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This is Carly Beam with the Becker Spine

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and Orthopedics podcast. And today, I'm thrilled to

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be joined by doctor James Mooney, a spine

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surgeon at Virginia Commonwealth University.

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Doctor Mooney, thank you so much for being

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here today.

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Thanks for having me, Carly. I've listened to

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Becker's on the past, and I think you

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guys do a great job covering the health

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care system. So I really appreciate the opportunity.

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Absolutely. And thank you for your kind words

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as well.

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Before we dive into our questions, can you

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just introduce yourself and share more about your

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background?

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Yeah. So my name is James Mooney. I'm

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a complex and minimally invasive,

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spine surgeon here at Virginia Commonwealth University

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in Richmond, Virginia. I'm a new faculty.

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I did my training down in Birmingham, Alabama

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at the University of Alabama,

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for seven years in neurosurgery residency, and then

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I was up in Pittsburgh, Pennsylvania

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for a

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complex and minimally invasive,

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spine deformity fellowship.

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So excited to be in Richmond and, growing

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the program here. Yeah. And it sounds like,

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you know, you have a lot of expertise

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in just the full gamut of, spine surgery.

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Can you talk about some of the

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biggest spine trends that you're following in health

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care?

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Yeah. Of course. So I think, you know,

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with any field,

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artificial intelligence is at the forefront of, everyone's

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minds. And so from my standpoint as a

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complex

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spine surgeon, you know, I think about what

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are the areas that,

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AI is going to assist us with in

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the OR. And so,

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I think there's a number of categories as

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far as planning for these bigger spine deformity

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surgeries. So, you know, that ranges from radiographic

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planning to the execution of complex spine surgeries.

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And, you know, ultimately, I think we're heading

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towards the future where every surgery,

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is ultimately planned and executed according to evidence

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based

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algorithms.

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And that's, you know, multifactorial

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where AI can, number one, you know, help

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us choose who to operate on. Number two,

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help us construct our surgical plans, and then,

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lastly, help us execute the plan in the

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OR and monitor our progress towards our preoperative

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goals intraoperatively.

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And then I think really the next frontier

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for artificial intelligence and health care as a

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whole and, you know, specific to spine surgery

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is,

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incorporating these AI paradigms into our clinical decision

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making.

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You know, right now, if you ask five

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different spine surgeons, you know, how to approach

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a case, you might get five different answers.

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So, you know, how do we utilize

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AI to help standardize decision making for

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spine surgeons and help choose the best option

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for each unique patient.

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I also think it's important to monitor the

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safety of these algorithms. So having,

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resources that are devoted to, making sure, you

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know, these technologies are used safely.

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So I think, you know, that's the number

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one area I'm following. I think number two,

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is the

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shift, sort of from RVU based metrics towards,

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value based care and specifically for spine surgery.

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I think

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it's important to, you know, make sure the

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right surgeries are being done for the right

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patients and shifting from

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a RVU incentive based,

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you know, setup where surgeons are compensated based

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on volume of surgery. You know? How do

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we shift things and,

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to more of a patient centered outcome?

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And, ultimately, you know, registries and health system

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analytics will help us

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progress towards that point where we're determining, which

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patients are benefiting from, which surgery,

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and,

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rewarding surgeons for their outcomes.

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And then lastly, I think an area that's

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been a particular interest to me is,

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you know, the expansion of minimally invasive as

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well as patient specific technologies and precision medicine.

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And for spine surgery, in particular,

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the growth of Ultra MIS,

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surgery and endoscopic spine surgery, I think, is

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really interesting.

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You know, it's one of those revolutions, and

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they've been doing it in Asia for long

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periods of time.

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But in The US, it's relatively new, but

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I think it's, something that's here to stay,

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and it's important for a center that provides

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spine care to be able to offer the

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full gamut of care ranging from,

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you know, the most minimally invasive approach with

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an endoscopic surgery to, a big deformity correction.

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And I think, you know, tailoring that surgery

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to the specific patient is incredibly important, and

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we can't lose sight of that.

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And then the last thing is, you know,

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three d printed implants and patient specific technologies,

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I also think are,

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the future as well. I haven't incorporated them

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yet, but that's something we're hoping to to

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bring on as we grow at VCU.

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Yeah. Those all really fascinating, exciting areas of

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just kind of what's ahead for future spine,

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especially all of the ways that

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AI sounds like it's really making,

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is bring helping to bring patient care in

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a more,

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streamlined and effective

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way. And

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one thing I wanna circle back to one

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things you said about, this shift from RVU

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to VBC. I'd love to hear your insights

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on what you think is gonna be needed,

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from surgeons, from hospitals, practice leaders, etcetera, for

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this shift to

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really be effective and to

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to take off?

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Yeah. I mean, I think it's easy to

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talk about, but, you know, actually instituting it

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is a lot,

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bigger of a challenge. And so, you know,

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I'm right at the beginning of my career,

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and these are just things I've been following

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early on. But I think it's gonna take

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a, you know, a massive overhaul really of

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the way things are

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set up currently,

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just given that we've been following the specific,

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you know, metrics and ways of compensating surgeons

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for years. So,

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I don't have the specific solution, but I

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think it's gonna take a lot of, you

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know, lobbying,

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from our organizations

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and,

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participation

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from,

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spine surgeons that are at the front line

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to really make this a reality. You know,

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people talk about it a lot, but, you

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know, putting that into action is a lot

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more difficult. And, hopefully, you know, I can

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help be a part of that moving forward

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as well.

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Got it. And, yeah, I'd love to, you

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know, hear more about just kind of your

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own,

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how you're using AI in both your complex

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and minimally based in spine care, whether it's

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in the OR or outside.

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What are you using it the most for?

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Yeah. You know, I think

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all aspects of of care,

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can be utilized. Again, I think safety is

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key,

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particularly

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for,

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evaluating and working up a patient for documentation.

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You know, Epic has specific AI

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workflows that can be used to generate clinic

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notes, and that's been incredibly helpful with streamlining

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clinic appointments.

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And then moving into the OR, we've just

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incorporated,

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patient specific rods and,

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software into our surgical planning, and that software

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actually

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will, take a patient's preoperative scan,

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you know, plan your surgery out in conjunction

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with engineers and allow you to generate a

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rod that,

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at least radiographically

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would generate a good outcome for the patient.

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The software, it also will track patient

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outcomes over time as well as,

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did your,

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actual surgical

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outcome radiographically

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match what was planned preoperatively, and there's a

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massive amount of data that can be

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acquired over time using those paradigms.

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So for intraoperative planning for preoperative planning, it's

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been very helpful. I think the next forefront

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is really incorporating it into,

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the intraoperative,

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you know, are we achieving the correction that

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we planned preoperatively,

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as well as helping us to standardize decision

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making.

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And, again, those things are a little further

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further off, but, you know, not too far

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off.

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Yeah. Thank you for breaking that down. And

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I wanna ask you, I know you have

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you have a unique perspective having,

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training in both

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complex

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spine surgery and minimally

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invasive. And, you know, obviously, the, there is

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we're seeing more technologies and trends towards,

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minimally invasive surgery.

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But, you know, why is it important

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for

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minimally invasive spine surgeons to kind of understand,

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the complex and and vice versa?

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Yeah. That's a terrific question. And so, you

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know,

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I think my the re one of the

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reasons I did a fellowship was to really

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understand,

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understand, which patients to operate on in terms

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of,

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who is who is right for a particular

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procedure. And, you know, in my mind starting

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out as a surgeon,

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my goal is to offer the patient the

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least invasive surgery that we can

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offer to achieve the goals of surgery. And

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so a lot of times, in these cases,

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you know, I'm being sent patients that have

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big scoliotic deformities

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or or,

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you know, issues that radiographically

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you would want to,

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if you didn't know hear about the patient's

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symptoms, you you could offer a large surgery.

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But when you actually talk to the patient

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and figure out that this might be a

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single nerve that's affected, that, minimally invasive decompression

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could give them years of relief before they

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need a big surgery.

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And having that minimally invasive training has been

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very helpful,

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in working these patients up and being able

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to offer

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them that, the least invasive approach. And then,

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you know, anytime you operate on a patient,

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if you fuse a segment of the spine,

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you're subjecting the rest of the spine to

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more motion and potential

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breakdown and need for future surgeries. So, really,

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my deformity training has helped me understand angles

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and,

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preoperative planning even for a small single level

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surgery.

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You know, it's really important to get that

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correction,

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even if you're doing an, you know, a

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single level five one or four five fusion.

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In the grand scheme of things, if you

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get that wrong, you're setting the patient up

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for many future surgeries. So I think that's

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where my minimally invasive training,

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UAB has combined with the, you know, the

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deformity training to really,

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help me be able to offer a full

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gamut of spine, procedures to patients.

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Definitely. And, yeah, I was wondering, what do

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you think will be the one true disruptor

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to spine surgery next year?

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Yeah. Within the next year, I think AI

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is going to continue

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improving,

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outcomes. And,

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you know, I

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it's yet to be seen the full extent

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of where ultra minimally invasive surgery is going

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to head.

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I'm actively following that as well.

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But I think it's gonna be, you know,

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not one single factor, but a combination of

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all of these things that are,

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intersecting. It's such an exciting time,

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where you have, you know, new technologies,

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data,

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collaboration,

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between surgeons, engineers, scientists.

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And,

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yeah, I I don't I don't think it's

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gonna be one specific thing, but really a

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combination

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of all of these things we're talking about.

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Got it. And then just my last question

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for you, doctor Mooney. How are you thinking

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about growth headed into 2026?

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Yeah. For sure.

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You know, it's it's a really exciting time

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for me being a new faculty at VCU.

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There's really three categories that I think of

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in terms of growth over the next, two

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years, and that's from a clinical standpoint,

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from an academic standpoint, and then from an

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educational standpoint. And so, you know, clinically,

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our goals as a spine department are to,

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increase access to care. You know, historically,

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UVA,

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and Duke have been the major centers in

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the area.

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And our goal is to to really offer

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patients in the Richmond area access to total

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spine care,

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including, you know, complex as well as MIS,

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spine surgery.

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And to achieve that, we're, you know, expanding

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our reach to different areas,

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in Fredericksburg, Virginia. I've been going to Williamsburg,

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where William and Mary is to,

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you know, work with athletes there,

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and increase our sports medicine exposure, and we've

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been getting referrals and expanding our reach in

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those areas, which has been great.

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Second is to increase, you know, capabilities in

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the OR. And so we've, you know, brought

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in MIS systems over the past few months

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to help achieve those goals.

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I mentioned the unit,

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patient specific rods, which we've been incorporating into

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surgery as well,

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and then all of the AI planning, robotics,

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and enabling technologies,

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that are really going to help transform things,

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at VCU.

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Improving collaborations

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goes along with that. So with orthopedics, endocrinology,

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ENT, PM and R, PT, pain medicine, oncology,

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and really, you know, incorporating all those departments

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to make VCU,

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a spine center of excellence.

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And then, you know, from an academic standpoint,

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we're trying to really grow our research footprint,

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looking into predictive analytics,

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outcomes data.

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And I've been partnering with the engineering department

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to help

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preoperative planning with three d printing as well

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for, bigger deformity

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operations.

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And then we're working to get involved in

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the American Spine Registry over the next, few

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months where we can,

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you know, longitudinally

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collect large amounts of data over time.

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And then lastly, you know, from educational standpoint,

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we wanna improve

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education for the residents,

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improve their exposure to complex techniques

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and enabling technologies and ultimately,

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potentially,

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get a fellowship down the road. Mhmm. So

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those are the main categories I'm really excited

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about.

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Got it. Well, you know, thank you so

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much, doctor Mooney, for joining us today. It's

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been a pleasure speaking, and I look forward

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to connecting again down the line.

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Of course. Thanks so much for having me.

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I appreciate it.