Dr. Andrew Fanous, Section Chief of Neurosurgery at Inova Alexandria Hospital

Summary

Becker’s Healthcare Podcast: In-Depth Conversation with Dr. Andrew Fanous on Advancements in Spine Surgery

Release Date: August 10, 2025

In the latest episode of the Becker’s Healthcare Podcast, host Carly Beam engages in a comprehensive discussion with Dr. Andrew Fanous, Section Chief of Neurosurgery at Inova Alexandria Hospital. Dr. Fanous shares his extensive expertise on the cutting-edge technologies transforming spine surgery, the integration of these innovations into clinical practice, and the evolving landscape shaped by federal healthcare policies.

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1. Introduction to Dr. Andrew Fanous

Dr. Andrew Fanous, a board-certified neurosurgeon at Inova Health System in Northern Virginia, brings a wealth of experience to the conversation. With specialized training in complex and minimally invasive spine surgery, Dr. Fanous provides invaluable insights into the current and future state of spine surgery technologies.

“I am a neurosurgeon at Inova Health System in Northern Virginia. I am based in Alexandria, Virginia. I am board certified neurosurgeon and I'm also fellowship trained in complex and minimally invasive spine surgery.” [00:17]

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2. Cutting-Edge Technologies in Spine Surgery

Dr. Fanous identifies several transformative technologies that are reshaping spine surgery. These innovations not only enhance surgical precision but also improve patient outcomes and operational efficiencies.

a. Spine Robotics

Spine robotics enhance the accuracy of instrumentation, reduce radiation exposure, and shorten operative times. Dr. Fanous notes their current use primarily in larger spine cases, with future advancements anticipated to include more autonomous functionalities.

“Spine robotics are going to become more autonomous and they will offer sort of multi-level trajectory planning and hopefully eventually they will also be able to help us when we're performing the compressions in spine surgery.” [01:42]

b. Augmented Reality (AR) and Mixed Reality (MR)

AR and MR technologies allow surgeons to visualize patient anatomy directly within their field of view, enhancing surgical planning and execution. Dr. Fanous envisions these systems evolving into multifunctional platforms that assist beyond the operating room.

“You can have the surgeon use the AR and MR technologies not just to perform surgery, but also to do more than just the surgery.” [01:42]

c. AI-Driven Surgical Planning and Imaging Tools

Artificial Intelligence (AI) plays a crucial role in personalizing surgeries through predictive analytics and optimizing surgical trajectories. Dr. Fanous emphasizes AI's potential in risk stratification and patient selection to minimize postoperative complications.

“AI-driven surgical planning and imaging... enhances personalization of surgeries, which is something that is very desirable nowadays.” [01:42]

d. 3D Printed and Patient-Specific Implants

Custom implants tailored to a patient’s unique anatomy improve osteointegration and fusion rates, thereby reducing the likelihood of surgical failures and the need for revisions. However, Dr. Fanous points out the current limitation in emergency scenarios due to production lead times.

“They improve osteo integration and by extension, fusion... But we're hoping that in the future we can have a rapid point of care printing, especially for trauma and deformity patients.” [01:42]

e. Motion Preservation Devices

These devices aim to preserve spinal motion, thereby decreasing the risk of adjacent segment disease and reducing the need for future surgeries. The primary challenge remains the lagging reimbursement, particularly in the United States.

“They decrease the risk of adjacent level disease and, you know, additional segment disease by preserving motion rather than fusion.” [01:42]

f. Endoscopic Spine Surgery

Endoscopic techniques offer minimally invasive options that reduce recovery time and complications. Despite their benefits, the steep learning curve and limited access areas present barriers to widespread adoption in the U.S.

“It reduces recovery time, it minimizes muscle damage, and it lowers the risk of complications.” [01:42]

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3. Integration of Technologies into Clinical Practice

Dr. Fanous elaborates on how these technologies are meticulously incorporated into his surgical practice to enhance precision and patient outcomes.

“We are employing them currently mainly for instrumentation in larger spine cases... augmented reality systems allow visualization of patient anatomy directly into our field of view as surgeons.” [01:36]

He highlights the synergistic use of multiple technologies to not only perform surgeries more effectively but also to manage preoperative and postoperative care comprehensively.

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4. Future Developments in Spine Surgery Technologies

a. Evolution of Endoscopic Spine Surgery

Looking ahead, Dr. Fanous anticipates significant advancements in endoscopic spine surgery through the integration of robotics and stereotactic navigation. These enhancements aim to increase precision and reduce reliance on radiation-heavy imaging techniques.

“I would really love to see more integration of endoscopic spine surgery with things like robotics and robotic assistance or even stereotactic navigation for us that will provide us with greater precision.” [07:28]

b. Advancements in Minimally Invasive Surgery

The next few years are expected to witness smarter robotics and more individualized surgical approaches. Dr. Fanous foresees a shift towards outpatient settings for more complex spine surgeries, driven by advancements in imaging, augmented reality, and biologics.

“Ultimately we'll see that those changes will improve patient outcomes, decrease recovery times, decrease the risk of complications, making spine surgery less invasive, more accessible, and highly efficient.” [15:32]

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5. Addressing Challenges and Solutions

a. Reimbursement Issues for Motion Preservation Techniques

Despite the clinical benefits, reimbursement for motion preservation remains inadequate. Dr. Fanous emphasizes prioritizing patient welfare and actively advocating with payers to secure necessary support.

“We end up doing what is right for the patient and we continue to advocate for our patients.” [08:21]

b. Impact of Federal Healthcare Policy Changes

Dr. Fanous discusses the dual impact of the GOP spending bill and the CMS 2026 physician fee schedule on spine surgery. The Medicaid cuts under the GOP bill may reduce surgery referrals from underserved areas, while the CMS fee schedule presents both challenges and opportunities through efficiency cuts and new ambulatory specialty models.

“The market winners will be the ones who are offering measurable value.” [14:04]

He underscores the necessity for spine surgeons to adopt value-driven approaches and engage with data-driven outcome tracking to thrive in this evolving policy landscape.

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6. The Role of AI and Data in Enhancing Surgical Outcomes

AI is pivotal in refining surgical approaches and predicting patient-specific outcomes. Dr. Fanous highlights how AI-enabled tools can analyze extensive surgical data to recommend optimal strategies, thereby enhancing precision and reducing complications.

“AI enhanced CIRCLE assistance is going to play a larger role in predicting the most effective surgical approaches and the tools for each patient.” [14:18]

This alignment with CMS’s focus on data-driven healthcare underscores the strategic importance of integrating AI into spine surgery practices.

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7. Future of Minimally Invasive Spine Surgery

Looking forward, Dr. Fanous envisions a landscape where minimally invasive techniques are augmented by smarter robotics and enhanced imaging technologies, facilitating more individualized and outpatient-based spine surgeries. These advancements promise to make spine surgery more precise, accessible, and efficient, ultimately leading to better patient outcomes.

“Spine surgery will be more individualized down the road and it's going to target the patient's exact anatomy and pathology, which will result hopefully in faster recovery for the patients.” [15:32]

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Conclusion

The conversation with Dr. Andrew Fanous offers a profound glimpse into the future of spine surgery, highlighting the interplay between technological innovation, clinical practice, and healthcare policy. As spine surgery continues to evolve, the integration of advanced technologies and data-driven approaches will be pivotal in enhancing patient care and navigating the complexities of the healthcare landscape.

“It’s been a pleasure to speak with you, and I look forward to connecting with you down the line.” [17:07]

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This detailed summary encapsulates the key discussions and insights shared by Dr. Fanous, providing valuable information for healthcare professionals and enthusiasts interested in the advancements and future directions of spine surgery.

Transcript

[A]

This is Carly Beam with the Becker Spine and Orthopedics podcast. I'm thrilled to be joined today by Dr. Andrew Fanu at Inova. Andrew, thank you so much for being here today. Before we dive into questions, can you introduce yourself and tell us a bit more about your background?

[B]

Sure. My name is Andrew Fanous. I am a neurosurgeon at Inova Health System in Northern Virginia. I am based in Alexander, Virginia. I am board certified neurosurgeon and I'm also fellowship trained in complex and minimally invasive spine surgery.

[A]

Thank you, Dr. Fanous. And first question, can you tell me what are some of the most exciting technologies that you're seeing in spine surgery today and how are you incorporating them into your practice?

[B]

Yeah, I mean, we are very lucky that spine surgery tends to be a very high tech subspecialty of neurosurgery and orthopedic surgery. I would say that the most exciting technologies today that are really shaping, shaping how we as surgeons are planning and executing and monitoring our surgeries are spun robotics, augmented reality and mixed reality, AI driven surgical planning and imaging tools. There are also 3D printed and patient specific implants, motion preservation devices, and of course endoscopic spine surgery. I would say these are the top technologies that are currently very exciting for us as spine surgeons.

[A]

Great. And I'd love to hear how you're incorporating any or all of these technologies into your work.

[B]

Yeah, I mean, there are a lot of different ways that we have been incorporating those technologies. So if you take them sort of one by one and you take a look at spine robotics, for example, as we all know, they're increasing accuracy of instrumentation, they are reducing exposure to radiation, they shorten operative times. So we are really employing them currently mainly for instrumentation in larger spine cases. Of course, you know, future trends, you know, beyond navigation and instrumentation and so on, I think that spine robotics are going to become more autonomous and they will offer sort of multi level trajectory planning and hopefully eventually they will also be able to help us when we're performing the compressions and spine surgery. When it comes to augmented reality, for example, and mixed reality, currently we are incorporating them in our practice by using them for visualization of patient anatomy directly into our field of view as surgeons. We're hoping, and I've actually been to some meetings lately where I've seen kind of more evolution of augmented reality and mixed reality systems where they are integrating multi functionality kind of abilities and capabilities. Only one platform. And using those multifunctionality platforms, you can have the surgeon use the AR and Mr. Technologies not just to perform surgery, but also to visualize preoperative imaging, looking at office notes, recording videos, taking interoperable pictures and so on. So you can actually employ those powerful tools for not just to perform surgery, but to do more than just the surgery. When it comes to AI driven surgical planning and imaging, of course, it's very important because currently it uses predictive analytics and optimizing alignments and implant sizes, surgical trajectories, and therefore it enhances personalization of surgeries, which is something that is very desirable nowadays. But moving forward, we're also hoping that we can employ AI for risk stratification and patient selection. By doing this, we can actually avoid post operative complications. In my practice, I've also been employing 3D printed and patient specific implants. They're extremely important because these are custom implants, usually inter bodies and interbody cages that are matching the patient's anatomy. And by doing this, they actually improve osteo integration and by extension, fusion. And when you improve fusion rates, then reduce failures and revision risks. Of course, there are some challenges currently with those kind of technologies. For example, you know, turnover is currently a challenge. It takes about a couple of weeks. So if you have a patient coming through the emergency department that needs a surgery right away, you cannot really use patient specific implants at this time. But we're hoping that in the future we can have a rapid point of care printing, especially for trauma and deformity patients. Motion preservation is another very interesting and very exciting technology that we have been employing in our practice as well. So these are, you know, technologies that decrease the risk of adjacent level disease and, you know, additional segment disease by preserving motion rather than fusion, which is what we, you know, what most spine surgeons currently do. And of course, by, you know, preventing fusion and preventing adjacent segment disease, you're also by extension, reducing reoperation rates down the road. Limitations currently for this technology is that reimbursement is still very much lagging. So we're seeing less adoption of both cervical and lumbar spine motion preservation techniques in the US and less so in the US than in places like Europe, for example, where there's better reimbursement. And finally, I would say that endoscopic spine surgery is something that me personally, I'm very excited about. It allows for minimally invasive procedures, it reduces recovery time, it minimizes muscle damage, and it lowers the risk of complications. Of course, the usage of endoscopic spine surgery, especially in the US has still been limited, mainly because there are very steep learning curve for surgeons and also because it offers, you know, to a certain degree, limited access to some areas of the spine. So it's not really suitable for all kind of conditions. But I do believe that there is a, you know, big room for improvement when it comes to endoscopic spine surgery. I think there is, there will be more adoption in the United States and I'm hoping that in the next few years or so we'll see more adoption to the point where we're using it to the same degree that is being used in places like East Asia, for example, where it's mainstream for spine surgery.

[A]

Thank you. And I appreciate your breakdown of all these different areas of spine technologies. I was wondering specifically with endoscopic spine surgery, what kind of evolutions do you hope to see in the next two or three years?

[B]

I would really love to see more integration of endoscopic spine surgery with things like robotics and robotic assistance or even stereotactic navigation for us that will provide us with greater precision. When we currently use endoscopic spine surgery, we are forced to use fluoroscopy, which is very cumbersome and of course it's very high risk of radiation. But if we can somehow develop in the next couple of years some integration between endoscopy and navigation and between endoscopy and robotics, I think that would be a huge thing.

[A]

Got it. And you mentioned earlier about motion preservation and challenges with the reimbursement. Can you dive more into how you're addressing those and how your, what your strategy is for trying to get those payers to work with you?

[B]

Yeah, I mean, honestly, what we do is we end up doing what's right for the patient. So especially for younger patients that we know fusion down the road is going to be detrimental for them. Regardless of what the reimbursement is, we still push hard for motion preservation techniques like this, replacements, and it is challenging and we end up doing a lot of, you know, peer to peer meetings with the payers. But, you know, we end up doing what is right for the, for the patient and we continue to advocate for our patients.

[A]

Thank you. Thank you. And, and then when it comes to your work in augmented reality, and can you discuss just kind of by the numbers, how much, if there are any cost savings, time efficiency savings, could dive into that more. That'd be great.

[B]

Yeah, there's definitely cost savings associated with augmented reality systems because it is very helpful in performing minimally invasive surgery. So as opposed to big open surgeries that will require a lot of intraoperative resources. And of course Hospital resources. Post operatively, you can perform smaller surgeries with smaller incisions using augmented reality and mixed reality systems. So the recovery will be shorter, the resources interoperability will be less, the patient will be discharged faster from the hospital. So of course in general that does translate into improved outcomes, but also better uses of resources.

[A]

Thank you. And obviously been several developments in federal health care policy from the GOP spending bill to CMS and their proposed 2026 physician fee schedule. I was wondering how you anticipate these changes or affect the growth of the spine technologies that we've been talking about.

[B]

Yeah, that's a great question. And it's really what is on everyone's mind right now. If you take them kind of one by one. If you, if we take first, the GOP is the one big beautiful bill, which is really a spending bill With Medicaid cuts. You see that there will be tighter Medicaid budgets and stricter eligibility for surgeries. So it will slash Medicaid provider taxes, it will tighten eligibility and it's going to add work requirements. And this could reduce volume of spine surgery referrals from Medicaid, especially when it comes to rural areas and low income areas. In addition, I would say that rural and community hospitals may face operational strains. Even though there will be increased funding for rural hospitals, this may not offset the overall cuts. And as a result, you know, spine tech vendors may see kind of lower uptake in these areas of, you know, rural areas and community hospital areas. And they may need to shift their focus to better funded hospital systems on sometimes even to private pay markets. When it comes to the CMS and the 2026 physician fee schedule that is proposed, it's also a mixed bag because there will be higher base conversion factors. CMS is proposing about a 3.7% boost to physician payments for 2026. However, when it comes to procedure based specialties like spine sur, there will be about a 2.5% cut. They're calling it the efficiency cut. And that adjustment is probably going to end up kind of offsetting the proposed boost in physician payments. The CMS 2026 physician fee schedule also proposing, you know, mandatory ambulatory specialty models or ASMs. It's a new model and it's mainly targeting spine and heart failure management and it rewards usage of digital tools, care coordination and outcome tracking. So, you know, as a result, the spine surgeons, their effective reimbursement may stagnate or may even decline. And that's going to make investments in high cost technologies less financially appealing. But on the other hand, there will be new opportunities created by the ambulatory specialty model through remote monitoring, telehealth, patient engagement platforms and so on. I think the takeaways for the spine sector is that there will be a shift to value driven propositions. Surgeons will need to engage early into alternative payment models and there will be a focus on data, data and sort of evidence based medicine. The CMS will increasingly reward data driven outcome tracking. So the surgeons will need to be very careful about that. And I think the market winners will be the ones who are offering measurable value. And you know, since CMS is going to focus on value based shift and.

[A]

I imagine that while some of the AI tools, AR tools and some of the technologies that we've been discussing will hopefully help and help surgeons get that data that they need to show their value.

[B]

Absolutely, that's a great point. So really, AI enhanced CIRCLE assistance is going to play a larger role in predicting the most effective surgical approaches and the tools for each patient. And of course, when you employ AI to analyze thousands of databases from previous surgeries, AI can also recommend optimal approaches for achieving the best possible outcome. And it can also perform predictive analytics down the road. So you can use softwares to predict complications, healing times, you know, patient specific risks based on the unique anatomy and pathology and history of the patient. That will ensure that the surgeons are, you know, being more informed before making decisions. And that will result in more individualized treatment plans. And this would further reduce complications and improve surgical precision down the road, which is really what CMS is looking for ultimately.

[A]

Yeah. And then, and then Dr. Fanou, can you talk about minimally invasive surgery? How will that evolve the next two to three years? I know we discussed a little bit about endoscopic spine, but how about other minimally invasive techniques?

[B]

Yeah, I think there is a lot of exciting developments that will happen in the next two to three years. When it comes to minimally invisible spine surgery. I think we will see smarter robotics and the surgeons will rely more on robotics for both routine and complex cases. And that will reduce human error and will increase consistency. I think there will be more patient centered approaches with advancement in imaging and augmented reality, biologics and so on. Spine surgery will be more individualized down the road and it's going to target the patient's exact anatomy and pathology, which will result hopefully in faster recovery for the patients. There will be enhanced precision as well, using AI and augmented reality to push the boundaries of precision and personalization in spine surgery. And probably one of the most exciting parts of minimally invasive spine surgery in the next couple of years is going to be the shift towards outpatient surgery. So as we're employing more and more less invasive techniques, we'll see even more complex spine surgeries being performed in outpatient settings. And if you combine all of those exciting areas together, ultimately we'll see that those changes will improve patient outcomes, decrease recovery times, decrease the risk of complications, making spine surgery less invasive, more accessible, and highly efficient.

[A]

Absolutely. Well, Dr. Fanuz, thank you so much for joining us today. It's been a pleasure to speak with you, and I look forward to connecting with you down the line.

[B]

My pleasure.