From the Desk of the President
What 2026 Changes to Expect in Spine Surgery
William Mitchell, MD
President, North American Spine Society Neurosurgical & Spinal Specialists Marlton, NJ
As we move into 2026, the landscape of spine surgery will continue to evolve and change. The rate of that change will continue to accelerate at a faster rate. Technology will enable these changes. Patients and health care systems will demand such changes. Previous experimental technologies such as AI-driven predictive modeling and augmented reality will transition from “early adopter” curiosities into standard common usage. Here is a look at predicted changes that will reshape spine care in 2026.
1. Site of Service
Perhaps the most significant change in 2026 is the location of the surgery itself. Driven by improvements in anesthesia and ultra-minimally invasive techniques, complex spine procedures will continue to migrate from the hospital setting to outpatient facilities and be performed on an outpatient basis. Furthermore, more physicians will be employed by health systems as private practice becomes further cost prohibitive.
Health systems will continue to maximize hospital revenue while optimizing physician productivity through efficient management, consolidation, and contracting.
- Protocols for Enhanced Recovery After Surgery (ERAS) have matured, allowing patients who undergo spinal surgery, including fusion procedures, to go home within hours. Those who remain in a facility will be “observed” and not admitted as an inpatient.
- Insurance companies are increasingly incentivizing outpatient care due to significantly lower costs and lower infection rates compared to traditional inpatient settings. Hospitals and providers will continue to be driven to provide care within this paradigm. Hospitals will continue to have ownership in the majority of ambulatory surgery centers.
- These incentives and paradigms pose a risk of further stratification of health care with the sickest patients and riskiest procedures being limited to specific facilities and providers. Physicians will lose more autonomy.
2. AI Assistant
In 2026, artificial intelligence will be an extension of decision-making for those involved in health care. This includes all parties involved including the patient, provider, health systems, and payor. Health Systems and payors will utilize AI to decide appropriate care.
AI models now analyze a patient’s BMI, bone density, and health history to predict the “risk-reward profile” of a surgery before the first incision is made. Data will drive decision making.
Ambient AI “scribes” are becoming standard in clinics, capturing patient conversations and automatically generating notes and billing codes. These “scribes” will become a requirement by health care systems and networks.
3. Operating Room
The operating room will continue to evolve in 2026 with “assistants,” including robots and navigation. While traditional navigation relied on looking away from the patient at a separate monitor, 2026 sees the widespread adoption of Augmented Reality and Advanced Navigation.
Navigation systems have become less expensive and easier to use with less radiation exposure. Surgeons use AR headsets to superimpose 3D renderings of a patient’s CT scan directly onto their anatomy in real-time. This “X-ray vision” allows for millimeter-level precision in placing pedicle screws and implants.
The next generation of robots moves away from single-arm assistants to multi-arm “humanoid” systems that can perform complex decompressions alongside the surgeon.
The era of “off-the-shelf” hardware continues fading. 3D printing (additive manufacturing) has advanced to the point where implants will be custom designed for the individual patient. For patients with complex deformities or tumors, 3D-printed implants provide a fit that standard hardware cannot match. New porous titanium cages are designed with lattice structures that mimic human bone, encouraging faster “ingrowth” and reducing the risk of the implant sinking (subsidence).
4. Economic and Access Challenges
Despite these technical leaps, 2026 brings hurdles. Cost of health care continues to grow faster than the economy and inflation. Technology, the aging population, and the expanded treatment for all conditions, including spine, continue to expand. This adds economic stress to individuals and employers.
High initial costs for robots and AR systems continue creating a divide between high-tech “centers of excellence” and smaller rural practices. The large health systems have more resources and leverage with payers allowing for such investments. Costs still outweigh reimbursement for technology and increased volume must compensate for the additional costs.
At least one generation of surgeons has only trained with navigation and robots. Some of those surgeons are unable to perform surgery without this technology. Surgeons will face increased resistance from payers regarding the use of new technology. Innovative procedures will require rigorous data-backed proof of “value-based” outcomes before they are widely covered. The additional cost will need to be justified.
I look forward to reading these predictions next year and comparing it to what actually transpired. The one certainty is that I will be at least partly incorrect.