Spine and orthopedic consolidation is moving on several fronts as reimbursement pressure, outpatient migration and rising practice costs push groups to seek more scale.
Health systems are acquiring established regional practices, pain and spine platforms are expanding across state lines, and some independent groups are consolidating with one another to preserve physician ownership.
Here are some of the markets and models where consolidation is accelerating.
Health systems are buying established regional platforms
One of the largest recent deals came in South Dakota, where Sioux Falls-based Avera Health acquired The Center for Neurosciences, Orthopaedics & Spine in Dakota Dunes.
The acquisition, which takes effect Jan. 1, includes more than 100 physicians, advanced practice providers, physical and occupational therapists and athletic trainers across nine specialties and subspecialties. The deal also includes more than 350 staff members and eight clinic locations.
The center already provides outreach services at 29 satellite locations across South Dakota, Iowa and Nebraska, giving Avera an established regional network rather than requiring the health system to build one from scratch.
The deal follows a broader pattern of health systems pursuing large spine and neurosurgery groups. Charlotte, N.C.-based Atrium Health integrated Carolina NeuroSurgery & Spine Associates into its system in 2025, while New York City-based NYU Langone Health acquired Rothman Orthopaedics’ New York practices the same year.
Pain and spine platforms are expanding across the Southeast
The Southeast has become another active area for consolidation, particularly among organizations combining interventional pain, minimally invasive spine care and ASC networks.
Thomasville, Ga.-based Summit Spine & Joint Centers acquired Southeast Neurology & Pain Management in July. The practice has locations in Thomasville, Tallahassee, Fla., and Panama City, Fla.
It was Summit’s third practice acquisition in three years and expanded the platform to 55 clinics and 21 ASCs across Georgia, Florida, North Carolina, South Carolina and Tennessee.
Atlanta-based Resolve Pain Solutions also acquired Southcoast Spine and Pain in Aiken, S.C., in March. Russell Daniel, MD, medical director of Southcoast Spine and Pain, joined the platform and also began seeing patients at Resolve’s existing practice in Evans, Ga.
“The additional support Resolve is able to provide to me, and our team will allow our practice to grow,” Dr. Daniel said.
The Mid-Atlantic is seeing new platform and health system ties
Consolidation in Pennsylvania and Maryland is taking several forms, from practice-platform partnerships to health system affiliations that stop short of outright acquisition.
Horsham, Pa.-based SEPA Pain & Spine partnered with DxTx Pain and Spine in March. SEPA has seven physicians and provides spinal injections, nerve blocks and spinal cord stimulation.
Patrick Fall, DO, said the partnership would allow the practice to maintain what made it successful while gaining “the scale, resources, and operational support” to grow.
Maryland-based TidalHealth pursued a different model. The health system integrated Peninsula Orthopaedic Associates under the TidalHealth Peninsula Orthopaedic Institute in April. Peninsula Orthopaedic Associates remains physician-owned, but the structure aligns orthopedic and spine care across the health system’s hospitals, clinics and outpatient centers.
The model combines physician leadership with shared governance, clinical standards and infrastructure while allowing the practice to retain its ownership structure.
North Carolina’s orthopedic market is getting more integrated
North Carolina has also seen several orthopedic groups deepen their relationships with health systems.
Gastonia-based Carolina Orthopaedic & Sports Medicine Center joined CaroMont Health in June. The physicians and staff were integrated into CaroMont Medical Group under the newly established CaroMont Orthopedic & Sports Medicine Center.
Charlotte-based OrthoCarolina has taken a different approach. The physician-owned group expanded its long-standing affiliation with Atrium Health in July while retaining physician ownership and control of the practice. The organizations are aligning Atrium Health’s Musculoskeletal Institute with OrthoCarolina and launching an ASC joint venture.
“Atrium Health is the right organization for this new engagement because we share a longstanding commitment to advancing orthopedic care,” OrthoCarolina CEO Leo Spector, MD, said.
The two North Carolina moves illustrate how consolidation can range from full employment to strategic affiliation, with physician groups increasingly weighing how much independence they are willing to trade for scale and infrastructure.
Texas groups are consolidating to stay independent
Not all consolidation ends with a health system or outside investor.
Five orthopedic and spine practices in the Dallas-Fort Worth market are uniting under the OrthoTexas brand, creating an organization with more than 70 physicians across 22 locations.
Michael Briseño, MD, chairman of OrthoTexas and a spine surgeon at North Texas Orthopedics & Spine Center in Grapevine, said fragmentation has weakened independent physicians’ influence as hospitals and other organizations have grown.
“A lot of small groups have worked in their silos for decades and done well, but that has diluted our voice,” Dr. Briseño said.
The strategy is effectively consolidation in defense of independence: creating enough scale to strengthen payer negotiations, invest in infrastructure and compete with larger systems without moving physicians into an employed model.
Florida health systems are adding spine practices
Health system acquisition is also extending further into Florida’s orthopedic and spine markets.
Vero Beach-based Cleveland Clinic Indian River Hospital acquired Orthopaedic Center of Vero Beach in February, expanding its orthopedic, spine, physical therapy and rehabilitation services.
The practice’s physicians and staff remained at its existing Vero Beach location during the transition, while patients gained access to Cleveland Clinic’s shared EHR, referral network and five-hospital Florida system.
The acquisition reflects one advantage large health systems have in the consolidation market: an established practice can immediately bring physicians, patient relationships and downstream orthopedic and spine volume into the system.
The pressure to get bigger is unlikely to ease
The pace of deals is being reinforced by practice economics.
Six large orthopedic groups were actively going to market in 2026, more than in 2025, Dana Jacoby, president and CEO of Vector Medical Group, told Becker’s in June.
At the same time, consolidation is shifting away from a simple private equity-versus-independence divide. Health systems, physician-led platforms, PE-backed management organizations and large independent groups are all competing to build scale.
The common thread is control of more than the physician professional fee. Outpatient facilities, imaging, rehabilitation, pain management and other ancillary services have become increasingly important as reimbursement pressure makes it harder for practices to rely on surgical fees alone.
That is likely to keep regional groups with strong referral networks, outpatient assets and established patient bases among the most attractive targets for the next wave of spine consolidation.
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