Four spine surgeons from the University of California San Francisco have joined Sacramento, Calif.-based Sutter Health to launch the Sutter Advanced Neuroscience & Spine Institute at California Pacific Medical Center in San Francisco.
The institute’s permanent home, the Advanced Neuroscience & Spine Care Complex on CPMC’s Mission Bernal campus, is a 129,000-square-foot facility that Sutter said will cost nearly $500 million when it opens in 2028. When the system first unveiled the project in April 2024, it put the price at $442 million.
Shane Burch, MD, chief of spine surgery at Sutter’s new institute, spoke with Becker’s on erasing the line between neurospine and orthopedic spine — and why he and three colleagues left UCSF to do it.
Dr. Burch focuses on spinal deformity and complex cervical spine surgery. He is joined by former UCSF physicians Sigurd Berven, MD, Aaron Clark, MD, and Alekos Theologis, MD, all now part of Sutter West Bay Medical Group.
At most hospitals, spine surgery lives in two places at once: Neurosurgeons and orthopedic surgeons both operate on the spine, typically from separate departments with separate leadership. Asked what integration looks like day to day at the new institute, Dr. Burch started with that organizational structure.
“We broke down the silos between neurosurgery and ortho, so neurospine and ortho spine, and we basically said we’re just going to be spine. So no neurospine, no orthospine. It’s just spine,” he said. “We’re going to be a spine division slash spine department within Sutter, and ultimately that’s going to benefit the patient because there’s going to be efficiencies of care throughout the system.”
The change also reaches the question of who oversees spine surgeons, a role that in a traditional structure can fall to a department chair whose own practice looks nothing like spine surgery.
“We’re not looking at having somebody who does total hip replacements tell spine surgeons how to manage their clinic, because it’s completely different, like night and day,” Dr. Burch said. “So the governance is really important for having spine surgeons govern spine surgeons, and that can lead to efficiencies and less channels that you have to go through in order to get what you want done.”
The longer-term ambition is about how the next generation of spine surgeons is trained, and Dr. Burch reached back roughly half a century for a model.
“Vascular surgery kind of splintered away from general surgery, became its own thing. Spine surgery is going to be the same thing. It’s going to splinter away from orthopedic surgery and neurosurgery,” he said.
The integration Dr. Burch described does not end at the surgery department’s walls. Physical medicine and rehabilitation, physical therapy and pain management typically sit in different departments from spine surgery, with their own schedules and referral queues.
“I’d say that 80% of the patients that I see get treated nonoperatively,” Dr. Burch said.
For a surgeon, that makes the referral as important as the procedure, and it puts a premium on having nonsurgical colleagues close by.
“When we say, ‘Hey, listen, there are other ways to treat this that are completely safe and have a high probability of success,’ we need to have an integrated service where I can essentially refer down the hallway to the physiatrists or to the physical therapists,” he said.
The same dedicated-team approach extends to the specialists who support complex spine operations. Long reconstructive cases often depend on a vascular surgeon to provide surgical access to the spine and an anesthesia team managing hours of time under anesthesia.
“There’s other ancillary services that are spine specific. So there’s like vascular surgery who do our exposures, and we are hiring a vascular surgeon just to do our spine exposures,” Dr. Burch said.
The institute is building a similar team for anesthesia.
“Similarly, we are setting up an anesthesia program for spine, especially for complex spine. It’s like transplant medicine. You need dedicated anesthesiologists for complex spine. That’s the program that we’re setting up,” he said.
Building that model meant leaving one of the country’s best-known academic medical centers on a bet that Sutter would be able to break down the “silos” that he said exist in many large institutions.
“What I will say is that we are out from under the bureaucracy of a large institution, and so the reason we chose to move is because the system that we’ve moved into is much more nimble, and it is open to innovation,” Dr. Burch said.”I’m about to innovate way more here than I could ever see.”
Sutter’s financial commitment grew as the recruitment came together; the projected cost of the complex has risen by more than $50 million since 2024. For Dr. Burch, the size of the group that moved is part of what the investment reflects.
“That represents a program, right?” he said. “So it was one of those things where it was like the perfect opportunity for both parties.”
The investment comes as spine reimbursement tightens. CMS’ proposed 2027 physician fee schedule would cut payment for neurosurgery by about 2% and orthopedic surgery by about 7%. Dr. Burch’s answer to the economics begins with the size of the patient base Sutter can draw from.
“Sutter has 1% of the U.S. insured population. It’s massive. If you do the math, it drives a lot of patients to see spine surgeons,” he said. “And the thing that we’re really innovating is triage, and how do we triage 1% of the insured U.S. population for back care?”
The triage effort is still being built, and Dr. Burch was direct about what rides on it.
“So that triage, if you want the nuts and bolts, is what’s going to fund and fuel the economic aspect of this,” he said.
Triage carries the highest stakes at the top of the acuity scale. Adult spinal deformity and complex cervical reconstruction are among the most resource-intensive operations in spine surgery and the ones in which complications cost patients and hospitals the most.
“Those people need to be cared for. I don’t think anybody’s going to deny anybody with that condition care because people with adult spinal deformity have some of the worst health states of anybody,” Dr. Burch said.
Instead of a single surgeon deciding when a high-risk patient is ready, the institute brings those cases before a full team.
“We have a multidisciplinary care team going through all of our cases,” he said. “So we have anesthesia, we have hospitalists, we have pain management specialists, we have physical therapy, we have nursing, we have surgeons.”
The review is meant to set timing, not to serve as a gatekeeper.
“Not that it’s like a committee to stop somebody from that surgery, but it’s more of a when you should have surgery, not an if you should have surgery,” Dr. Burch said.
The team began seeing patients this fall at Sutter’s Mission Bernal Care Center in San Francisco while the permanent complex is under construction. A few weeks in, Dr. Burch described the institute as being in the most uncomfortable stretch of any launch.
“We’re in the ‘finding out the I don’t know what I don’t know’ phase, but I can tell you that if there’s a hurdle in the way, we’re either going to go over it, around it, underneath it, or through it,” he said.
Dr. Burch gave much of the credit for that pace to Sutter’s administration, which signed off on a plan the surgeons put in writing before they arrived.
“We gave them a 30-page detailed document of our vision and they asked questions, and then they said, ‘OK, that seems like the right thing to do. Let’s do it,'” he said. “And that, honestly, it’s like a breath of fresh air. Working with an administration that trusts the clinicians and the clinicians that trust the administration, it’s very refreshing.”
The complex won’t open until 2028, and Dr. Burch measures the institute’s larger goal on an even longer timeline: whether other programs follow it.
“The fun part is that this could be a fundamental change in how people view how spine care is delivered and taught, and that’s pretty exciting,” he said.
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.
