Longevity medicine has built an industry around helping people live longer without losing the ability to live well.
Robert Masson, MD, president and neurological surgeon at the Orlando, Fla.-based Masson Spine Institute, thinks spine surgeons belong in that conversation.
Not because surgery prevents aging. And not because every painful spine should be operated on. His argument begins with a narrower problem: What happens when someone who was working, exercising and living independently suddenly loses the physical ability to do those things?
Spine care tends to describe that moment through pathology. A herniated disc. Stenosis. Instability. A nerve under compression.
Dr. Masson sees a loss of something else: function-years.
“I was never fixing X-rays,” Dr. Masson told Becker’s. “I was restoring lives.”
After more than 13,000 procedures, the neurosurgeon specializing in minimally invasive spine surgery and sports spine medicine believes the field should think more broadly about what a successful operation produces. Pain scores, complications and radiographic outcomes matter. But they do not fully capture whether a patient got back what the spine problem took away.
That, he argues, is where surgery intersects with longevity.
The life before the MRI
Many patients do not experience spine disease as a gradual march toward surgery. They experience a drop.
Someone who had been functioning at a relatively high level develops pain, weakness or neurological symptoms. Activities disappear. Work gets harder. Exercise stops. Independence can begin to erode.
By the time surgery enters the conversation, Dr. Masson said, the clinical focus can become the abnormality visible on imaging.
He starts with what existed before it.
“When I see that, I think, ‘You were recently in a really good place. How do we get you back there?’” he said.
That changes his first question. “What are your goals?”
The answer may have little to do with an MRI. One patient wants to return to a sport. Another wants to work without neurological symptoms. Another simply wants to move through daily life independently again.
“Nobody ever asks people about their goals, something so fundamental and simple,” he said. Some patients, he added, have become emotional simply because someone took the time to ask.
The distinction is important because an operation can accomplish its technical objective without restoring everything a patient considers important.
“We’re trained to operate on a disease, look at an MRI and fix what’s wrong, but often without a goal structure,” he said.
For Dr. Masson, surgery is therefore not the finish line. It is one intervention in an attempt to return a patient toward the functional baseline a spine crisis disrupted.
Why pain is not enough
Pain is one measure of that recovery. Dr. Masson does not think it is sufficient.
Tolerance varies enormously between patients, and pain itself does not necessarily reveal what someone can do. Function can.
Dr. Masson treats professional athletes, but he rejects the idea that their recoveries are instructive because elite athletes are biologically different from everyone else.
“They’re not,” he said. “They’re just incentivized.” They often enter an injury with something many patients have to build during recovery: strength, flexibility, balance, disciplined habits and a powerful reason to return.
That has shaped how Dr. Masson thinks about the infrastructure surrounding an operation. Physical therapy, pain management, mental health support, coaching and other disciplines may all have a role depending on the patient. Surgery can correct a structural problem. It cannot, by itself, rebuild everything that deteriorated while the patient was unable to function.
“Doing the surgery without connecting patients to a broader clinical ecosystem that addresses those fundamental building blocks doesn’t solve the bigger problem,” he said.
An X-ray can look better. Pain can improve. “But does it get that person back to who they want to be?” he said.
The part of longevity that surgery can unlock
This is where Dr. Masson’s argument becomes larger than postoperative recovery.
Much of healthy aging depends on the ability to move. Exercise, strength training and many strategies for managing weight and metabolic health become harder when a structural spine problem makes walking or activity intolerable.
Dr. Masson believes that relationship has been underappreciated. He does not argue that spine surgery treats diabetes, hypertension or metabolic disease. His point is that restoring movement can give patients back a tool those conditions are often managed through.
It also makes him wary of evaluating surgical readiness through isolated numbers.
Dr. Masson said he may be more comfortable operating on a patient with a high body mass index who remains strong, mobile and nutritionally prepared than someone with a lower BMI but poor strength, resilience or nutritional status.
“We’ve got to do better than we’re doing,” he said. “It’s got to be a broader picture. It’s got to involve bigger teams, multiple disciplines.”
In that framework, the relationship between surgery and longevity is almost paradoxical.
Longevity culture often emphasizes avoiding major medical intervention. Dr. Masson argues there are patients for whom avoiding the necessary intervention can itself cost healthy years.
When not having surgery becomes the risk
Dr. Masson reached that point himself. He ruptured a cervical disc while wakeboarding and spent roughly two years avoiding surgery. He continued working and exercising despite the injury. Then he began losing coordination in his dominant hand.
For a microsurgeon, the significance was immediate. He underwent surgery within days.
“There’s a tendency to think surgery is just about pain,” he said. “It’s about something that’s stealing your vitality and your purpose.”
The operation was in 2013. Dr. Masson said the decade that followed included skiing, tennis, basketball and auto racing.
His experience did not convince him that surgery should come earlier for everyone. It reinforced something more conditional. There is a point at which the consequences of leaving a structural problem untreated can become more important than the goal of avoiding an operation.
“When it needs to be fixed, surgery plays a huge role,” he said. “But it’s got to make sense.”
That caveat runs through his philosophy. Patients should exhaust appropriate nonsurgical options. The pathology has to fit. The operation has to have a clear objective.
But once those conditions are met, Dr. Masson believes the field should stop treating the need for surgery as a failure of healthy living. Sometimes, he argues, surgery is the intervention that allows healthy living to resume.
A different spine surgery scorecard
Changing that perception would require surgeons to change how they describe success.
Spine surgery has become sophisticated at measuring failure. Surgeons track complications, reoperations, pseudarthrosis, failed fusion and persistent pain. Dr. Masson believes the opposite end of the outcome curve deserves more attention.
“We talk about pain scores, complication rates, failed fusions and failed arthroplasties,” he said. “But we don’t spend enough time talking about what success should look like and what a top 1% outcome looks like when we get it right.”
His preferred target is intentionally demanding. “We should be focused visually on the top 1% recovery and do whatever we need to do to hit the top 1%,” he said.
That does not mean every patient can achieve the same recovery. It means designing care around the best functional outcome realistically available to that individual.
For Dr. Masson, that begins before the incision and continues after it. It includes preparation, surgical execution and the support required to rebuild function. It also requires consistency inside the operating room. Dr. Masson believes communication, team coordination and reliable surgical systems are part of longevity care for a simple reason: A complication can erase the functional recovery the operation was intended to create.
The value of surgery, then, is not merely that something was repaired. It is what the repair enables afterward.
The argument MSK surgeons have not made
Dr. Masson believes that distinction matters beyond the exam room.
The longevity economy has become increasingly focused on maintaining strength, mobility and independence with age. Musculoskeletal surgeons spend their careers treating conditions that can abruptly take those capabilities away.
Yet Dr. Masson believes surgeons have largely allowed the longevity conversation to develop without them.
“I think surgeons have a leadership role in making clear that surgery can play an important part in healthy longevity,” he said. “Right now, the mindset is still largely about fixing X-rays.”
He sees the same problem in debates over the economic value of surgical care. Surgeons can argue about reimbursement, but Dr. Masson believes the profession also has to become better at explaining what society receives when an operation works.
“What have we done to show our value?” he said. “Not much.”
A successful spine operation can be counted as a decompression, fusion or disc replacement.
Dr. Masson wants another unit considered alongside them: the years of function that follow. That framing does not make every operation valuable, nor does it erase the risks, failures or inappropriate surgeries that have shaped perceptions of the field.
It raises a different question for operations that are appropriately indicated and successfully performed. Not simply: Did the surgery work? But: What did the surgery allow the patient to get back?
For Dr. Masson, that is the longevity argument spine surgery has yet to fully make.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
