Robotics, AI and advanced implants are reshaping spine and orthopedic surgery, but some surgeons are questioning whether the latest technologies always deliver better care.
From overriding robotic recommendations to challenging unnecessary implants and costly surgical platforms, physicians are raising concerns about overreliance on technology, patient selection and the need to preserve clinical judgment.
Here are six perspectives Becker’s reported:
- An orthopedic surgeon overrides a robot’s recommendation. James Gholson, MD, an orthopedic surgeon at El Camino Health in Mountain View, Calif., described stopping a younger surgeon he was assisting after the robotic system recommended a bone cut he believed could create complications requiring revision implants. He completed the step manually, and the robot subsequently assessed the result as satisfactory. Dr. Gholson warned that increasing reliance on robotics could leave younger surgeons without the manual skills needed to recognize or correct inaccurate recommendations.
- Orthopedic surgeons question unnecessary pain implants. Travis Doering, MD, of the Upper Extremity Institute of Austin (Texas), and Earl Kilbride, MD, of Austin Orthopedic Institute, raised concerns about peripheral nerve stimulation devices being implanted before patients receive adequate evaluations for treatable underlying conditions. Dr. Doering described removing a nerve stimulator from a patient who ultimately needed shoulder replacement surgery. Both surgeons support the technology for appropriate patients but advocate stronger oversight and more careful patient selection.
- A neurosurgeon questions whether better technology is driving more surgery. Jonathan Baskin, MD, a neurosurgeon at Atlantic Brain and Spine in Morristown, N.J., warned that advances in navigation and instrumentation may be lowering the threshold for spinal fusion. Although these technologies have made procedures more precise and accessible, he questioned whether greater technical capabilities are influencing decisions about which patients need surgery.
- A spine surgeon warns against endoscopy hype. Andrew Chung, MD, an orthopedic spine surgeon at Banner Health in Phoenix, cautioned that enthusiasm for endoscopic spine surgery is outpacing training and evidence. Although endoscopy accounts for approximately 50% to 60% of his practice, he warned against marketing that portrays fusion and instrumentation as inherently undesirable. He said the technique’s long-term credibility will depend on demonstrating meaningful improvements in patient outcomes.
- A neurosurgeon questions the value of costly robotics. Bryan Lee, MD, a complex spine neurosurgeon at Barrow Brain and Spine in Phoenix, said a high-cost robotic platform did not outperform his established navigation workflow in efficiency or reliability after more than 15 cases. His experience raises questions about whether additional technological sophistication provides enough clinical or operational value to justify the investment.
- A spine surgeon challenges AI’s role in the operating room. Jeffrey Carlson, MD, an orthopedic spine surgeon at Orthopaedic & Spine Center in Newport News, Va., sees value in AI for reducing administrative work but cautioned against overstating its current surgical capabilities. He emphasized that surgeons must retain the skills to complete procedures independently when technology fails or produces misleading information.
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