Some of the possibilities Theresa Williamson, MD, sees emerging in neurotechnology still sound like science fiction.
Researchers are working on implanted devices that can record signals around a spinal cord injury and stimulate the nervous system with the goal of improving recovery. Dr. Williamson, a neurosurgeon and bioethicist who directs the Center for Innovative Neurotechnology for Neural Repair at Providence, R.I.-based Brown University Health, sees a future in which some of those technologies could eventually be controlled remotely, even from a patient’s home.
“When you think about having an implanted device that you can control with your cell phone, it sounds futuristic,” Dr. Williamson told Becker’s. “But it’s really right there.”
For Dr. Williamson, the question is no longer simply what researchers can build. It is how advances that expand the possibilities after neurological injury ultimately reach the patients who could benefit from them.
“The pace of the academic research is way outpacing what’s available,” she said.
That gap could become one of neurotechnology’s defining challenges. Developing sophisticated devices is expensive. Bringing them safely from the laboratory into clinical care takes time and commercial investment. And the return may not be immediate enough to attract the capital needed to make them broadly available.
Dr. Williamson worries that without careful attention to access, increasingly powerful technology could widen disparities that already exist.
“I could see a future where, if you have an injury and you’re from a certain demographic, your outcome will be different from another’s,” she said. “That’s already true, but I think with poor technology, that gap has the potential to widen.”
When the prognosis starts to change
Dr. Williamson sees two areas where neurotechnology could have an especially significant impact in spine: spinal cord injury and pain.
At Brown’s Center for Innovative Neurotechnology for Neural Repair, researchers are working with spinal cord stimulation that can record from the area of a patient’s injury and send signals to the spinal cord with the goal of directed recovery. The longer-term vision includes bringing some of those capabilities into patients’ homes.
What excites Dr. Williamson is the possibility of understanding signals from the spinal cord more precisely and using that information to influence its function.
But as a bioethicist, she also sees a less obvious consequence of that progress: It could change what physicians can tell patients after devastating injuries. Clinical decisions depend in part on giving patients the best available information about what is likely to happen with or without treatment. If new technologies expand the range of possible outcomes, those conversations become more complicated.
“How do we offer them some hope and optimism, and then also get them access to the technologies that can improve their potential outcomes?” Dr. Williamson said.
She believes that creates another responsibility for surgeons: knowing what is available beyond their own operating rooms and institutions.
“If you had a family member who suffered a spinal cord injury, where would you be calling to see if they could get help?” she said. “Can we do the same thing to try to plug our patients in?”
The surgeon’s job could get bigger, not smaller
The rise of neurotechnology also raises questions about what happens to the surgeon’s role as devices become capable of doing more.
Dr. Williamson sees two ways surgeons can approach that shift. They can view technology as something that could eventually replace parts of what physicians do. Or they can see it as a way to expand the population of patients medicine can help.
“We are expanding the number of patients whose lives we may be able to improve,” she said.
Dr. Williamson has already watched the boundaries of surgical care change during her career. She pointed to spinal metastases as one example.
Early in her residency, treatment options for some of those patients were far more limited. By the end of her training, she was studying the increasingly complex decisions surrounding their care. She expects neurotechnology to continue pushing those boundaries.
It could also require surgeons to develop skills today for technologies that do not yet exist in routine practice. Dr. Williamson performs endoscopic spine surgery and sees a potential connection between minimally invasive techniques and future neurotechnology.
As electrodes and other devices become smaller, she said, surgeons may eventually deploy them using technical platforms they are already learning for other procedures.
“It should be encouraging for surgeons to keep up with the latest technology because I think that’s how the devices are going to become available,” she said.
Keeping up, however, does not mean embracing every innovation uncritically. “It is critical to be skeptical of new technology,” Dr. Williamson said.
Surgeons need to know whether a technology works, whether its potential benefit justifies its risks and whether patients understand what living with a device could mean over the long term.
The last question is especially important when the patient is young. “If the patient’s 19, what is it going to look like when they’re 80 to have an implanted device?” she said.
The access problem comes next
For all the scientific questions still being answered, Dr. Williamson believes some of neurotechnology’s biggest obstacles may ultimately be economic.
Developing and testing an implantable device safely requires substantial resources. Collaboration with commercial partners is therefore critical, she said, because academic researchers often do not have the capital or infrastructure to bring technologies through development and into widespread clinical use.
But the financial return can take time. “We need spaces and funders who understand that, to do this work well and safely and make sure we don’t harm patients,” she said.
Without that long-term investment, Dr. Williamson worries some technologies could ultimately be available only to a subset of patients. “If we want to democratize it, we have to figure out ways to get investors to understand the long-term and broader return of investment,” she said.
Access also depends on demonstrating value to payers. Dr. Williamson said practicing medicine has made health policy much less abstract. Physicians can see firsthand what happens when they believe a new technology could benefit a patient but cannot persuade a payer that it is worth covering.
Part of the answer, she believes, may be changing how success is measured.
“What does success look like to someone who’s had a spinal cord injury, rather than our traditional definitions?” she said.
Better data could help answer that question. Dr. Williamson sees a potential role for AI in tracking how patients fare and capturing outcomes that matter to them. “The more we can redefine how we’re measuring success and communicate that outside of our own neurosurgical meetings, the more we can demonstrate that there is a really strong ROI,” she said.
What the next decade could make possible
Despite those obstacles, Dr. Williamson remains optimistic. Within five to 10 years, she hopes advances in spinal cord stimulation, brain-computer interfaces and neural prostheses will make restoring function after neurological injury faster and more feasible.
“I’ve met the skeptics,” she said. “I’ve met people who have said, ‘I’ve been saying that my whole career,’ but I’m going to remain optimistic on this one.”
She also expects technology to change more routine interactions between surgeons and patients. AI could reduce some administrative burdens, help explain imaging and test results and give physicians more time to communicate with patients.
But realizing the larger promise of neurotechnology will require more than technological progress. Dr. Williamson said it will take sustained funding, coordinated collaboration among researchers, clinicians and developers, evidence demonstrating meaningful outcomes and policy capable of translating those results into access.
“Someone has to pay for it to be done,” she said. “That requires showing the data.”
For Dr. Williamson, that may be the defining challenge of neurotechnology’s next decade: not simply expanding what medicine can do, but ensuring those advances can reach the patients they were designed to help.
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.
