Spine surgery’s technology boom is making operations more precise, less invasive and increasingly data-driven.
It is also creating a new set of problems. As robotics, navigation, AI, endoscopy and neurotechnology move deeper into spine care, surgeons are confronting limitations that cannot necessarily be solved by the next platform. Technology can be precisely wrong. Foundational skills can erode. Training can lag behind innovation. And some of the field’s most promising advances may never reach the patients who could benefit from them.
Here are six risks emerging alongside spine surgery’s technology boom.
1. Precision can still be wrong: Robotics and navigation can help surgeons plan trajectories and place instrumentation with extraordinary precision. But those systems remain dependent on the information guiding them.
Colin Rhoads, DO, a spine surgeon at Crystal Clinic Orthopaedic Center in Akron, Ohio, told Becker’s navigation can become inaccurate if anatomy shifts after imaging is captured.
“It’s just a tool, really,” Dr. Rhoads told Becker’s. “It can be precisely wrong as well.”
The technology can tell a surgeon exactly where to go. The surgeon still has to recognize when the map no longer matches the patient.
2. Surgeons risk losing skills the robot cannot replace: As enabling technology becomes more reliable, younger surgeons may fail to master techniques previous generations considered fundamental.
Megan Johnson, MD, a pediatric orthopedic surgeon at Scottish Rite for Children in Dallas, sees that as a potential downside of the robotics era. Surgeons still need to recognize inaccurate navigation, place instrumentation without technological assistance and continue an operation when a system fails.
“If you show up and the robot or the navigation’s not working, you need to know how to do the case without it,” Dr. Johnson told Becker’s.
She supports robotics and navigation, but believes the fundamentals must come first. “As we go into the future, there may be a time when spine surgeons have never put in a pedicle screw by hand,” she said. “To me, that’s a little bit scary.”
3. AI can appear more certain than it is: AI is moving into spine care through documentation, patient selection, risk prediction, surgical planning and navigation. Yet its ability to produce convincing answers can obscure how early some applications remain.
Dean Chou, MD, chief of spine surgery and vice chair of neurosurgery at New York City-based Columbia University Vagelos College of Physicians and Surgeons, has seen that limitation firsthand. When he asked an AI system to generate an image of an interbody cage in a disc space, it repeatedly positioned the implant in anatomically inappropriate locations.
“I would say that it’s in its infancy right now,” Dr. Chou told Becker’s. “It is still a tool, and it is one tool in the armamentarium of everything.” For now, AI can generate an answer. Surgeons still have to determine whether that answer makes clinical sense.
4. Technology is advancing faster than surgeons can be trained to use it: Endoscopic spine surgery may have a workforce problem before it has a technology problem. Many practicing surgeons were not exposed to endoscopy during residency or fellowship, and the faculty who trained them often were not either. Courses can introduce the technique, but proficiency requires cases, mentorship and time.
“I don’t think we have a technology problem in spine surgery,” Ben Burch, MD, an orthopedic spine surgeon at Atlanta Spine Institute, told Becker’s. “I think we have a training pipeline problem.”
Dr. Burch also warned that a smaller incision should not be confused with an easier operation. “It tends to be easier on the patient and harder on the surgeon,” he said.
As demand grows, closing that training gap may matter as much as advancing the technology itself.
5. The patients who could benefit may not be the ones who get access: Some of spine and neurotechnology’s most ambitious advances are approaching what once sounded like science fiction, including implanted devices designed to record and stimulate signals around spinal cord injuries.
Theresa Williamson, MD, a neurosurgeon and bioethicist who directs the Center for Innovative Neurotechnology for Neural Repair at Brown University Health in Providence, R.I., sees another challenge emerging alongside that progress.
“The pace of the academic research is way outpacing what’s available,” Dr. Williamson told Becker’s.
Development costs, commercialization and payer coverage can all determine whether promising technology reaches routine clinical care. Without attention to access, she said, increasingly powerful technologies could widen existing disparities.
“I could see a future where, if you have an injury and you’re from a certain demographic, your outcome will be different from another’s,” Dr. Williamson said. “That’s already true, but I think with advanced technology, that gap has the potential to widen.”
6. A multimillion-dollar robot can become a dust collector: Hospitals continue making large investments in robotic spine technology, but purchasing a platform does not guarantee surgeons or health systems will fully realize its value.
Michael Gallizzi, MD, a robotic and endoscopic spine surgeon at The Steadman Clinic in Vail, Colo., said successful programs require sustained surgeon commitment and teams that use the technology frequently enough to move beyond the learning curve.
“The biggest thing I’ve noticed throughout my career is there are dabblers and there are doers,” Dr. Gallizzi told Becker’s.
Without that commitment, a major capital investment can produce a very different result.
“They do this big capital expenditure, and then it becomes a dust-collecting item in the back of their facility,” he said. The uncomfortable lesson is that buying the latest technology may be the easiest part. Building the people, workflows and volume necessary to make it worthwhile can be considerably harder.
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.
