From enabling technology to outpatient spine strategies, here are the research plans for six spine surgeons.
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’s something new or interesting you heard/discovered about the spine field and why?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, Oct. 7.
Editor’s note: Responses were lightly edited for clarity.
Question: Where are you focusing your research efforts in the next 18 months?
Jeffrey Carlson, MD. Coastal Virginia Surgery Center (Newport News): We have been working diligently on our processes and techniques to transition all of our spine surgeries to a same-day-outpatient (SDO) platform. From anesthetic procedures, minimally invasive surgical techniques, nursing exemplars and post-operative processes, every aspect of the surgical flow has been evaluated and tested to provide the expected care for these surgeries in the SDO setting. We are at a point where we are expanding our ability to safely perform larger, more complex surgeries in the outpatient setting. Our focus will be on increasing confidence towards multilevel fusions from three to four spinal segments in the cervical and lumbar spine. Scrutinizing patient selection and post-operative safety are the focus of our current research. As patients increasingly want less pain, quicker return to work and a faster recovery, we need to determine what can be done safely in the SDO setting.
Vance Gardner, MD. Medical director at Hoag Orthopedics (Irvine, Calif.): At Hoag Orthopedics, the nonprofit, 501(c)(3) arm founded by Hoag Orthopedic Institute physicians, we are proud of our comprehensive research program, our ongoing research studies appearing in leading publications and prospective research. Looking ahead, we will continue to advance our research program while deep diving into resources for outcome results and the insights they provide.
This year, we have five fellows in their sixth year of orthopedic sub-specialty training — two in arthroplasty, two in surgical sports medicine and one in spine surgery. In addition to clinical training, these fellows and their faculty conduct research projects designed to deliver results that can be published in peer-reviewed literature. Clinical research utilizing Hoag Orthopedic Institute’s access to massive clinical data has been very productive. In addition, we conduct prospective research for data registries of various diagnostic and surgical entities (at times coupled with tissue and serum analysis in partnership with local university laboratories), randomized clinical trials, biomechanical studies and systematic reviews and meta-analyses on important topics. Our staff, led by research manager Teddy Quilligan, are experts in helping the fellows and faculty with project feasibility assessment, protocol development, data collection, statistical analysis and manuscript drafting. We published 24 manuscripts in peer-reviewed literature from July 2024 to July 2025.
Many important questions in orthopedic surgery require large databases for reliable outcome results. Last year we published two manuscripts using the PearlDiver claims data source (both investigating total shoulder arthroplasty questions). PearlDiver offers access to a large volume of deidentified patient records, where we can track any aspect of hospital and/or outpatient visit billing data over time. Our team, including our investigator-initiated research project lead Evan Simpson, has become proficient in the coding that is required to create protocols delivering understandable and important outcome results. Over the next 18 months, we expect to utilize this research tool in at least 10 projects designed to determine reliable outcome analyses that will significantly contribute to the arthroplasty, sports medicine and spine surgery literature.
Steven Girdler, MD. DISC Surgery Center (Newport Beach, Calif.): Over the next 18 months, my research efforts at Disc Sports & Spine Center will continue to focus on the safety, advocacy and healthcare economics of outpatient spine surgery. We are evaluating outcomes across a variety of complex spinal operations, including artificial disc replacement, anterior lumbar fusion and lateral interbody fusion. With advancements in surgical technique, anesthesia and perioperative care, many procedures once thought to require hospitalization can now be performed safely in an outpatient setting. Our goal is to generate high-quality data that not only validates this approach but also helps refine patient-selection criteria and optimize recovery pathways.
Our findings to date are very encouraging — over the past eight years, we have successfully completed a large volume of outpatient spine surgeries with no unplanned transfers to the hospital. Building on this foundation, we are now expanding our studies to include cost-effectiveness analyses and patient-reported outcomes, which will provide a more complete picture of the value outpatient surgery brings to patients and the healthcare system. By sharing these results, we aim to contribute to a growing body of evidence that supports safe, efficient and patient-centered care, while also advocating for broader access to outpatient spine procedures.
Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): Over the next 18 months, my research is centered on four interconnected areas, what I often refer to as “the 4 Es” — Ergonomics, Enabling Technology, Economics and Education.
Ergonomics: We are using wearable sensors to analyze posture, force, and strain during surgery, breaking procedures into their riskiest steps. The goal is to design early interventions, tools, and training that prevent surgeon musculoskeletal injury and fatigue. And develop protocols to evaluate enabling tech ergonomic impact.
Enabling Technology: We are developing an Enabling Technology Value Index (ETVI); a multi-stakeholder framework to measure outcomes, costs, ergonomics, and usability of new tools. This index will guide more responsible, evidence-based adoption across health systems with input from all major stakeholders.
Economics: Our value science program applies Time-Driven Activity-Based Costing (TDABC), real-world evidence, and payment model design to spine and musculoskeletal care. We aim to clarify costs, outcomes, and value drivers to support the shift toward value-based care, without the gigantic amount of resources that people fear are necessary.
Education: Studying elements of learning curves is a large focus and one that we hope to reproduce from an evaluation perspective. We aim to reproduce these evaluations across technologies and centers to generate data that guides responsible adoption and shapes structured training for the next generation of surgeons.
William Taylor, MD. University of California San Diego: We are focusing on internal treatments. Although many of these have failed in the past with inappropriate use of stem cells, we believe that appropriate growth factors will show tremendous increases in use and utility in the next five to 10 years.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Our interests will continue and focus on clinical research methodology and outcome result reporting tied to innovative surgical techniques in both spinal and cranial surgery. Collaborative efforts with our local university’s cognitive neuroscience department and neurosurgeon pool will continue its three-decade work to enhance outcomes in neurovascular disease and robotic use for complex spinal disease as it is being addressed in the operating room. The majority of data collection, analysis and reportage centers around Medicare and its affiliations, the benchmarks of both common and infrequent disease processes are being remitted and propagated.
