1 00:00:00,080 --> 00:00:02,240 This is Carly Beam with Becker Spine and 2 00:00:02,240 --> 00:00:04,799 Orthopedics podcast, and I'm thrilled to be joined 3 00:00:04,799 --> 00:00:07,519 today by doctor Roger Hardell with Weill Cornell 4 00:00:07,519 --> 00:00:10,000 Medicine. Doctor Hardell, thank you so much for 5 00:00:10,000 --> 00:00:10,980 being here today. 6 00:00:11,359 --> 00:00:13,199 Carly, thanks so much for having me back 7 00:00:13,199 --> 00:00:14,900 on this podcast. I'm very 8 00:00:15,304 --> 00:00:16,745 happy, and I wish you a happy New 9 00:00:16,745 --> 00:00:17,245 Year. 10 00:00:17,704 --> 00:00:20,745 Likewise. Likewise. And, doctor Harlow, if you could 11 00:00:20,745 --> 00:00:22,505 just introduce yourself and tell us a bit 12 00:00:22,505 --> 00:00:24,425 more about your background just for, you know, 13 00:00:24,425 --> 00:00:26,525 anyone new who might be, listening. 14 00:00:27,065 --> 00:00:28,720 Yeah. Yeah. Yeah. I'm happy to do that. 15 00:00:28,720 --> 00:00:31,140 I'm I'm a neurosurgeon. I'm 16 00:00:31,440 --> 00:00:34,399 a a spine neurosurgeon at this point in 17 00:00:34,399 --> 00:00:35,060 my career. 18 00:00:35,840 --> 00:00:38,260 I run the spine program at Weill Cornell 19 00:00:38,399 --> 00:00:40,320 Medicine in New York City, and I'm one 20 00:00:40,320 --> 00:00:42,340 of the co directors of ArcSpine 21 00:00:43,115 --> 00:00:44,094 at New York Presbyterian 22 00:00:44,715 --> 00:00:45,215 Hospital 23 00:00:45,755 --> 00:00:46,814 in New York City. 24 00:00:47,435 --> 00:00:49,755 Mhmm. And, doctor Haro, can you talk about 25 00:00:49,755 --> 00:00:53,195 the top three trends you're following in health 26 00:00:53,195 --> 00:00:55,295 care and in spine surgery today? 27 00:00:55,835 --> 00:00:57,934 Sure. You know, we have a 28 00:00:58,310 --> 00:00:58,810 integrated 29 00:00:59,429 --> 00:01:01,829 and very large program now. We, you know, 30 00:01:01,829 --> 00:01:04,390 we're at New York Presbyterian Hospital at, in 31 00:01:04,390 --> 00:01:05,530 in New York City. 32 00:01:05,909 --> 00:01:08,069 And and now what we've done over the 33 00:01:08,069 --> 00:01:10,310 last, you know, ten years is really integrate 34 00:01:10,310 --> 00:01:10,810 the 35 00:01:11,114 --> 00:01:14,075 spine programs at Columbia Cornell under the umbrella 36 00:01:14,075 --> 00:01:15,694 of New York Presbyterian Hospital. 37 00:01:16,635 --> 00:01:18,394 And in that role, of course and I 38 00:01:18,394 --> 00:01:20,075 and I do this together with Larry Lanky, 39 00:01:20,075 --> 00:01:22,234 who's like Bandin Shah, who are my main 40 00:01:22,234 --> 00:01:25,194 counterparts at the Columbia campus, and with Dan 41 00:01:25,194 --> 00:01:26,254 Rule here at Cornell. 42 00:01:27,609 --> 00:01:29,950 But obviously working with a large group 43 00:01:30,329 --> 00:01:32,269 of health care providers, surgical, 44 00:01:32,729 --> 00:01:33,229 nonoperative, 45 00:01:34,409 --> 00:01:38,269 from really multiple disciplines that are all importantly 46 00:01:38,569 --> 00:01:40,969 involved in the care of patients with back 47 00:01:40,969 --> 00:01:41,469 issues. 48 00:01:41,849 --> 00:01:43,415 You You know, there's so many things that 49 00:01:43,415 --> 00:01:45,094 come up all the time that are really 50 00:01:45,094 --> 00:01:46,395 relevant and sometimes 51 00:01:46,855 --> 00:01:49,415 directly related to surgery, sometimes a little bit 52 00:01:49,415 --> 00:01:50,395 outside surgery. 53 00:01:51,174 --> 00:01:52,935 But what I've seen over the last year 54 00:01:52,935 --> 00:01:55,495 has become really more and more interesting and 55 00:01:55,495 --> 00:01:56,395 I think relevant 56 00:01:56,775 --> 00:01:57,275 in 57 00:01:58,189 --> 00:02:00,030 our care of patients with back and neck 58 00:02:00,030 --> 00:02:00,530 issues 59 00:02:00,989 --> 00:02:03,150 is certainly I I I would say there 60 00:02:03,150 --> 00:02:05,870 are three things. There's artificial intelligence, of course, 61 00:02:05,870 --> 00:02:07,409 as as in many aspects 62 00:02:08,110 --> 00:02:09,969 of life and and health care. 63 00:02:10,830 --> 00:02:11,229 What I'm 64 00:02:11,854 --> 00:02:13,935 what I see evolve more and more is 65 00:02:13,935 --> 00:02:14,435 biologics, 66 00:02:14,894 --> 00:02:18,094 you know, disc especially for degenerative disc disease. 67 00:02:18,094 --> 00:02:21,235 I'm not talking about fusion biologics, really more 68 00:02:22,014 --> 00:02:24,834 biologics in terms of disc repair, disc 69 00:02:25,294 --> 00:02:27,394 regeneration, and sometimes even disc replacement. 70 00:02:28,310 --> 00:02:30,389 And then finally, as a as a surgeon 71 00:02:30,389 --> 00:02:32,469 in the Operating Room who's very excited about 72 00:02:32,469 --> 00:02:34,789 minimally invasive spine surgery, I think that whole 73 00:02:34,789 --> 00:02:36,569 area of navigation and robotics 74 00:02:37,349 --> 00:02:39,770 is really fascinating. So those are the three 75 00:02:40,585 --> 00:02:43,224 areas that I follow very closely amongst many 76 00:02:43,224 --> 00:02:46,344 others, but those are three areas within spine 77 00:02:46,344 --> 00:02:48,284 surgery and medicine, spine medicine 78 00:02:49,064 --> 00:02:51,645 that I think are the most exciting, 79 00:02:51,944 --> 00:02:52,925 artificial intelligence, 80 00:02:53,224 --> 00:02:53,724 biologics, 81 00:02:54,469 --> 00:02:56,889 and the whole area of navigation and robotics. 82 00:02:57,590 --> 00:02:59,349 Yeah. You know, I wanna hone in on 83 00:02:59,349 --> 00:03:01,750 what you're talking about with biologics. It's still, 84 00:03:01,750 --> 00:03:02,550 you know, very 85 00:03:03,509 --> 00:03:05,050 there needs to be a lot more 86 00:03:05,509 --> 00:03:08,310 research in this area in spine orthopedics. And 87 00:03:08,310 --> 00:03:08,969 I'm wondering 88 00:03:09,724 --> 00:03:11,104 what kinds of 89 00:03:11,564 --> 00:03:14,784 innovations in spine biologics could elaborate more on, 90 00:03:15,324 --> 00:03:17,484 what's exciting you in that area and what 91 00:03:17,484 --> 00:03:18,544 you think will 92 00:03:19,004 --> 00:03:21,564 really define this year when it comes to 93 00:03:21,564 --> 00:03:22,305 spine biologics. 94 00:03:23,250 --> 00:03:25,830 Yeah. I think the challenge with spine biologics 95 00:03:26,049 --> 00:03:26,870 is partially, 96 00:03:27,569 --> 00:03:30,709 obviously, the the regulatory pathway that that has 97 00:03:30,930 --> 00:03:32,150 that has really 98 00:03:32,530 --> 00:03:34,389 challenged our ability to, 99 00:03:35,250 --> 00:03:37,030 pursue some of the fascinating 100 00:03:37,814 --> 00:03:40,055 strategies that that come to mind when you're 101 00:03:40,055 --> 00:03:42,875 thinking about degenerative disc disease and biologics. 102 00:03:43,175 --> 00:03:44,775 You know, we're very, I think we've got 103 00:03:44,775 --> 00:03:45,995 a lot of data now, 104 00:03:46,854 --> 00:03:49,995 showing that augmentation of diseased discs with 105 00:03:50,319 --> 00:03:53,379 various types of stem cells, autologous or 106 00:03:53,840 --> 00:03:55,939 or or allograft stem cells 107 00:03:56,400 --> 00:03:58,740 holds holds a significant promise. 108 00:03:59,760 --> 00:04:02,480 What I'm what I'm very excited about is 109 00:04:02,480 --> 00:04:05,139 our current work on angular repair because, 110 00:04:05,905 --> 00:04:08,625 you know, one of the biggest untapped needs 111 00:04:08,625 --> 00:04:09,764 in spine surgery 112 00:04:10,144 --> 00:04:11,125 is that whole 113 00:04:11,664 --> 00:04:14,625 problem of recurrent disc herniation in patients who 114 00:04:14,625 --> 00:04:17,745 have a discectomy in the cervical or lumbar 115 00:04:17,745 --> 00:04:18,245 spine. 116 00:04:18,569 --> 00:04:20,810 And then there's not much that we can 117 00:04:20,810 --> 00:04:23,370 do really to prevent the disc from further 118 00:04:23,370 --> 00:04:23,870 degenerating 119 00:04:24,730 --> 00:04:26,189 or even reherniating. 120 00:04:26,490 --> 00:04:28,330 So the whole area of the current disc 121 00:04:28,330 --> 00:04:28,830 herniation 122 00:04:29,370 --> 00:04:31,870 and the opportunity that I think biologics 123 00:04:32,245 --> 00:04:34,725 can potentially give us here to prevent that 124 00:04:34,725 --> 00:04:37,064 from really happening over time. 125 00:04:38,084 --> 00:04:39,925 You know, I've I've done a lot of 126 00:04:39,925 --> 00:04:41,685 research in my lab to you know, I 127 00:04:41,685 --> 00:04:44,084 work with a a biomedical engineer up in 128 00:04:44,084 --> 00:04:46,724 Ithaca, Larry Bonasa. We've been working together for 129 00:04:46,724 --> 00:04:47,464 many years 130 00:04:47,789 --> 00:04:50,050 on disc repair, regeneration, replacement. 131 00:04:50,909 --> 00:04:53,149 But what we've done now more recently is 132 00:04:53,149 --> 00:04:56,029 really try to bring to the forefront the 133 00:04:56,029 --> 00:04:58,289 whole area of of annual repair with, 134 00:04:59,069 --> 00:05:01,889 we use collagen glues, plus minus cells. 135 00:05:02,514 --> 00:05:04,754 We just started a small company, a start 136 00:05:04,754 --> 00:05:05,415 up company 137 00:05:05,955 --> 00:05:08,514 that will hopefully be able to bring this 138 00:05:08,514 --> 00:05:10,615 through the FDA into clinical trials. 139 00:05:11,395 --> 00:05:12,835 And and that for me is really one 140 00:05:12,835 --> 00:05:14,615 of the most exciting things because 141 00:05:15,169 --> 00:05:17,410 it seems such a simple problem. You know? 142 00:05:17,410 --> 00:05:19,269 How do you prevent recurrent discreditation? 143 00:05:19,970 --> 00:05:23,089 But it's really an a totally untapped problem. 144 00:05:23,089 --> 00:05:25,169 You know? To totally we we don't really 145 00:05:25,169 --> 00:05:26,389 have have a good solution. 146 00:05:26,850 --> 00:05:28,689 And there's so many patients, you know, hundreds 147 00:05:28,689 --> 00:05:31,064 of thousands of patients every year who have 148 00:05:31,384 --> 00:05:32,605 lumbar disc herniation, 149 00:05:33,944 --> 00:05:35,245 who undergo surgery, 150 00:05:35,705 --> 00:05:37,625 and they all ask the same question. You 151 00:05:37,625 --> 00:05:39,545 know, how can you prevent that disc from 152 00:05:39,545 --> 00:05:41,884 reherniating? And we just don't have an answer. 153 00:05:42,185 --> 00:05:42,845 To me, 154 00:05:43,360 --> 00:05:45,199 this is one of the most basic issues 155 00:05:45,199 --> 00:05:46,740 in spine surgery currently. 156 00:05:47,120 --> 00:05:49,360 Mhmm. So I'm I'm very excited about that. 157 00:05:49,360 --> 00:05:51,220 And I you know, we've got some mechanical 158 00:05:51,680 --> 00:05:52,180 solutions. 159 00:05:53,279 --> 00:05:54,580 You know, we've got Barricade. 160 00:05:55,360 --> 00:05:58,180 There's another small company from Israel, Spinal, 161 00:05:59,355 --> 00:06:01,435 that that has a little implant that's not 162 00:06:01,435 --> 00:06:03,134 FDA approved at this point. 163 00:06:03,675 --> 00:06:05,435 But I'm not sure that implants are really 164 00:06:05,435 --> 00:06:07,115 the final solution. I think there has to 165 00:06:07,115 --> 00:06:08,334 be some kind of biological 166 00:06:09,035 --> 00:06:09,535 intervention, 167 00:06:10,954 --> 00:06:11,454 either, 168 00:06:12,040 --> 00:06:14,759 in isolation or together with some type of 169 00:06:14,759 --> 00:06:15,259 implant 170 00:06:15,720 --> 00:06:18,780 that help us regenerate and repair that annular 171 00:06:18,840 --> 00:06:20,840 defect. And and that's that's something that I'm 172 00:06:20,840 --> 00:06:21,980 very excited about. 173 00:06:22,439 --> 00:06:26,040 And I imagine everything, with Exploins Biologics, it 174 00:06:26,040 --> 00:06:27,580 sounds like you 175 00:06:29,454 --> 00:06:29,954 multidisciplinary 176 00:06:30,735 --> 00:06:31,235 collaboration 177 00:06:31,535 --> 00:06:33,294 and just kind of work with others just, 178 00:06:33,294 --> 00:06:35,875 you know, beyond just spine, itself. 179 00:06:36,814 --> 00:06:38,914 Yeah. I think that's crucial, and that's 180 00:06:39,535 --> 00:06:41,214 yeah. And that brings me to another point. 181 00:06:41,214 --> 00:06:42,735 If you if you wanna do this type 182 00:06:42,735 --> 00:06:45,069 of research, clinical research, you need a a 183 00:06:45,069 --> 00:06:46,209 team of multidisciplinary 184 00:06:47,629 --> 00:06:48,850 specialists. And that's 185 00:06:49,389 --> 00:06:51,649 that's exactly why we started Oxpine 186 00:06:52,750 --> 00:06:54,910 at in New York City, which which is 187 00:06:54,910 --> 00:06:55,730 really a 188 00:06:56,235 --> 00:06:58,014 combination of operative and nonoperative 189 00:06:58,394 --> 00:07:00,394 providers that we just opened. It's actually a 190 00:07:00,394 --> 00:07:02,394 year ago. Exactly one year ago, we we 191 00:07:02,394 --> 00:07:04,814 opened Prospero, our spine center 192 00:07:05,435 --> 00:07:06,654 in Hudson Yards, 193 00:07:07,115 --> 00:07:08,634 where we have 60,000 194 00:07:08,634 --> 00:07:11,110 square feet, and it's the first time that 195 00:07:11,110 --> 00:07:13,509 Columbia and Cornell doctors work together in one 196 00:07:13,509 --> 00:07:14,009 space. 197 00:07:14,709 --> 00:07:16,169 And we've got, you know, 198 00:07:17,189 --> 00:07:20,169 25 surgeons. We've got, 30 nonoperative 199 00:07:20,949 --> 00:07:23,930 spine providers. We've got physical therapy, radiology. 200 00:07:24,574 --> 00:07:26,334 So this type of research, if you wanna 201 00:07:26,334 --> 00:07:27,935 do this type of research where you really 202 00:07:27,935 --> 00:07:30,595 include patients, you need you need a 203 00:07:31,375 --> 00:07:32,035 a multidisciplinary 204 00:07:32,735 --> 00:07:35,294 team of specialists that all work together, and 205 00:07:35,294 --> 00:07:37,074 that's exactly what we have now. 206 00:07:37,629 --> 00:07:39,770 Yeah. And, you know, have there been any, 207 00:07:40,189 --> 00:07:42,829 any hurdles, any challenges when it comes to, 208 00:07:42,829 --> 00:07:45,310 you know, bringing together all these specialties, or 209 00:07:45,310 --> 00:07:46,990 has it been smooth sailing for the most 210 00:07:46,990 --> 00:07:47,490 part? 211 00:07:48,269 --> 00:07:50,509 Yeah. I wish it was smooth sailing. It's 212 00:07:50,509 --> 00:07:51,069 not. It's, 213 00:07:51,664 --> 00:07:54,485 no. In our case, it really worked because 214 00:07:55,504 --> 00:07:57,985 I mean, as individual physicians, we all wanna 215 00:07:57,985 --> 00:08:00,164 work together. The problem is then 216 00:08:00,704 --> 00:08:02,164 bureaucracy comes into 217 00:08:03,024 --> 00:08:03,524 comes, 218 00:08:04,279 --> 00:08:06,199 comes in the way and the bureaucracy in 219 00:08:06,199 --> 00:08:09,340 terms of the logistics, the infrastructure, the financial 220 00:08:09,879 --> 00:08:10,379 aspect. 221 00:08:10,759 --> 00:08:13,160 In our case, at Oxpawn, it worked because 222 00:08:13,160 --> 00:08:16,600 it was really obviously envisioned by individuals, but 223 00:08:16,600 --> 00:08:17,340 then really 224 00:08:18,115 --> 00:08:20,834 supported and put into practice by by the 225 00:08:20,834 --> 00:08:23,475 hospital and by the universities. You know? And 226 00:08:23,475 --> 00:08:25,475 and I think that's really important. If you 227 00:08:25,475 --> 00:08:27,574 if you wanna build something like a multidisciplinary 228 00:08:28,194 --> 00:08:30,834 spine center, you need the support of the 229 00:08:30,834 --> 00:08:33,174 overarching structure. And in our case, 230 00:08:33,529 --> 00:08:35,769 that's the hospital and the university, and that's 231 00:08:35,769 --> 00:08:37,470 the the key to success. 232 00:08:38,410 --> 00:08:40,649 Absolutely. Unfortunately, you know, we we've had that, 233 00:08:40,649 --> 00:08:41,710 and we have that. 234 00:08:42,250 --> 00:08:44,910 But, obviously, then you also need the individual 235 00:08:44,970 --> 00:08:45,470 subspecialties, 236 00:08:45,850 --> 00:08:47,850 departments, and so forth to all be willing 237 00:08:47,850 --> 00:08:48,750 to work together. 238 00:08:49,485 --> 00:08:51,825 Yeah. Absolutely. And do you have any advice 239 00:08:51,884 --> 00:08:52,365 for, 240 00:08:52,845 --> 00:08:55,565 you know, hospital leaders who, you know, they're 241 00:08:55,644 --> 00:08:58,684 they see your example and they and they 242 00:08:58,684 --> 00:09:00,845 want to replicate that on their own? What 243 00:09:00,845 --> 00:09:02,990 would be the biggest piece of advice you'd 244 00:09:02,990 --> 00:09:06,050 have for creating a more integrated spine orthopedic 245 00:09:06,190 --> 00:09:06,690 neurosurgery 246 00:09:06,990 --> 00:09:07,490 program? 247 00:09:08,110 --> 00:09:10,029 Yeah. No. That's a great question. I you 248 00:09:10,029 --> 00:09:12,269 know, we've and it it didn't happen out 249 00:09:12,269 --> 00:09:13,570 of out of the blue. 250 00:09:14,504 --> 00:09:16,825 You know, we we had at at on 251 00:09:16,825 --> 00:09:19,785 the Cornell side, we've had experience building a 252 00:09:19,785 --> 00:09:22,264 spine center since the early two thousands, and 253 00:09:22,264 --> 00:09:23,085 it was really 254 00:09:23,465 --> 00:09:24,524 initially just 255 00:09:25,065 --> 00:09:26,045 a bunch of, 256 00:09:26,690 --> 00:09:29,330 surgeons and nonoperative doctors who had an interest 257 00:09:29,330 --> 00:09:30,070 in spine. 258 00:09:30,929 --> 00:09:32,769 And we started meeting every week, and we 259 00:09:32,769 --> 00:09:34,529 had a conference. We had a case conference. 260 00:09:34,529 --> 00:09:35,830 You know, we found a neuroradiologist 261 00:09:36,929 --> 00:09:39,190 with an interest in spine, then we had, 262 00:09:39,894 --> 00:09:42,934 two surgeons, myself, somebody else. We had one 263 00:09:42,934 --> 00:09:45,195 of the pain management guys, one of the, 264 00:09:45,654 --> 00:09:47,595 PM and R physiatry doctors, 265 00:09:48,054 --> 00:09:50,475 and and a physical therapist and a neurologist, 266 00:09:50,695 --> 00:09:52,389 actually. And and we all, you know, we 267 00:09:52,389 --> 00:09:54,389 were, like, similar age group. We all had 268 00:09:54,389 --> 00:09:56,549 this an interest in spine, and we decided 269 00:09:56,549 --> 00:09:59,190 to meet meet up once a week and 270 00:09:59,190 --> 00:10:01,509 discuss cases that we had seen in clinic 271 00:10:01,509 --> 00:10:03,509 where we had some questions or we wanted 272 00:10:03,509 --> 00:10:04,009 input. 273 00:10:04,605 --> 00:10:07,004 And that's really how the spine center started 274 00:10:07,004 --> 00:10:09,725 in in our in our case here twenty 275 00:10:09,725 --> 00:10:11,745 years ago, twenty plus years ago. 276 00:10:12,205 --> 00:10:14,125 And then it slowly evolved, and then we 277 00:10:14,125 --> 00:10:15,105 decided to 278 00:10:15,884 --> 00:10:18,365 see actually patients together. So we we moved 279 00:10:18,365 --> 00:10:21,320 our clinic schedules around, and we found a 280 00:10:21,320 --> 00:10:23,560 location where we could actually see patients together 281 00:10:23,560 --> 00:10:24,540 within the hospital. 282 00:10:25,160 --> 00:10:27,639 And then slowly, we and then we tracked 283 00:10:27,639 --> 00:10:30,920 volumes. We tracked patient volumes, surgery volumes. We 284 00:10:30,920 --> 00:10:32,379 could show that it 285 00:10:32,759 --> 00:10:33,820 increased our productivity, 286 00:10:34,725 --> 00:10:37,225 and that's how the hospital started paying attention. 287 00:10:37,284 --> 00:10:39,284 And then slowly, you get the hospital on 288 00:10:39,284 --> 00:10:39,784 board. 289 00:10:40,245 --> 00:10:41,524 So really just kind of looking at the 290 00:10:41,524 --> 00:10:43,365 numbers, it sounds like. That's the key to 291 00:10:43,365 --> 00:10:45,524 everything. Yeah. So it takes a long time. 292 00:10:45,524 --> 00:10:47,764 It's a slow process, but that's kinda how 293 00:10:47,764 --> 00:10:49,065 it worked in our case. 294 00:10:49,750 --> 00:10:51,269 That's great. And, you know, I want to 295 00:10:51,269 --> 00:10:53,110 pivot back to what you're saying about AI 296 00:10:53,110 --> 00:10:54,870 as well. Obviously, in 2025, 297 00:10:54,870 --> 00:10:57,190 AI and health care is, you know, it's 298 00:10:57,190 --> 00:10:58,709 really exploded. It's huge, 299 00:10:59,269 --> 00:11:02,389 huge talking point among, you know, physicians, leaders. 300 00:11:02,389 --> 00:11:03,769 And I'm wondering, 301 00:11:04,245 --> 00:11:06,504 you know, how how are you using 302 00:11:07,044 --> 00:11:09,285 AI in your practice right now? What are 303 00:11:09,285 --> 00:11:10,345 you going to, 304 00:11:11,285 --> 00:11:13,384 do to same, do differently? 305 00:11:14,965 --> 00:11:17,365 Yeah. I mean, I think AI penetrates every 306 00:11:17,365 --> 00:11:18,345 aspect of 307 00:11:18,929 --> 00:11:20,789 our lives as individuals 308 00:11:21,090 --> 00:11:23,830 and as surgeons, and the key is to, 309 00:11:24,929 --> 00:11:26,070 try to make it, 310 00:11:27,169 --> 00:11:28,549 you know, make it safe, 311 00:11:29,009 --> 00:11:29,830 make it effective, 312 00:11:30,690 --> 00:11:32,610 and, and and to make sure you don't 313 00:11:32,610 --> 00:11:33,350 lose really 314 00:11:33,914 --> 00:11:35,514 some of the principles of how we take 315 00:11:35,514 --> 00:11:36,894 care of patients, of course. 316 00:11:37,754 --> 00:11:39,674 You know, I I certainly I mean, our 317 00:11:39,674 --> 00:11:41,855 practices, it's helpful for preoperative 318 00:11:43,115 --> 00:11:45,834 evaluation of patients' literature reviews. You know, if 319 00:11:45,834 --> 00:11:47,595 if you're not sure about, you know, what's 320 00:11:47,595 --> 00:11:49,115 out there in the literature, AI is a 321 00:11:49,115 --> 00:11:51,830 huge advantage in that regard. It can really 322 00:11:52,050 --> 00:11:52,690 help you, 323 00:11:53,570 --> 00:11:56,610 review the literature very quickly, make certain decisions 324 00:11:56,610 --> 00:11:59,090 in terms of surgical procedures. Obviously, you always 325 00:11:59,090 --> 00:12:00,230 gotta double check. 326 00:12:00,930 --> 00:12:03,274 The other thing that I use AI for 327 00:12:03,274 --> 00:12:05,674 increasingly in working with some of the companies 328 00:12:05,674 --> 00:12:07,054 who are involved in navigation 329 00:12:07,995 --> 00:12:08,735 and in, 330 00:12:09,914 --> 00:12:10,414 intraoperative, 331 00:12:10,715 --> 00:12:12,894 you know, stereotactic navigation and robotics 332 00:12:13,674 --> 00:12:15,855 is the whole area of AI 333 00:12:16,460 --> 00:12:18,080 and, for example, automatic, 334 00:12:19,100 --> 00:12:20,160 automated segmentation. 335 00:12:21,019 --> 00:12:22,539 Or, you know, we work I work with 336 00:12:22,539 --> 00:12:23,740 Brainlab, for example, 337 00:12:24,940 --> 00:12:26,399 to come up with a workflow, 338 00:12:27,340 --> 00:12:30,139 to use augmented reality through a microscope or 339 00:12:30,139 --> 00:12:30,639 exoscope 340 00:12:31,254 --> 00:12:34,794 to facilitate the workflow for MIS telus surgery. 341 00:12:35,495 --> 00:12:37,995 Right? MIS telus surgery is a great operation 342 00:12:38,054 --> 00:12:40,454 because there are certain landmarks that you use 343 00:12:40,454 --> 00:12:41,595 with every operation. 344 00:12:42,375 --> 00:12:45,754 And using AI and using intraoperative or preoperative 345 00:12:45,975 --> 00:12:46,475 imaging, 346 00:12:46,910 --> 00:12:47,809 you can automatically 347 00:12:48,190 --> 00:12:51,490 have the software identify these landmarks and then 348 00:12:51,629 --> 00:12:53,809 indicate or highlight these landmarks 349 00:12:54,509 --> 00:12:55,889 while you're doing the operation. 350 00:12:56,350 --> 00:12:59,149 And those landmarks become relevant at different portion 351 00:12:59,389 --> 00:13:01,009 to different parts of the surgery. 352 00:13:01,389 --> 00:13:03,245 So you can literally then the AI have 353 00:13:03,245 --> 00:13:05,565 you guide through the through an operation from 354 00:13:05,565 --> 00:13:08,204 a to z depending on the landmarks when 355 00:13:08,204 --> 00:13:10,365 they become relevant. That that's that's one of 356 00:13:10,365 --> 00:13:12,605 those things that I'm working on that I'm 357 00:13:12,605 --> 00:13:15,084 very excited about that goes way beyond just 358 00:13:15,084 --> 00:13:16,865 putting screws into the spine. 359 00:13:17,210 --> 00:13:20,029 This is really just, facilitating the workflow. 360 00:13:20,730 --> 00:13:22,730 And a T Lift is a great example, 361 00:13:22,730 --> 00:13:25,389 but any any spine operation could really be 362 00:13:25,769 --> 00:13:26,269 benefiting 363 00:13:26,889 --> 00:13:28,190 from this type of, 364 00:13:28,570 --> 00:13:31,549 automatic segmentation and integration through 365 00:13:32,084 --> 00:13:34,904 microscope or the exoscope or even the endoscope 366 00:13:35,444 --> 00:13:37,064 and then project this information 367 00:13:37,764 --> 00:13:40,404 into the visual field of the surgeon. So 368 00:13:40,404 --> 00:13:41,865 that's that's AI 369 00:13:42,245 --> 00:13:43,704 in the operating room. 370 00:13:44,419 --> 00:13:46,980 And then and then there's obviously AI that 371 00:13:46,980 --> 00:13:47,799 you can use, 372 00:13:49,059 --> 00:13:49,799 for postoperative 373 00:13:50,179 --> 00:13:50,679 assessment, 374 00:13:51,459 --> 00:13:52,279 write manuscripts, 375 00:13:53,059 --> 00:13:54,500 I mean, help you in a in a 376 00:13:54,500 --> 00:13:57,379 in a intelligent way, improve the quality of 377 00:13:57,379 --> 00:13:58,039 your manuscript. 378 00:13:58,975 --> 00:14:00,975 And, I mean, there's so many and then 379 00:14:00,975 --> 00:14:03,375 scribes. Right? We we discuss it currently at 380 00:14:03,375 --> 00:14:05,455 Oxpine. You know? Is there is there a 381 00:14:05,455 --> 00:14:06,514 need for AI 382 00:14:07,294 --> 00:14:09,774 scribes, for example? You know? And that's something 383 00:14:09,774 --> 00:14:11,215 that we're discussing. I know a lot of 384 00:14:11,215 --> 00:14:13,615 institutions have that implemented already. I think there 385 00:14:13,615 --> 00:14:15,589 are pros and cons, but sooner or later, 386 00:14:15,589 --> 00:14:18,070 it's gonna be it's gonna be common practice, 387 00:14:18,070 --> 00:14:20,230 I'm sure. Oh, yeah. Let's start let's break 388 00:14:20,230 --> 00:14:22,629 down those pros and cons you mentioned there. 389 00:14:22,629 --> 00:14:23,129 What 390 00:14:23,509 --> 00:14:24,949 where what do you think could be done, 391 00:14:24,949 --> 00:14:27,289 you know, to improve to improve the pros 392 00:14:27,750 --> 00:14:28,709 and, you know, 393 00:14:29,269 --> 00:14:30,584 smooth out the cons. 394 00:14:31,445 --> 00:14:33,764 Yeah. So, you know, the cons are, obviously, 395 00:14:33,764 --> 00:14:35,144 you wanna make sure that whatever 396 00:14:35,524 --> 00:14:37,945 whatever you do is is accurate, safe, 397 00:14:38,565 --> 00:14:39,065 ethical. 398 00:14:39,605 --> 00:14:40,105 Right? 399 00:14:40,565 --> 00:14:42,485 So I think those are those are in 400 00:14:42,485 --> 00:14:44,644 general with AI. So you gotta you gotta 401 00:14:44,644 --> 00:14:45,784 be very, very careful. 402 00:14:46,860 --> 00:14:49,440 A good example is writing a manuscript. Right? 403 00:14:50,059 --> 00:14:52,700 People discuss the pros and cons, what's ethical, 404 00:14:52,700 --> 00:14:55,340 what's not ethical. Right? I think there's I 405 00:14:55,340 --> 00:14:56,879 think there are ways of 406 00:14:57,180 --> 00:14:58,240 of using AI 407 00:14:59,125 --> 00:15:02,824 to create an outline for a scientific manuscript, 408 00:15:02,884 --> 00:15:03,625 for example, 409 00:15:04,084 --> 00:15:05,384 to review the literature, 410 00:15:06,004 --> 00:15:06,745 to critically 411 00:15:07,684 --> 00:15:10,004 review the quality of your own writing and 412 00:15:10,004 --> 00:15:11,144 improve that potentially. 413 00:15:11,605 --> 00:15:13,009 But But I think you always gotta make 414 00:15:13,009 --> 00:15:14,690 sure that you check and double check and 415 00:15:14,690 --> 00:15:16,610 triple check. You know, that's that's the most 416 00:15:16,610 --> 00:15:17,589 important part. 417 00:15:18,690 --> 00:15:20,610 It it But I think that, we're we're 418 00:15:20,610 --> 00:15:22,870 gonna get better at this. And, eventually, 419 00:15:24,129 --> 00:15:25,490 I think it's gonna be more and more 420 00:15:25,490 --> 00:15:26,309 common practice. 421 00:15:27,235 --> 00:15:29,875 Definitely. And then, doctor Hartle, the last question 422 00:15:29,875 --> 00:15:31,875 I have for you right now is what's 423 00:15:31,875 --> 00:15:35,394 something that all spine surgeons, whether they're working 424 00:15:35,394 --> 00:15:36,934 with the health system independently, 425 00:15:38,115 --> 00:15:40,455 what should all spine surgeons be doing 426 00:15:40,835 --> 00:15:42,455 to thrive this year? 427 00:15:43,529 --> 00:15:45,389 To thrive this year is 428 00:15:46,330 --> 00:15:47,289 I think that, 429 00:15:48,409 --> 00:15:50,990 you know, personally, in my own practice 430 00:15:51,450 --> 00:15:51,950 and 431 00:15:52,330 --> 00:15:54,330 to I think for spine surgeons is gen 432 00:15:54,409 --> 00:15:56,490 in general, what I find the most important 433 00:15:56,490 --> 00:15:57,789 part this year, 434 00:15:58,725 --> 00:16:00,725 but probably also last year and next year, 435 00:16:00,725 --> 00:16:03,304 is really communicate with patients. Right? 436 00:16:03,764 --> 00:16:05,464 I think at the end of the day, 437 00:16:05,924 --> 00:16:08,404 the the what we provide as a service 438 00:16:08,404 --> 00:16:08,904 is 439 00:16:09,684 --> 00:16:11,605 try to help patients get through a very, 440 00:16:11,605 --> 00:16:12,985 very difficult time 441 00:16:13,490 --> 00:16:16,449 in their lives, sometimes with neurological deficit, but 442 00:16:16,449 --> 00:16:17,589 frequently with pain. 443 00:16:17,970 --> 00:16:19,970 And that's a very, very unique problem. There 444 00:16:19,970 --> 00:16:22,769 are very few specialties in medicine that really 445 00:16:22,769 --> 00:16:24,870 have to deal with the complexity 446 00:16:25,735 --> 00:16:27,735 of symptoms that we have to deal with, 447 00:16:27,735 --> 00:16:30,475 neurological problems, pain, the psychological 448 00:16:30,855 --> 00:16:32,934 impact that that has on patients and their 449 00:16:32,934 --> 00:16:33,434 families. 450 00:16:34,134 --> 00:16:35,735 And I think no matter how good the 451 00:16:35,735 --> 00:16:38,129 technology is, no matter how how much you're 452 00:16:38,529 --> 00:16:40,789 using navigation, robotics, biologics, 453 00:16:41,090 --> 00:16:41,590 AI, 454 00:16:41,970 --> 00:16:43,429 I think at the end of the day, 455 00:16:43,490 --> 00:16:45,649 you gotta take the time to communicate with 456 00:16:45,649 --> 00:16:47,190 your patients and be available. 457 00:16:47,570 --> 00:16:49,649 And that's really that's I think that's the 458 00:16:49,649 --> 00:16:51,190 biggest challenge. And I think 459 00:16:51,570 --> 00:16:53,029 as we as we become 460 00:16:54,184 --> 00:16:55,565 more involved with technology, 461 00:16:56,024 --> 00:16:57,164 I think this 462 00:16:57,544 --> 00:16:59,865 personal note of this kind of art that 463 00:16:59,865 --> 00:17:01,245 you develop, this 464 00:17:01,865 --> 00:17:04,585 feeling for your patient and the ability to 465 00:17:04,585 --> 00:17:05,085 communicate 466 00:17:05,625 --> 00:17:08,184 is only gonna become more important because 467 00:17:08,700 --> 00:17:10,779 it's gonna become more important because it's gonna 468 00:17:10,779 --> 00:17:13,339 help you differentiate yourself, let's say, from your 469 00:17:13,339 --> 00:17:13,839 competition. 470 00:17:14,859 --> 00:17:16,859 It's also gonna be more important because it 471 00:17:16,859 --> 00:17:19,839 helps you avoid conflict with patients, you know, 472 00:17:20,380 --> 00:17:22,159 if something goes wrong, let's say. 473 00:17:22,619 --> 00:17:23,119 Mhmm. 474 00:17:23,434 --> 00:17:25,355 So it's really an old principle. It's nothing 475 00:17:25,355 --> 00:17:27,835 new, but it's just even more important now 476 00:17:27,835 --> 00:17:30,335 than it used to be, I think. Communication, 477 00:17:31,595 --> 00:17:32,095 empathy, 478 00:17:33,115 --> 00:17:33,434 and, 479 00:17:33,914 --> 00:17:35,134 sometimes just 480 00:17:35,769 --> 00:17:38,250 taking a step back and think about the 481 00:17:38,250 --> 00:17:38,750 basics. 482 00:17:39,609 --> 00:17:42,170 Very well said. Well, doctor Hardo, thank you 483 00:17:42,170 --> 00:17:44,429 so much for joining us on today's podcast. 484 00:17:45,049 --> 00:17:46,890 It's great to connect, and I look forward 485 00:17:46,890 --> 00:17:48,269 to chatting in the future. 486 00:17:48,587 --> 00:17:50,587 Carly, thank you so much. And, again, happy 487 00:17:50,587 --> 00:17:52,527 New Year, and thanks for having me.