This is Carly Beam with Becker Spine and
Orthopedics podcast, and I'm thrilled to be joined
today by doctor Roger Hardell with Weill Cornell
Medicine. Doctor Hardell, thank you so much for
being here today.
Carly, thanks so much for having me back
on this podcast. I'm very
happy, and I wish you a happy New
Year.
Likewise. Likewise. And, doctor Harlow, if you could
just introduce yourself and tell us a bit
more about your background just for, you know,
anyone new who might be, listening.
Yeah. Yeah. Yeah. I'm happy to do that.
I'm I'm a neurosurgeon. I'm
a a spine neurosurgeon at this point in
my career.
I run the spine program at Weill Cornell
Medicine in New York City, and I'm one
of the co directors of ArcSpine
at New York Presbyterian
Hospital
in New York City.
Mhmm. And, doctor Haro, can you talk about
the top three trends you're following in health
care and in spine surgery today?
Sure. You know, we have a
integrated
and very large program now. We, you know,
we're at New York Presbyterian Hospital at, in
in New York City.
And and now what we've done over the
last, you know, ten years is really integrate
the
spine programs at Columbia Cornell under the umbrella
of New York Presbyterian Hospital.
And in that role, of course and I
and I do this together with Larry Lanky,
who's like Bandin Shah, who are my main
counterparts at the Columbia campus, and with Dan
Rule here at Cornell.
But obviously working with a large group
of health care providers, surgical,
nonoperative,
from really multiple disciplines that are all importantly
involved in the care of patients with back
issues.
You You know, there's so many things that
come up all the time that are really
relevant and sometimes
directly related to surgery, sometimes a little bit
outside surgery.
But what I've seen over the last year
has become really more and more interesting and
I think relevant
in
our care of patients with back and neck
issues
is certainly I I I would say there
are three things. There's artificial intelligence, of course,
as as in many aspects
of life and and health care.
What I'm
what I see evolve more and more is
biologics,
you know, disc especially for degenerative disc disease.
I'm not talking about fusion biologics, really more
biologics in terms of disc repair, disc
regeneration, and sometimes even disc replacement.
And then finally, as a as a surgeon
in the Operating Room who's very excited about
minimally invasive spine surgery, I think that whole
area of navigation and robotics
is really fascinating. So those are the three
areas that I follow very closely amongst many
others, but those are three areas within spine
surgery and medicine, spine medicine
that I think are the most exciting,
artificial intelligence,
biologics,
and the whole area of navigation and robotics.
Yeah. You know, I wanna hone in on
what you're talking about with biologics. It's still,
you know, very
there needs to be a lot more
research in this area in spine orthopedics. And
I'm wondering
what kinds of
innovations in spine biologics could elaborate more on,
what's exciting you in that area and what
you think will
really define this year when it comes to
spine biologics.
Yeah. I think the challenge with spine biologics
is partially,
obviously, the the regulatory pathway that that has
that has really
challenged our ability to,
pursue some of the fascinating
strategies that that come to mind when you're
thinking about degenerative disc disease and biologics.
You know, we're very, I think we've got
a lot of data now,
showing that augmentation of diseased discs with
various types of stem cells, autologous or
or or allograft stem cells
holds holds a significant promise.
What I'm what I'm very excited about is
our current work on angular repair because,
you know, one of the biggest untapped needs
in spine surgery
is that whole
problem of recurrent disc herniation in patients who
have a discectomy in the cervical or lumbar
spine.
And then there's not much that we can
do really to prevent the disc from further
degenerating
or even reherniating.
So the whole area of the current disc
herniation
and the opportunity that I think biologics
can potentially give us here to prevent that
from really happening over time.
You know, I've I've done a lot of
research in my lab to you know, I
work with a a biomedical engineer up in
Ithaca, Larry Bonasa. We've been working together for
many years
on disc repair, regeneration, replacement.
But what we've done now more recently is
really try to bring to the forefront the
whole area of of annual repair with,
we use collagen glues, plus minus cells.
We just started a small company, a start
up company
that will hopefully be able to bring this
through the FDA into clinical trials.
And and that for me is really one
of the most exciting things because
it seems such a simple problem. You know?
How do you prevent recurrent discreditation?
But it's really an a totally untapped problem.
You know? To totally we we don't really
have have a good solution.
And there's so many patients, you know, hundreds
of thousands of patients every year who have
lumbar disc herniation,
who undergo surgery,
and they all ask the same question. You
know, how can you prevent that disc from
reherniating? And we just don't have an answer.
To me,
this is one of the most basic issues
in spine surgery currently.
Mhmm. So I'm I'm very excited about that.
And I you know, we've got some mechanical
solutions.
You know, we've got Barricade.
There's another small company from Israel, Spinal,
that that has a little implant that's not
FDA approved at this point.
But I'm not sure that implants are really
the final solution. I think there has to
be some kind of biological
intervention,
either,
in isolation or together with some type of
implant
that help us regenerate and repair that annular
defect. And and that's that's something that I'm
very excited about.
And I imagine everything, with Exploins Biologics, it
sounds like you
multidisciplinary
collaboration
and just kind of work with others just,
you know, beyond just spine, itself.
Yeah. I think that's crucial, and that's
yeah. And that brings me to another point.
If you if you wanna do this type
of research, clinical research, you need a a
team of multidisciplinary
specialists. And that's
that's exactly why we started Oxpine
at in New York City, which which is
really a
combination of operative and nonoperative
providers that we just opened. It's actually a
year ago. Exactly one year ago, we we
opened Prospero, our spine center
in Hudson Yards,
where we have 60,000
square feet, and it's the first time that
Columbia and Cornell doctors work together in one
space.
And we've got, you know,
25 surgeons. We've got, 30 nonoperative
spine providers. We've got physical therapy, radiology.
So this type of research, if you wanna
do this type of research where you really
include patients, you need you need a
a multidisciplinary
team of specialists that all work together, and
that's exactly what we have now.
Yeah. And, you know, have there been any,
any hurdles, any challenges when it comes to,
you know, bringing together all these specialties, or
has it been smooth sailing for the most
part?
Yeah. I wish it was smooth sailing. It's
not. It's,
no. In our case, it really worked because
I mean, as individual physicians, we all wanna
work together. The problem is then
bureaucracy comes into
comes,
comes in the way and the bureaucracy in
terms of the logistics, the infrastructure, the financial
aspect.
In our case, at Oxpawn, it worked because
it was really obviously envisioned by individuals, but
then really
supported and put into practice by by the
hospital and by the universities. You know? And
and I think that's really important. If you
if you wanna build something like a multidisciplinary
spine center, you need the support of the
overarching structure. And in our case,
that's the hospital and the university, and that's
the the key to success.
Absolutely. Unfortunately, you know, we we've had that,
and we have that.
But, obviously, then you also need the individual
subspecialties,
departments, and so forth to all be willing
to work together.
Yeah. Absolutely. And do you have any advice
for,
you know, hospital leaders who, you know, they're
they see your example and they and they
want to replicate that on their own? What
would be the biggest piece of advice you'd
have for creating a more integrated spine orthopedic
neurosurgery
program?
Yeah. No. That's a great question. I you
know, we've and it it didn't happen out
of out of the blue.
You know, we we had at at on
the Cornell side, we've had experience building a
spine center since the early two thousands, and
it was really
initially just
a bunch of,
surgeons and nonoperative doctors who had an interest
in spine.
And we started meeting every week, and we
had a conference. We had a case conference.
You know, we found a neuroradiologist
with an interest in spine, then we had,
two surgeons, myself, somebody else. We had one
of the pain management guys, one of the,
PM and R physiatry doctors,
and and a physical therapist and a neurologist,
actually. And and we all, you know, we
were, like, similar age group. We all had
this an interest in spine, and we decided
to meet meet up once a week and
discuss cases that we had seen in clinic
where we had some questions or we wanted
input.
And that's really how the spine center started
in in our in our case here twenty
years ago, twenty plus years ago.
And then it slowly evolved, and then we
decided to
see actually patients together. So we we moved
our clinic schedules around, and we found a
location where we could actually see patients together
within the hospital.
And then slowly, we and then we tracked
volumes. We tracked patient volumes, surgery volumes. We
could show that it
increased our productivity,
and that's how the hospital started paying attention.
And then slowly, you get the hospital on
board.
So really just kind of looking at the
numbers, it sounds like. That's the key to
everything. Yeah. So it takes a long time.
It's a slow process, but that's kinda how
it worked in our case.
That's great. And, you know, I want to
pivot back to what you're saying about AI
as well. Obviously, in 2025,
AI and health care is, you know, it's
really exploded. It's huge,
huge talking point among, you know, physicians, leaders.
And I'm wondering,
you know, how how are you using
AI in your practice right now? What are
you going to,
do to same, do differently?
Yeah. I mean, I think AI penetrates every
aspect of
our lives as individuals
and as surgeons, and the key is to,
try to make it,
you know, make it safe,
make it effective,
and, and and to make sure you don't
lose really
some of the principles of how we take
care of patients, of course.
You know, I I certainly I mean, our
practices, it's helpful for preoperative
evaluation of patients' literature reviews. You know, if
if you're not sure about, you know, what's
out there in the literature, AI is a
huge advantage in that regard. It can really
help you,
review the literature very quickly, make certain decisions
in terms of surgical procedures. Obviously, you always
gotta double check.
The other thing that I use AI for
increasingly in working with some of the companies
who are involved in navigation
and in,
intraoperative,
you know, stereotactic navigation and robotics
is the whole area of AI
and, for example, automatic,
automated segmentation.
Or, you know, we work I work with
Brainlab, for example,
to come up with a workflow,
to use augmented reality through a microscope or
exoscope
to facilitate the workflow for MIS telus surgery.
Right? MIS telus surgery is a great operation
because there are certain landmarks that you use
with every operation.
And using AI and using intraoperative or preoperative
imaging,
you can automatically
have the software identify these landmarks and then
indicate or highlight these landmarks
while you're doing the operation.
And those landmarks become relevant at different portion
to different parts of the surgery.
So you can literally then the AI have
you guide through the through an operation from
a to z depending on the landmarks when
they become relevant. That that's that's one of
those things that I'm working on that I'm
very excited about that goes way beyond just
putting screws into the spine.
This is really just, facilitating the workflow.
And a T Lift is a great example,
but any any spine operation could really be
benefiting
from this type of,
automatic segmentation and integration through
microscope or the exoscope or even the endoscope
and then project this information
into the visual field of the surgeon. So
that's that's AI
in the operating room.
And then and then there's obviously AI that
you can use,
for postoperative
assessment,
write manuscripts,
I mean, help you in a in a
in a intelligent way, improve the quality of
your manuscript.
And, I mean, there's so many and then
scribes. Right? We we discuss it currently at
Oxpine. You know? Is there is there a
need for AI
scribes, for example? You know? And that's something
that we're discussing. I know a lot of
institutions have that implemented already. I think there
are pros and cons, but sooner or later,
it's gonna be it's gonna be common practice,
I'm sure. Oh, yeah. Let's start let's break
down those pros and cons you mentioned there.
What
where what do you think could be done,
you know, to improve to improve the pros
and, you know,
smooth out the cons.
Yeah. So, you know, the cons are, obviously,
you wanna make sure that whatever
whatever you do is is accurate, safe,
ethical.
Right?
So I think those are those are in
general with AI. So you gotta you gotta
be very, very careful.
A good example is writing a manuscript. Right?
People discuss the pros and cons, what's ethical,
what's not ethical. Right? I think there's I
think there are ways of
of using AI
to create an outline for a scientific manuscript,
for example,
to review the literature,
to critically
review the quality of your own writing and
improve that potentially.
But But I think you always gotta make
sure that you check and double check and
triple check. You know, that's that's the most
important part.
It it But I think that, we're we're
gonna get better at this. And, eventually,
I think it's gonna be more and more
common practice.
Definitely. And then, doctor Hartle, the last question
I have for you right now is what's
something that all spine surgeons, whether they're working
with the health system independently,
what should all spine surgeons be doing
to thrive this year?
To thrive this year is
I think that,
you know, personally, in my own practice
and
to I think for spine surgeons is gen
in general, what I find the most important
part this year,
but probably also last year and next year,
is really communicate with patients. Right?
I think at the end of the day,
the the what we provide as a service
is
try to help patients get through a very,
very difficult time
in their lives, sometimes with neurological deficit, but
frequently with pain.
And that's a very, very unique problem. There
are very few specialties in medicine that really
have to deal with the complexity
of symptoms that we have to deal with,
neurological problems, pain, the psychological
impact that that has on patients and their
families.
And I think no matter how good the
technology is, no matter how how much you're
using navigation, robotics, biologics,
AI,
I think at the end of the day,
you gotta take the time to communicate with
your patients and be available.
And that's really that's I think that's the
biggest challenge. And I think
as we as we become
more involved with technology,
I think this
personal note of this kind of art that
you develop, this
feeling for your patient and the ability to
communicate
is only gonna become more important because
it's gonna become more important because it's gonna
help you differentiate yourself, let's say, from your
competition.
It's also gonna be more important because it
helps you avoid conflict with patients, you know,
if something goes wrong, let's say.
Mhmm.
So it's really an old principle. It's nothing
new, but it's just even more important now
than it used to be, I think. Communication,
empathy,
and,
sometimes just
taking a step back and think about the
basics.
Very well said. Well, doctor Hardo, thank you
so much for joining us on today's podcast.
It's great to connect, and I look forward
to chatting in the future.
Carly, thank you so much. And, again, happy
New Year, and thanks for having me.