The spine field has seen important advances in treatments but there are some areas that have yet to be solved, Roger Härtl, MD, said.
Dr. Härtl, of Och Spine at NewYork-Presbyterian/Weill Cornell Medical Center, discussed the potential of two realms of innovation for spine care on an upcoming episode of the “Becker’s Spine and Orthopedic Podcast.”
Note: This is an edited excerpt.
Question: Spine and orthopedic biologics still need more research. What kinds of innovations in spine biologics are exciting you? What do you think will really define this year in this area?
Dr. Roger Härtl: The regulatory pathway has really challenged our ability to pursue some of the fascinating strategies that come to mind when you’re thinking about degenerative disc disease and biologics. I think we’ve got a lot of data showing that augmentation of diseased discs with various types of stem cells, autologous or or allograft stem cells, holds a significant promise. What I’m very excited about is our current work on annular repair. One of the biggest untapped needs in spine surgery is that whole problem of recurrent reherniation in patients who have a discectomy in the cervical and lumbar spine. There’s not much that we can do really to prevent the disc from further degenerating or even reherniating, [and] I think biologics can potentially prevent that from really happening over time.
I’ve done a lot of research in my lab, and we’ve been working together for many years on disc repair, regeneration and replacement. What we’ve done more recently, is really try to bring to the forefront the whole area of annular repair with collagen glues. We just started a small company that will hopefully be able to bring this through the FDA into clinical trials. That is really one of the most exciting things because it seems like such a simple problem. How do you prevent recurrent reherniation? But it’s really a totally untapped problem and we don’t really have a good solution. There’s so many patients who have lumbar disc herniation who undergo surgery, and they all ask the same question. How can you prevent that disc from reherniating? This is one of the most basic issues in spine surgery, so I’m very excited about that. We’ve got some mechanical solutions, but I’m not sure that implants are really the final solution. I think there has to be some kind of biological intervention, either in isolation or together with an implant that helps us regenerate and repair that annular defect.
Q: AI has really exploded in healthcare. How are you using AI in your practice right now, and what will you do differently in 2026?
RH: AI penetrates every aspect of our lives as individuals and as surgeons. The key is to try to make it safe and effective and to make sure you don’t lose some of the principles of how we take care of patients. It’s helpful for preoperative evaluation of patients and literature reviews. If you’re not sure about what’s out there in the literature, AI is a huge advantage in that regard. It can really help you review the literature very quickly and make certain decisions in terms of surgical procedures. Obviously, you always have to double check [the information].
The other thing I use AI for, along with companies who are involved in navigation and in intraoperative stereotactic navigation and robotics, is automated segmentation. I’ve worked with a company to come up with a workflow to use augmented reality through a microscope or exoscope to facilitate the workflow for minimally invasive transforaminal lumbar interbody fusion. Minimally invasive TLIF is a great operation because there are certain landmarks that you use with every case, and with AI and intraoperative or preoperative imaging, you can automatically have the software identify these landmarks while you’re doing the operation. Those landmarks become relevant to different parts of the surgery so you can have the AI guide you through an operation.
That’s one of those things that I’m working on that I’m very excited about that goes way beyond just putting screws into the spine. But any spine operation could really be benefiting from this type of automatic segmentation and integration through microscope or the exoscope or even the endoscope and then project information into the visual field of the surgeon. Then there’s AI that you can use for postoperative assessment and writing manuscripts in an intelligent way to improve the quality.
