Podcast Summary: Becker’s Healthcare Podcast with Dr. David L. Skaggs

Episode Title: David L. Skaggs, MD, Co-Director of Cedars-Sinai Spine
Published: December 6, 2025
Host: Carly Beem
Guest: Dr. David L. Skaggs

Main Theme

This episode features Dr. David Skaggs, Co-Director of Cedars-Sinai Spine, discussing leading innovations in spine surgery, particularly the intersection of pediatric and adult spine care. Dr. Skaggs reflects on advances in imaging, robotics, instrumentation, and the evolving training pathways required for future spine surgeons. He concludes with a look at anticipated healthcare trends headed into 2026, including the impact of government policy and artificial intelligence.

Key Discussion Points & Insights

1. Background and Collaborative Approach

• Dr. Skaggs shares his extensive background: 25 years at Children’s Hospital Los Angeles before joining Cedars-Sinai, where he now works alongside neurosurgeon Dr. Alex Tuchman in a center with about 30 spine surgeons (00:25).
• Interdisciplinary Collaboration: Emphasizes that combining neurosurgeons and orthopedic surgeons yields the best outcomes in spine care.

  “We believe very deeply that a combination of neurosurgeons and orthopedic surgeons working together deliver the best spine care.” (Dr. Skaggs, 00:33)

2. Technological Innovations in Imaging—AI Synthetic CT

• Synthetic CT from MRI: Recent breakthrough where AI generates a CT image from MRI data, crucially sparing children from extra radiation (01:23).
  • The process: A quick MRI sequence produces a high-quality CT (within 1mm accuracy), including 3D reconstructions.
  • Reduces need for multiple separate imaging studies for adults as well.
• Game Changer for Surgery: Synthetic CT (proprietary: Bone MRI) enables navigation and robotics in surgeries without real-time radiation exposure (02:39).

  “It’s one of the few things I’ve seen in medicine where AI actually makes a difference in practical terms.” (Dr. Skaggs, 01:31)
  “All of a sudden, we don’t radiate the patient at any point for navigation or robotic usage, which is a complete game changer.” (Dr. Skaggs, 03:15)

3. Minimally Invasive and Robotic Techniques in Pediatric Spine

• Transitioning to Robotics: Dr. Skaggs learned robotic-assisted spine surgery upon joining Cedars-Sinai, enabling minimally invasive, outpatient procedures for children (03:36).
• Impact: For conditions like spondylolysis in young athletes, incisions now can be as small as 2cm, placing screws with high precision.

  “Now with the use of a robot, we could literally make a 2 centimeter incision, or even less, and put a screw or screws perfectly across the fracture site.” (Dr. Skaggs, 04:09)
  “I never, back in my days at Children's Hospital, imagined I’d be doing outpatient pediatric spine surgery.” (Dr. Skaggs, 04:20)

4. Applying Adult Surgery Lessons to Pediatrics

• Spinal Alignment: Lessons from adult surgery about optimizing lumbar alignment are now used in pediatric procedures to improve long-term back health (04:55).
  • Ensuring L4-S1 lordosis of at least 35 degrees prevents later back pain.

  “If I wasn’t… learning from my adult colleagues, I probably wouldn’t be doing as good of a job on children as we are now.” (Dr. Skaggs, 05:41)

5. Inclusive Design in Surgical Tools

• Need for Better Tool Ergonomics: Dr. Skaggs reflects on designing instrumentation based on his own (large) hands, unaware that this excludes those with smaller hands—especially as more women and diverse surgeons enter the field (06:07).

  “I owe everyone in the world with small hands an apology...” (Dr. Skaggs, 06:43)

  • Predicts enlightened companies will design tools for a broader range of hand sizes.

6. Training the Next Generation of Spine Surgeons

• Pediatric Spine is Highly Specialized: Few children need spine surgery, meaning limited training centers with sufficient case volume (07:24).
  • Advocates for longer, more specialized fellowships—often two years, with integration during residency, especially as surgery becomes more subspecialized.

  “There’s really just too much to learn for one year to know all of spine and really be good at it.” (Dr. Skaggs, 08:56)

7. Biggest Healthcare Trends for 2026

• Concerns:
  • Reduced government reimbursement threatens access for Medicaid patients; reduced support for academic research (10:01).

    “If a doctor sees a patient on government insurance such as Medicaid, they actually lose money because their overhead is more than Medicaid pays... if that government support is going to be cut back even more, I think the patients on Medicaid are going to have even more difficult time with access.” (Dr. Skaggs, 10:11)

  • Research funding is also being cut, affecting innovation and clinical progress.
• Hopeful Innovations:
  • Artificial Intelligence: AI will soon deliver solutions that are “better, faster and less expensive”, especially in radiology and neuromonitoring during surgery (10:40).
    • Example: AI at Columbia University predicts loss of neuromonitoring—when a patient is at risk of paralysis—20 minutes earlier than a human technician.

    “I think that AI is really going to make things safer.” (Dr. Skaggs, 11:46)

Notable Quotes

• On Interdisciplinary Care:

  “A combination of neurosurgeons and orthopedic surgeons working together deliver the best spine care.” (00:33)

• On Synthetic CT Technology:

  “It’s one of the few things I’ve seen in medicine where AI actually makes a difference in practical terms.” (01:31)
  “All of a sudden, we don’t radiate the patient at any point for navigation or robotic usage, which is a complete game changer.” (03:15)

• On Surgical Ergonomics and Inclusion:

  “I owe everyone in the world with small hands an apology, because without knowing, I’ve been designing things for people with big hands.” (06:43)

• On the Scope of Modern Spine Training:

  “There’s really just too much to learn for one year to know all of spine and really be good at it.” (08:56)

• On AI and Patient Safety:

  “AI really is going to offer us solutions that are better, faster and less expensive... I think that AI is really going to make things safer.” (11:46)

Key Timestamps

| Timestamp | Topic/Quote | |-----------|--------------------------------------------------------------------------------| | 00:25 | Dr. Skaggs introduces his background and Cedars-Sinai’s team | | 01:23 | Breakthrough in synthetic CT creation from MRI for children and adults | | 02:39 | Explains ‘Bone MRI’—enabling navigation and robotics with less radiation | | 03:36 | Introduction to robotics in pediatric spine: minimally invasive advances | | 04:55 | Adopting adult surgical principles to improve pediatric outcomes | | 06:07 | Reflection on tool design and hand size inclusivity in instrumentation | | 07:24 | Depth and duration of modern pediatric spine surgery training | | 10:01 | Challenges: Declining government reimbursement, limited access for Medicaid | | 10:40 | Artificial intelligence: Opportunities in radiology and intraoperative safety | | 11:46 | Closing thoughts on AI-driven improvements in healthcare safety |

Conclusion

Dr. David Skaggs provides a panoramic view of today’s most exciting innovations in spine surgery—AI-synthesized imaging, robotics, and cross-disciplinary learning—while candidly acknowledging challenges facing training, tool design, and healthcare access. He expresses both concern and optimism for 2026, with artificial intelligence promising new leaps in patient safety and cost-effectiveness.