In spine surgery, progress is often measured in millimeters. Smaller incisions. More precise instrumentation. Less disruption to surrounding tissue. But after more than two decades in private practice, Sean McCance, MD, believes the specialty risks confusing technological sophistication with better patient care.
“Sometimes surgeons can get caught up in technology and the shininess of the new toy, and forget that it’s really about the outcome of the patient,” he told Becker’s.
As founder and director of New York City-based Spine Associates of NYC and co-director of spine surgery at Mount Sinai Hospital, Dr. McCance has watched navigation, robotics and minimally invasive techniques reshape the operating room. He embraces advances that improve care but questions whether every new tool delivers on its promise.
For him, the challenge is knowing when innovation makes a meaningful difference, and when it doesn’t.
When minimally invasive becomes minimally effective
Dr. McCance sees substantial value in minimally invasive surgery, particularly approaches such as lateral lumbar interbody fusion and selected percutaneous fixation techniques that can reduce surgical disruption and shorten recovery.
But he cautions against treating incision size as a measure of surgical success.
“If you try to do a million things through a tiny incision and don’t achieve them, you end up with minimally effective surgery instead of minimally invasive surgery,” he said.
That distinction shapes his perspective on endoscopic spine surgery. Although he does not perform endoscopic procedures himself, he believes the technique can work well for selected soft-tissue nerve compressions, including certain disc herniations. More extensive bony decompression can be challenging, particularly for surgeons still developing proficiency.
Having treated patients following unsuccessful endoscopic procedures, he favors tubular approaches for appropriate cases in his complex and revision-focused practice. His concern is not with minimally invasive surgery itself, but with allowing the pursuit of a smaller incision to overshadow the procedure’s effectiveness.
The technology trade-off
Navigation and robotics present a similar dilemma. Dr. McCance credits advances in navigation with improving accuracy in complex revision procedures, particularly when previous fusions have altered normal anatomy.
Yet he has also encountered operations in which the technology added time without an obvious benefit.
During a recent four-level degenerative scoliosis case, he and another experienced surgeon used navigation but found it slowed their workflow.
“I actually find that it increases the mental load,” he said. Surgeons must interpret the screen, monitor navigation references and reconcile the technology’s guidance with their own anatomical judgment.
He acknowledges that the experience may differ for younger surgeons trained with navigation from the beginning of their careers. Robotics, meanwhile, can be valuable for selected percutaneous procedures without necessarily improving every operation. The point, he argues, is that technology should be evaluated according to the problem it solves, not simply its sophistication.
The most overlooked part of spine care
Asked where spine surgery could improve most over the next several years, Dr. McCance did not point to a breakthrough implant or surgical platform.
He pointed to the physical examination. “I can’t tell you how many patients I see for second opinions who say, ‘Wow, you’re the first doctor who’s examined me,'” he said.
He worries that time pressures can encourage physicians to rely heavily on imaging without fully understanding the patient’s symptoms and circumstances. For Dr. McCance, meaningful improvement begins with identifying the source of pain, determining whether surgery is necessary and selecting the appropriate intervention.
He also sees opportunities to individualize recovery. Better preoperative conditioning, nutritional optimization and rehabilitation plans tailored to each patient’s fitness and procedure could improve outcomes without requiring a technological breakthrough.
Wearables may eventually help surgeons monitor postoperative activity and guide recovery goals. But he expects the specialty’s progress to remain largely incremental, rather than driven by a single transformative innovation.
The value of independence
Dr. McCance’s approach to patient care is closely tied to the practice model he has spent 26 years building. Since opening his Manhattan practice in 2000, he has expanded Spine Associates into a five-surgeon independent group comprising orthopedic and neurosurgical spine specialists. The practice treats conditions ranging from degenerative disease to spinal tumors, deformities and complex revisions.
For particularly demanding operations, two surgeons may operate together, combining their experience and potentially improving efficiency. Dr. McCance believes independence allows physicians greater control over patient care, including how much time they spend with each person.
“People want to see the doctor. They don’t necessarily want to see the hospital,” he said.
Maintaining that autonomy requires significant administrative support. His practice operates out of network, and he said reimbursement disputes with insurers demand a dedicated team. He worries those pressures have led too many physicians to view hospital employment as their only realistic option.
“I think too many doctors either don’t consider being private or just assume they have to be employed to have patients,” he said.
He believes greater control over clinical decisions, schedules and practice environments can help physicians avoid burnout and remain engaged in their work.
His advice to younger surgeons is to consider alternatives to employment, even when independence requires taking a risk. “Look for models where you can practice the way you want to practice,” he said.
For Dr. McCance, the future of spine surgery is not simply about what new technology allows surgeons to do. It is about preserving the time, independence and clinical judgment to decide what patients actually need.
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