AI is beginning to transform spine surgery long before a patient enters the operating room. Instead of relying solely on imaging to understand anatomy, surgeons are increasingly using AI to generate predictive insights, personalize surgical planning and improve intraoperative decision-making.
D. Kojo Hamilton, MD, professor of neurological surgery at the University of Pittsburgh School of Medicine and director of the neurological surgery spine fellowship at the University of Pittsburgh Medical Center, recently spoke with Becker’s about how AI is reshaping preoperative planning, the role it will play inside the operating room and how it will redefine the next generation of neurosurgeons.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Looking ahead, what do you believe will be the single biggest change AI brings to pre-operative planning for complex spine surgery — and why?
Dr. Kojo Hamilton: For the past few decades, we relied on static targets for pre-operative planning using population matched outcomes for groups and extrapolating expectations of optimal results. AI allows us to transition from these static radiographic targets to dynamic, patient-specific biomechanical “digital twins.” Instead of aligning a patient to a generic, population-averaged radiographic norm, machine learning models can now synthesize multi-modal data, integrating biplanar radiographs, advanced cross-sectional imaging, dynamic gait-tracking and bone quality metrics, such as opportunistic CT attenuation.
The three most transformative effects of this knowledge are the arrival of personalized implants, the ability to mitigate mechanical failure and AI’s use in predicting compensatory mechanisms in other joints that help maintain the body’s balance.
Q: As AI becomes increasingly capable of analyzing patient data and supporting surgical decisions, where do you see it having the greatest impact inside the operating room, and where do you believe human judgment will always remain essential?
Dr. Hamilton: This is crucial for adoption. Current robotic platforms and navigation systems are largely passive; they act as highly precise GPS systems, showing where our instruments are relative to pre-operative scans. AI will turn these into active co-pilots. By continuously processing real-time video, intraoperative imaging, neuromonitoring signals and haptic feedback, such as torque resistance during pedicle preparation, an AI-co-pilot will dynamically adjust navigation maps to account for intraoperative spinal drift, providing safety buffers and warning the surgeon.
Ultimately, the higher stakes for decisions will still remain with the surgeon. These include the ethical consequence of all decisions, as well as the feel of tissue and ability to pivot from data received and real time required changes associated with complications or patient physiologic responses to planned procedures.
Q: As both a professor at the University of Pittsburgh School of Medicine and director of the neurological surgery spine fellowship at UPMC, you’re helping shape the future of neurosurgery. When today’s residents become senior surgeons a decade from now, how do you expect AI will have changed what it means to be an exceptional neurosurgeon?
Dr. Hamilton: The time has come for rapid acknowledgment of the foreseeable future. As AI increasingly levels technical skills, from instrumentation placement to the fine-tuning of decompression for stenotic and compressed neural elements, the neurosurgeon’s role is evolving into that of a skilled information processor and architect.
This includes not only being able to take over manually at every stage of a procedure, but also having a high degree of operational acumen with sophisticated robotic systems. As educators, we face a distinct challenge. We must train residents to become expert cognitive supervisors of robotic systems while ensuring they still possess the manual, “freehand” rescue skills required to safely complete an operation if the navigation system fails or the power goes out.
Ultimately, as the cognitive and manual load of routine tasks is shared with AI, the exceptional surgeon will have more bandwidth to dedicate to what matters most: complex clinical reasoning, real-time crisis management and the deeply human art of patient communication and empathy. The best surgeons of the next decade will be those who use the efficiency of technology to spend more time understanding the human being behind the pathology.
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.