A potential overreliance on new technology, the lack of standardization and long-term data and underappreciation of global spinal alignment are three of the most overlooked issues in spine care and spine surgery, according to surgeons.
These six spine surgeons recently connected with Becker’s to share the trends and issues that are getting enough attention.
Note: Responses were lightly edited for clarity and length.
Question: What do you feel is an overlooked issue in modern spine surgery?
Justin Field, MD. Spine Surgeon of Desert Institute for Spine Care (Phoenix): I still think that cervical artificial disc replacement is overlooked. We all are aware of its benefits of decreasing the rates of adjacent segment degeneration. Yet, many surgeons feel that cervical ADR is only reserved for younger patients with mild disc height loss and a herniation. Cervical ADRs are applicable for many cervical conditions and for young and older patients with good bone quality and up to moderate height disc loss. Patients with myelopathy and/or radiculopathy of the cervical spine can tremendously benefit from cervical disc replacement when conservative treatments fail to govern relief. Patients with two level cervical disc disease may benefit from two level ADRs or a hybrid procedure with one level ACDF and one level ADR. The technology will continue to be enhanced as more physicians focus on the attributes and application of cervical ADRs.
Brian Gantwerker, MD. CEO of The Craniospinal Center of Los Angeles: I think one issue that is frequently, if not constantly overlooked, is the heterogeneity of spinal pathology and its treatment. There seems to be a lack of understanding that each patient and each problem is very unique. While there are some agreed-upon treatments and approaches, each surgery is truly carefully customized for each patient. That is why I think spinal bundle payments don’t make any sense to me. Having spine surgery is not like having a wart removed. I think hospital systems and people in Congress need to understand that. We already understand that because they make us justify each and everything we want to do, however, they just don’t wanna pay for it. Doctors have a PR problem and we have not done a good job communicating this fact. We need to get better at it if you wanna have a seat at the table.
James Harrop, MD. Spine Surgeon of Thomas Jefferson University Hospital (Philadelphia): I believe one of the biggest issues for medicine in general, including spine surgery is that we have become too technology specific and focused. Are we focusing on it too much and “taking our eye off our main goal”? Are we losing our physician patient contact and relationships? The greatest predictor of a successful operation is understanding the patient’s problem. A precise history and physical exam trumps the most advanced imaging, although I acknowledge technology has been extremely beneficial.
However, as technology has evolved it has created a further gap between patient and physicians. Physical evaluations and communication is getting further distanced. For example, telemedicine in my experience completely limits your ability to examine the patient as well as observe their movements and body positions, rather the focus of the appointment and decisions relies on technology like radiographs and EMG. Physicians are now screening patients through AI of radiology records and operative reports excluding the patient’s perspective of the issue. Further, this also occurs in the operating room. Technology has become so advanced, we are bordering on letting it make operative decisions. Robots and navigation systems for example are fantastic “tools.” However, they are merely tools and you first must understand anatomy and the surgical goal as defined by the patient’s complaints. The analogy of technology for operative advancements to your car’s GPS would be similar to using and not knowing how to drive or where you are going. To summarize, technology is accelerating, which is important and hugely beneficial for our patients, but we should all take a step back and spend a little bit more time with our patients.
Jordan Kump, MD. Orthopedic Spine Surgeon of Orthopedic Centers of Colorado (Denver): One of the most overlooked issues in modern spine surgery is the underappreciation of global spinal alignment, particularly in single-level or motion-preserving procedures. While we routinely correct focal pathology, subtle disruptions in sagittal balance often go unrecognized, yet they can lead to long-term dysfunction, adjacent segment disease and poor patient-reported outcomes. As we continue to emphasize minimally invasive approaches and faster recovery, we can’t lose sight of the biomechanical harmony of the entire spine. A small misstep in alignment today may become a driver of failure tomorrow.
Jakub Sikora, MD. Orthopedic Spine Surgeon of Salt Lake Orthopedic Clinic: The biggest issue in moderate spine surgery is the recent tactic that insurance companies are taking to limit MRI approval. Often the criteria for what makes the patient eligible for an MRI changes, and the most challenging part is they often look for six plus weeks of physical therapy prior to having an MRI done. They are expecting us to treat the problem before we even have a diagnosis. If they can limit access to an MRI, then they can deny or delay paying for any reasonable care that the patient is entitled to.
Rohit Verma, MD. Assistant Attending Spinal Surgeon of Northwell Health (New Hyde Park, N.Y.): Modern spine surgery is undergoing a transformative era with the emergence of robotics, artificial intelligence, endoscopic techniques and a growing range of surgical options including motion-sparing technologies, facet replacements and artificial disc replacements. While innovation is exciting, one major issue that often goes overlooked is the lack of standardization and long-term comparative data. For patients, this rapid evolution can be overwhelming. It’s not uncommon for the same diagnosis to yield three completely different surgical recommendations, depending on the surgeon’s training, generation and the technologies available to them. In many cases, the choice of procedure is more reflective of the surgeon’s background than evidence-based consensus. What we truly need is robust, long-term data that spans decades, comparing outcomes across surgical techniques, devices and diagnoses. Without this, it’s difficult to provide patients with clear, personalized guidance rooted in long-term success and functional outcomes. Bridging this gap between innovation and standardized, outcomes-based care is, in my view, one of the most pressing needs in modern spine surgery.
