In this special edition of Ask the Expert: Spine Series from UCI Health, spine surgeons Nitin Bhatia, MD and Michael Oh, MD discuss the current state and future of spine care — from outpatient robotic surgery to motion-preserving implants and precision-driven biologics.
Learn how UCI Health is leading the charge in advanced spinal procedures through active clinical trials, patient-specific devices, and cross-disciplinary innovation in collaboration with engineering and stem cell research experts.
Learn more: ucihealth.org/spine
Welcome to our Ask the Expert series. Uh, I'm Doctor Nitin Batia, spine surgeon here at UCI Health. Today I'm joined by my esteemed colleague Doctor Michael O. Thanks for being here today. We're gonna discuss uh advancements in spinal surgery including devices and biologics with a focus on the ongoing clinical trials being done at UCI Health. Thank you for being here, Doctor O and welcome. Thank you for having me. Uh, it's a pleasure to be a part of this series and really appreciate the opportunity to talk about the exciting work, uh, especially the research we're doing here at UCI spine. Fantastic. Well, let's start with an overview of spine surgery and some of the new technologies. Generally, what are some of the most exciting aspects of spinal devices and spinal biologics being developed these days? I think the movement into ultra minimally invasive spine surgery and the technology around that, especially endoscopes, that's an exciting area. Uh, it's robotics, uh, that's moved also into spine surgery, as you know, from orthopedics. It's been part of orthopedics for a while, but spine surgery, it's uh coming in and it's, uh, bringing in a whole new level of precision right now. The same thing with some of the biologics, we, we have newer biologics that especially if you need a fusion, it helps ensure that you get a fusion. So, uh, I think those are some of the important advances that we're seeing right now. Very interesting you talk about robotics today and The orthopedic surgery department, we actually had a lecturer talking about robotics and knee replacements, and it's been around for probably decades, but as you mentioned, spine surgery, it seems like it's relatively new. you tell us about some of the advancements being done at UCI Health regarding robotic spine surgery perhaps by yourself? Absolutely we were early adopters of robotics technology, but, uh, and because of that we were able to move it here to the Irvine Med campus and start our outpatient robotic spine program. Uh, traditionally, uh spine fusions have been done in inpatient settings with 3 to 5 day length of stay, but with this precision of these robotic devices to help guide with the advancement of some from some of these antibiotic devices and ability to do to do fusions through smaller portals. Now we can do one or two level fusion and have the patient go home the same day or the next day. So I think uh. Certainly, cutting off a couple of days from a hospital stay might not seem like the greatest advancement, but if you're the patient, it makes a big deal whether you go home the same day or you have to stay in the hospital 3 or 4 days. Well, it sounds very attractive to me for sure. Now, one thing you mentioned in that kind of surgery is a fusion, which we know is locking together two bones. I understand there's been a lot of advancements here at UCI Health on studies looking at non-fusion technologies or what we call motion sparing technologies. Can you describe some of those? Absolutely motion preservation is uh certainly increasing part of our practice here, and we were part of two recent cervical artificial disc studies. Uh, those are the, uh. That's the process where we develop uh better implants. So it's incremental, but if you want the state of the art, you have to come to a place like UCI that's involved in these clinical trials. That's developing the next generation of artificial discs for the cervical spine or even lumbar facet replacements, uh, so that we can preserve motion. So these are motion preserving type of surgeries and uh certainly fusions are very important part of our spine surgeon toolbox. But as these devices come in and are being developed, we can spare our patients that loss of motion by using uh artificial discs or artificialtris. Uh, these clinical trials, as you mentioned, really sound like they provide better care not just for us but for future generations. Can you describe how UCI Health is participating in clinical trials and spine surgery and perhaps a few that are ongoing now, right? So. The clinical trials that uh that we participate in are really carefully uh prepared emphasizing patient safety. This is how new products get to market. They come to institutions like us, uh so that uh we maintain the selection criteria so a patient comes in, we want to make sure they meet all of the inclusion criteria for the study. Once that's met, they get enrolled either into the investigational device or to the control arm of the study. Uh, this is how science works and how we determine whether this new device is actually better than a previous device. So we do that and then the patient gets enrolled in the study and we follow end up following these patients, often for 2 to 3 years or even longer to make sure that the outcomes are better and that the safety profile is just as good or better than the existing devices. Oh, sounds fantastic. Sounds like it's a great opportunity for patients to really get cutting edge care. So, yeah, so I was gonna follow up with the second part of your question, so some of the other ongoing studies right now, so. Uh, we have, uh, as far as fusion studies, we have uh Doctor Hashmi, uh, running a study looking at patient specific implants. So if you do need a fusion in the cervical spine, these implants are matched to your bone density. So again, each of these incremental steps are to increase precision, patient, uh specific parameters and to make, make for a better end result in terms of outcomes and safety. Another example is we have a study in the lumbar spine, also a fusion studies that's looking at at a biologic called bone morphogenic protein that's uh that's can be used to increase bone growth and increase rates of fusion, so that if you do need a fusion, you get a fusion, and I think that that's another important study we have ongoing here. Fantastic, really interesting. Now, do all hospitals in Orange County participate in clinical trials, or is it unique to UC Irvine? It's unique to academic centers. Uh, certainly there might be some small studies, but, but the depth and breadth of studies that we do here, uh, is unmatched within the region. If you think about clinical trials, we have 6 to 8 clinical trials ongoing at any time. We have a couple of other research activities with our partners over at, for example, the stem cell center. We're looking at spinal cord injuries and how stem cells, uh, may cure that problem. We also work with our engineering department and uh trying to develop the next generation of spine robotics, not just the ones we have right now. And we work with our translational scientists to bring things from the benchtop into the clinical practice. So unless you have an. A university, uh, it's, you can't do this kind of research. Uh, really sounds like having these other experts, not just in spine surgery, but in other fields really allows UCI Health to provide an extraordinarily high level of care for our patients currently and future patients. Right, absolutely, the only academic site in the in the region and certainly competitive in the in the Western United States for for all of these areas. It's really exciting, uh, the If I were a patient or I was a provider out in the community who wanted to take advantage of this amazing opportunity to get care at UCI Health, first of all, what kind of symptoms or problems are usually referred to a spine surgery team for evaluation and then how would they go around finding us? So most people end up seeing a spine surgeon because they have either neck pain with arm complaints or back pain with leg complaints. Uh, those are patients that have degenerative spine conditions, and we have studies that look into, uh, each of those kind of symptoms. But if you have a problem, for example, with the spinal cord, it might not really be pain. It, it would be problems with numbness or clumsiness in the hands, dropping things, gait disturbances, even bowel and bladder or sexual dysfunctions. All of those can come from disorders of the spinal cord and the spine surgeons, we deal with that as well as the ceramic structures, the bone and discs around the around the spine. So anything from back pain to arm pain to leg pain. To weakness we treat and as a symptom and we find the diagnosis and and we see if they're eligible for any of these uh innovative trials and studies. Now because somebody comes to see you as a spine surgeon, does that mean they're absolutely gonna have surgery? No, that's, I think that's one of the benefits of being a truly comprehensive spine center here at UCI we have a lot of other things. Uh, to offer them, including with working with our physiatrist, the, the physical medicine rehab department, working with our pain physicians, looking at less invasive surgical interventions, uh, uh, the procedure based uh solutions to chronic neck and back pain. That's all very interesting. Kind of as a a summary and a wrap up, what would you say, what would you say sets UCI health apart in regards to spine research and spine innovation? Uh, I think what sets apart as part of our mission that uh we really are at the forefront of this discovery and uh the way we deliver that care is also in a friendly manner is that we are not off putting, we, uh, uh, want to be the friendliest place you can get care as well as the, the most trusted and the most advanced place where you can get care for your back, uh, and spine needs. Doctor O, thank you so much for your time and your valuable insights to all of those out there. If you're interested in participating in care at UCI Health, whether from our spine team or through clinical trials, you can find more about us on our website at UCI Health. You can also contact the Spine Center directly. Thank you again, Doctor. Cody.
