The most difficult part of building a great spine program may have little to do with surgery. It is getting patients through the door before weeks pass, knowing when an operation should be avoided, coordinating the teams required for the most complex cases and making sure patients aren’t left navigating recovery alone.
For Puya Alikhani, MD, chief of neurosurgery at Tampa (Fla.) General Hospital, those responsibilities are just as central to surgical excellence as technical expertise.
Earlier this month, the hospital became the first program worldwide to earn Surgical Review Corp.’s Center of Excellence in Neuro Spine Surgery designation. Dr. Alikhani, who also leads the spine division at the Tampa-based University of South Florida Morsani College of Medicine, became the first surgeon to receive SRC’s Master Surgeon designation in the specialty.
The recognition reflects years of work across surgical care, multidisciplinary coordination and quality improvement. But Dr. Alikhani is quick to redirect attention from the individual surgeon to the people and processes surrounding each operation.
“I am just one person, and there is a huge army and silent forces behind this success,” he told Becker’s.
After roughly 18 years at USF and Tampa General, including about a decade as an attending surgeon, Dr. Alikhani has come to see the strength of a spine program less as a collection of individual accomplishments than as the ability to deliver coordinated care from the first appointment through recovery.
“When it comes to surgery, it’s not all about surgical technique,” he said. “It comes before, during and after surgery.”
The work that happens before the first incision
For all the attention paid to new surgical technologies, Dr. Alikhani believes some of the greatest opportunities to improve spine care remain outside the operating room.
Access is one of them. Patients previously could wait several weeks for an initial appointment at Tampa General. The program has since developed a spine triage process that Dr. Alikhani said has shortened the wait for an initial evaluation to about one week.
Rather than waiting for a surgeon to begin the diagnostic process, patients can be evaluated, undergo additional testing and arrive at a surgical consultation with more of the necessary workup completed.
That process can help determine whether an operation is appropriate or whether a patient would benefit from continued conservative treatment. Dr. Alikhani considers that distinction fundamental to good spine care. The program works with physical therapy, chiropractic and pain management teams to offer alternatives to surgery when appropriate. Some patients, he said, have been able to avoid operations through those services.
“Surgery comes with risk, and as surgeons, we have to be honest with our complications and our risks,” he said.
He views surgery as a last resort when other treatments may provide relief.
The other major opportunity comes after patients leave the hospital. Dr. Alikhani wants patients recovering from surgery to feel that they remain connected to the same team that guided them through their operation. Questions about wound care, pain or follow-up appointments should not require navigating a maze of departments.
“When the patient goes home, they need to feel that they have one team,” he said.
His goal is for patients to have a single number they can call and confidence that their concerns will reach someone equipped to help. Improving access before surgery and communication afterward remains an ongoing priority, he said, even as the program expands its surgical capabilities.
When other surgeons have run out of options
Those systems become particularly important for patients whose conditions are too complex for a routine surgical pathway. Tampa General treats patients with severe spinal deformities, multiple previous operations and persistent symptoms, including some who have sought opinions at several other centers without finding a surgical option.
Dr. Alikhani described patients who arrive with extensive scar tissue, significant pain and limited mobility after repeated procedures. Some have reached a point where their quality of life has deteriorated substantially, but another operation carries considerable risk.
The decision to intervene is rarely straightforward. Every Wednesday, a multidisciplinary team meets to review challenging cases and consider whether surgery can offer a meaningful benefit. For patients who may require extensive revision or deformity correction, Dr. Alikhani emphasizes an honest discussion about what another operation entails.
“This is a big operation. This is a very high-risk operation. This can get complicated,” he said, describing what he tells patients considering these procedures.
The complexity also changes what is required of the program. Anesthesiologists must be prepared for lengthy, technically demanding operations. Operating room nurses, imaging teams, residents and fellows each play a role in executing the surgical plan. Afterward, specialized pain management and transitional care teams help patients move from the hospital to rehabilitation or home.
Dr. Alikhani sees his leadership responsibility as bringing those groups together before gaps in coordination affect care. “My goal as the spine director is to bring all those teams together, to be their voice and talk to all of them to make sure we’re on the same page,” he said.
For programs seeking to expand their complex spine capabilities, his experience points to a challenge that cannot be solved by surgical expertise alone: The more demanding the operation, the more important the infrastructure around it becomes.
The question every new technology should answer
Tampa General has expanded its minimally invasive, endoscopic and complex spine capabilities, and Dr. Alikhani believes surgeons must continue learning new techniques.
But he draws a distinction between adopting technology and improving care.
“Is this new technology going to help the patient? Is this going to make a difference in the patient’s life?” he said. For him, the relevant measures are practical. Will patients walk farther, function better or return to activities that matter to them? “Sometimes the answer is yes, and sometimes the answer is no,” he said.
That perspective also shapes how he evaluates surgical decisions more broadly. Having the technical ability to perform a procedure does not necessarily mean the patient will benefit from it.
The same principle applies to complex revision cases, where the possibility of restoring function must be weighed against the risks of another major operation. In a specialty increasingly defined by sophisticated techniques and expanding surgical capabilities, Dr. Alikhani believes the responsibility to question their value remains essential.
The recognition raises the stakes
For Tampa General, the SRC designation marks a milestone. For Dr. Alikhani, it also creates a new level of accountability.
“With every recognition, there is going to be more judgment and more scrutiny,” he said.
Patients and colleagues now have heightened expectations of the program, he said, making continued improvement even more important. That means studying outcomes, acknowledging complications, strengthening the team and remaining open to learning rather than treating recognition as proof that the work is finished.
“I always tell my colleagues, my students and my residents, the bar is high. Now it’s even higher,” he said.
Despite being the first surgeon worldwide to receive SRC’s Master Surgeon recognition in neuro spine surgery, Dr. Alikhani repeatedly emphasized that the achievement belongs to far more people than those whose names appear on the designation.
He credited administrators, preoperative teams, operating room nurses, rehabilitation specialists and the clinicians who manage patients after surgery.
For a specialty that often measures progress through increasingly complex operations and advanced technology, his message offers a different perspective on what makes a program exceptional.
The real test may not be how much a spine team can accomplish in the operating room, but how well it cares for patients before they enter it and after they leave.
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