NASS 40th Anniversary: Forecasts from the Next Generation of Leaders
As NASS enters the second half of its 40th anniversary year, our attention turns to the future. For this issue of SpineLine, we surveyed past 20 Under 40 honorees and members of the Early Career Advisory Council to explore how they see the field evolving by 2040, and how their own careers are taking shape in 2025.
The outlook? Largely optimistic. While a third of respondents reported feeling neutral, most expressed confidence that spine care is moving in the right direction.
When asked about which innovations would have the greatest impact by 2040, artificial intelligence (AI) and machine learning (ML) topped the list by a wide margin. Regenerative medicine, biologics, and robot-assisted surgery also emerged as key technologies shaping the future. Respondents also emphasized the importance of multidisciplinary teams and access to care as essential in spine care’s future.
Spine Care Enters the Data Era: Navigating the Promise and Pitfalls of AI
As NASS enters the second half of its 40th anniversary year, our attention turns to the future. For this issue of SpineLine, we surveyed past 20 Under 40 honorees and members of the Early Career Advisory Council to explore how they see the field evolving by 2040, and how their own careers are taking shape in 2025.
The outlook? Largely optimistic. While a third of respondents reported feeling neutral, most expressed confidence that spine care is moving in the right direction.
When asked about which innovations would have the greatest impact by 2040, artificial intelligence (AI) and machine learning (ML) topped the list by a wide margin. Regenerative medicine, biologics, and robot-assisted surgery also emerged as key technologies shaping the future. Respondents also emphasized the importance of multidisciplinary teams and access to care as essential in spine care’s future.
Which of the following will have the greatest positive impact on spine care by 2040?
Expanded Teams, Unified Goals: The Future of Spine Is Not Solo
As spine care continues to grow in complexity, many early-career professionals project a future where no provider, or discipline, operates in isolation. Team-based models, cross-specialty collaboration, and broader inclusion of nonphysician professionals surfaced in the responses.
Many respondents emphasized the importance of recognizing underutilized roles within spine teams, particularly in value-based environments. “Nonphysician spine professionals can play a critical role in value-based care and increasing implementation of stepped models of care. I see them further integrating into teams where they can provide initial work-up and management of spine-based pain, and initiate escalation of care when appropriate,” asserted Anna-Marie Ziegler, DC, MM, MS.
Ram Haddas, PhD, MBA, pointed to the role of data and sensor-based feedback loops as central to effective interdisciplinary spine care, “Professionals such as biomechanists, physical therapists, and rehabilitation scientists will be essential in bridging objective biomechanical data with clinical decision-making. Their expertise will not only support diagnosis and treatment planning, but also drive the development and implementation of personalized, data-informed interventions tailored to individual patient biomechanics and functional profiles.
“An ideal team-based spine care model in 2040 will be characterized by seamless integration of multidisciplinary expertise, underpinned by continuous, objective data streams and advanced analytics, all focused on delivering personalized, value-driven clinical outcomes,” he concluded.
Others emphasized global integration of specialties, systems, and perspectives. “I hope the culture of spine surgery evolves into a more globally connected and collaborative community. Leveraging AI and shared international data, we can develop unified guidelines, enhance decision-making, and promote more equitable spine care worldwide. This transformation will represent not only technological advancement but also a cultural commitment to inclusivity and collective responsibility in advancing our field,” added Acosta.
As the boundaries of collaboration expand, so do expectations for how patient care is initiated and navigated. “Ideally, team-based spine pain models will incorporate but not be limited to physical therapists, recreational therapists, psychologists, chiropractors, orthopedic surgeons, and neurosurgeons. A skilled, collaborative team is needed to meet the complex needs within spine care,” Ziegler suggested.
The next era of spine care appears rooted in connection. As the definitions of team and expertise continue to expand, so too, the capacity to offer more tailored, collaborative, and inclusive care to a broader patient population.
What’s the biggest threat to spine care over the next 10-15 years?
Technological Breakthroughs Offer Promise of Access
While AI and integrated care models dominated the conversation, respondents also pointed to technological advances and expanded access as powerful forces on the horizon. These topics sparked clinical hopes as well as ethical considerations.
For some, the promise of innovation is inseparable from the desire to restore lost function. “I’d like to see us provide the ability to get people back to their lives after an ASIA A injury… I want to see them walking again and back to their normal, preinjury lives,” Uri P. Hadelsberg, MD, MBA said.
Acosta emphasized that technological breakthroughs must not be isolated benefits of high-resource settings, “It is essential to invest in global data sharing, standardized education, and equitable innovation.” He also noted, “There’s a risk that advanced technologies like robotics, navigation, and predictive analytics could widen the gap between high- and low-resource settings.”
Haddas highlighted the role that wearable technologies can play in decentralizing access, “Biomechanics and motion analysis have the potential to lead transformative advances in equity and access to spine care through the development of cost-effective, portable wearable technologies combined with AI-powered remote assessment and telehealth platforms, including intuitive tablet-based applications capable of accurately diagnosing and monitoring disability and function.
“Clinically, it supports early identification of at-risk individuals and enables timely, preventive care that can reduce the burden of chronic spinal disability… by bridging technological innovation with population health, biomechanics will be instrumental in reshaping spine care into a more accessible, equitable, and value-based system globally.” Concluded Haddas.
With technological breakthroughs coming from the fields of biologics, AI, and robotics, this generation of clinicians and scientists is pressing for a future that is both innovative and equitable.
Which of the following do you believe will become standard of care by 2040?
Progress with Purpose
Across specialties, early-career voices point toward a future they’re already helping shape. Their visions include algorithmic precision, biologic restoration, interdisciplinary care models, universal increase to access, and ethical deployment of technology.
This generation is tech fluent as well as systems conscious. They’re advocating for inclusion, accountability, and equity alongside the push for robotics and regenerative breakthroughs. While their forecasts differ in the details, they converge around a shared hope: that the next 15 years will bring progress as well as purpose.
Their voices reflect a field that’s aware of its challenges as well as its possibilities. As NASS celebrates its 40th anniversary, these rising leaders remind us that the next era of spine care will be shaped not only by the innovations that are invented, but by how, and who, we include.
When I think of the future of spine care, I am:
