This is Carly Beam with the Becker Spine
and Orthopedics podcast.
And today, I'm thrilled to be joined by
doctor Frank Varonis, chief of neurosurgery
at the Marcus Neuroscience
Institute.
Doctor Varonis, thank you so much for being
here today.
Thank you, Carly.
Pleasure to be here.
And so, doctor Varonis, before we dive into
questions, can you introduce yourself and share more
about your background?
Sure.
So I'm,
Frank Villones.
I'm a neurosurgeon.
I have been, practicing for many years.
I did my
medical school in Athens, Greece.
My master of public health at Harvard, my
PhD at Duke,
and my residency in neurosurgery at Tufts Medical
Center.
I
Prior
to coming here to,
Boca Raton, I was,
for sixteen years at,
USF and,
Moffitt Cancer Center,
where I also served as,
chief of neurosurgery.
That's in a nutshell,
my synopsis of my
life so far.
It's a great impressive background
you have. It looks like just from all
over the world as well.
And, you know, I'm wondering, doctor Varonis,
what are the top three trends that you're
following in health care today?
Yeah.
Certainly, I mean, I'm I'm interested
in,
health care as as a general,
rule.
But in particular,
things that can
help with the efficiency of delivery of the
health care such as,
AI.
That's one thing.
Also,
technology,
innovations,
and also research.
There
are some of the things that,
I would be interested in and,
the the strengths and the weaknesses
of, the system. As you know, there's no
health care system that's perfect,
so
it's important to try
even in small ways,
to to improve on the current one.
Absolutely. You touched on some really big things
going on here. You mentioned health care delivery,
AI, and research. I want to, hone in
a bit. I'd love to hear how
you're using AI in your practice. I know
a lot of spine surgeons I've talked to,
they've shared just the various ways it's helped
them both in the clinical office setting,
with surgery itself. I'd love to hear your
perspective.
I
mean,
AI from, my perspective
right now is on the research tool.
We've developed,
an AI software,
that applies to spine,
so that,
for example,
if,
somebody
we can enter somebody's CAT scan or MRI,
in the system, and then the AI can,
deliver for us,
a computer model of somebody's spine, and then
we can
potentially ask questions,
from a biomechanical
standpoint.
Like, if we do this intervention,
what will happen to the spine and so
on and so forth. So from a research
standpoint, that's, more or less what I have.
We have I have been involved,
as far as AI is concerned, but
I can see that AI has a lot
of other applications
potentially in medicine. We see AI
reading,
CAT scans sometimes,
or or getting warnings
about,
somebody's CAT scans.
And I think there's also a lot of
potential applications of AI,
not just,
in data analytics, but also in,
responses to patients' questions and so on and
so forth.
Definitely. That's really interesting what you're saying about
research.
What do you predict?
Like, how much will AI
grow in the research well realm are you
expecting?
You know, I think I think it will
grow to some
degree. Now what how exactly it's going to
work and,
you know,
and how AI is gonna be coordinated
and so on,
it's difficult really to predict. But for example,
to give you some,
idea, we we get,
you know,
health professionals
get thousands of phone calls a day.
You have to have,
people answering the phone.
A lot of the questions, like, 80% of
the questions are routine,
and, potentially,
AI can answer those questions. So you can
have,
something automated,
whatever,
and answer those questions and only
reserve,
you know, a a face to face, so
to speak, or
a person to person
response
for the 20%
of the questions that they really need somebody
who knows more about things.
So just just a a very
you know, just an idea, so to speak.
I see also AI being,
I think already is
applied
in terms of,
you know, billing or,
scheduling
or,
main times,
for insurance companies,
as far as,
deem as to whether service is appropriate or
not appropriate.
AI has the potential
to analyze very quickly,
a lot of data and respond to things,
much faster than a human can.
So so there's a lot of,
little ways that AI can make a difference,
primarily in the efficiency of health care delivery.
Definitely.
And when you think about, the Marcus Neuroscience
Institute and in your department,
how are you thinking about growth in the
next twelve to twenty four months?
Growth
typically,
happens,
in in the sense of, hiring,
more people to cover,
certain gaps,
that we have,
maybe neurology or surgery,
pain management,
rehabilitation,
things like that.
So growth is through
people, but also
through,
new technologies,
robotics,
augmented
reality,
things like that,
as well
as, research.
We
have been
fortunate to receive,
especially today's day where research dollars are very
difficult to find,
we
have been able to receive,
research funds from,
the Marcus Foundation, which is a philanthropic,
foundation.
And through that, we pursue
research in,
domains such as brain tumor research,
drug delivery,
spine research, so on and so forth.
So these are the areas where we we
see a lot of
potential,
expansion and growth.
And,
we we like to stay
stay current and on the cutting edge of,
things.
Yeah. And are there are there any other
spine and,
neurosurgery
technologies besides, you know, the AI that we've
discussed? Are there any other technologies
that really excite you lately?
What I've been, very excited about, inspiring especially,
without trying to to get into,
too many details and being esoteric is the
motion preservation
technology that has been,
has become part of, my practice in spine
on a daily basis.
And,
as you know, in, spine, we have essentially
two types of procedures.
So just to be very simple here, simplistic,
we can decompress something or free up something,
or we can,
do,
reconstruct
the spine.
Reconstructing
the spine typically has been the domain of
fusions,
where you glue together pieces of the spine.
This works in the short term, but in
the long term, a lot of times, people
develop problems
above or below their fusions because of the
stresses
that developed,
develop,
adjacent to a fused segment of the spine.
So motion preservation
in the sense,
of,
disc replacement,
as well as facet replacement
has been
a thing that
really can restore the motion segment and prevent
this domino effect that we see
with fusions
and stop that particular cascade of
more segments that need to be fused that
lead to
lack of mobility and certainly disability
in the end.
Yeah. And definitely with, you know, with spinal
fusion, I know that's still
largely considered the gold standard in spine, and
then we also have
the push towards motion preservation and its benefits.
How are you in your practice,
how are you kind of balancing
the the benefits and needs of both in
your patients?
I mean, the the issue is more or
less the indications,
as well
as,
what can you do
because
many times,
our biggest problem actually with motion preservation
is getting insurance approval.
A lot of insurance companies, they consider it
experimental
despite the fact that there is, like, decades
of research and,
pretty much everything that we use is FDA
approved. So,
when something is FDA approved, I don't know
how people can claim that's experimental.
But but, insurance denials is a big obstacle,
to utilizing,
these technologies.
I think,
especially for young people, you would like to
do as much motion preservation
operations
instead of fusions. You don't want to have
30 year olds, with fusions because then, inevitably,
they're gonna have more issues down the road.
If somebody's very old
and their spine
is very rigid and, you know,
semi,
fused, so to speak, then, you know, motion
preservation may not be the best,
option there.
But,
I think,
still,
to some degree, we
you know, it it's it's an art and
not
a science,
I mean, to some degree, because
we're still learning about how we effectively can
utilize these type of technologies.
And thank you for breaking that down. My
last question for you, doctor Varonis,
what do you think will be a key
disruptor to spine surgery and neurosurgery
in 2026?
I think,
increasingly, the biggest disrupt and the biggest problem
we have
is is coming from the insurance industry
and the cost of health care products.
So that's that's the biggest issue and whether,
first of all, patients can't afford
insurance
because insurance is very expensive.
Second, whether insurance will cover certain
items because,
as you know,
we don't have,
too many
restrictions as to how much
a new drug or a new device
can cost in The US. You know, FDA,
delivers
or is concerned with safety, but there's no
price control. So anybody can essentially
price it any way they want. So so
pricing of of new
technologies or new products,
lack of insurance coverage,
denials
by insurance,
and affordability
of health care,
is is the potential
disruptors,
that I see that can curtail,
innovation
and, force us,
against the wall.
I mean, physicians are in in the practice
of medicine
because they like what they do, but we
constantly have to shape what we do and
fight for what we believe
with a lot of other,
stakeholders in the health care
industry,
in order to get the maximum benefit for
the patient.
And that's not an easy thing. You know?
And something
has changed over the years. It was not
like that when I first,
practiced medicine. We didn't have to worry about
those things.
But now this is peer reviews,
peer to peer, so to speak,
denials,
things like that are gonna be obstacles
in the health care delivery
because of cost primarily,
and they're gonna limit,
you know, the access,
of the best technologies to a lot of
patients.
Yeah. Doctor Ramos, I wanna just check on
one quick follow-up. With all these headwinds you're
describing,
how what how are you strategizing
to get ahead of these next year?
Well,
we
really cannot
strategize on those things because
they're beyond our controls, to be honest with
you. I mean, whether
Aetna approves something or,
United
approves something or doesn't approve something is is
impossible for us to to really play any
kind of role.
But, what we do, you know, that we
can do is
educate patients about,
the type of technologies we have now and,
provide patients with options, you know, because
also what I've noticed in health care,
inspiring particularly, is a lot of patients are
uninformed.
They they only have the only they're only
given one option.
And sometimes that's not the best option,
for them.
Alright. Well,
thank you so much for joining the podcast
today, doctor Varonis. It's been a pleasure speaking,
and I look forward to connecting down the
line. Thank you, Carly. I appreciate, the opportunity.