At the start of 2025, spine surgeons discuss the words that will define their specialty in the year.
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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Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Tuesday, Jan. 14.
Editor's note: Responses were lightly edited for clarity and length.
Question: What word will define the spine field in 2025?
Nitin Bhatia, MD. Orthopedic Surgeon at UCI Health (Orange, Calif.): The word that will define the spine field in 2025 will be "Precision." The application of artificial intelligence, robotics and personalized medicine in spine care is leading to highly accurate diagnostics and treatments tailored to individual patient needs. At UCI Health, we are utilizing cutting edge techniques including robotic surgery, AI and computer-aided 3D navigation to ensure that each patient is holistically evaluated and treated as precisely as possible to improve outcomes and minimize recovery time.
Jeffrey Carlson, MD. Orthopaedic & Spine Center (Newport News, Va.): As insurance providers and healthcare systems continue to squeeze physicians, I think the surgeons in the field of spine surgery are on the precipice of discovering their worth to hospital systems and insurance providers. The word I would use to anticipate the new year is "Alternatives." Spine surgeons have long been the largest economic drivers for many practices and systems. As we have gotten more facile at outpatient surgical techniques, we have less need of the hospital and practice alignments. Now spine surgeons can provide an increasing variety of high-quality surgical treatments to their patients at surgery centers or office-based practices. This allows spine surgeons to more freely pursue opportunities that will not include ER coverage or unequal sharing of the fruits of their hard work. This will create intense negotiations that can be quite productive to drive the free market toward increasing access to care, new technologies and cost savings.
Brian Fiani, DO. Spine Surgeon. (Birmingham, Mich.): In 2025, the word that may define the spine field is "innovation." With advancements in technology, research, and treatment methodologies, the focus on innovative approaches will likely enhance patient care, improve surgical techniques, and offer new solutions for spine health challenges. This includes everything from minimally invasive procedures to personalized treatment plans driven by data analytics and artificial intelligence.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: The spine field will be defined by the word "evolution." We are seeing some positive change from a technical standpoint. More experience and papers have come that show treatments such as sacroiliac joint fusion, endoscopy, arthroplasty and shorter-segment fusions are all good options for our patients. While deformity correction remains an important aspect of spine surgery, not everyone needs a T10-Pelvis. It is important we as surgeons think carefully about these options and make sure we remain committed to treating the patient and not the film. As a group, we are getting better and better with technology. There is more to come, and I hope that while we look forward, we can rely on lessons of the past and keep some things "old school."
Lali Sekhon, MD, PhD. Spine Surgeon at Reno (Nev.) Orthopedic Center: "Flux," be it payments, indications, the role of enabling tech, etc. It's probably a good word for healthcare in general.
David Skaggs, MD. Cedars-Sinai (Los Angeles): A phrase that should define the spine field in 2025 is, "patient-centered focus when adopting new technology." New technology can be adopted for bad reasons such as marketing, wanting to please industry and ego. It can also be sidelined for bad reasons such as lack of investment, fear or inertia. The most important reason to adopt new technology is to improve patient care, while looking for improved efficiency and use of resources.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: "Appropriateness" is the word that we will define our field in 2025. With yet another Lown Institute study demonstrating that there is clear medical overuse in our field, including spinal fusions, vertebroplasties, and spinal interventions such as injections, we need to collectively do better to define what is appropriate for patients with spinal disorders. In the absence of collective efforts by practitioners to standardize our field and create clear appropriateness criteria that can be universally accepted, regulatory bodies and insurance companies will continue to encroach upon our ability as physicians to deliver the right care to our patients. This may ultimately limit our ability to actually deliver appropriate and safe care in a way that negatively impacts our ability to care for patients. The onus is upon us to act and act now. We cannot delay these efforts any further.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Sustenance. Since 2001, Medicare reimbursements for physician services have declined by almost 30%. This is reflective in the numbers of providers who willfully refuse to treat or participate in service delivery. Notwithstanding, the result of these willful restrictive choices further burden the physicians and systems that provide complex spinal surgery and other needy services. On average, the referral appointment wait time for a specialist (in our health system) is between three and six months. This time element will only increase as the throughput for these healthcare metrics will be further reduced as the front end burdens. Insurers are already scrutinizing most case submissions in the intent to withhold care from its outset. This current decline in services will require a significant correction and political intervention if and only when the public becomes so outraged with the state of healthcare delivery.