Emerging Challenges and Opportunities in Spine Health: A Comprehensive Overview

Robert Rothrock, MD

On Friday, January 24, 2025, Baptist Health will host its annual Spine Symposium, an educational event that highlights state-of-the-art, evidence-based spine care, utilizing clinical trial data from the last 18 months. The event, which is in-person and virtual, is geared towards a variety of healthcare professionals, including primary care physicians, family medicine physicians, neurologists, neurosurgeons, pain specialists, physician assistants, respiratory therapist, and clinical pharmacists, among others.

By the end of this symposium, participants will be equipped to identify critical red flags for expert evaluation and management of spine-related complaints, review recent evidence-based research on diagnosing and managing common spinal conditions, and assess the roles of both conservative and surgical approaches in treating degenerative spine pathology. Additionally, they will gain insights into clinical strategies aimed at enhancing neurological outcomes in spinal pathology treatments.

Prior to the symposium, Robert Rothrock, MD, a spinal neurosurgeon at Baptist Health Miami Neuroscience Institute, provided commentary on a number of topics related to spine health. In the discussion, Rothrock talked about the impact of obesity on spinal conditions, the importance of recognizing subtle signs pf chronic spinal cord compression, and some of the common symptoms clinicians should be aware of. In addition, he provided insight on some of the latest literature in spine health that is driving the field forward, the current concerns with unnecessary spinal surgeries, and some of the emerging challenges experts face in spine health.

NeurologyLive: What are the biggest talking points in spine health currently? Where do we also need to direct more attention to?

Robert Rothrock, MD: As much of our population is aging, and ever more focused on health care and longevity, many patients are directing questions towards what can be done to prevent spinal issues.While many spinal health related issues are not necessarily directly preventable, there is no question that over the last several decades, there has been a major negative impact on general health and spine health by the increasing prevalence of morbid obesity. The promise of GLP1-agonists in treating correctly indicated patients is foremost on the mind of many frontline spinal health providers. Given that these medications appear to help many individuals significantly decreased their weight, and given that weight loss can often have major impact on both short-term and long-term spinal health outcomes, there is hopefully improvement on the way regarding population based health of the spine.

Are there certain red flags that clinicians should be more widely aware of? Even non-specialists as well?

These days, many physicians, advanced practice providers, and patients are very aware of stroke symptoms. In my experience, significantly less individuals are aware of signs of chronic spinal cord compression, otherwise known as myelopathy. Most people are familiar with the symptoms of acute and severe spinal cord injury, such as quadriparesis and paraparesis, but the subtle symptoms of compressive cervical and thoracic myelopathy can be much more insidious. Many patients are initially worked up for stroke like symptoms, but the brain imaging is negative. The symptoms include clumsiness of the hand, altered sensation to the hands, difficulty with walking and balance, frequent falls, bowel or bladder alteration in habits, and other vague body symptoms. Physical examination findings will often reveal hyperreflexia throughout, Hoffmann's reflexes in the hands, and clonus in severe cases. This more subtle clinical diagnosis deserves careful consideration, given that the long-term implications of advanced spinal cord compression can be devastating and irreversible.

Over the last 18 months, what types of notable trials or studies have helped further the field?

I was particularly interested in recent study by Grundes et al published in the Spine Journal measuring differences in expectations of outcome between patients and their treating surgeons.This study was titled "Expectations in patients undergoing spine surgery are high and unmet." (September 2024). In this prospective single center study, the authors compared and measured the difference between patient's relatively high expectations regarding surgical outcomes, and the actual measured postoperative outcome, utilizing standardized measures of pain scale. In this study, only about 30% of patients undergoing lumbar spinal surgery had a clinical outcome matching their preoperative expectation. I think that this study highlights the importance of clear and direct communication on the part of the spine surgeon, and the critical nature of establishing appropriate and realistic preoperative expectation of outcomes. So many of the issues that we face in clinical practice relate to poor or inefficient communication between physician and patient.

Going forward, are there any emerging concepts in spine health/research the clinical community should keep a close eye on?

There have been several recent studies highlighting and/or questioning the necessity of relatively high cost spinal surgeries, and indicating that certain cities and catchments have an increased incidence of what are termed unnecessary spinal surgeries. Those of us who believe in evidence-based and excellent quality spinal surgery are concerned about public perception of our specialty. Unfortunately, there are certain bad actors who give the majority of our clinical specialty a bad reputation. When performed for the appropriate indications, spinal surgeries have outstanding and enduring clinical results. Many patients lives are changed permanently for the better as a result of their surgical spinal interventions. I would recommend to anyone in the community considering undergoing surgical spinal intervention to choose an expert and board-certified surgeon in whose care to trust.