Spine Surgeons At Risk? Examining Interventional Procedures Through the Lens of Disruptive Innovation

In recent years, there has been marked growth in the scope of treatments that interventional pain management (IPM) offers to patients. Some of these interventions address non-surgical conditions, while others now compete with minimally-invasive spine surgery (MIS). Given the upstream position of IPM in the flow of patient referrals, the question must be asked - are MIS spine surgeons at risk? In this literature review, we critically analyze the latest IPM procedures through the framework of “disruptive innovation”, as defined by scholar Clayton Christensen. Key features of disruptive innovations include affordability, market decentralization, poor initial performance, and appeal to a new consumer population. Interventional procedures such as intradiscal cell therapy, L2 medial branch neurostimulation (Reactiv8), and basivertebral nerve ablation(Intracept) could represent disruptive innovations. Spine surgeons, however, are focused largely on sustaining innovations, which are incremental and expensive improvements of existing techniques. Surgeons can combat this problem by absorbing promising interventional procedures into their care models, proactively seeking solutions for current “non-consumers”, and increasing investments in MIS. Spine surgeons are not accustomed to analyzing care through the lens of business principles. The lessons of the “innovator’s dilemma” must be applied, if MIS surgeons and their patients are to thrive in the coming decades.