For years, innovation in spine care has been defined by what happens in the operating room, new techniques, advanced implants and, more recently, robotics.
But Khalid Odeh, MD, believes the biggest opportunity to improve outcomes begins much earlier. “If I could change one thing about how musculoskeletal care is delivered, it wouldn’t be a new surgical technique,” he said. “It would be how patients enter the system.”
Dr. Odeh, a spine surgeon with Michigan Orthopaedic Specialists and attending spine surgeon at Corewell Health in Royal Oak, Mich., spends much of his time treating complex spinal conditions. But just as often, he sees something else, patients who may never have needed to see a spine surgeon in the first place.
A system that doesn’t filter
In today’s healthcare environment, patients with back or neck pain often move through a fragmented system with few clear guardrails. Many are referred to specialists early, while others face delays, even when their conditions warrant urgent evaluation.
“There’s not a great way of filtering as a healthcare system,” Dr. Odeh said.
The result is a mismatch that plays out daily in spine clinics. Patients with short-term musculoskeletal pain, conditions that typically improve with time, medication or physical therapy, are scheduled into specialty visits. At the same time, patients with more serious pathology can take longer to reach the right level of care.
Imaging patterns reflect the same imbalance. MRIs are often ordered before they are clinically necessary, particularly for patients without neurological symptoms, where findings are unlikely to change management. In some cases, imaging and referrals are also shaped by insurance requirements, which can push patients toward specialist visits before appropriate workups are completed.
“A lot of them would get better without even seeing a spine surgeon,” Dr. Odeh said.
Rethinking the entry point
Rather than focusing on downstream interventions, Dr. Odeh sees an opportunity to redesign how patients enter the system altogether. He envisions a more structured front-end triage model, where patients are directed early based on clinical signals rather than default referral patterns.
In that model, patients with neurological deficits, such as weakness or numbness, would be fast-tracked to surgical evaluation. Those with mechanical pain would be routed toward therapy-first care, while individuals with chronic pain would be guided toward multidisciplinary management.
“Those patients do need at least a consultation from a surgical doctor,” he said, referring to patients with neurological symptoms.
For many others, he said, effective care can begin and often resolve outside of a surgical setting.
A practical role for AI
AI is frequently discussed as a future solution in healthcare, but Dr. Odeh sees a more immediate, targeted application.
He points to triage as an area where AI could help analyze clinical documentation from emergency departments, urgent care centers and primary care visits, identifying key indicators and guiding referral decisions.
“If it’s just acute musculoskeletal pain, that’s not something that needs to be seen by a spine surgeon,” he said.
For AI to play a meaningful role, however, it must be precise. The ability to reliably distinguish between routine pain and signs of neurological compromise will be critical to earning physician trust and improving patient flow.
From volume to value
A shift toward more effective triage would likely change the composition of spine clinics, reducing overall volume while increasing the proportion of patients who truly need specialist care. For Dr. Odeh, that shift is not a loss, but an improvement.
“I think most spine surgeons would rather have a smaller number of patients that could benefit from surgery,” he said.
Fewer, more appropriate visits would allow for longer, more meaningful interactions, particularly for patients considering surgery, where time, education and shared decision-making are essential.
The challenge beneath the solution
Designing a better entry point is conceptually straightforward. Implementing it is not.
Patients enter the system through multiple channels, primary care offices, urgent care centers and emergency departments, each operating with different incentives and varying levels of coordination.
“There’s not a lot of integration,” Dr. Odeh said.
Creating a more effective triage model would require alignment across those stakeholders, along with improved data sharing and communication between systems. In more integrated environments, that coordination is easier to achieve. In more fragmented settings, it remains a significant barrier.
A shift that starts earlier
For Dr. Odeh, the future of musculoskeletal care will not be defined solely by advances in surgical technique, but by how effectively the system guides patients to the right care at the right time.
By improving triage at the front end, he believes healthcare systems can reduce unnecessary imaging, shorten time to appropriate treatment and ultimately improve outcomes.
“It’s about optimizing patient care and directing patients more appropriately,” he said.
In a field often focused on what happens in the operating room, the most meaningful change, he argues, may happen long before a patient ever gets there.
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