As spine surgery races toward a more automated future, Andrew Meyers, DO, an orthopedic spine surgeon at the Orthopaedic & Spine Clinic Of Louisiana in Monroe has a perspective many leaders don’t, not because he’s anti-technology, but because he trained in the middle of its takeover.
Dr. Meyers watched robotics move from novelty to default in real time. By his second year of orthopedic residency, his program adopted a knee replacement robot and quickly converted most total knees to robotic cases. When he rotated through spine, the same shift happened again, only faster.
“It was at that point where I was like, ‘Man, we’re not learning the way we were yesterday,’” Dr. Meyers told Becker’s.
For Dr. Meyers, the concern isn’t that robotics are “bad,” it’s what happens when the field forgets how to operate without them.
When robotics becomes the default
Dr. Meyers said the shift was immediate once his program brought in a spine robot. Before, he was mostly assisting. Then, suddenly, he was placing screws on nearly every case.
“I went from doing none of the screws on the rotation to suddenly my attending was like, ‘Oh, this is so easy — here, you put in all the screws on every patient,’” he said.
But that confidence didn’t feel earned.
“I was like, ‘I could do it with my eyes closed, you just drop the screw,’” he said. “There’s no technical feel.”
About a week later, the robot broke.
With the robot malfunctioning, the team reverted to traditional screw placement. Dr. Meyers said it raised a question he hasn’t been able to shake: if trainees don’t learn manual techniques, what happens when technology fails, or when surgeons practice in settings where robotics and navigation aren’t available?
It’s one thing, he said, for experienced surgeons to use robotics as a stress reliever, a tool that allows them to focus on higher-level decision-making. It’s another for trainees to use it as a substitute for skill-building.
“In training, it’s like a cheat code,” he said. “You’re cheating yourself.”
The surgeons who trained before robotics may not see the risk coming
Most established surgeons using robotics today trained in an era where freehand and fluoroscopy-guided techniques were non-negotiable. That foundation changes how they approach the tool.
Dr. Meyers worries the next generation won’t have the same internal alarm system.
“The surgeons today that are older and established have had all those foundational years before that,” he said. “The new people coming into the field may not have the mindset immediately that this is a tool, not something they can just run through the OR.”
He added that you can warn trainees repeatedly that robotics are only an assist, but the message doesn’t fully land until something goes wrong.
“You can tell somebody 100 times, ‘This is just to assist you,’” Dr. Meyers said. “But they don’t grasp the seriousness of it until something bad has happened, because it’s so easy to use.”
What fundamentals look like before tech ever enters the room
Even with robotics, Dr. Meyers said strong surgeons still do the unglamorous work: studying imaging, planning screw sizes and trajectories, and thinking through the case before walking into the OR.
He described recently performing a large thoracic fusion where he used a robot, but still planned the case as if the robot weren’t there.
“I still, on preoperative imaging, measured the pedicle sizes, measured the screw lengths, the same thing I would have done without the robot,” he said.
The difference, he said, is that robotics can tempt surgeons into trusting the system more than their own preparation, especially as vendors begin integrating AI planning tools that automate decisions.
“Now they’re releasing more AI software that’s coming with the robot,” Dr. Meyers said. “Like, ‘Oh, it’s just going to plan all the screws immediately.’ So more people probably just trust the software.”
That trust, he said, may or may not be warranted.
The moment fundamentals matter most: when your gut says “something’s off”
Robotics doesn’t only fail when something breaks. Sometimes the risk is subtler, like when the system is functioning, but the guidance doesn’t match what the surgeon believes is true.
Dr. Meyers said this is where training shows up in the most meaningful way: the ability to question what you’re seeing and slow the process down before harm occurs.
“You’re in that moment intraoperatively, ‘Can I trust what it’s telling me?’” he said. “There’s something in your stomach, that gut feeling of, ‘This doesn’t seem right.’”
In those moments, he said, the surgeon needs options, not just the robot’s plan.
“Do I need to bring in a C-arm to confirm?” he said. “Do I need to do a manual pedicle finder … to cross-reference?”
And if the robot truly fails mid-case, the surgeon has to finish the operation safely anyway, without hesitation, panic or improvisation.
“If the robot doesn’t work, or something breaks, or the part gets dropped and now it’s dirty, that’s bound to happen,” he said.
The core rule, Dr. Meyers believes, is that the surgeon must remain the driver, even when the tool is powerful.
“The surgeon needs to always be in control in that OR,” he said. “Not the robot.”
Robotics will shape where surgeons choose to practice — and who gets care
Dr. Meyers’ concern becomes even sharper because of where he practices. In more rural regions, hospitals may not have robotics or navigation available at all. And even if they do, there may not be another spine surgeon down the street to call if something goes sideways.
“I’m the only spine surgeon in the area,” Dr. Meyers said. “So if I get a robot … and it breaks down, there’s no one for me to call.”
That reality, he said, makes foundational competency more than a professional preference, it’s a patient safety requirement.
“The most important takeaway is that trainees should be able to come out of fellowship and take a job anywhere,” he said. “When the hospital tells them, ‘We don’t have a robot,’ it shouldn’t be that big of an issue.”
He also believes the technology gap between urban and rural America could become one more force pulling surgeons toward major cities, and away from communities that need them.
“It’s hard to get surgeons out to more places in need,” he said. “This is just one more thing that’s going to keep surgeons wanting to stay in a city.”
How he’d train spine surgeons in a robotics era
Dr. Meyers said robotics have a place in training, but only with guardrails. If he were building a modern curriculum, he’d intentionally cap how many cases are done robotically, so trainees are forced to build manual skill and confidence alongside new tools.
“I would isolate a certain percentage of cases to make sure we’re not going above a threshold,” he said, “so the fellows or residents are evenly distributed getting that experience without heavy technological assistance.”
He also believes fellowship programs should disclose their robotics and navigation mix as clearly as they list case volumes and procedural breakdowns.
“I really do believe they should require something that says, ‘We do 70% robotics and navigation and 30% fluoroscopic or freehand-guided instrumentation,’” he said. “So as a trainee, we know what to look for.”
That transparency, he acknowledged, might not change everyone’s preferences, especially as hype around technology continues to shape where trainees want to go.
“I was against the grain,” Dr. Meyers said. “Every time I mentioned this stuff, people looked at me like I was weird because I didn’t want any of that.”
Not “anti-robot” — but pro-preparedness
Dr. Meyers repeatedly returned to one idea: robotics should expand what surgeons can do, not narrow what they know how to do. The danger, he argued, is building a workforce that can only operate under perfect conditions, with the newest tools, in the biggest cities, with backup options everywhere.
“God forbid the whole day goes sideways, and the patient’s asleep and you’re halfway through the surgery,” he said. “How can you get out of it, actually finishing the case, and do no harm? That anxiety in those situations, that feeling of, ‘Oh my gosh, what do I do? I don’t know if I can do this,’ is devastating. That is immense pressure.”
For Dr. Meyers, that worst-case scenario isn’t fearmongering, it’s the reason fundamentals still matter. As robotics and AI become more embedded in spine surgery, he believes the next generation has to train for the moments when technology isn’t available, isn’t accurate or simply isn’t an option.
“New people coming out really, really need to consider that,” Dr. Meyers said. “And tailor their training around it.”
