From evolving spine innovations to advancements in intradiscal therapies, here are the discoveries exciting surgeons today.
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: As payers expand site-neutral payment policies, what impact will this have on your practice? Where do you see opportunities or risks?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, Oct. 14.
Editor’s note: Responses were lightly edited for clarity.
Question: What’s something new or interesting you heard/discovered about the spine field and why?
Arthur Jenkins, MD. JenkinsNeuroSpine (New York City): All the novel ways technology and biosimilars and biologicals are helping with wound healing. One of my areas of expertise involves complex patients (including hypermobile patients), which means I see a lot of patients with collagen disorders who have higher rates of wound complications. The recent influx of oral dietary supplements, implants like tissue anti-scarring materials like amniotic tissue membranes and now cod fish skin (that’s a real thing, provided in sterile packaging), and topical wound debridement and healing measures make wound problems less and less of an issue after surgery.
One way that things aren’t changing (even though the media hype is through the roof) is in the use of AI. For every 100 startups that propose to have an “AI” (meaning their app or algorithm) solution to a problem that may or may not exist, maybe one or two will improve our ability to provide care to patients (a risk stratification for post-op complications based on pre-op EKG? Yes please!). As for the rest, my response to their pitches are, “yes, and how will this help me care for patients?” The answer is usually that it will do the same thing (at best) as ONE of the tasks my staff are already doing, but it’s just a tool to make their job easier, which is usually what we called “computer programs”, not “AI”s. Even my “AI scribe” still can’t write patient notes as well as my human scribe (but it does make her job easier).
Bowen Jiang, MD. Providence St. Jude Medical Center (Orange County, Calif.): One of the most exciting advancements I’ve seen is the integration of robotic navigation systems like ExcelsiusGPS into spine surgery. At Providence St. Jude Medical Center, we’re using this technology to perform highly precise procedures through smaller incisions, which significantly reduces tissue disruption. That translates to less postoperative pain, fewer complications and faster recovery for our patients. What’s particularly compelling is how this platform allows us to tailor each surgical approach to the patient’s unique anatomy and condition — bringing a new level of personalization and accuracy to spine care.
Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): Innovation isn’t slowing down, but we’re not always innovating in the right places.
The technologies and innovations are accelerating: robotics, sensors, AI, data-driven planning. But technology without accountability isn’t advancement, it’s actually a distraction. But like BMWs without cupholders in the 1990s, we sometimes forget the real needs: access, continuity, outcomes that matter, and yes … sometimes just someone to call patients back.
I’ve realized that the future of the spine field won’t be defined by who has the most technology, but by who finds the most important areas to address and applies it responsibly. Many in our field want to innovate faster, but I am constantly reminded that responsible innovation means asking harder questions like does this make care safer, more efficient, and more human? Or are we simply adding another layer of complexity?
Payam Moazzaz, MD. DISC Surgery Center at Carlsbad (San Diego County): With current advances in technology, including robotics and navigation, it is amazing how much we can accomplish as spine surgeons with minimally invasive approaches. Smaller incisions and shorter surgeries allow patients to get up and be active starting just a few hours after their surgery. This has greatly shortened recovery timeframes and removed the typical stigma historically associated with spine surgery. The results achieved at DISC — a highly specialized, spine-focused outpatient surgery center — are phenomenal due to DISC’s team approach and focus on quality and outcomes. This allows us to perform complex spinal surgeries on an outpatient basis, providing an excellent experience for our patients, who get to go home and start their recoveries on the same day.
Gurtej Singh, MD. Centers for Advanced Orthopedics (Bethesda, Md.): Intradiscal therapies remain the “holy grail” for treating anterior column mechanical low back pain. Many options have come forward, from PRP formulations to different MSC sources, but all still have limitations.
Two new approaches are worth watching. One targets the annulus, aiming to treat annular tears that often cause chemical neuritis and don’t respond well to standard injections or medications. The other is a new material for the nucleus designed to maintain disc hydration and structural integrity under load. The goal is to restore balance and take stress off the posterior spine, slowing the degenerative cascade we see so often.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Recent developments in understanding neuroinflammation’s role in chronic pain have shifted some thinking about pain persistence beyond structural pathology. Research by Ji et al. (2018) and others has demonstrated that microglial activation in the spinal cord can maintain pain signals independent of ongoing tissue damage. This has implications for why some patients develop chronic pain while others with similar imaging findings do not. Additionally, advances in disc regeneration research, including growth factor therapies and stem cell applications, show promise in preclinical studies, though clinical translation faces significant regulatory and efficacy hurdles. The disconnect between imaging findings and clinical symptoms continues to be a major area of investigation, with studies consistently showing poor correlation between MRI abnormalities and pain levels.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): For this practitioner and other spinal surgeons, the acceptance and use of digital health and telemedicine are conventional standards of care especially administering care in the rural and distant setting. The practice of video/telephone calling has allowed for timelier follow-up visitations which in turn, premiates passage of both diagnostic and therapeutic information to patients either anticipating surgery or results of studies. A valuable tool for both patient and provider alike could be preferable and better utilized to reestablish/reinforce patient relationships and experience.
