As spine surgeons reflect on the past year and what’s ahead, AI and payer woes are among the key disruptors physicians anticipate in 2026.
Several spine surgeons joined “Becker’s Spine and Orthopedics Podcast” to share their insights.
Note: These excerpts were lightly edited. Some responses are from upcoming episodes.
Question: What will be a key disruptor to spine surgery in 2026?
Erich Anderer, MD. NYU Langone Health (New York City): The obvious answer in any surgical field is going to be tech and advanced robotics and this kind of thing. Thinking outside the box, there’s just so much stuff going on with AI and predictive analytics. I think that we’re actually going to probably end up basing some treatment on algorithms that were written via an AI model. A lot of that’s actually being done in the neurosurgery world and at NYU where we can use de-identified data. If somebody comes in with this complaint at this time of day, with this, we can almost predict what kind of problem they’re going to have, where they’re going to get discharged to all these things, which I think is going to be sort of interesting, because clearly you’re going to have to have some sort of human oversight into how this is done, but harnessing the power of AI and tech in general, I think for these types of things is really going to change the way that we that we diagnose and treat disease.
Scott Blumenthal, MD. Texas Back Institute (Plano): I think it will be more restrictions on advanced technology. We got these great technologies that come out, and if they don’t fit the protocols they’re going to restrict patients’ access to it much like pharmaceuticals that come up with these great new drugs and it takes years to get on the formulas of these insurance companies …. At the Center for Disc Replacement at the Texas Back Institute, we’ve stayed within the insurance networks, whereas a lot of the disc replacement surgeons opt for an out-of-network strategy so they don’t have to deal with headwinds that we’ve been having to deal with. But for the most part most patients can’t really afford to do out-of-network cash pay models for disc replacements.
James Mooney, MD. Virginia Commonwealth University (Richmond): Within the next year, I think AI is going to continue improving outcomes. It’s yet to be seen the full extent of where ultra-minimally invasive surgery is going to head. I’m actively following that as well, but I think it’s going to be not one single factor, but a combination of all of these things that are intersecting at such an exciting time, where you have new technologies, data, collaboration between surgeons, engineers, scientists.
Frank Vironis, MD, PhD. Marcus Neuroscience Institute (Boca Raton, Fla.): I think increasingly, the biggest disruption and the biggest problem we have is coming from the insurance industry and the cost of healthcare products. That’s the biggest issue …. The FDA is concerned with safety, but there is no price control, so anybody can essentially price it any way they want. So pricing of new technologies or new products, lack of insurance coverage, denials by insurance and affordability of health care are the potential disruptors that I see that can curtail innovation and force us against the wall. Physicians are in the practice of medicine because they like what they do, but we constantly have to shape what we do and fight for what we believe with a lot of other stakeholders in the healthcare industry in order to get the maximum benefit for the patient, and that’s not an easy thing.
Nolan Wessell, MD. University of Colorado (Aurora): Conversations about declining reimbursements are not isolated to spine surgery, it’s across the board. A close colleague and friend of mine wrote a paper in the Journal of Arthroplasty last year that said orthopedic surgeons have taken a 31% hit on inflation adjusted income over the last quarter century. I’m not complaining on a personal level, but what this has led to in other specialties are care deserts. Here in Colorado, a healthcare system that covers the Gunnison Valley … because of declining reimbursements, have had to shut down their obstetrics and gynecology programs, and that’s leaving countless women and their babies without a place to receive their care. If we’re not careful, we’re going to see those same trends trickle over into other specialties. We’ve seen it in primary care. We’re seeing it in OB-GYN, and I am concerned that not enough red flags are popping up amongst the individuals and organizations that have the ability to influence how funding is allocated and how these decisions are made. So I’m going to be watching that really closely, especially as we learn more about the 2026 CMS fee schedule and how that might affect practices and patients’ ability to access care.
