This is Carly Beam with the Becker Spine
and Orthopedics podcast. And today, I'm thrilled to
be joined by doctor James Mooney, a spine
surgeon at Virginia Commonwealth University.
Doctor Mooney, thank you so much for being
here today.
Thanks for having me, Carly. I've listened to
Becker's on the past, and I think you
guys do a great job covering the health
care system. So I really appreciate the opportunity.
Absolutely. And thank you for your kind words
as well.
Before we dive into our questions, can you
just introduce yourself and share more about your
background?
Yeah. So my name is James Mooney. I'm
a complex and minimally invasive,
spine surgeon here at Virginia Commonwealth University
in Richmond, Virginia. I'm a new faculty.
I did my training down in Birmingham, Alabama
at the University of Alabama,
for seven years in neurosurgery residency, and then
I was up in Pittsburgh, Pennsylvania
for a
complex and minimally invasive,
spine deformity fellowship.
So excited to be in Richmond and, growing
the program here. Yeah. And it sounds like,
you know, you have a lot of expertise
in just the full gamut of, spine surgery.
Can you talk about some of the
biggest spine trends that you're following in health
care?
Yeah. Of course. So I think, you know,
with any field,
artificial intelligence is at the forefront of, everyone's
minds. And so from my standpoint as a
complex
spine surgeon, you know, I think about what
are the areas that,
AI is going to assist us with in
the OR. And so,
I think there's a number of categories as
far as planning for these bigger spine deformity
surgeries. So, you know, that ranges from radiographic
planning to the execution of complex spine surgeries.
And, you know, ultimately, I think we're heading
towards the future where every surgery,
is ultimately planned and executed according to evidence
based
algorithms.
And that's, you know, multifactorial
where AI can, number one, you know, help
us choose who to operate on. Number two,
help us construct our surgical plans, and then,
lastly, help us execute the plan in the
OR and monitor our progress towards our preoperative
goals intraoperatively.
And then I think really the next frontier
for artificial intelligence and health care as a
whole and, you know, specific to spine surgery
is,
incorporating these AI paradigms into our clinical decision
making.
You know, right now, if you ask five
different spine surgeons, you know, how to approach
a case, you might get five different answers.
So, you know, how do we utilize
AI to help standardize decision making for
spine surgeons and help choose the best option
for each unique patient.
I also think it's important to monitor the
safety of these algorithms. So having,
resources that are devoted to, making sure, you
know, these technologies are used safely.
So I think, you know, that's the number
one area I'm following. I think number two,
is the
shift, sort of from RVU based metrics towards,
value based care and specifically for spine surgery.
I think
it's important to, you know, make sure the
right surgeries are being done for the right
patients and shifting from
a RVU incentive based,
you know, setup where surgeons are compensated based
on volume of surgery. You know? How do
we shift things and,
to more of a patient centered outcome?
And, ultimately, you know, registries and health system
analytics will help us
progress towards that point where we're determining, which
patients are benefiting from, which surgery,
and,
rewarding surgeons for their outcomes.
And then lastly, I think an area that's
been a particular interest to me is,
you know, the expansion of minimally invasive as
well as patient specific technologies and precision medicine.
And for spine surgery, in particular,
the growth of Ultra MIS,
surgery and endoscopic spine surgery, I think, is
really interesting.
You know, it's one of those revolutions, and
they've been doing it in Asia for long
periods of time.
But in The US, it's relatively new, but
I think it's, something that's here to stay,
and it's important for a center that provides
spine care to be able to offer the
full gamut of care ranging from,
you know, the most minimally invasive approach with
an endoscopic surgery to, a big deformity correction.
And I think, you know, tailoring that surgery
to the specific patient is incredibly important, and
we can't lose sight of that.
And then the last thing is, you know,
three d printed implants and patient specific technologies,
I also think are,
the future as well. I haven't incorporated them
yet, but that's something we're hoping to to
bring on as we grow at VCU.
Yeah. Those all really fascinating, exciting areas of
just kind of what's ahead for future spine,
especially all of the ways that
AI sounds like it's really making,
is bring helping to bring patient care in
a more,
streamlined and effective
way. And
one thing I wanna circle back to one
things you said about, this shift from RVU
to VBC. I'd love to hear your insights
on what you think is gonna be needed,
from surgeons, from hospitals, practice leaders, etcetera, for
this shift to
really be effective and to
to take off?
Yeah. I mean, I think it's easy to
talk about, but, you know, actually instituting it
is a lot,
bigger of a challenge. And so, you know,
I'm right at the beginning of my career,
and these are just things I've been following
early on. But I think it's gonna take
a, you know, a massive overhaul really of
the way things are
set up currently,
just given that we've been following the specific,
you know, metrics and ways of compensating surgeons
for years. So,
I don't have the specific solution, but I
think it's gonna take a lot of, you
know, lobbying,
from our organizations
and,
participation
from,
spine surgeons that are at the front line
to really make this a reality. You know,
people talk about it a lot, but, you
know, putting that into action is a lot
more difficult. And, hopefully, you know, I can
help be a part of that moving forward
as well.
Got it. And, yeah, I'd love to, you
know, hear more about just kind of your
own,
how you're using AI in both your complex
and minimally based in spine care, whether it's
in the OR or outside.
What are you using it the most for?
Yeah. You know, I think
all aspects of of care,
can be utilized. Again, I think safety is
key,
particularly
for,
evaluating and working up a patient for documentation.
You know, Epic has specific AI
workflows that can be used to generate clinic
notes, and that's been incredibly helpful with streamlining
clinic appointments.
And then moving into the OR, we've just
incorporated,
patient specific rods and,
software into our surgical planning, and that software
actually
will, take a patient's preoperative scan,
you know, plan your surgery out in conjunction
with engineers and allow you to generate a
rod that,
at least radiographically
would generate a good outcome for the patient.
The software, it also will track patient
outcomes over time as well as,
did your,
actual surgical
outcome radiographically
match what was planned preoperatively, and there's a
massive amount of data that can be
acquired over time using those paradigms.
So for intraoperative planning for preoperative planning, it's
been very helpful. I think the next forefront
is really incorporating it into,
the intraoperative,
you know, are we achieving the correction that
we planned preoperatively,
as well as helping us to standardize decision
making.
And, again, those things are a little further
further off, but, you know, not too far
off.
Yeah. Thank you for breaking that down. And
I wanna ask you, I know you have
you have a unique perspective having,
training in both
complex
spine surgery and minimally
invasive. And, you know, obviously, the, there is
we're seeing more technologies and trends towards,
minimally invasive surgery.
But, you know, why is it important
for
minimally invasive spine surgeons to kind of understand,
the complex and and vice versa?
Yeah. That's a terrific question. And so, you
know,
I think my the re one of the
reasons I did a fellowship was to really
understand,
understand, which patients to operate on in terms
of,
who is who is right for a particular
procedure. And, you know, in my mind starting
out as a surgeon,
my goal is to offer the patient the
least invasive surgery that we can
offer to achieve the goals of surgery. And
so a lot of times, in these cases,
you know, I'm being sent patients that have
big scoliotic deformities
or or,
you know, issues that radiographically
you would want to,
if you didn't know hear about the patient's
symptoms, you you could offer a large surgery.
But when you actually talk to the patient
and figure out that this might be a
single nerve that's affected, that, minimally invasive decompression
could give them years of relief before they
need a big surgery.
And having that minimally invasive training has been
very helpful,
in working these patients up and being able
to offer
them that, the least invasive approach. And then,
you know, anytime you operate on a patient,
if you fuse a segment of the spine,
you're subjecting the rest of the spine to
more motion and potential
breakdown and need for future surgeries. So, really,
my deformity training has helped me understand angles
and,
preoperative planning even for a small single level
surgery.
You know, it's really important to get that
correction,
even if you're doing an, you know, a
single level five one or four five fusion.
In the grand scheme of things, if you
get that wrong, you're setting the patient up
for many future surgeries. So I think that's
where my minimally invasive training,
UAB has combined with the, you know, the
deformity training to really,
help me be able to offer a full
gamut of spine, procedures to patients.
Definitely. And, yeah, I was wondering, what do
you think will be the one true disruptor
to spine surgery next year?
Yeah. Within the next year, I think AI
is going to continue
improving,
outcomes. And,
you know, I
it's yet to be seen the full extent
of where ultra minimally invasive surgery is going
to head.
I'm actively following that as well.
But I think it's gonna be, you know,
not one single factor, but a combination of
all of these things that are,
intersecting. It's such an exciting time,
where you have, you know, new technologies,
data,
collaboration,
between surgeons, engineers, scientists.
And,
yeah, I I don't I don't think it's
gonna be one specific thing, but really a
combination
of all of these things we're talking about.
Got it. And then just my last question
for you, doctor Mooney. How are you thinking
about growth headed into 2026?
Yeah. For sure.
You know, it's it's a really exciting time
for me being a new faculty at VCU.
There's really three categories that I think of
in terms of growth over the next, two
years, and that's from a clinical standpoint,
from an academic standpoint, and then from an
educational standpoint. And so, you know, clinically,
our goals as a spine department are to,
increase access to care. You know, historically,
UVA,
and Duke have been the major centers in
the area.
And our goal is to to really offer
patients in the Richmond area access to total
spine care,
including, you know, complex as well as MIS,
spine surgery.
And to achieve that, we're, you know, expanding
our reach to different areas,
in Fredericksburg, Virginia. I've been going to Williamsburg,
where William and Mary is to,
you know, work with athletes there,
and increase our sports medicine exposure, and we've
been getting referrals and expanding our reach in
those areas, which has been great.
Second is to increase, you know, capabilities in
the OR. And so we've, you know, brought
in MIS systems over the past few months
to help achieve those goals.
I mentioned the unit,
patient specific rods, which we've been incorporating into
surgery as well,
and then all of the AI planning, robotics,
and enabling technologies,
that are really going to help transform things,
at VCU.
Improving collaborations
goes along with that. So with orthopedics, endocrinology,
ENT, PM and R, PT, pain medicine, oncology,
and really, you know, incorporating all those departments
to make VCU,
a spine center of excellence.
And then, you know, from an academic standpoint,
we're trying to really grow our research footprint,
looking into predictive analytics,
outcomes data.
And I've been partnering with the engineering department
to help
preoperative planning with three d printing as well
for, bigger deformity
operations.
And then we're working to get involved in
the American Spine Registry over the next, few
months where we can,
you know, longitudinally
collect large amounts of data over time.
And then lastly, you know, from educational standpoint,
we wanna improve
education for the residents,
improve their exposure to complex techniques
and enabling technologies and ultimately,
potentially,
get a fellowship down the road. Mhmm. So
those are the main categories I'm really excited
about.
Got it. Well, you know, thank you so
much, doctor Mooney, for joining us today. It's
been a pleasure speaking, and I look forward
to connecting again down the line.
Of course. Thanks so much for having me.
I appreciate it.