Amid surgical advances and increased challenges in spine practices, surgeons discuss the future of the landscape.
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 be the next major way AI is integrated into spine care?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, June 3.
Editor’s note: Responses were lightly edited for clarity and length.
Question: What will spine practices look like in 10 years?
Jeffrey Deckey, MD. Spine surgery chair at Hoag Orthopedic Institute (Irvine, Calif.): Even more than general orthopedic practices and medical groups, spine practices will evolve demonstrably. Spine care is a high cost and complex medical delivery system for all providers. Technology and AI will transform the nature of spine care both in and out of the operating room. Spine practices will rely on artificial intelligence tools in 10 years to improve every step of diagnostic, practice and patient selection based on predicted clinical outcomes. Wearable technology, patient matched implants and orthobiologics will be employed to greater effect. On the practice side integrated spine teams comprised of spine surgeons, pain management, PT, physiatrists and behavioral health and others will collaborate on a mandated “conservative spine care” first agenda, where spine surgery is considered as a last resort. In the value-based marketplace of spine care, outcomes will dictate new care models, reimbursement and care settings, such as the trend toward more outpatient surgery. Bundled payments for all episodic care under a risk model will be normal.
Data metrics will create the spine practice of the future. Change in orthopedics and spine care is often very slow to adopt in practice management and clinical care. That era is over. The future spine practice, like a lot of orthopedic care, is in a race to better measurable, predicted and reimbursed-based patient outcomes. Welcome and brace for the future.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: In a decade we will all be 10 years older and still trying to solve the same problems, unless we get better at making a cogent argument to improve healthcare. In my 15 years of practice, doctors have gotten to be better advocates. Unless we get even better we will be watching the same reruns. We have to make our case to the public, be prepared for industry-funded hit pieces in major news outlets of all stripes and enlist our patients to help.
Mohammed Khan, MD. New Jersey Brain and Spine (Paramus): In 10 years spine practices will be fundamentally reshaped by precision medicine, advanced imaging and AI-driven decision-making. Surgeons will rely on real-time data to tailor treatments, with minimally invasive and outpatient procedures becoming the norm. Value-based care will shift the focus from volume to outcomes, emphasizing long-term function and quality of life. The most successful practices will blend surgical excellence with integrated, patient-centered care delivering not just procedures, but durable solutions.
Patrick Roth, MD. New Jersey Brain and Spine: Spine practices in the next decade will evolve alongside broader healthcare reform. As reimbursement shifts from procedure-based payments to outcomes-based models, spine care will need to deliver measurable improvements in health, not just services. This will require databanks that track outcomes beyond subjective pain scores, incorporating radiographic findings, physical exam results, and broader measures of well-being.
Artificial intelligence will become integral to diagnosis and treatment planning. Patients will input their symptoms and AI, informed by anatomical and functional imaging plus a structured physical exam, will generate precise diagnoses and optimized care plans. These systems will continuously improve with outcome data feedback.
Diagnosis and treatment will occur within integrated care models. Physical therapists, chiropractors, and pain management will be part of the same team. PTs will help conduct baseline exams and shift focus toward education and patient accountability. Virtual visits will enable comprehensive initial assessments from home.
As financial incentives realign, spine practices will focus on delivering health. Providers will become “knowledge workers,” using real-time data to fine-tune care and build collaborative, accountable relationships with patients. This will benefit both clinical outcomes and professional fulfillment.
Krishna Satyan, MD. Dallas Neurosurgical & Spine (Plano, Texas): As the practice of medicine continues to evolve, so does the practice of spine surgery. There are many external factors that affect how a spine surgeon can manage his or her patients. Unfortunately insurance and pharmaceutical restrictions will continue to impact what decisions can be made, consequently affecting the care provided to patients and the cost to patients. This will continue until it is addressed by legislation. Additionally with advances in artificial intelligence, we will see more and more diagnostic studies interpreted by AI, with physicians overseeing these results. While in some ways there may be increased accuracy, there is also the potential for increased errors, as there are no dedicated physicians for each study, and a supervising physician may miss things if they are evaluating too many studies and overseeing too much artificial intelligence. Spine surgeons will have to become more reliant than ever on interpreting films on their own, rather than relying on interpretations provided by the radiologist or AI expert.
Alex Vaccaro, MD, PhD. President at Rothman Orthopaedics (Philadelphia): Current day spine surgery primarily relies on preoperative and/or intraoperative fluoroscopy and CT imaging, which can be associated with substantial radiation and increase the lifetime risk of malignancies. However, there are several enabling technologies that are already in use and will transform spine surgery practice over the next 10 years. For instance, with the push to perform more minimally invasive surgery, navigated/robotic decompression and instrumentation and advances in anesthesia techniques enabling expanded awake surgery indications are quickly gaining popularity. Augmented and virtual reality are also on the horizon with the promise of increased precision, reduced complications, and enhanced patient safety. This will require a migration from ergonomically awkward head mounted devices, steep learning curves, and lack of ability to simulate physical touch. While much of the progress in spine surgery over the last century has revolved around hardware innovations, the next century will be dominated by software innovations. Patient engagement through telemedicine and remote patient monitoring skyrocketed during the COVID-19 pandemic and are now part of standard practice for a sizeable number of spine surgeons. Ease of obtaining telehealth privileges in multiple states through initiatives such as the Interstate Medical Licensure Compact has also elevated its appeal. Predictive analytics and technologies such as AI and machine learning have emerged as tools positioned to produce a paradigm shift in multiple aspects of care. This includes patient selection for specific spinal procedures, preoperative workup, outcome prediction, as well assisting in the detection of difficult to visualize spinal fractures and malignancies.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): To my understanding, both management of complex spinal disorders and healthcare delivery will be fashioned around a number of trends as we see them currently implemented. Technological advancements presently utilized, as AI will further streamline process and outcome driven surgical choice for patient and surgeon alike. Innovative care models based on cost-shifting will likely become clearer especially in regard to the most complex of diagnosis and treatment. Health-literacy prevalence and acknowledgment will drive the consumer-centric care and its expectations. Larger health-systems will remain centers of more complex care delivery, as these patient flow patterns of economics and intricacy will become more demarcated. Cynicism aside, healthcare cost will continue to rise, demand will increase with an aging populace, therefore giving rise to more socio-economic challenges like exclusion and more fragmented care.
