From technology to policy, spine surgeons discuss the most impactful disruptors in the field today.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.
Next question: What will spine practices look like in 10 years?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, May 27.
Editor’s note: Responses were lightly edited for clarity and length.
Question: What’s the biggest disruptor in spine today, and how is it impacting your own work?
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: I think the current environment in DC, with people in Congress and the Senate ignoring the obvious check engine light on our healthcare system is the biggest disruption today. Funding an ineffective and fraudulent privatization of Medicare is the exact opposite of what the plan should be.
Brandon Hirsch, MD. DISC Sports and Spine Center (Newport Beach, Calif.): While no longer a new technology, spinal endoscopy continues to disrupt the field. The entry of a large device company with extensive experience in joint arthroscopy has reinvigorated innovation and interest in the technique. Patient education and interest in spinal endoscopy continues to grow rapidly as more patients experience its benefits. The growth in interest and increased competition in the device industry is driving technical innovation forward, which will benefit all involved.
Mohammed Khan, MD. New Jersey Brain & Spine (Paramus): The biggest disruptor in spine today is the rapid integration of enabling technologies — robotics, navigation, and AI-driven planning. These tools are transforming surgical precision, reducing variability, and shortening learning curves for complex procedures. In my own practice, robotics and navigation have enhanced the safety and efficiency of minimally invasive spine surgery, particularly in deformity and revision cases. AI-driven imaging and predictive analytics are beginning to influence preoperative planning and outcomes forecasting, allowing for more personalized, data-driven care.
Pierce Nunley, MD. Spine Institute of Louisiana (Shreveport): Robots in spine surgery are overhyped and underdeliver. While they could theoretically enhance safety and outcomes, evidence is lacking. Instead, they inflate costs and reduce efficiency. Industry and investors, prioritizing profits over patients, push this technology, disregarding its burden on healthcare systems. Young surgeons, overly reliant on robots, often struggle or cancel procedures when systems fail, a growing issue. I am a commercial pilot and must be capable at ALL times of flying without the autopilots, all surgeons should master manual techniques, such as placing pedicle screws, yet many lack this skill. Until robots can autonomously and safely perform complex tasks — like manufacturing robots do — their value remains questionable, and the current technology’s cost-benefit ratio is unjustifiable.
Michael Oh, MD. UCI Health (Orange, Calif.): The biggest disruptor is the continued movement from inpatient to outpatient spine surgery. This involves a significant reorganization of personnel, investment in new technologies, adoption of MIS technologies, use of ERAS protocols, and preoperative collaboration with physical therapists. Examples of this include awake spine fusion, robotic-assisted outpatient spine fusion, endoscopic decompression and fusion. For me, this has impacted my workflow by performing more staged outpatient surgery (separated by months) rather than a single surgery that involves a prolonged inpatient hospital stay. The growth of outpatient spine surgery will benefit the surgeons and systems that have already invested in these programmatic changes and technologies.
Jeremy Smith, MD. Hoag Orthopedic Institute (Irvine, Calif.): Two disruptors in our field of medicine, like all of orthopedics, are robot assisted technology in minimally invasive spine surgery and the move to do more complex spine surgeries with the same outcomes in the outpatient setting. Both disrupters are patient centric, enabling patients to recover from spine surgery in their own bed the day of surgery. Technology continues to drive innovation in the operating room, which translates to better outcomes for my patients. For my patients, being out of pain and not having to spend the night in a hospital setting following surgery, is the biggest game changer.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The biggest ‘disruptors in spine surgery’ are certainly recognized in technological advancements. Minimally invasive techniques, robotic assisted surgery, and the integration of AI into surgical practices, ostensibly are meant to improve outcomes and surgical efficiency. However, addressing administrative challenges related to insurance regulations and approvals remains a here and now challenge requiring gratuitous time and effort for surgeons and patients alike.
Recently, our institute presented our data collection and submission process/outcome at our annual meeting outlining the imperatives and supplements needed to insure timely indemnity approvals. We have found that both urgent and complex spinal surgery case submissions are readily acknowledged at the insurance approval level and critically turned over in the process. These machinations are currently optimized by most surgeons, yet far from absolute in terms of authorization, especially when modality interpretation/concurrence is so variable in its reporting. We remain committed to the process of surgical integrity as this relates to the coordinated efforts of approvals, appeals and healthcare delivery.
