trial. Extracted from donors and expanded in number by tissue culture, this process isolates and grows the stem cells into pure MPCs which are injected into the nucleus pulposus. This technology does not have FDA approval.

Utilizing expanded, autologous MSCs for injection into the painful disc is the second method. Federal regulations require the approval of an Investigational New Drug application supported by prospective, randomized clinical trials for the use of expanded autologous MSCs. The FDA has not approved this technology.

The third method involves autologous point of care therapy. This technology does not require FDA approval. The patient’s own MSCs are directly injected into the nucleus pulposus of the symptomatic degenerated disc(s) using standardized two needle discography technique. This requires fluoroscopic visualization and 2-3cc of MSCs are slowly injected into the symptomatic nucleus pulposus.

I have used Celling Biosciences ART21 technology to perform autologous point of care therapy since October 2011. To date, I've performed 72 autologous MSCs injections in the lumbar and cervical spine.

Research conducted at the Spine Institute includes an IRB approved, prospective, two-arm study to evaluate the treatment of discogenic low back pain with intradiscal injection of autologous bone marrow-derived cells.

Early analysis of the research data reveals the average lumbar pre-treatment Oswestry Disability Index (ODI) was 56.5% and improved to 22.4% at three-month follow-up (P=0.0001). The average lumbar pre-treatment Visual Analogue Scale (VAS) for pain was 7.9 (on a scale of 1-10) and improved to 4.2 at three months (P=0.0005).

There have been no complications associated with the iliac crest aspiration or disc injection. Thus far no patient in the study has undergone spine surgery following treatment. Results obtained with this technique suggest its potential clinical efficacy in the treatment of moderate to severe degenerative disc disease. These results require verification with longer follow-up and randomized prospective studies.

For more information regarding treatment options please visit our websites at or

See this article online on the International Society for the Advancement of Spine Surgery website.

Friday, August 24, 2012

Spine Surgeon Dr. Kenneth Pettine to Co-Host Meeting on Ambulatory Spine Surgery

Leading spine surgeons, ambulatory surgery center experts
to gather in Dallas in October

LOVELAND, Colo. – August 23, 2012 — Kenneth Pettine, MD, founder of The Spine Institute and Loveland Surgery Center in Colorado, is pleased to announce an upcoming meeting and cocktail reception supporting spine surgery in an ambulatory surgery center.

The meeting will take place October 25, 2012, from 5:30-7:30 p.m. in the West End Room at the Omni Hotel in Dallas, Texas. It is hosted by Dr. Pettine and Paradigm Spine. Two panels of nationally recognized spine surgeons and ASC financial experts will discuss a number of topics, including the benefits of spine surgery performed at an ASC, how to build and operate a successful ASC, education on insurance approval for spine surgeries at an ASC, current research and advanced technology.

The panelists scheduled to speak are as follows: Dr. Kenneth Pettine; Dr. Donald Johnson II, founder of Southeastern Spine Institute in South Carolina; Dr. John Peloza, founder of Center for Spine Care in Dallas; Dr. Alan Villavicencio, founder of Minimally Invasive Spine Institute in Colorado; Kenneth Hancock, president of Meridian Surgical Partners; Jeff Leland, CEO of Blue Chip Surgical Center Partners; Marc Viscogliosi, CEO of Paradigm Spine; and Robin Young, founder of Pearl Diver.

"I am very pleased to host this symposium. It will bring together some of the most prolific spine surgeons and ASC experts to discuss quality and financial topics on outpatient spine surgery," said Dr. Pettine. "Attendees will come away with a greater understanding of the clinical and economic benefits for patients, payers and surgeons when spine surgery is performed at an ASC."

The symposium's main sponsor is Access MediQuip, with additional support provided by
Meridian Surgical Partners and Blue Chip Surgical Center Partners.

To learn more about the meeting and RSVP, contact Kay Roberts at (970) 286-1329 or

Note: This symposium is not part of the official program as planned by the NASS Annual Meeting Program Committee.

About Dr. Kenneth Pettine
Kenneth Pettine, MD, is founder of The Spine Institute and Loveland Surgery Center in
Colorado, and co-founder of the Society for Ambulatory Spine Surgery. He has an extensive background in spinal surgery, research and rehabilitation; is co-inventor and co-designer of the Maverick artificial disc, a disc replacement device for the low back; and is co-inventor of the Prestige cervical artificial disc. He is the principal investigator for a dozen FDA studies involving non-fusion spine technology.

Wednesday, July 11, 2012

Mesoblast Interview: The Best Adult Stem Cell Technology in the World?

As published on Read article online here.
Mesoblast (MSB.AX) (OTC:MEOBF) CEO Silviu Itesu speaks on his company`s adult stem cell technology, particularly mesenchymal precursor cells, and the low-cost manufacturing capabilities that the technology implies. Itesu discusses development compound Revascor for use in congestive heart failure and details the latest Phase II results. In 60 patients the drug saw no adverse events and a 0% event rate (hospital visits, mortality) compared to 20% in a control group; the company is planning to initiate a 1500-patient Phase III study in the coming few months. The trials are funded entirely by Teva (TEVA), says Itesu, but the company`s financial situation would allow for a few years of `solo` operation.
Itesu briefly compares Mesoblast`s production strategies to those of Dendreon`s (DNDN) Provenge, and explains how Mesoblast`s production will be significantly less expensive. The conversation also covers two more pipeline products, a Type-2 diabetes treatment and an intervertebral disc treatment, both of which have shown promising results in Phase II studies. 
Click here to view the video interview of Mesoblast CEO Silviu Itesu.

Thursday, June 21, 2012

Eight ASCs in the United States Embracing Medical Tourism

Written by Laura Miller | Becker's ASC Review | June 21, 2012

Here are eight ambulatory surgery centers that have embraced medical tourism in the United States and attract patients from other countries. 

Red Rock Surgery Center (Las Vegas). Red Rock Surgery Center reaches out to its Las Vegas community as well as patients from around the world with their medical tourism branch. The surgery center was founded more than 10 years ago and surgeons perform approximately 1,000 procedures there annually. The center includes three operating rooms and one minor laser procedure room, allowing surgeons to perform a multitude of cases at the ASC. Medical staff at the center includes ophthalmologists, plastic surgeons, pain management physicians, hand surgeons, general surgeons and podiatrists. Red Rock Surgery Center is accredited by the Accreditation Association for Ambulatory Health Care and owned by David Malitz, MD.

The Surgery Center at Doral (Doral, Fla.). The Surgery Center at Doral includes interventional pain management, urology, general surgery and hand and upper extremity surgery. Alejandro Badia, MD, founded Badia Hand to Shoulder Center which works with the International Orthopedic Group to serve inbound medical tourist patients, who have their surgeries at The Surgery Center at Doral. The surgery center has three operating rooms, arthroscopic equipment and family waiting room. After traveling for their surgery, patients are able to stay at a hotel located near the center for recovery, often accompanied by a recovery room nursing staff. The patients are able to have rehabilitation and follow up visits while staying for a few days in the area.

Legacy Neurosurgery Spine & Brain Specialists Outpatient Surgery Center (Little Rock, Ark.).
 Legacy Neurosurgery Spine & Brain Specialists has served patients who travel across the country to have their surgery performed at a lower cost than it would be at their local hospital. They often serve cash-pay or high deductible patients traveling long distances. Led by Scott Schlesinger, MD, the team of neurosurgeons performs minimally invasive spine surgery as well as non-operative pain management procedures. The brain disorders they treat include brain tumors, aneurysms and arterial venous malformations. Additional services at the center include physical therapy.

Orthopedic Surgery Center of Orange County (Newport Beach, Calif.).
 The Orthopedic Surgery Center of Orange County is owned by the Orthopedic Specialists of Southern California and Hoag Hospital. It is a medical tourism facility associated with Patients Without Borders and has been an accredited ambulatory surgery center since 1999. Surgeons perform several procedures at the center, including ACL reconstruction, meniscus repair, shoulder surgery and spine surgery. The center is contracted with major insurance companies and will bill non-contracted payors. 

Surgery Center of Oklahoma (Oklahoma City).
 Surgery Center of Oklahoma is a 32,535-square-foot facility that is owned and operated by surgeons and anesthesiologists in central Oklahoma. The facility has been accredited by the Accreditation Association for Ambulatory Health Care since 1998 and includes prices for their services on the ASC website to attract patients of self-pay, self-insured or high-deductible plans. Surgeons at the ASC perform orthopedics, general surgery, ophthalmology, and ENT procedures. There are multiple lodging areas near the surgery center for patients to stay after their procedures. According to the ASC's website, they are able to offer lower prices since they don't have to process claims and there is no risk of non-payment.

Concord (N.H.) Ambulatory Surgery Center.
 Concord Ambulatory Surgery Center is accredited by the Accreditation Association for Ambulatory Health Care and provides ENT, orthopedics, plastic surgery, general surgery and pain management procedures. The facility has two operating rooms, four bed preparation areas and eight station recovery areas. Concord Ambulatory Surgery Center provides complete coordinated care to Canadian patients, which includes scheduling appointments, travel, accommodation and transportation to the facility. The procedures offered to medical tourism patients include knee arthroscopy, ACL reconstruction, liposuction, tonsillectomy and rotator cuff repair.

Loveland (Colo.) Surgery Center. 
Kenneth Pettine, MD, spine surgeon and co-owner of Loveland Surgery Center, noticed that patients were traveling to India and Germany to pay cash for procedures such as lumbar artificial disc replacement, which some insurance companies do not cover, although the technology is cleared by the FDA and surgeons in the United States can perform them. He felt he could provide these patients the same quality procedure at Loveland Surgery Center at a lower price if the patients were willing to pay cash. The cash price includes implant, surgeon, facility and anesthesia fees. Loveland Surgery Center is a Joint Commission-accredited facility.

Squaw Peak Surgery Center (Phoenix). 
Squaw Peak Surgery Center was founded in 1998 by Anthony Yeung, MD, and has two operating rooms. The surgeons perform endoscopic spine surgery and a dorsal endoscopic rhizotomy surgery invented and developed by Dr. Yeung. The surgery center can accommodate cash pay patients and Dr. Anthony's practice, Desert Institute for Spine Care, offers to coordinate care for medical tourists. The surgery center also has negotiated discounted rates at area hotels for their patients. The surgeons are team spine surgeons for several professional athletes, including the Arizona Diamondbacks, Colorado Rockies, Kansas City Royals, Seattle Mariners, Los Angeles Dodgers and Cincinnati Reds.

Read this article online

Wednesday, June 20, 2012

Key Challenges, Opportunities for Growth in Spine Surgery

Written by Bob Spoerl | Becker's ASC Review | June 18, 2012

At the 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 15, Kenneth Pettine, MD, a spine surgeon at the Loveland (Colo.) Surgery Center; Larry Teuber, MD, a spine surgeon and president of Medical Facilities in Rapid City, S.D.; and Timothy T. Davis, MD, DABNM, DABPMR, DABPM, a spine surgeon and director of interventional pain and electrodiagnostics at The Spine Institute in Los Angeles, discussed trends in spine surgery and ideas for improving profitability and outcomes of spine programs. Scott Becker, JD, CPA, partner at McGuireWoods, moderated the session. 

Mr. Becker kicked off the discussion by asking the spine surgeons some of the top spine surgery trends on their minds.

Dr. Davis said he sees a growing trend of spine centers and surgeons needing to meet certain criteria to get surgeries covered. He compared the trend to what he said has happened to cardiology.

"I think it's going to come down to really having to follow a strict algorithm of spine care, he said. "We already have to do this in the worker's compensation environment."

Electronic medical records will become increasingly important for spine surgeons to ensure every procedure has been tried and standards are being followed,  which is critical for reimbursement.

Dr. Pettine said he's seeing a trend in payors denying spine procedures, what he called a "dramatic change" in spine surgeons' ability to get surgeries authorized. He suggested all orthopedic surgeons study insurance plans' guideline packets, which state the requirements needed to get procedures authorized.

"If you don't understand the rules, you can't play the game," he said. 

He predicted the total number of spine procedures performed could drop by as much as 30 percent in the next year because of payor denials. 

Dr. Teuber echoed the notion by saying the backlog of pre-authorizations for spine surgeries is huge.

Later in the conversation, Mr. Becker asked the panel about some of the most exciting developments they're seeing.

"Biologics are far and away the next frontier of spine," Dr. Davis said. He was referring to the use of biologics both in surgery and prior to it. He said it's the "biggest single improvement in spine care."

Dr. Teuber agreed and added "implants will always be a growth area too.”

Dr. Pettine discussed the future in terms of where spine procedures happen. "Spine care in an ASC setting is absolutely the future," he said. It's the place where "all of the modern minimally invasive techniques for spine" can be utilized.

"The hospitals absolutely cannot compete with an ASC," he added. "We can provide this care [for] significantly less."

In order to be profitable over the next five years performing spine surgery, Dr. Pettine said spine centers should seriously look at case rates. There's an opportunity for ASCs to pick up potential spillover patients from other surgeons who sign with hospitals but lack the time to perform as many surgeries, he said.

"As far as hospitals purchasing doctors, I think that's great. The minute the hospital purchases several neurosurgeons, then he's no longer competition," he said.