From advancements in technology to shifts in the payer landscape, spine surgeons are thinking about the trends they want to get ahead of to stay strong heading into 2025.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.
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Editor's note: Responses were lightly edited for clarity and length.
Question: What's a spine trend surgeons should get ahead of going into 2025?
Joel Beckett, MD. UCLA Health/DISC Sports and Spine Center in Marina del Rey, Calif.: As we move toward 2025, one spine surgery trend that surgeons should embrace is the growing integration of artificial intelligence and machine learning in spinal care. From preoperative planning to postoperative outcomes tracking, AI has demonstrated its ability to enhance decision-making processes, predict surgical outcomes, and even improve precision in complex surgeries. Surgeons who familiarize themselves with AI-driven technologies and implement them into their practices can offer more personalized, data-backed care to patients. This technology has the potential to assist in everything from preoperative imaging analysis to real-time intraoperative navigation, helping to reduce complications and improve patient outcomes.
Additionally, the shift toward value-based care will continue to reshape how we approach spinal surgery. With payers increasingly focusing on cost efficiency, quality of care, and patient satisfaction, surgeons must prioritize minimally invasive techniques, shorter recovery times, and better long-term outcomes. This trend requires surgeons to not only keep up with surgical advancements but also to adopt comprehensive postoperative care strategies, including rehabilitation and patient education. By staying ahead of these evolving trends, surgeons can better position themselves and their practices to deliver exceptional, patient-centered care while navigating the changing healthcare landscape.
Nitin Bhatia, MD. Orthopedic Surgeon at UCI Health (Orange, Calif.): As we approach 2025, there are several emerging trends in spinal surgery that are heavily influenced by artificial intelligence. Surgeons and healthcare providers who adopt these innovations early will be well-positioned to improve patient outcomes, streamline operations, and stay competitive. Some AI-related trends that spine surgeons should be familiar with and get ahead of entering 2025, include:
Robotics combined with AI is revolutionizing precision in spinal surgery. AI can process real-time data to guide robotic systems, allowing surgeons to achieve higher precision, even in complex procedures like spinal fusion or deformity correction. The combination of AI and robotics offers enhanced dexterity, accuracy, and the ability to perform minimally invasive procedures with reduced tissue damage.
Machine learning models are also advancing outcomes research in spine surgery. By leveraging large datasets from patient records, ML can help identify patterns that contribute to successful (or unsuccessful) surgeries. This could lead to personalized surgical techniques, rehabilitation programs, and patient management strategies based on real-world data.
AI is making its way into surgical training and education, using virtual reality (VR) and simulation technologies. These AI-driven platforms allow surgeons to practice complex spinal procedures in a controlled environment with real-time feedback. This helps improve both training efficiency and skill acquisition, allowing surgeons to gain hands-on experience before entering the operating room.
AI-driven natural language processing is increasingly used to automate clinical documentation processes. AI can extract key information from patient records, standardize documentation for spine procedures, and reduce the administrative burden on surgeons. This allows surgeons to spend more time with patients and less time on paperwork
As AI technologies evolve, the early adoption of these tools by spine surgeons could significantly enhance the precision, efficiency, and outcomes of their practices. Surgeons who embrace AI-powered solutions in areas such as preoperative planning, robotic surgery, and diagnostic imaging will likely see improved patient satisfaction and competitive advantages in the fast-evolving landscape of healthcare technology.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: This has been said hundreds of times by myself and others but endoscopy is going to be a key player going forward. The payers will lag in terms of the appropriate additional value they should add, but market demand is rising. We should all embrace technology. It should, however, not be used for each and every case. As with everything we do, it's not a contest to see how many you can do, but how well you can do it in the right patient.
Philip Louie, MD. Virginia Mason Franciscan Health (Tacoma, Wash.): The intersection between outcomes, economics and enabling technology! These three factors, which are largely relevant in our practices now — are headed toward a collision in which they will all greatly influence each other.
Even in a healthcare landscape still heavily influenced by fee-for-service models in which there are currently pressures to provide quantity of care, there is an ongoing shift toward value-based care by the payers. While fee-for-service incentivizes volume, surgeons must navigate the growing pressure to deliver higher quality care at lower costs. We need to have a better understanding of the economics that drive our ability to provide care. Innovation may be more directed toward programs and pathways to integrate collaborative, multidisciplinary care models that streamline (and partially standardize) aspects of the whole surgical episode of care.
Enabling technologies will help drive the ability to collect meaningful data as well as improve the safety and efficacy of the surgeries we perform. At the core of value-based care is the goal of improving patient outcomes while controlling costs, and enabling technologies — align perfectly with this vision. While the initial investment often serves as a barrier, the long-term savings through better outcomes and fewer complications make these tools essential in a value-based care model, especially with software components that are collecting large amounts of data and "learning from each case."
David Skaggs, MD. Cedars-Sinai (Los Angeles): One of the trends I think a spine surgeon should get ahead in 2025 is minimizing radiation to patients, particularly in young patients. For example, oblique X-rays are not indicated to diagnose spondylolysis. If the diagnosis is not obvious on a PA or lateral X-ray, and there is clinical suspicion, move up to more advanced imaging. In addition, in young people there is no reason to get flexion and extension X-rays in the setting of spondylolysis or spondylolisthesis. It does not add to the patient's prognosis or suggest treatment.
From a technological perspective many centers are now investing in EOS imaging which can drastically decrease radiation load in a deformity practice.
Also on the horizon are MRI sequences which can do a surprisingly good job of imaging bone. I predict in the next year or two one may not need a preoperative or intraoperative CT scan to use navigation or robots as the MRI/bone imaging technology is advancing quickly.
Alexander Tuchman, MD. Cedars-Sinai (Los Angeles): Another trend that spine surgeons should get ahead of is using pre-operative planning software routinely for multilevel fusions. We now have improved understanding of alignment targets for multilevel fusions. Furthermore, the evidence that meeting patient-specific alignment targets reduces the rate of mechanical complications continues to grow. Preparing a patient-specific plan and executing it in the OR with enabling technologies and/or pre-contoured rods will likely become the standard of care for elective spinal fusions over the next several years.