Evidence & Technology Spine Summit Recap
Industry’s Role in Orchestrating New Technology Adoption Amongst Physicians
Alan Hilibrand, MD
Rothman Orthopaedics
Bensalem, PA
A highlight of the 2026 Evidence & Technology Spine Summit was a panel discussion in the non-CME section discussing industry’s role in developing new technology and in orchestrating physician adoption of new technologies. Present for our panel discussion were Eric Major, CEO, See All AI; Jason Hannon, CEO, Mainstay Medical; Rebecca Whitney, CEO, Highridge; Todd Alamin, MD, spine surgeon at Stanford University; and Vinny Francio, MD, physiatrist at Washington University. The panel was moderated by Alan Hilibrand, MD, and Jason Savage, MD.
The conversation began by discussing how emerging technologies face several hurdles to making it into clinical practice. After the investment in developing the technology, companies need to prove the efficacy in clinical trials, then train physicians in the indications and technical skills required to use the technology. One question that was posed to the panel was whether we are incentivizing industry to develop technologies that will ultimately help patients. Rebecca Whitney noted that industry needs to innovate responsibly. She used the example of Tether, a somewhat-disruptive technology in the world of adolescent deformity. She noted that the company focused on how they could train the correct physicians to use the device in the correct patients. She noted that early in development they established a standardized procedure for the technology and how physicians would qualify to use it. They customized their training in a multi-step process that included shadowing in the operating room, case review with experienced surgeons, and cadaver training. A surgeon was unable to obtain access to the product unless they were approved in 100% of this training program.
Dr. Alamin, who developed the Limiflex device over 15 to 20 years while working as a spine surgeon at Stanford, suggested that his product faced similar issues. How do you manage the use of this product? How can you fund a large clinical trial? Can you develop a training program to assist with these issues? For instance, completion of a good lumbar decompression is a prerequisite skill for using this device effectively. Similarly, being able to identify vertical foraminal stenosis as a contraindication is another prerequisite. But how do you ensure the prerequisites are met? He noted that it would not be realistic to have all surgeons send X-rays of their patients for review. However, the need for a thorough decompression suggests at least partial guardrails around its use, such as not having nonsurgeons implant this device.
There were different issues facing Jason Hannon, the founder and CEO of Mainstay Medical. For his device, a multifidus stimulator, surgeons and nonsurgeons would both be capable of implanting this device. He suggested that for his device there are 3 requirements, and the surgical technique is the easiest of those. The bigger issue was teaching surgeons and non-surgeons to recognize multifidus dysfunction, which is the indication for the procedure, and then making sure that physicians can recognize and select those patients, to have successful outcomes.
SeeAll AI is a new technology that leverages AI to develop CT-like images from standard fluoroscopic X-rays. CEO Eric Major talked about how the system leverages the latest AI technology and computing power to “understand” the 3-dimensional implications of 2-dimensional fluoroscopic images, with the aid of deep learning over thousands of acquired images in its database. In the case of this technology, the goal would be to bring something to market that does not require special training and does not require a representative in the operating room. The technology could be used with a good working fluoroscopic machine and radiology technician, and an application for the technology.
Dr. Francio discussed how training works in the non-surgical side of spine. He noted that after his PM&R training, he completed a 2-year anesthesiology-based pain fellowship which included multiple trainings for devices such as interspinous spacers, peripheral nerve stimulation, and basivertebral nerve ablation. He discussed a training process that included lectures, direct work with a fellowship mentor, direct work with the companies at cadaver courses following fellowship. In addition, for some procedures like basivertebral nerve ablation, he needed to submit 5 cases before he would have clearance to continue doing so as an independent physician.
Follow-up discussions included questions about how to set a price for new technologies. The panel noted that it is a combination of many factors including what the physician and hospital are reimbursed, the effectiveness of the device, and the perceived benefit. Generally, a longer-term reduction in reoperation rates should promote a higher price but several of the panel argued that hospitals, and especially an Ambulatory Surgery Center (ASC), does not always look at the long-term outcomes in determining the value of a new procedure. Major noted that SeeAll AI will be offered as a software service, and that it will be charged a different price in different settings such as the ASC, the hospital, and the office. Jason Hannon said there are also some perverse incentives, such as reimbursement being higher for his device at an ASC than at a hospital.
Unfortunately, the problem with a new technology is that insurance usually will not reimburse for it and surgeons will not know how to best select patients for it until it has been applied in a generalizable population. There was interest in having NASS use its research team and members in surgical and non-surgical areas to develop clinical trials at “arm’s length” from the companies. Given the respect and long-standing relationships between NASS and payors, it was felt by the panel that a NASS-sponsored trial would better facilitate acceptance of new technology by patients, physicians, and payors. Obviously, there are many challenges to doing this effectively and it requires patient-centered partnerships among all stakeholders and following the appropriate progression from product development, to clinical outcomes, to optimal patient selection, to guideline recommendations, to insurance reimbursement structures.