Spine technologies tout improved precision, efficiency and patient outcomes but they come at a hefty price tag, especially in ASC settings.
Surgeons discuss the technologies that have provided the best payoff for their practice and margins.
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: How are advancements and collaborations in pain management affecting your surgical work?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, Jan. 20.
Editor’s note: Responses were lightly edited for clarity.
Question: What technology investment has delivered the highest return in terms of outcomes, efficiency, costs or surgeon satisfaction?
James Bruffey, MD. Scripps Health (San Diego): The technology investments at our institution that have delivered the highest return in terms of outcomes, efficiency and surgeon satisfaction coalesce around preoperative and intraoperative imaging and adjunct imaging technologies, including navigation and robotic-assisted surgery.
Preoperative imaging technologies allow for surgical planning to reduce variation, improve efficiency in the operating room, reduce operative times and improve clinical outcomes. These include, but are not limited to, patient-specific implants and implant placement plans.
Intraoperative imaging technologies such as 3D-C arm capability, intraoperative navigation for implant placement, often facilitating less invasive approaches, in adjunct with robotic assistance in some cases, when applicable, have improved intraoperative precision, efficiency and safety. This has allowed surgery to be performed with better outcomes than traditional operative techniques, with shorter hospital stays, fewer complications and improved patient satisfaction.
Ehsan Jazini, MD. VSI (Reston, Va.): Robotics has delivered the highest ROI by making complex work reproducible, allowing for higher precision, a more controlled surgical workflow, and improved surgeon efficiency. Modern disc replacement has provided significant patient-centered value by preserving motion, accelerating recovery and improving functional outcomes.
Bowen Jiang, MD. Providence St. Jude Medical Center (Fullerton, Calif.): The technology investment that has delivered the highest return in outcomes, efficiency, costs and surgeon satisfaction is the ExcelsiusGPS system. Its robotic navigation allows us to perform spine procedures with exceptional precision through smaller incisions which reduces tissue disruption and speeds recovery. For short segment one- to two-level lumbar fusions, this platform has helped us lower length of stay to the point where patients are now routinely discharged the same day of surgery or after less than 23 hours of observation with an overnight stay. That shift alone has cut postoperative costs tremendously while improving the overall patient experience. From a surgeon’s perspective the accuracy and streamlined workflow make it one of the most impactful tools we have.
Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): Intraoperative 3D imaging with navigation (with or without robotics). It’s one of the few platforms that can improve multiple value domains across a wide range of cases.
Clinically, it improves the reliability of instrumentation and reduces intraoperative complications and revisions. Operationally, it lowers intraoperative uncertainty, leading to more predictable OR flow and fewer workflow disruptions. Economically, its true ROI is best captured through averted downstream costs (revision avoidance, reduced waste, and lower post-acute utilization). It also improves surgeon satisfaction and longevity by reducing cognitive load and radiation exposure.
If I can take it one step further…. The big caveat (and the real message): we still don’t have a universally honest way to measure “return” in spine, because we argue about which outcomes count, we under-measure true cost, and we rarely quantify efficiency + satisfaction in a rigorous way. So I’d propose a ROT framework to evaluate these technologies:
1. Patient outcomes: complications, revisions, functional recovery (not just POD1 X-rays).
2. Process outcomes: OR time predictability, radiation dose, workflow interruptions.
3. True costs: TDABC across the episode + downstream utilization.
4. Team outcomes: surgeon/staff cognitive + physical load, burnout/retention signals.
Alex Vaccaro, MD, PhD. Rothman Orthopaedics (Philadelphia): One of the most transformative technology investments in modern spine surgical practice has been the introduction of spine robotics. This enabling technology has delivered measurable improvements in clinical efficiency, avoidance of surgeon radiation exposure, reduced surgeon stress and fatigue, and implant placement precision. The robot has made the placement of multiple pelvic implants more efficient, allowing the accurate placement of two to three screws on one side of the ileum routine if necessary depending on the degree of deformity correction necessary.
I have used several systems and am most impressed by the introduction of a system which allows for real‑time tracking and adaptive trajectory guidance. This helps improve screw placement accuracy, which can be experienced with any type of patient movement such as thoracic expansion with respiration.
The final evolution of robotic spine surgery will be systems that sense cortical wall penetration and neural vascular proximity in order to avoid inadvertent injury to the neurovascular elements.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: AI-powered clinical documentation tools like Abridge have been transformative, and I advocate for them because they address one of the biggest threats to good patient care: physician burnout. When surgeons are drowning in documentation requirements, we can’t give patients the time and attention they deserve. These tools have given me back hours each week and, more importantly, let me be fully present during patient encounters. The ROI is immediate: I’m a better doctor because I’m not exhausted by administrative burden. Unlike expensive technologies that add complexity, AI documentation tools make it easier for surgeons to focus on what we were trained to do — thoughtful clinical decision-making and excellent patient care. This matters for patients because burned-out physicians can’t deliver their best work. When hospitals invest in tools that support physician well-being, they’re investing in better patient care.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Regarding the highest returns on clinical efficiencies and patient interactions, the current rendition of Epic/DAX Copilot has served our advanced practitioners and surgical conduit and its continuum quite well. Our clinical/clerical staff and health system counterparts have utilized these processes from gathering intake information to the diagnosis/treatment and scheduling portion of surgical caseloads for a number of years. Continuity is established and maintained, optimizing efficiency in a systematic fashion, a constant endeavor at minimizing the looming chaos plaguing healthcare at this moment in time.
