Continued innovation in spine techniques and technology are reshaping what the “gold standard” will be.

Nine spine surgeons discuss what that gold standard could look like.

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: How are changes in reimbursement models and insurance policies affecting the financial viability of spine practices today?

Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Wednesday, August 21.

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

Question: What will the new gold standard of spine surgery look like?

Rachel Bratescu, MD. George Washington University (Washington, D.C.): The road to becoming referred to as the ‘gold standard’ for technology, implants or biologics is not necessarily linear and especially in the spine community can be very subjective depending on a surgeon’s training, experience, geography and available resources. An important historical pattern to highlight with new ideas or techniques is that there is often an initial period of uncertainty and skeptical feedback from the community; in a specialty where the stakes are high we greatly value long-term evidence of efficacy and safety before implementing novel procedures.

Two trends that will likely gain increasing momentum in the coming years include the push toward outpatient surgeries performed in ASCs, which is closely interrelated to increasing utilization of minimally invasive techniques. One example being unilateral biportal endoscopy – while this is considered the ‘gold standard’ in other countries, the inherent learning curve is an additional factor in the United States that is likely hindering its more widespread adoption.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: The gold standard of spine will be shorter and shorter length of stays, minimal, if any blood loss, and more durable results. There is much room for development in the realm of minimally invasive spine and disc arthroplasty. My hope is that few, if any, opioids postoperatively will be needed for spine patients. Some day, I envision patients having the most minimal of pain and eschewing opioids altogether.

Jian Guan, MD, board certified neurosurgeon Pacific Neuroscience Institute-South Bay and Spine Institute (Torrance, Calif.): The new gold standard for spine surgery is going to be the continued proliferation and development of more personalized treatments for each individual patient’s spinal pathology. With the continued spread and evolution of technologies such as navigation and robotics, and further improvements in material sciences, we will move further and further away from the idea of one-size-fits-all solutions for broad swathes of spinal conditions in favor of customized approaches that maximize recovery and minimize both risk and patient downtime.

Sean Jandhyala, MD. RWJBarnabas Health Medical Group and Community Medical Center (Toms River, N.J): The future of spine surgery will blend traditional non-operative and operative techniques with the utilization of spinal robotics, machine learning, and artificial intelligence. It is critical that both aspects of spine surgery, traditional and modern technology are incorporated in the future care of spine patients to maximize optimal outcomes.

Todd Lanman, MD. ADR Spinal Restoration Center (Beverly Hills, Calif.): ​​Artificial joint replacements have transformed orthopedic surgery, establishing themselves as the gold standard for treating severe degenerative joint diseases in hips and knees. This advancement is now being mirrored in spinal surgery, where artificial disc replacement (ADR) is emerging as a superior alternative to traditional spinal fusion for both cervical and lumbar conditions.

ADR offers significant benefits by preserving natural motion, unlike fusion, which immobilizes vertebrae. This motion-preserving approach can enhance functionality and promote quicker recovery. To ensure patients have access to skilled surgeons, we have launched the ADR Spine Top Doctors program. This network connects individuals with experienced artificial disc replacement specialists across the U.S, facilitating access to high-quality care. As ADR gains recognition, this initiative will play a vital role in improving patient outcomes and expanding the availability of this innovative treatment option in spinal surgery.

Kathryn McCarthy, MD of Norton Leatherman Spine (Louisville, Ky.): An outcome that results from integrating:

1. A finely tuned human surgical skill,

2. Interpretation and implementation of data generated by robust numbers of patient experience both clinically and radiographically, likely with AI format,

3. Safe incorporation of technology and

4. A surgeon with a warm heart and perhaps even a smile.

Emeka Nwodim, MD. Centers for Advanced Orthopaedics (Bethesda, Md.): I believe the future of spine surgery will continue to be promising and innovative. We are currently witnessing a range of advancements, including minimally invasive and endoscopic spine surgical techniques, which can yield excellent results and patient outcomes, when performed by skilled hands. However, I believe the gold standard will remain in open surgery. This technique has stood the test of time and is consistent and reproducible amongst surgeons both nationally and globally.

Jimmy Zhu, MD. Endeavor Health Orthopaedic & Spine Institute (Naperville and Plainfield, Ill.): We live in an exciting era of technological innovations. The goals of spine surgery have not changed, namely decompression, stabilization, and deformity correction. As spine surgeons, however, we have a plethora of tools in our toolbox to accomplish those goals with more accuracy, efficiency, reliability, and reproducibility. We hope that continues to translate to clinical significance in the immediate and long-term postoperative periods. Therefore, the new gold standard of surgery will likely involve larger use of technology, depending on the healthcare system and surgeon comfort. These technologies likely will focus on motion preservation, minimizing surgical footprints and optimization of spinal parameters. Artificial intelligence also will become an increasingly bigger part of spine surgery and healthcare, in general, to facilitate patient care optimization.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Colloquially speaking, the gold standard is the widely accepted orthodoxy against which others are compared and maintained. Currently, the most reliable procedure, independent of application and usage, is spinal fusion. For better or worse, these procedures are globally accepted as means to address acute and degenerative spinal disease. Yet since the planetary healthcare crisis and its devaluation of services and means, this too has become further scrutinized and less sanctioned. Depending on patient demographic served, most larger institutions who administer to the aged and needy rely upon conventional decompressive surgical techniques to subserve frequently seen diagnosis. Intraoperative 2D/3D device accuracy and alignment surgical assist currently expands one’s capabilities especially helpful in salvage procedures.