The spine industry keeps producing new technology. Bilal Butt, MD, wants to know how much of it actually makes surgery better.
At Cleveland Clinic, where surgeons have access to advanced implants, robotics and navigation systems, the challenge is no longer simply what technology can make possible. It is determining which innovations improve outcomes enough to justify their cost, and which offer little more than a variation on something already available.
“There’s been an explosion of new spine technologies, many of which differ only slightly from what’s already available,” Dr. Butt, a spine surgeon at Cleveland Clinic, told Becker’s.
For surgeons and health systems, separating meaningful advances from incremental changes requires looking beyond a device’s capabilities. The more consequential questions involve whether it makes surgery safer and more predictable, improves recovery or reduces the likelihood of another operation.
Dr. Butt believes those questions should guide technology decisions long before a new product becomes part of routine practice.
The real cost of innovation
Cervical corpectomy illustrates the stakes. The complex procedure involves removing part or all of a vertebral body to relieve spinal cord compression, followed by reconstruction to stabilize the spine. Historically, surgeons often used bone harvested from the patient’s iliac crest for reconstruction, adding a second surgical site and the possibility of donor-site complications.
Newer expandable implants offer another option. Some can be adjusted in height and depth, with customizable endplates designed to accommodate individual anatomy and promote bone growth.
For Dr. Butt, the potential value lies in achieving a better fit, reducing implant subsidence, improving fusion and lowering the risk of revision surgery.
“When I choose an implant, it has to make the operation more predictable and reproducible while providing a meaningful benefit to the patient,” he said.
That benefit must justify the investment. An implant may carry a higher upfront price, but if it reduces complications or prevents another operation, the long-term value could outweigh the initial expense.
The difficulty is determining whether those improvements actually occur. At Cleveland Clinic, Dr. Butt said, surgeons consider not only clinical outcomes but also whether a technology makes procedures more efficient and consistent across operating room teams.
“If I’m doing a corpectomy, my outcome should be very comparable to my partners,” he said. A technology that works well for one surgeon but is difficult to reproduce across a department may offer less value than its early results suggest.
When surgeon enthusiasm isn’t enough
That distinction becomes critical when hospitals consider adopting technology beyond an individual surgeon’s practice.
“Surgeon enthusiasm can introduce new technology to colleagues, but its broader adoption depends on the value they see in using it,” Dr. Butt said.
Surgical navigation offers an example. Once relatively uncommon navigation is now widely used for procedures such as pedicle screw placement. At Cleveland Clinic, Dr. Butt said, it also provides an advantage in training: Attending surgeons can monitor screw trajectories while residents and fellows operate.
That visibility can reduce the cognitive burden of technically demanding procedures and provide another layer of oversight.
But the value of navigation may differ across practice settings. A technology that offers significant benefits at a large teaching institution may be less essential to an experienced surgeon working independently. For Dr. Butt, that is why technology decisions cannot be separated from the environment in which a device will be used.
The evidence problem
The upfront cost of a new implant or robotic platform is relatively easy to calculate. The financial benefit of avoiding a complication or revision may not become apparent for months or years.
Dr. Butt said Cleveland Clinic’s patient volume and research infrastructure help address that uncertainty. The institution maintains large registries and conducts studies comparing outcomes across surgical approaches. Its researchers are examining patients who underwent robotic procedures against those treated without robotics, building on several years of clinical experience.
Cleveland Clinic also participates in investigational device studies and postmarket research, allowing surgeons to evaluate technologies beyond their initial introduction.
“We can evaluate a technology’s value through research and share those findings so other institutions can assess whether it could work for them,” Dr. Butt said.
That ability is particularly important in a market where products may reach surgeons before their long-term advantages are fully established. Dr. Butt pointed to biologics as an area where the volume of available options can make decisions especially difficult. His team places considerable weight on high-quality clinical evidence when evaluating products and is reluctant to adopt those without sufficient supporting data.
The same scrutiny applies to new implants. When manufacturers introduce a device, Dr. Butt wants to know what makes it meaningfully different from existing options. If that distinction cannot be explained or supported, he sees little reason to bring it forward for broader evaluation.
Who decides what is worth adopting?
Dr. Butt believes practicing surgeons need a voice in technology decisions. At Cleveland Clinic, spine surgeons in senior leadership positions remain involved in patient care, giving them firsthand insight into which innovations address real clinical needs.
That perspective will become increasingly important as technology advances. Dr. Butt expects robotics to grow more autonomous, potentially performing portions of spine procedures within the next 10 to 15 years.
But greater capabilities will also demand greater scrutiny. As hospitals face an expanding range of options, distinguishing what is technologically possible from what is clinically worthwhile will become essential.
Dr. Butt believes that judgment must begin in training. At Cleveland Clinic, fellows learn to use advanced technology, but also to question the evidence behind it and recognize when it offers a meaningful advantage.
“Use the data to guide decisions,” he said. “This is evidence-based medicine.”
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.
