Spine surgery has never been more sophisticated. Robotic navigation has improved precision. Endoscopic procedures have made operations less invasive. New lateral approaches continue to expand what surgeons can treat through smaller incisions.
Juan Uribe, MD, chief of the division of spinal disorders and vice chair of neurosurgery at Phoenix-based Barrow Neurological Institute, said the next major breakthrough may have little to do with another surgical technology. Instead, it may be changing how surgeons learn to use the technologies they already have.
“We teach surgery the same way it’s been done since the ’50s and ’60s,” Dr. Uribe told Becker’s. “Now we have all these enabling technologies. It’s super challenging.”
For more than two decades in academic medicine, Dr. Uribe has watched spine surgery evolve at extraordinary speed. What has changed far less, he argues, is the educational model responsible for preparing surgeons to perform those increasingly complex procedures safely.
That disconnect led him to a question that has become the focus of his work. Can the learning curve move out of the operating room?
The patients behind every learning curve
Every new surgical procedure begins the same way: Someone has to learn it.
For generations, that process has followed a familiar path. Residents observe experienced surgeons, practice in cadaver laboratories and gradually perform portions of procedures under supervision before operating independently.
The model has produced generations of highly skilled surgeons. It has also accepted a reality that Dr. Uribe believes deserves to be challenged.
“The learners start making mistakes, and these are real cases,” he said. Most of those mistakes are not catastrophic. Operations may take longer. A step may require correction. Technical efficiency develops with repetition.
Longer procedures, however, can increase the risk of complications, including infection and other adverse events. For Dr. Uribe, the issue is ultimately about the patient.
“The patient can be your mom, can be my father,” he said, explaining why he believes the earliest stages of surgical training should happen somewhere other than the operating room whenever possible.
What aviation can teach surgeons
A comparison that shaped Dr. Uribe’s thinking came from outside healthcare: Pilots spend hours inside flight simulators before carrying passengers because the cost of learning certain lessons during a real flight is unacceptable.
“When a plane crashes, it’s 150 souls that die,” Dr. Uribe said. “In surgery, when a problem happens, it’s one patient at a time.”
That difference, he argues, has shaped public perception more than professional responsibility. While aviation built an educational system designed to prevent mistakes before they happen, surgery has accepted that part of the learning process unfolds on real patients. But Dr. Uribe believes that assumption no longer has to define surgical education.
That philosophy led Barrow Neurological Institute to build a virtual and mixed reality laboratory dedicated to spine surgery training. The goal is not simply to create another simulator. It is to re-create enough of the operating room that technical skills become familiar before surgeons ever enter one.
Commercial virtual reality platforms already exist, Dr. Uribe said, but many struggle with one critical limitation: Although they can reproduce what surgeons see, they cannot reproduce what surgeons feel.
A surgeon placing a pedicle screw depends on tactile feedback. Resistance changes. Bone quality changes. Instrument feel changes. Without that feedback, the educational value becomes limited. Barrow’s approach combines immersive virtual reality with patient-specific 3D-printed spine models and the same instruments surgeons use during actual operations.
“We were able to find a way to connect both worlds,” Dr. Uribe said. Residents wear a headset that re-creates the operating room while simultaneously working on physical anatomy they can feel. The experience is designed to resemble surgery closely enough that the operating room becomes a place to apply skills, not first develop them.
The surgeons who may benefit most
Although the laboratory was initially developed for residents and fellows, Dr. Uribe increasingly believes experienced surgeons may have the greatest need
Many practicing spine surgeons completed training before endoscopic surgery, advanced lateral approaches and many minimally invasive techniques became widely available. Learning those procedures traditionally has meant attending a weekend cadaver course before returning home to perform cases on actual patients.
“You don’t have the luxury to become a resident again,” Dr. Uribe said.
Simulation offers another path. Instead of arriving at a training course unfamiliar with the procedure, surgeons can spend hours rehearsing each step. And instead of performing a first case after a single weekend, they can repeat the operation enough times to develop confidence before treating a patient.
“You don’t want to be a dinosaur,” Dr. Uribe said. “You don’t want to keep only doing what you learned 10 years ago.”
Why minimally invasive surgery raises the stakes
For Dr. Uribe, simulation becomes more important as spine surgery becomes less invasive.
Procedures such as endoscopic spine surgery and advanced lateral approaches demand precise trajectories through narrow anatomical corridors, where a few millimeters can determine whether a patient experiences a routine recovery or a serious complication. Those techniques also present some of the steepest learning curves in spine surgery.
At Barrow, the mixed-reality platform allows surgeons to rehearse those procedures before entering the operating room, and they can practice on patient-specific anatomy while using the same instruments they would use during surgery.
For Dr. Uribe, the goal has remained the same from the beginning.
“Definitely the main reason is actually to decrease complications in the patients,” he said.
As simulation becomes more realistic and computing power advances, Dr. Uribe expects immersive training to play a larger role in surgical education.
“I bet the cadaver training will become obsolete,” he said. He also believes simulation will eventually become part of how surgeons demonstrate competency not only during residency, but whenever they adopt new procedures or technologies.
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.
