Spine robots and enabling technologies come with expensive price tags making some practices and hospital leaders hesitant about adoption unsure of the return on investment.
However, spine surgeons say these costs should be measured against other important metrics besides what’s on the balance sheet.
These technologies, for instance, may improve efficiency, reduce complication risks or provide valuable surgical data.
Eight surgeons share their perspective on tech’s true ROI.
Note: Responses were lightly edited for clarity and length.
Question: Enabling technologies and robots come at a high price point. While ROI is one important factor to consider, what are some other ways surgeons can evaluate the payoff of these purchases?
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: There’s always the patient satisfaction and their level of return to activity. One of the questions I always ask postoperatively is, “Are you glad you did the surgery?” That’s a really simple question that doesn’t require visual analog scales or complicated inventories. Thankfully, the vast majority of my patients say “yes.” No matter what technique or style you use to do the surgery, you always want the patient to answer that in the affirmative. Also with your complication rates, we all want that to be as low as humanly possible.
But the overall question is: Is what we’re doing making a clinically significant difference? If I ever change and improve what I’m doing, does it pay off for the patient at the end? I do think we should never stop reaching for better outcomes, but at the same time sometimes you’re just trying to tweak things, for the sake of it, and that’s not a good way to operate. I think if you’re doing a good job, and your patients are happy that’s a pretty good place to land. But we should also always be careful not to get too satisfied with ourselves.
Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): ROI is only one part of the equation. Surgeons and health systems should also consider the broader concept of value, including clinical impact, workflow reliability and system-level efficiency. For example, enabling tech and robots may improve surgical accuracy, reduce complication risk, decrease radiation exposure, streamline operative workflows or improve ergonomics even if these benefits are not immediately reflected in direct financial return.
I have been working on developing an Enabling Technology Value Index (ETVI) to evaluate emerging surgical technologies across multiple domains. Working to incorporate clinical outcomes, process reliability, and operational efficiency, while pairing these metrics with granular and more global cost measurements. By combining outcome improvements with transparent episode-of-care cost data, the framework helps quantify the true value contribution of a technology rather than focusing solely on purchase price or traditional ROI.
In practice, approaches like the ETVI will allow surgeons and hospital leaders to make more structured (and measureable) decisions about enabling tech adoption; identifying tools that actually improve patient care, workflow performance, or system efficiency, even in cases where the financial payoff may be more indirect or longer-term.
Craig McMains, MD. OrthoIndy (Indianapolis): The term “enabling technology” is more than a marketing label. It’s exactly the framework surgeons should use to evaluate these platforms. The question is simple: Does this technology enable me to perform a procedure I previously wouldn’t have felt comfortable doing, or does it make a previously challenging surgery meaningfully easier?
If a surgeon who does excellent open TLIFs can suddenly transition to an all-MIS workflow and deliver faster return to work, lower pain scores, or decreased infection rates, then the technology has potential long-term value despite its upfront cost. Those outcomes don’t immediately show up on a C-suite spreadsheet. Enabling technologies might not drive more surgeries on a year-end basis, but the quality of those surgeries can substantially increase. That’s the metric that matters to patients and ultimately it’s the metric that should matter to the institutions buying these systems.
Lali Sekhon, MD, PhD. Reno (Nev.) Orthopedic Center: The ROI over straight navigation is limited right now. We want what we don’t have. Decompressions done to paper thickness. Disc preps done autonomously. Screws placed robotically, not just a guide.
Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): The use of robotic assistance and computer navigation in spine surgery enables minimally invasive techniques to be performed with greater accuracy and reproducibility while decreasing radiation exposure for everyone in the OR and decreasing both physical and cognitive load on the surgeon.
In my opinion, this is the greatest “payoff” for this technology. While minimally invasive surgery has been unequivocally shown to be more beneficial to the patient (in terms of lower complication rates, less post-operative pain, and quicker recovery), the adoption of minimally invasive surgery in the USA is still limited. Therefore, enabling technologies such as robotic-assisted surgery are very important to promote wider adoption of minimally invasive spine surgery.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: ROI is the wrong primary lens for most of these decisions, and the vendors know it — which is why their financial models tend to be optimistic.
Here’s how I’d encourage surgeons and hospital systems to think more broadly:
1. Surgeon learning curve and workflow fit. A technology that takes 40 cases to reach proficiency and adds 25 minutes per procedure has a real cost that rarely appears in the ROI model. Time in the OR is finite and expensive. Honest assessment of workflow impact matters.
2. Patient selection applicability. What percentage of your actual case mix does this platform meaningfully improve? Many technologies show strong outcomes in the cases where they’re used — but if that’s 20% of your volume, the system-level benefit is modest.
3. Training and recruitment value. For academic and tertiary centers, the ability to train fellows on emerging platforms and recruit surgeons who want to work in a technology-forward environment has genuine strategic value even if it doesn’t appear on a balance sheet.
4. Data infrastructure. Does the platform generate structured, exportable outcomes data? Surgical technology that produces proprietary, siloed data is a liability in an era of registry participation and value-based accountability.
5. Alignment with where care is going. Prior authorization, payer scrutiny, and outcomes-based contracting are all moving in the same direction: demanding evidence that interventions improve outcomes at a sustainable cost. Technologies that help surgeons demonstrate that case-by-case will matter more over time.
Xiaofei (Sophie) Zhou, MD. University Hospitals (Cleveland): ROI can be thought of as a direct revenue stream due to the purchase of a technology, but it can also include driving ancillary business. For example, although we know not every patient is a candidate for every surgery, sometimes new/interesting technology is what drives a patient into a specific office. The patient may not qualify for the initial specific spine surgery that they seek, but may find rapport with the office or surgeon and maintain their care at that institution. Investment in technology can also drive improvement in recruitment of surgeons or residents. ROI is not just about money in and out — but about growth of the system and the practice.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Both economic and clinical advantages such as shorter hospital stays (15% to 30% reductions), faster patient recovery, better post-operative pain management, and reported outcomes are inferential and acknowledged. Both surgeon and ancillary education, availability and maintenance time/costs endure. Arguably, the tenured success of standard microscopic orthodoxy has served so many for so long. The financial realities and expected outcomes definitively parallel the customary, usual and the unutterable; the better surgeon begets the better outcomes.
