In 2025, spine surgeons are looking to push innovation and care forward through their research.

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.

Next question: What unique challenges does your practice setting face compared to others?

Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Tuesday, Feb. 25.

Editor’s note: Responses were lightly edited for clarity and length.

Question: What research projects are you involved in this year?

Brian Fiani, DO. Spine Surgeon. (Birmingham, Mich.): Laser therapy and photobiomodulation systems.

Steven Girdler, MD. DISC Sports & Spine Center (Newport Beach and Marina del Rey, Calif.): As the director of clinical research at DISC Sports and Spine Center, I am actively involved in many areas of ongoing research in addition to my clinical practice. We are currently performing both prospective and retrospective studies on cervical disc replacement, including involvement with ongoing FDA trials. We are also committed to studying outcomes of many types of outpatient spine surgery. Transitioning surgical cases from the hospital setting to the outpatient setting is something that has already happened in many areas of medicine, and making this transition for spine surgeons is paramount for the success of physicians, hospitals and healthcare networks. Our data of thousands of patients who have had surgery in the outpatient setting can show that effective and safe spine surgery can occur without necessitating inpatient admission. Our goal is to ensure continued safety and quality for patients is preserved, while adding value for physicians and healthcare systems.

Kenneth Illingworth, MD. Cedars-Sinai Spine Center (Los Angeles): At Cedars-Sinai, we have the privilege to be involved with a wide breadth of clinical research. One area of significant interest for us in pediatric spine research has been the use of MRI generated synthetic CTs. Kids are at increased risks of detrimental effects of radiation exposure from medical imaging, in particular CT scans. We were one the first centers in the country to utilize synthetic CTs from MRIs for evaluation and management of our pediatric spine population. This has resulted in the first ever case report on its use in pediatric spondylolysis, a stress fracture of the lower back, in the Journal of Bone and Joint Surgery. We feel strongly that this will be a game changer for evaluation of our pediatric patients, and we continue to study its value in evaluation and treatment.

Marc Levine, MD. RWJBarnabas Health Medical Group (Hamilton, N.J.): My research this year is aimed at finding technologies that allow for more accurate placement of spinal implants and instrumentation. Standard intraoperative imaging techniques such as fluoroscopy can now be integrated with pre-operative as well as intraoperative CT scans to incorporate navigation and robotic technologies. Ultimately, these technologies will lead to safer surgeries and faster recovery times.

Spinal surgery technology has evolved in the blink of an eye; however, the principles behind surgeries remain constant.

What I’m working on and the approach I’m looking to take will not only improve patient outcomes and streamline workflows but also be the culmination of decades of spinal surgery technological advancements.

Philip Louie, MD. Virginia Mason Franciscan Health (Tacoma, Wash.): Some of the more novel areas of research that we are diving into this year include:

Surgical ergonomics: using sensors to assess body positions and pinpoints during common surgeries to provide more granular pain points that put us at risk of becoming our own patients and eventually identifying interventions.

How patients perceive risk: Patients have a complex framework through which they make decisions involving risk that goes far beyond the simple percentage chance of a complication. This subconscious decision-making algorithm may encompass functional needs, social/family requirements, occupational duties and pain. Furthermore, each patient is unique in their considerations. A better understanding of patients’ risk propensities will allow us to be a better partner in the conversations about choosing between various interventions so that we can guide patients towards treatments that are most likely to improve their satisfaction with their medical care.

Enabling technology value index: Enabling tech plays a crucial role in advancing spine surgical care. However, understanding the value of these technologies, especially with the impact on outcomes and costs associated with utility, is difficult to generalize across healthcare systems and stakeholders.

Hao-Hua Wu, MD. UCI Health (Orange, Calif.): Engaging in research inspires me to create, dream and discover. I love challenging the boundaries of what we currently know, specifically related to surgical treatment of spine tumors, cervical myelopathy, global health, and leadership principles. To me, research is also an opportunity to build meaningful connections with some of the best and brightest minds. The projects I am most excited to work on are examining the burden of disease of spinal cord injury (SCI) in Nepal and comparing outcomes of SCI patients who are treated with and without surgery. This past November, the Global Spine Research Initiative (GSRI) of UC Irvine travelled to Kathmandu to visit Dr. Dipak Maharjan and Dr. Subin Byanjankar of Star Hospital in Kathmandu. Together, with the help of a multidisciplinary team, including Dr. Dheera Ananthakrishnan, we are planning to start the initial phases of these studies in 2025. Our hope is that we can utilize the data from these studies to improve the care of spinal cord injury patients in Nepal. 

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): As member of an integrated neuroscience institute, current projects center around continual data collection and reportage of noteworthy/exceptional complex neurosurgery cases, AI development of coextending diagnosis and range application for spinal treatment paradigms, (writing programmatic assists for patients, providers and systems), and strengthening indemnity strategies for surgical indications and clinical overhearers. A number of presentations relating to reimbursement strategies and surgical assurances were presented both last and this year at national parent meetings. We continue to intermittently appraise and critique different operative products for efficiencies and cost stratification without industry dependence or allotment. The macrocosm of spinal implantation is under massive transition and scrutiny based on spinoff acquisition and abridged federal funding.