The observation that geographic use of ISP devices is more prevalent in high-income areas compared to low-income areas raises intriguing insights into the dynamics of spinal surgery. This difference could be attributed to various factors, including patient preferences, access to information, and the choices offered by healthcare providers.

It's plausible that higher-income patients, who may have greater access to healthcare information and resources, are more inclined to explore less invasive surgical options like ISP devices, as opposed to more invasive procedures like pedicle screws or laminectomies. They might also have the means to seek out surgeons and research their condition and treatment options independently.

In contrast, lower-income patients may not have the same level of access to education and resources, potentially limiting their awareness of less invasive options like ISP devices. This disparity in patient education and choice highlights the importance of patient advocacy and equitable access to healthcare information and options.

Despite challenges from insurance companies and concerns among orthopedic spine surgeons and neurosurgeons, the trend of increasing ISP use in outpatient ambulatory surgery centers for conditions like spinal stenosis and spinal fusions continues. Surgeons who are reevaluating ISP devices, particularly those with stable biomechanical characteristics, a solid clinical track record, low device-related failure rates, and appropriate FDA clearance, are contributing to the evolution of spinal surgery techniques and approaches.

The adoption of ISP devices in the outpatient setting represents a shift in the way spinal conditions are treated, potentially offering benefits such as shorter recovery times and reduced healthcare costs. As the medical community continues to explore these options, the landscape of spinal surgery may continue to evolve.