Issue link: https://beckershealthcare.uberflip.com/i/1541321
21 ORTHOPEDICS or microsurgical decompression. Essentially, we examined the unmeasured components of a CPT code — such as the learning curve, stress level, and procedural difficulty. e findings were striking: these elements are actually higher in endoscopic surgery than in open decompression. With the endoscope, you're at the neural elements within a few minutes, whereas in open or microscopic surgery, much more time is spent on patient positioning, exposure, and bleeding control before the critical phase even begins. Surgeons in the survey felt that endoscopic decompression should be reimbursed at about 152% of a single open decompression due to its greater technical and cognitive demands. Much of our current research focuses on quantifying procedural difficulty and empowering surgeons to define appropriate credentialing and reimbursement criteria. e method of visualization — open, microscopic, or endoscopic — shouldn't determine payment. Instead, reimbursement should reflect the true procedural work and complexity involved in performing the operation. Q: What are some of the major healthcare trends you've been following lately? KL: One of the biggest issues globally is how to manage an aging population — particularly conditions like spinal stenosis, cervical spondylotic myelopathy, and osteoporotic compression fractures. We're seeing growth in endoscopic treatments and personalized approaches to care, especially in pain management. Our teams are also working on pharmacogenetic analyses to identify which patients are likely to respond to narcotics and which are not. e goal is to develop predictive protocols so we can identify, in advance, who will respond best to surgical or interventional treatment. Across many outcome studies, roughly 20% of surgical patients don't do as well as expected — and we don't yet fully understand why. Studying that 20% subgroup is critical to improving results, reducing complications, and lowering costs. Many of the financial burdens in healthcare arise from that subset requiring reoperations or extended care. As public health systems move toward resource optimization, spine surgeons have a fiduciary responsibility to engage in those discussions. We can't stay in our own silos — we have to collaborate across specialties and remain relevant in shaping how care is delivered and valued. Q: How much are you incorporating AI into these models? KL: AI, robotics, and navigation technologies are rapidly evolving in spine care, and the challenge now is defining how they add measurable value. AI is especially powerful for processing large datasets—imaging studies, MRI analytics, and clinical parameters—to help develop front- end treatment algorithms. For example, we're working on protocols that assess intraoperative instability in advanced degeneration to determine when an interbody reconstruction or fusion might be more effective and efficient than decompression alone. AI can play a major role in analyzing those datasets to guide evidence-based decision-making. Similarly, navigational robotics enhance implant precision and reproducibility. e next step is clearly articulating how these technologies improve outcomes and make financial sense by optimizing resource utilization. at's the conversation we need to advance within the spine community. n