New robots, navigation platforms and AI tools continue to enter the market. But as reimbursement falls behind the cost of care, spine leaders are raising the bar for what is worth the investment.
Spine’s technology pipeline is not slowing. A July Becker’s analysis of five emerging technologies examined developments ranging from personalized implants and AI-assisted patient selection to phone-based navigation. The analysis found that FDA clearance, once treated as the defining milestone for a new device, is increasingly only the first hurdle. Technologies must also generate convincing clinical evidence and establish a path to payment.
At the same time, spine and orthopedic leaders say the financial capacity to adopt those technologies is tightening. Antonia Chen, MD, chair of orthopedics at UT Southwestern Medical Center in Dallas, told Becker’s declining procedural reimbursement has reduced organizations’ ability to incorporate new technology. Products that improve patient care or reduce administrative burdens remain worthwhile, she said, but those without data or a proven track record are becoming more difficult to justify.
Ernest Braxton, MD, a partner at Vail (Colo.) Summit Orthopaedics and Neurosurgery, has identified multilevel lumbar fusion and cervical disc arthroplasty in Medicare Advantage populations as particularly pressured procedures. He attributed the squeeze to flat commercial rates, rising implant costs, prior authorization requirements and post-payment denials. Michael Gross, MD, orthopedic director of Union Middlesex Orthopedics in Woodbridge, N.J., said spinal fusion and other facility-based procedures are facing lower reimbursement as practices devote more resources to authorization, review and collection.
Together, those pressures are creating a more difficult question for spine programs: not whether a technology is innovative, but whether its clinical and operational value is sufficient to absorb its cost.
Robotics faces its economic test
Robotics has become the clearest test of spine’s technology economics. American Spine Registry data show reported use remains limited and has recently plateaued. Lumbar robotics increased from 0.23% of procedures in 2017 to 1.76% in 2023 before declining to 1.45% in 2024. Computer assistance reached 3.4% in 2024, while cervical robotics and computer assistance were reported in 0.3% and 1.1% of cases, respectively.
The registry may not capture the full market. Vladimir Sinkov, MD, of Sinkov Spine Center in Las Vegas, told Becker’s selection bias could understate adoption. Other surgeons view the plateau as evidence that cost and complexity are limiting growth. M. Craig McMains, MD, of OrthoIndy in Indianapolis, cited early-adopter saturation, rising prices and proprietary imaging and implant ecosystems. Lali Sekhon, MD, PhD, of Reno (Nev.) Orthopedic Center, questioned whether robotics offers enough value beyond navigation to persuade more cautious buyers.
“Hospitals and ASCs don’t need a shinier Ferrari,” Dr. McMains said. “They need a fleet of Toyotas.”
Robotics can still generate a return, but utilization appears critical. Michael Gallizzi, MD, of The Steadman Clinic in Vail, Colo., said organizations often overlook benefits across the episode of care, including greater accuracy, fewer complications, shorter stays and the migration of appropriate cases to outpatient settings. High-volume programs are also better positioned to standardize workflows and move beyond the learning curve, he said.
James Bruffey, MD, of Scripps Health in San Diego, has reported gains in precision, efficiency and safety from imaging and navigation technologies. Bowen Jiang, MD, of Providence St. Jude Medical Center in Fullerton, Calif., said robotic navigation has contributed to routine same-day discharges and stays of less than 23 hours for short-segment lumbar fusion patients.
The divide is therefore less about support for robotics than whether a program has the volume, workflow consistency and downstream savings needed to justify it.
AI shifts the ROI conversation
AI presents a different financial equation. It generally does not require the same capital commitment as a surgical robot, but disconnected tools, implementation costs and weak staff adoption can still undermine the investment.
John Bring, vice president of clinical innovation and performance at Omaha, Neb.-based Sequel Ortho, told Becker’s practices should begin with measurable problems rather than technology features. He identified scheduling, call center operations, referral management and patient communication as high-volume workflows where AI can improve access without disrupting clinical care.
“The business case for AI isn’t primarily labor reduction. It’s capacity creation,” Mr. Bring said. That capacity can be measured through productivity gains, avoided hiring, recovered revenue and improved patient retention, he said. By contrast, point solutions that are not integrated into existing workflows can leave organizations with another application, another login and little sustained adoption.
His recommendation: “Don’t buy AI. Buy outcomes.”
The calculation becomes more complicated as AI moves from administrative work into clinical decision-making. Spine leaders are exploring platforms that combine imaging, documentation and wearable data to support patient selection and surgical planning. However, the July technology analysis found that evidence for many of those applications remains immature.
Daniel Park, MD, and Kern Singh, MD, of Rush University Medical Center in Chicago, have argued that large language models predict text rather than reason clinically and are better suited to supporting physician judgment than replacing it. Meanwhile, William Kemp, MD, a spine surgeon in Richmond, Va., said insurers are already using AI to scrutinize physical therapy documentation.
AI therefore offers both sides of the margin equation. It may remove administrative friction and expand capacity, but it can also add implementation costs or strengthen the utilization-management tools used by payers.
The next advantage may be smaller
Margin pressure may not stop innovation, but it could favor technologies with lower capital requirements. Paul McAfee, MD, director of the Scoliosis and Spine Center of Maryland in Baltimore, plans procedures on his phone and has pointed to navigation systems that use an iPhone in a sterile mount to check screw trajectories. The setup he described costs about $1,200, compared with roughly $1.5 million for a conventional robotic platform.
“You could have a $1.5 million system from one of the big strategic companies,” Dr. McAfee said, “and doctors still want to plan the surgery on their iPhone.”
The economic difference is significant for ASCs and lower-volume programs. A phone-based or reusable navigation tool does not require the same case volume, physical footprint or implant commitment as a traditional robot.
The lower price does not eliminate the need for evidence. No handheld robot specifically designed for spine had received FDA clearance as of July, and lightweight navigation systems must still demonstrate accuracy, reliability and clinical value. But they represent a notable reversal in the direction of spine technology: The next meaningful advance may reduce the capital burden instead of increasing it.
Taken together, the registry data and surgeon interviews suggest the market is becoming more selective, not less innovative. New technologies are still advancing, but adoption increasingly depends on demonstrated value rather than technical promise alone.
In a tighter financial environment, the burden of proof has shifted to the technology itself.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
