Spine surgery has no shortage of futuristic technology. Robots, AI, navigation and augmented reality are all moving deeper into operating rooms.
But recent Becker’s conversations with spine surgeons suggest enthusiasm is becoming more selective. The question is no longer whether a technology is impressive. It is whether it produces enough clinical, operational or financial value to justify the cost and disruption required to use it.
That distinction is particularly visible in robotics and AI, where several surgeons say expectations have moved faster than the technology itself.
The robot may be doing less than patients think
One of the biggest disconnects around spine robotics may start with the word “robot.”
Vijay Yanamadala, MD, of Hartford (Conn.) HealthCare, told Becker’s that current spine robots are better understood as sophisticated positioning and guidance systems. Surgeons still make the incisions, place the implants and perform the operation themselves. He said comparing them with systems that actually execute portions of an operation has created unrealistic expectations among patients and hospital leaders.
Lali Sekhon, MD, PhD, of Reno (Nev.) Orthopedic Center, was more pointed when discussing why adoption has plateaued.
“Million dollar drill guides and good for marketing,” he told Becker’s, arguing that the value proposition beyond navigation remains limited for many surgeons.
The American Spine Registry’s 2026 data showed reported robotics and computer-assisted utilization flattening after early growth, although some surgeons cautioned that incomplete reporting may understate actual use.
Seven-figure systems face a higher burden of proof
Surgeons are not necessarily arguing that robotic guidance lacks value. The bigger issue is whether every program needs the most expensive version of it.
M. Craig McMains, MD, of OrthoIndy in Indianapolis, pointed to rising prices, proprietary implant ecosystems and workflow complexity as barriers to broader adoption.
“Hospitals and ASCs don’t need a shinier Ferrari,” he told Becker’s. “They need a fleet of Toyotas.”
Bryan Lee, MD, a complex spine neurosurgeon at Barrow Brain and Spine in Phoenix, reached a similar conclusion after incorporating a high-cost robotic platform into an already established navigation workflow. After more than 15 cases, he said the robotic system did not outperform his existing approach in efficiency or reliability.
“Robotic spine surgery is not yet a replacement for well-established, high-performing workflows,” Dr. Lee said.
Meanwhile, lower-cost navigation is challenging the assumption that more sophisticated guidance requires a seven-figure machine. Paul McAfee, MD, director of the Scoliosis and Spine Center of Maryland in Baltimore, has highlighted phone-based navigation that uses an iPhone in a sterile mount costing roughly $1,200.
“You could have a $1.5 million system,” he told Becker’s, but surgeons still want to plan procedures on their phones.
AI in the OR may be ahead of itself
AI has perhaps an even larger expectations problem. Jeffrey Carlson, MD, an orthopedic spine surgeon at Orthopaedic & Spine Center in Newport News, Va., sees clear value in AI scribes because they can reduce documentation time and allow physicians to focus more closely on patients. His assessment changes inside the operating room.
“AI in the operating room is overhyped,” Dr. Carlson told Becker’s. He cautioned that surgeons still need the technical expertise to finish a procedure if software provides misleading information, a system glitches or power is lost.
Matthew Harb, MD, an orthopedic surgeon with The Centers for Advanced Orthopaedics in Washington, D.C., similarly said the hype outpaces reality around AI replacing surgical decision-making or technical skill. He sees greater near-term opportunity in risk stratification, imaging, documentation and perioperative optimization.
That mirrors what other spine surgeons have told Becker’s: AI may be most useful first in the less glamorous parts of care, documentation, patient triage, scheduling and planning, rather than autonomous surgery. Michael Verdon, DO, for example, said an algorithmic triage system at his practice doubled clinic throughput and increased surgical volume about 10%.
The newest technology is not necessarily the best investment
Some surgeons are also pushing back on the idea that a modern spine program can be defined by the equipment it owns.
At Becker’s Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference in Chicago, Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles, warned surgeons not to become distracted by novelty.
“We shouldn’t get lost in the coolest and newest,” Dr. Gantwerker said.
Arthur Jenkins, MD, a neurosurgeon at New York City-based Jenkins NeuroSpine, described an increasingly simple threshold for emerging technology: It has to be cost-effective, time-effective and beneficial to the patient.
“You can’t keep losing $20 on every case but make it up in volume,” he said.
That economic test is becoming more consequential as physician reimbursement tightens. Recent Becker’s reporting found organizations raising the bar for robots, navigation systems and AI products that do not yet have strong evidence or an obvious route to payment.
Even good technology can become expensive furniture
Some of the hype problem may not be the technology at all. It may be how hospitals adopt it.
Michael Gallizzi, MD, a robotic and endoscopic spine surgeon at The Steadman Clinic in Vail, Colo., told Becker’s that robotic programs depend heavily on case volume, surgeon commitment and teams that use the technology frequently enough to overcome the learning curve.
When organizations make the capital investment without building that infrastructure, he said, the result can be a machine that becomes a “dust-collecting item” instead of a clinical advantage.
Dr. Gallizzi remains bullish on robotics in the right environment, particularly at high-volume centers. That distinction matters. Surgeons questioning the hype are not rejecting innovation; they are raising the bar for what counts as useful.
In spine, the real question is no longer whether a technology is new. It is whether it is worth using.
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.
