Patient-specific spinal implants have often been associated with complex deformity surgery at academic and tertiary centers. Jonathan Hobbs, MD, believes their potential extends to appropriately selected patients undergoing surgery for degenerative conditions — and that access will be a central challenge as the technology evolves.
Dr. Hobbs, a neurosurgeon at Chesterton, Ind.-based Lakeshore Bone & Joint and a clinical associate in the department of neurosurgery at the University of Chicago, recently performed what the practice describes as the nation’s first two-level posterior lumbar fusion combining Carlsmed’s patient-specific Aprevo cages for transforaminal lumbar interbody fusion with Medtronic’s patient-specific UNiD rods. The procedure took place at Northwest Health-Porter in Valparaiso, Ind. Both the cages and rods were designed using the patient’s imaging and manufactured before surgery.
“Much of the adoption has occurred in complex deformity surgery at tertiary and academic centers,” Dr. Hobbs told Becker’s. “The question is how we extend that level of individualized planning to appropriately selected patients in the community. The barriers are not solely technical; they also involve cost, infrastructure and access.”
“Patients with degenerative disease deserve the same rigor in planning that we bring to complex deformity surgery,” he said. “The complexity of the diagnosis should not determine the attention we give to the patient’s anatomy, alignment and long-term functional goals.”
Translating a surgical plan into a reconstruction
Dr. Hobbs emphasized that conventional implants remain effective tools. “Experienced surgeons can achieve excellent results with conventional cages and manually contoured rods,” he said. “Patient-specific technology offers another way to translate a detailed preoperative plan into the final construct. The objective is not customization for its own sake; it is greater precision and reproducibility.”
The patient’s imaging informs the intended correction and implant design, giving the surgical team defined targets against which to assess the reconstruction. “The early evidence is encouraging, but it remains evolving, and much of it is industry-supported,” Dr. Hobbs said. “We need to determine whether more consistent execution of the surgical plan translates into better patient-reported outcomes, durable fusion and fewer revisions. Any reduction in overall healthcare costs must be demonstrated rather than assumed.”
Avoiding revision is first a patient-centered goal, he said. “Most people don’t come to me on their best day,” Dr. Hobbs said. “Our responsibility is not only to address the immediate problem, but to consider the long-term consequences of the reconstruction.”
He also cautioned against overreading his own results. “In my practice, I have seen encouraging recovery trajectories, including improvements in pain, function and postoperative opioid requirements,” he said. “Those observations are important, but they do not establish that customization alone is responsible. That distinction requires systematic follow-up and comparative data.”
Extending access to community care
“My interest is in translating advances developed in academic settings into high-quality community care,” Dr. Hobbs said, adding that his recent appointment to the University of Chicago department of neurosurgery aligns with that interest.
As planning tools and implants evolve, he sees opportunities to expand their use in appropriately equipped community hospitals and, for suitable patients and procedures, ambulatory settings. “The goal is not to perform every complex operation in every setting,” he said. “It is to match the patient, the procedure and the resources appropriately, while making advanced care available closer to home whenever that can be done safely.”
“A patient in a rural community deserves the same consideration for advanced treatment as a patient living near a major academic center,” Dr. Hobbs said. “Access should be determined by clinical need and the capacity to deliver care safely — not by a ZIP code.”
The financial challenges remain substantial, and they are not unique to community practice. Christopher Ames, MD, director of spine tumor and spinal deformity surgery at University of California San Francisco, has also raised concerns with Becker’s about the economic pressures surrounding complex spine care. Smaller hospitals may struggle to invest in advanced technology, while academic referral centers shoulder more of the complex, often lower-reimbursed caseload.
“Manufacturers need to support research, development and production, and hospitals need to remain financially viable,” Dr. Hobbs said. “But reimbursement also needs to account for the resources required to deliver clinically appropriate care. Otherwise, access can become a function of an institution’s ability to absorb the expense.”
He hopes wider adoption and evolving reimbursement mechanisms will improve access but does not view those changes as assured. “A promising technology is not broadly accessible simply because it exists,” he said. “We need a sustainable model that allows appropriate patients to receive it without placing an untenable burden on hospitals or shifting that burden to patients.”
He also distinguishes between expanding access to technology and decentralizing the most complex surgery. Some deformity and revision cases may remain best served by specialized referral centers. “Broader access and regional specialization are not competing goals,” he said. “We can strengthen community-based care while maintaining referral pathways for cases that require highly specialized expertise and resources.”
The next frontier: Matching implant design to bone quality
Looking ahead, Dr. Hobbs is interested in customization that extends beyond implant geometry to material properties.
“The next frontier may be personalization not only of an implant’s shape, but also of its structural characteristics,” he said. “The question is whether we can tailor an implant more closely to the patient’s anatomy, bone quality and mechanical demands.”
He sees additive manufacturing as a potential avenue for that evolution, including more refined control over implant architecture and porosity. “I see this as an important direction for development rather than an established clinical capability,” Dr. Hobbs said. “The ambition is to move beyond an implant that fits the patient anatomically toward one that is also better matched mechanically. Whether that reduces subsidence or improves long-term outcomes will need to be tested.”
Broader adoption, he said, will require evidence of both technical accuracy and clinical benefit. “Radiographic accuracy is an important measure; it is not a substitute for a meaningful patient outcome,” he said.
Responsible adoption requires evidence and advocacy
For Dr. Hobbs, physician advocacy and evidence generation should advance together. “We do not have to choose between advocating for patients and insisting on better evidence,” he said. “Responsible adoption means selecting patients thoughtfully, measuring outcomes and having transparent conversations about both clinical value and cost.”
His preferred path is measured rather than indiscriminate adoption. “I favor a measured approach: thoughtful patient selection, rigorous follow-up and collaboration among physicians, hospitals, manufacturers and payers,” Dr. Hobbs said. “That allows us to advance care without confusing technological promise with proven benefit.”
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.
