The most advanced thing in spine care by 2028 may not be a robot, a navigation rig or a pair of augmented-reality glasses.
According to four surgeons who spoke on a panel at Becker’s Spine, Orthopedic and Pain Management-Driven ASC Conference in Chicago, the real leading edge will be the unglamorous work around the technology: getting paid for it, picking the right patient for it and wiring it into a program that can actually run at scale.
The session, “Leading Edge Spine Innovations by 2028,” brought together Arthur Jenkins, MD, a neurosurgeon at Jenkins NeuroSpine; Brian Gantwerker, MD, a neurosurgeon with The Craniospinal Center of Los Angeles; Junyoung Ahn, MD, an orthopedic spine surgeon at Texas Back Institute in Dallas; and M. Sohel Ahmed, MD, medical director of the neurosciences service line at Cook County Health in Chicago. Their consensus pushed back on the idea that innovation is a shopping list of new devices.
Dr. Jenkins said his first instinct as a surgeon is to chase the newest tool, but the economics usually intervenes. The newest technology often never reaches an ASC because it is too expensive and a new device has to clear a simple test: is it time effective, cost effective and patient effective?
“You can’t keep losing $20 on every case but make it up in volume,” he said.
Dr. Gantwerker was blunt about bringing new innovations and devices into his practice.
“It’s all about getting paid,” he said. “For technology, it’s about looking at your reimbursements using accounting software properly and understanding how you’re getting paid and how you’re getting ripped off, and then realizing which contracts you have to cut and really learning how to navigate the government websites. We opted out of Medicare three years ago. It was a real challenge to do that and they were actually holding on for dear life trying to not let us opt out.”
There were several steps Dr. Gantwerker took to leave Medicare, including involving his Congressional representative and the Small Business Administration ombudsman to advocate on his behalf. As he navigated the system, he realized it was important for him to rely on patient selection and avoid over-operating to maintain a strong reputation.
Reimbursement is also why some genuinely useful technology stalls. Dr. Gantwerker pointed to endoscopic spine surgery, which he argued has never caught on at scale because of how new CPT codes are valued. CMS works under a budget-neutral framework, creating or raising the value of one code forces a cut somewhere else.
“If you make a new code, it decreases the value of other codes,” he said. “That’s what we’ve gone back and forth between our guys at neurosurgery. We don’t want to devalue the 63030, which is a microdisc code, or 63047, which is a laminectomy, or 63056, which is a far lateral disc. Because if you make a new code, you’re going to mess everything else up. The problem is in order to make a new code and the cost of the endoscopic materials worthwhile, you have to make it less valuable to do the other code. It’s the balanced budget concept, which has been problematic for CMS.”
Dr. Jenkins added a related caution about orphaned technology, citing a percutaneous facet tool that delivered an excellent decompression but was built around high-cost disposables; when pass-through payments changed, the company went under and the device effectively vanished from the market.
That economic reality fed directly into the theme the panel kept returning to: patient selection separating good outcomes from bad ones, no matter how good the technology looks.
“Treat the patient, not the scan,” Dr. Gantwerker said, warning against operating on imaging findings alone or expanding a fusion without strong medical necessity.
Where Dr. Ahn saw the most consequential near-term innovation was in making patient selection quantitative rather than instinctive. At Texas Back Institute, surgeons are building models that estimate the risk at adjacent levels when planning a lateral case above a prior fusion, and that can compare options such as lumbar disc replacement against fusion and return a confidence interval for likely outcomes over time.
“We’re working on data to show us whether including that next level or what the stresses are going to be at the other levels and the risk of complications associated with a one-level revision or two-level revision,” Dr. Ahn said. “We’re getting granular, and I think that’s coming.”
Dr. Ahmed, the only panelist who does not operate, broadened the lens from any single tool to integration.
“In the years coming, we are going to have an explosion of spine tech, medtech, AI, robotics and navigation. How do you really integrate this technology data with the surgical expertise?” he said. “Patient-centered outcomes are going to create some seamless spine programs.”
He envisions a “home-to-home” spine program — from risk modification before surgery through AI-assisted or digital rehab afterward.
“It’s going to be a spine ecosystem versus each individual innovation,” he said. “It’s not an individual tool anymore. You really need to look at this longitudinal tool that you’re going to work with. It’s not going to be a fantasy anymore; it’s all right there with us.”
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.
