50 things to know about the spine field in 2024


Here are 50 things to know about the spine field from compensation, leadership, policy and more.

1. Compensation for orthopedic spine surgeons in 2024 range from $649,900 to $1.2 million, according to AMN Healthcare. The average salary is $975,820.

2. The average neurosurgery pay is $788,313, according to Doximity's "2023 Physician Compensation Report."

3. Payer coverage for artificial disc replacement is growing. Centinel Spine's lumbar disc replacement implant received payer coverage from multiple commercial groups in states including Tennessee, Illinois, New Mexico, Oklahoma, Texas, Michigan and North Carolina. 

4. Zoher Ghogawala, MD, is president of the North American Spine Society for the 2023-2024 term. He is a neurosurgeon and chair of neurosurgery at Lahey Hospital and Medical Center in Burlington, Mass. Dr. Ghogawala has been involved with NASS since 2008 and has leadership roles across several committees.

5. Some spine devicemakers are merging. Two notable mergers in 2023 were Globus Medical and NuVasive, and Orthofix and SeaSpine.

6. CMS cut the conversion factor for the physician fee schedule by 3.4% effective Jan. 1. The agency projects overall reimbursement for orthopedic and neurosurgeons will remain flat compared to 2023, according to a report from the International Society for the Advancement of Spine Surgery. ISASS noted in a Dec. 7 letter that policy and individual service charge changes will be "roughly balancing out."

7. Many spine surgeons are apprehensive of CMS' move to cut physician pay 1.25% and lowering the conversion factor 3.4%. 

"Congress must either delay the G code implementation, or preferably, provide funding for the G code," said Adam Bruggeman, MD, CEO of Texas Spine Center in San Antonio. "For the long term, we need to tie physician pay to the actual cost of doing business. There are several ideas on how to accomplish this, including the Doc Caucus's proposal from [October]."

8. Stryker's Mako spine robot is expected to hit the market in the second half of 2024. The spine robot's launch will focus on pedicle screw placement.

9. On Sept. 1, UnitedHealthcare began a two-phased approach to eliminate prior authorization requirements for several procedure codes, including four spine-related codes. The code removals will account for almost 20 percent of its overall prior authorization volume. 

10. The largest spine devicemakers include Medtronic, DePuy Synthes, Globus Medical, Zimmer Biomet and Alphatec.

11. Anchorage, Alaska; Saint Paul, Minn., and Minneapolis are the best cities for neurosurgeons, according to Zippia. Zippia ranked those cities based on average salary and job availability. 

12. Spine surgeons tend to earn around 7% more in multispecialty practices than single-specialty practices, according to MGMA. Those in physician-owned facilities earned about 5% more than spine surgeons in hospitals.

13. Costs of some spine procedures are more in ASCs compared to hospital outpatient departments, according to Medicare's price lookup tool. For example cervical spine replacement on average costs $2,958 at an ASC compared to $1,953 at an HOPD.

14. Endoscopic spine surgeries are more expensive for hospitals than open surgical procedures but they are associated with fewer complications for patients, according to a study published in the January edition of the Journal of Neurosurgery: Spine. Researchers found endoscopic procedures were more costly for hospitals, with disposable supplies accounting for 31.7% of the total cost of cases, compared to 10.1% of the cost for open procedures.

15. Spine surgeons are keeping their eyes on GLP-1 weight loss drugs like Ozempic and Wegovy. But it may take several years to see the full impact of the drugs in the specialty. 

"I am seeing increased usage of GLP drugs. Initially, the effect of these drugs will have little impact on spine and orthopedics; however, in a few years time, it will have a bearish effect as thinner people will have fewer spine and orthopedic problems. After a few more years business will pick up again since people will be living longer. I believe usage of this class of drugs will increase," John Prunskis, MD, CEO and medical director of the Illinois Pain & Spine Institute in Elgin, told Becker's.

16. A patient safety bill was signed five years after Christopher Duntsch, MD, PhD, nicknamed "Dr. Death," was sentenced for killing or injuring multiple patients. It's now a class A misdemeanor to lie on a medical license application. Physicians convicted of a felony or misdemeanor related to moral turpitude won't be allowed to practice in the state, and those who had their license restricted or revoked in another state won't be allowed to practice in Texas. 

17. Bundled payments from private insurers were a viable option for lumbar spinal fusion patients, according to a study published in the January 2024 issue of Spine. The study looked at lumbar spinal fusion patients from October 2018 to December 2018 who used CMS' Bundled Payments for Care Improvement Advance model, and compared that data with private bundle data from 2018 to 2020 to analyze the transition away from BPCI-A. Researchers concluded that bundled payments can be successful in lumbar spinal fusions and that "constant price adjustment is necessary so bundled payments remain financially beneficial to both parties and systems overcome early losses."

18. After adjusting for inflation, reimbursements for cervical disc replacement have fallen 12.9%  between 2009 and 2021, according to an analysis in the International Journal of Spine Surgery. Cervical disc replacements jumped 183% from 2007 to 2017, and Medicare beneficiary utilization increased 149%. Inflation-adjusted hospital charges for cervical disc replacement grew 22.4 percent, and inflation-adjusted Medicare reimbursement fell 1.2 percent per year. In 2009 reimbursement for the procedure was $1,928, and in 2021 it was $1,679.

19. Cervical disc replacement compared to anterior cervical discectomy and fusion did better at 10 years, according to a study in the International Journal of Spine Surgery.The study compared disc replacement using Zimmer Biomet's Mobi-C with ACDF across three centers. A total 155 patients were enrolled in the study, and composite success scores for the disc replacement group was 62.4%. The ACDF group had a composite success score of 22.2%.

20. The volume of cervical disc replacements grew steadily for nearly a decade, but have leveled off in the last few years, according to a study published in the journal Spine. Study authors examined data for cervical disc replacement and anterior cervical discectomy and fusion entered into the PearlDiver M151 Ortho data set. There were 19,301 single-level disc replacements and 181,476 ACDFs performed over the study period, 2010 to 2021.

21. Researchers at New York City-based Hospital for Special Surgery and Weill Cornell Medicine discovered a new stem cell that could affect spine care. The findings, published in Nature, uncovered vertebral stem cells that are uniquely present in the spine.

22. Healthcare systems could be strained by growing demand for spinal fusion cases, according to a study published in Clinical Orthopaedics and Related Research — a Wolters Kluwer publication. Vincent Heck, MD, a surgeon in Cologne, Germany, and his team evaluated nationwide data from the German Federal Statistical Office to estimate spinal fusion rates as functions of calendar year, age and gender. They estimated the use of posterior spinal fusion will grow 83 percent by 2060. 

23. Anterior cervical discectomy and fusion costs significantly less when performed in ASCs than the hospital setting for Medicare and privately insured patients, according to a study published in the Dec. 15 edition of Spine. Study authors concluded, "The ASC setting is a dominant option from a health economy perspective for first-time onelevel to two-level ACDF in select patients compared to the inpatient hospital setting."

24. A letter from the American Society of Neuroradiology that was co-signed by multiple spine groups is calling out Cigna over its policies related to closed-loop spinal cord stimulation therapy. The Nov. 30 letter expressed "profound objection" to Cigna's policy calling the therapy "experimental, investigational, and/or unproven" and said the classification neglects the research and evidence behind it. The letter urged Cigna to reevaluate its position and acknowledge the "overwhelming evidence supporting closed-loop SCS therapy."

25. Awake spine surgery is a technique that's growing in interest among physicians. Using regional anesthesia instead of general anesthesia can help patient recovery and improve costs.

"In five years I believe there will be greater adoption of awake spine surgery, driven by patients asking for the technique," Alok Sharan, MD, said. "As more data gets presented and published, patients will appreciate the rapid recovery that you can achieve when you avoid general anesthesia. In addition the cost savings of awake spine surgery will enable more of these cases to be completed in an ASC."

26. The number of spinal procedures performed in the ASC setting is on the rise, especially since the COVID-19 pandemic. A small study published by Cureus in 2022 found that out of the patients surveyed, 30 said they would prefer to undergo a spine operation in the ASC setting, while 28 said they would prefer to undergo surgery in a hospital setting. 

27. Augmedics treated its 5,000th patient using its Xvision spine system in 2023, the first augmented reality system to gain FDA approval for surgery. 

28. Medicare Advantage has been controversial with several major health systems dropping plan coverage due to denials, and some physicians following suit. Harel Deutsch, MD, co-director of the Rush Spine Center in Chicago told Becker's that he has been frustrated with how prohibitive it is.

"It's gotten much, much worse [than it was a year ago]. It was bad back then, but now it's five times worse," he said during a panel at the Becker's 29th Annual Meeting in October. "Every time I turn on the TV, I see ads for Medicare Advantage and basically Medicare Advantage, they'll disapprove any surgery you apply for. A lot of times I have to tell patients, look, you have to wait until you can unenroll and then do that. Then you can have your surgery."

29. The number of unnecessary surgeries performed in the field of spine and orthopedic care is on the rise, with an estimated 50 percent of lumbar spine surgeries deemed unnecessary, according to an Aug. 2 report from Forbes based on a Harvard Business Review study. 

30. The top executives at large orthopedic and spine device companies received millions of dollars in total compensation for the 2022 fiscal year, according to reports filed with the U.S. Securities & Exchange Commission. Kevin Lobo, Chair and CEO of Stryker, had the highest pay with $18.6 million.

31. Orthopedic spine surgery is dominated by white males, and that won't change any time soon, according to a study published in the journal Spine. Study authors found no significant movement toward a more diverse pool of spine fellows, with white, non-Hispanic males continuing to represent the largest percentage of surgeons in training. 

32. David Payne, MD, was sentenced in 2023 to 33 months in prison after he was found guilty of accepting bribes for performing surgeries at the now-defunct Pacific Hospital in Long Beach, Calif. His sentencing is the latest among several spine and neurosurgeons convicted in connection with Pacific Hospital.

33. Hospital charges for elective total cervical disc replacement increased significantly from 2009 to 2019, Medicare reimbursement hasn't kept up, according to a study published in the November 2023 issue of the Journal of Neurosurgery.

34. Cervical disc replacement has increased significantly from 2011 and 2021 while anterior cervical discectomy and fusion plateaued, according to a study published Feb. 24 in The Spine Journal. Researchers used the PearlDiver database to analyze patient demographics, complications and revisions for ACDF and cervical disc replacements between 2011 to 2021. More than 404,000 ACDF and more than 29,000 cervical disc replacement patients were included. ACDF and cervical disc replacements had overall complication rates of 12.20% and 8.77%, respectively. 

35. Premia Spine earnedThe International Society for the Advancement of Spine Surgery  CMS' New Technology Add-on Payment for the TOPS system. This provides up to an additional $11,375 beyond the standard DRG payment for the procedure. It's available at facilities that provide inpatient care for spinal stenosis and spondylolisthesis. The TOPS System earned the FDA's breakthrough technology designation in 2020 and granted PMA approval in June. The system is an alternative to lumbar spinal fusion for patients with spinal stenosis and spondylolisthesis.

36. The International Society for the Advancement of Spine Surgery successfully pushed for the deletion of Medicare Correct Coding Initiative edits for new CPT codes for lumbar decompression for transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in July 2023. ISASS also developed and submitted new coding change requests for the Barricaid procedure. The formal code change application was sent to the CPT Editorial Panel for a category I code for Implantation of an Annular Device. If approved, the updates will go into effect in 2025.

37. Prone lateral spine positioning has gained attention in recent years and has been touted for its efficiency in the operating room. A multicenter study published April 27 in Spine evaluated single-position prone lateral lumbar interbody fusion in revision cases and found it improved operative efficiency without any increase in complications.

38. In a study of 72 patients for the North American Spine Society Journal, prone transpsoas lateral interbody fusion with anterior docking was found to potentially "address shortcomings associated with traditional lateral interbody fusion by producing safe and reproducible access with improved restoration of segmental lordosis and optimization of spinopelvic parameters."

39. SpineLine, the publication of the North American Spine Society, named its 2023 class of "20 under 40," which highlights 20 musculoskeletal-focused physicians under 40 making a name for themselves in the orthopedic and spine industry.

40. Spine and orthopedic consolidation has accelerated in recent years, and private equity investment has been a popular avenue. Fourteen major private equity-backed orthopedic groups were formed between August 2017 and February 2023, according to a report in the Journal of Orthopaedic Experience & Innovation.

41. Some spine and orthopedic groups are exploring consolidation options that don't involve private equity. In 2023, Chicago-based Midwest Orthopaedics at Rush and Rockford-based OrthoIllinois aggregated, and three orthopedic groups — Durham, N.C.-based EmergeOrtho, Indianapolis-based OrthoIndy and Seattle-based Proliance Surgeons — came together to form PELTO Health Partners.

42. Healthgrades ranked the best spine hospitals in five states. 

43. The North American Spine Society honored four physicians in its 2023 Recognition Awards. Jamie Baisden, MD, earned the Henry Farfan Award; Sigurd Berven, MD, earned the David Selby Award; Behrooz Akbarnia, MD, earned the Leon Wiltse Award, and Michael Klein, MD, earned the Spine Advocacy Award.

44. The spine technology startup Waypoint Orthopedics recently raised $650,000 from Runway Healthcare, a medtech accelerator. The company, founded by Stephen Banco, MD, and Runway, developed a spine surgery navigation tool with an app-based operating system to help surgeons place pedicle screws. The system received FDA approval in September as an alternative to fluoroscopy.

45. An appeal board for the European Patent Office has revoked a pain management system patent belonging to California-based medical device company Nevro following a challenge from its competitors Medtronic and Boston Scientific. The decision invalidates Nevro's patent entitled "Multi-frequency Neural Treatments and Associated Systems and Methods." 

46. Richard Menger, MD, earned the Samuel Hassenbusch Young Neurosurgeon Award from the Congress of Neurological Surgeons for the second year in a row. Dr. Menger is a neurosurgeon with USA Health in Mobile, Ala. and focuses on complex spinal reconstruction.His award recognizes the top socioeconomic abstract among thousands of submissions.

47. Aetna updated its Clinical Policy Bulletin in February 2023 following a class-action settlement related to its lumbar disc replacement coverage. Aetna settled a 239-person class-action lawsuit calling out the insurer's coverage policy previously labeling lumbar disc replacement as "experimental and investigational." Lumbar partial disc prosthetics and multilevel lumbar disc replacement still have that label, according to Aetna's policy.

48. Fewer than 6% of anterior cervical discectomy and fusion patients at one- and two- levels required readmission after having the procedure at an outpatient center, according to a study from the International Journal of Spine Surgery. Researchers analyzed data from the State Ambulatory Services Database for New Jersey from 2003 to 2012.

49. Alex Vaccaro, MD, PhD, president of Philadelphia-based Rothman Orthopaedic Institute, was recognized as the world's top-rated spine care expert in 2021 and 2022 by Expertscape. He has been ranked in the top 0.0006% of spine surgeons since 2012.

50. A study in The Spine Journal examined whether most patients are willing to pay out of pocket for anterior cervical discectomy and fusion, degenerative lumbar spinal fusions and adult spine deformity surgery. About 40% of 979 surveyed respondents reported high levels of financial stress and 63% were Medicare users, while 13% were Medicaid users. About 30.1% of participants were willing to undergo an ACDF, 30.3% were willing to undergo an LF and 29.6% were willing to undergo ASD surgery for the cost of $3,000. Following a $100 price increase, willingness decreased by 2.1% for ACDF, 1.8% for LF and 2% for ASD. 

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