In spine care, progress rarely moves in a straight line.
Some ideas take years to reach the operating room, even after evidence supports them. Others arrive far more quickly, propelled by enthusiasm that outpaces validation. Between those two forces lies one of the field’s most persistent challenges: translating research into practice.
For Bryce Basques, MD, director of minimally invasive spine surgery at Providence, R.I.-based University Orthopedics and assistant professor of orthopedic surgery at Brown University, that gap is not theoretical. Through his work across clinical practice, research funding and guideline development, he has seen how ideas move through the system and where they tend to stall.
“I think it’s a really relevant question,” he said. “It’s always a challenge, not just for me, but for the spine surgery community as a whole.”
What emerges from that vantage point is not a lack of innovation, but a misalignment between evidence, incentives and adoption.
The science surgeons are still catching up to
Some of the most meaningful advances in spine are not new implants or devices, but a deeper understanding of biomechanics. One of the clearest examples is the growing emphasis on personalized spinal alignment. Research has increasingly shown that the position in which a spine is fused is critical to long-term outcomes, not simply a technical detail decided in the operating room.
“What we’ve learned recently is that the alignment you put someone’s spine in is critically important,” Dr. Basques said. If not carefully planned, he added, it “can lead to worse outcomes and a rapid need for additional spinal surgery.”
The implications are significant, particularly in a field often scrutinized for revision rates. And yet, this approach has not been uniformly adopted.
The reasons are layered. Some surgeons remain unconvinced. Others face practical constraints. Precision planning requires time, tools and a shift away from long-standing habits. Even when evidence is strong, implementation depends on whether clinicians have the infrastructure to act on it.
Still, Dr. Basques sees momentum building. With advances in planning software and AI-assisted tools, personalized alignment is becoming more accessible and is likely to move closer to standard practice.
Proven procedures that remain underused
If personalized alignment represents an idea still gaining traction, motion-preservation and minimally invasive procedures reflect a different kind of gap. These are not emerging concepts. They have been available for years, yet adoption remains uneven.
Disc replacement is one example. Despite decades of availability and broader insurance approval, it continues to be performed at lower rates than fusion-based procedures, Dr. Basques said. Endoscopic spine surgery has followed a similar path, with technical capability outpacing widespread use.
He points to both cultural and economic factors. “There’s just a lag time between what people see in training and what’s worked for them in their practice,” Dr. Basques said.
Reimbursement also plays a role. “Insurance typically pays less for disc replacement than they do for a fusion-based procedure,” he said, creating a structural disincentive to expand its use.
The result is a familiar pattern in healthcare. Evidence may support broader adoption, but the surrounding system determines how quickly that happens.
When the hype outpaces the data
At the other end of the spectrum are treatments gaining attention before the evidence fully supports them. Stem cell therapies, for example, are among the most prominent examples in spine care.
“There still is not any good evidence behind stem cell treatments in the spine,” Dr. Basques said, even as some clinics continue to market them directly to patients, often at significant cost.
Platelet-rich plasma occupies a more uncertain position. While supported in some areas of orthopedics, its role in spine care has not been clearly established.
AI presents yet a more complex case. It has already demonstrated value in areas such as surgical planning and outcome prediction, but its limitations remain significant. “We have to be a little bit careful,” Dr. Basques said, noting that many AI systems function as black boxes. “I don’t think we’re at the point where we can really 100% rely on AI to give foolproof answers.”
In medicine, where decisions have direct consequences, that uncertainty carries weight.
A different kind of risk: AI in prior authorization
If AI in clinical care is still developing, its use in insurance processes is already widespread and, in some cases, problematic. Dr. Basques described a growing reliance on automated systems to review and deny claims, often creating delays that directly affect patient care.
“It causes delays, leads to canceled cases and ultimately harms patients,” he said. “We really need to disrupt the prior authorization process because it’s so broken.”
The concern is not just about technology, but accountability. When decisions are made algorithmically, it becomes more difficult to identify responsibility and resolve errors quickly.
The constraints shaping what gets studied
Before research can influence practice, it must first be funded. Here, too, Dr. Basques sees limitations. Funding for spine research remains highly competitive. While specialty societies provide support, it is often not enough to sustain large-scale studies. At the same time, federal funding has become more difficult to secure.
As a result, certain types of research are more likely to move forward. Much of the current focus is on personalized medicine, particularly predicting how individual patients will respond to specific treatments. On the basic science side, efforts continue to examine the molecular mechanisms behind degeneration. These are critical areas of study, but they also reflect the scale of the challenge. In spine care, understanding disease has advanced significantly, but reversing it remains out of reach.
Bridging the divide within spine
If there is a single point where the research-to-practice gap could be narrowed, Dr. Basques believes it lies in greater collaboration.
Spine care remains divided between orthopedic surgery and neurosurgery. While techniques and technologies have increasingly overlapped, training pathways and professional structures remain distinct. “More collaboration between orthopedics and neurosurgery is going to be important to get the best available evidence and techniques out there,” he said.
Stronger alignment between the two specialties could improve not only how new techniques are taught, but also how the field advocates for policy changes, particularly in areas like reimbursement and prior authorization.
The next challenge for spine care
Spine surgery is not short on innovation. The field continues to generate new data, new tools and new approaches to care.
The challenge lies in translation.
Some advances remain underutilized despite strong evidence. Others gain traction before they are fully validated. The distance between discovery and practice is shaped not only by science, but by systems, incentives and collaboration.
Closing that gap will require more than better ideas. It will require a more coordinated effort to ensure that the right ones reach patients at the right time.
Related webinar: The Surgeon’s Perspective: Using Neuromonitoring Data When It Matters Most — a surgeon-led look at how neuromonitoring data drives real-time decisions in the OR. Register here.
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.
