Podcast Summary

Episode Overview

Podcast: Becker’s Healthcare Podcast
Guest: Dr. Scott L. Blumenthal, Spine Surgeon, Texas Back Institute
Host: Carly Beam
Date: November 28, 2025

Theme:
This episode features Dr. Scott Blumenthal, a pioneering spine surgeon specializing in disc replacement at the Texas Back Institute. The discussion centers on advancements in disc replacement, ongoing research, expansion of treatment indications, patient access challenges due to insurance, and the technological future of spine surgery, including the role of AI.

Key Discussion Points & Insights

1. Background and Legacy in Disc Replacement

• Dr. Blumenthal introduced himself as an orthopedic spine surgeon and co-founder of the Texas Back Institute’s Center for Disc Replacement, which spearheaded the development of disc replacement in the U.S. over 25 years ago.

  “We pioneered [disc replacement] in the US now over 25 years ago.” — Dr. Blumenthal [00:23]

2. Growth Opportunities for Disc Replacement (2026 and Beyond)

• Continued Expansion: Indications for motion preservation procedures like disc replacement are expected to broaden, largely due to patient demand for alternatives to spinal fusion.
• Patient Driven: There is increased patient awareness and preference for motion-preserving surgeries based on stories of negative outcomes with fusions.

  “Patients seem to try to look for an alternative to fusion...they are always asking for an alternative.” — Dr. Blumenthal [01:10]

3. Recent Research and Revision Rates

• Comparative Longevity: Texas Back Institute’s research shows revision rates for lumbar and cervical disc replacements are approximately 1.5%; this is favorably lower compared to 5-10% for hip/knee replacements at 10–20 years.
• Revision Strategies: Many revision surgeries can maintain motion (disc-to-disc), not necessarily reverting to fusion—a significant advance for patients.

  “We found we were able to do [revision disc to disc] in about a fourth to a third of those patients that did require revision.” — Dr. Blumenthal [02:38]

4. Causes of Complications in Disc Replacement

• Osteolysis: The most common issue, similar to joint replacements—wear particles cause cyst formation around the prosthesis.
• Technical/Learning Curves: Incomplete decompression of neural elements can require further revision, highlighting the importance of meticulous surgical technique.

  “The two most common reasons we see is a condition called osteolysis...second most common reason really is...failure to address all the pathology.” — Dr. Blumenthal [03:11–03:59]

5. Expanding Indications for Disc Replacement

• Older Patients Included: Initially reserved for the young, cervical disc replacement is increasingly suitable for older patients, including those with more arthritis or loss of cervical curvature, thanks to decades of expanded experience.
• Quality of Life Benefits: Large functional improvements for a wider patient group.

  “We have found that we can increase the age for patients to get disc replacements...helped a lot of our older patients into their 60s and 70s..." — Dr. Blumenthal [04:50]

6. Broader Trends in Spine Orthopedics and Practice Management

• Patient Access vs. Technology: Dr. Blumenthal pivots from the buzz around robotics and image guidance to the very real challenge of insurance barriers.
• Insurance 'Peer-to-Peer' Frustrations: He highlights frustrations with insurance-mandated reviews, which often do not meaningfully address patient care and rely on rigid protocols.

  "They're not trying to figure out the best strategy for helping a patient…they're there just to regurgitate these very restrictive policies." — Dr. Blumenthal [07:01]

• Systemic Issues: Administrative costs account for a large proportion of healthcare spending, detracting from care provider resources.
• Dehumanizing Language: The use of “provider” instead of “physician” is perceived as diminishing the doctor-patient relationship.

  “Even using the word provider, which is a very derogatory term to a physician, it just dehumanizes what we were trained to do..." — Dr. Blumenthal [09:19]

7. Barriers to Technology Adoption and Disruptors in 2026

• Insurance Restrictions as Key Disruptor: Rather than technology advances, Dr. Blumenthal sees access restrictions as the main headwind for adoption of advanced techniques in spine surgery.

  “I think it's going to be more restrictions to advanced technologies...if they don't fit the protocols, they're going to restrict patient access to it.” — Dr. Blumenthal [09:51]

• In-/Out-of-Network Dilemmas: Many practices exit insurance networks due to these barriers, but Texas Back Institute strives to stay in-network, though this presents its own challenges for affordability and access.

8. Current and Future Healthcare Trends

• Radiation-Free Navigation: Emerging focus on robotics and navigation for instrument placement in spine surgery.

• AI Concerns and Promise: AI, though frequently touted, may restrict rather than broaden access in the short term.

  “AI is going to work more against us than for us, at least in the short term. Because of access.” — Dr. Blumenthal [11:21]

• Promising AI Application: AI’s most immediate use is in clinical documentation—acting as a third-person scribe during patient intake/histories.

  “You basically can just have a conversation...and the AI generates the medical record. I think that's really, really cool.” — Dr. Blumenthal [11:58]

• Decision Support Potential: Long-term, AI may aid surgical planning and treatment selection (e.g., identifying candidates for motion preservation vs. fusion), but this is not yet routine.

Notable Quotes & Memorable Moments

• “Preserving motion is kind of where it's at. And motion equals function.” — Dr. Blumenthal [05:39]
• “On a micro level, you know, they're trying to outsmart us and we're trying to outsmart them. On a macro level, it just, it needs to go back to...not getting in the middle of the doctor patient relationship." — Dr. Blumenthal [09:05]
• “Administrative...costs are middle management, C suite type things and really don't go to the people that are either delivering the care or receiving the care. And that's just got to change.” — Dr. Blumenthal [08:44]

Important Timestamps

• 00:21–00:45 Introduction and Dr. Blumenthal’s background
• 01:02–01:32 Current and future opportunities in disc replacement
• 01:41–02:54 Revision rates and research insights
• 03:11–04:25 Causes of complications in disc replacement
• 04:42–05:28 Expanding indications, especially for older patients
• 05:58–08:00 Insurance and patient access to emerging technology
• 09:05–09:37 Navigating administrative barriers and physician frustration
• 09:51–10:52 Insurance restrictions as a key disruptor
• 11:02–12:49 Advances in robotics, navigation, and AI’s role in spine surgery

Conclusion

Dr. Scott Blumenthal delivered an engaging, candid discussion on the progress and challenges in disc replacement surgery. He underlines the growing scope for these motion-preserving procedures, the clinical and insurance-based barriers to delivering cutting-edge care, and the mixed promise of technological advances like AI. Ultimately, he advocates for a patient-centered approach—free from excessive administrative obstacles—that allows physicians to bring the latest innovations to more people.