James Mooney, a complex and minimally invasive spine surgeon with VCU Health

Summary

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Becker’s Healthcare Podcast – December 6, 2025

Guest: Dr. James Mooney, Complex & Minimally Invasive Spine Surgeon, VCU Health
Host: Carly Beem

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Episode Overview

This episode features Dr. James Mooney, newly appointed spine surgeon at Virginia Commonwealth University (VCU). Dr. Mooney shares his insights into current spine surgery trends, the integration of artificial intelligence (AI) in clinical and operative workflows, the industry shift from RVU-based compensation to value-based care, and his vision for expanding the VCU spine program. The conversation covers technological advances, clinical decision-making, practice transformation, and future disruptors in spine surgery.

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Key Discussion Points & Insights

1. Introducing Dr. James Mooney

• Dr. Mooney describes his background:
  • Residency at University of Alabama (7 years, neurosurgery)
  • Fellowship in complex & minimally invasive spine at University of Pittsburgh
  • New faculty at VCU with focus on program growth
  • [00:33]

    "I'm a complex and minimally invasive spine surgeon here at Virginia Commonwealth University in Richmond, Virginia… excited to be in Richmond and growing the program here." – Dr. Mooney

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2. Top Trends in Spine Surgery

a. Artificial Intelligence (AI) in Surgery

• AI is revolutionizing surgical planning, execution, and decision-making.
• Potential applications:
  • Radiographic planning
  • Algorithmic selection of surgical candidates
  • Real-time intraoperative monitoring and adjustment
  • Standardization of clinical decisions through evidence-based algorithms
  • Ongoing need for safety monitoring of AI systems
• [01:15]

  "Ultimately I think we're heading towards a future where every surgery is ultimately planned and executed according to evidence-based algorithms." – Dr. Mooney

b. Shift from RVU Metrics to Value-Based Care (VBC)

• Moving away from volume-based compensation towards outcomes and patient-centered metrics.
• Importance of registries and health system analytics in tracking and rewarding outcomes.
• [02:58]

  "How do we shift things to more of a patient centered outcome? And ultimately registries and health system analytics will help us progress towards that point…" – Dr. Mooney

c. Minimally Invasive Techniques & Patient-Specific Technologies

• Growth of ultra-MIS (minimally invasive surgery) and endoscopic methods, inspired by long-standing practice in Asia.
• Emphasis on tailoring the surgical approach to each patient.
• Anticipates adoption of 3D-printed implants and patient-specific technologies at VCU.
• [03:47]

  "It's important for a center that provides spine care to be able to offer the full gamut of care ranging from the most minimally invasive approach with an endoscopic surgery to a big deformity correction." – Dr. Mooney

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3. Realities and Challenges of Implementing Value-Based Care

• Acknowledges the difficulty of replacing entrenched compensation models.
• Calls for broader industry advocacy and frontline surgeon participation.
• [05:59]

  "I don't have the specific solution, but I think it's going to take a lot of, you know, lobbying from our organizations and participation from spine surgeons that are at the front line to really make this a reality." – Dr. Mooney

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4. Current Practical Applications of AI at VCU

• Clinical Documentation: AI tools within EPIC streamline clinic note generation.
• Surgical Planning: Incorporation of patient-specific rods and planning software, enabling preoperative to postoperative comparison and outcomes tracking.
• Data Collection: Large-scale data acquisition and analytics are being facilitated through these new technologies.
• [06:57]

  "We've just incorporated patient specific rods and software into our surgical planning… And there's a massive amount of data that can be acquired over time using those paradigms." – Dr. Mooney

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5. Importance of Dual Training: Minimally Invasive and Complex Spine Surgery

• Training in both fields allows nuanced decision-making, ensuring the "least invasive surgery that we can offer to achieve the goals of surgery."
• Cites patient examples where imaging suggests extensive surgery but symptoms support a simpler, less invasive option.
• Deformity training improves planning for even small procedures, reducing future complications.
• [09:19]

  "My goal is to offer the patient the least invasive surgery that we can offer to achieve the goals of surgery. And so a lot of times in these cases… minimally invasive decompression could give them years of relief before they need a big surgery." – Dr. Mooney

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6. Anticipated Disruptors in Spine Surgery for 2026

• Sees AI as a continuously growing influence.
• Predicts that true change will come from convergence of innovations: AI, data, minimally invasive techniques, and interdisciplinary collaboration.
• [10:53]

  "I don't think it's going to be one specific thing, but really a combination of all of these things we're talking about." – Dr. Mooney

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7. Plans for Growth at VCU Spine Center

a. Clinical Expansion

• Increasing access to comprehensive spine care in the Richmond area and satellite locations like Fredericksburg and Williamsburg.
• Actively working with local athletic programs for sports medicine growth.

b. Technology Implementation

• Integration of minimally invasive surgery systems.
• Adoption of patient-specific hardware, AI planning, and robotics.
• Building collaborations with other specialties.

c. Academic and Research Growth

• Expanding research in predictive analytics and outcomes.
• Partnership with engineering for 3D printing.
• Joining the American Spine Registry for longitudinal data.

d. Educational Initiatives

• Advanced training and technology exposure for residents.
• Aspiration to establish a fellowship.
• [11:38], [13:08]

  "Our goals as a spine department are to increase access to care… And then all of the AI planning, robotics and enabling technologies that are really going to help transform things at VCU." – Dr. Mooney
  "We're trying to really grow our research footprint, looking into predictive analytics, outcomes data… and ultimately potentially get a fellowship down the road." – Dr. Mooney

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Notable Quotes & Memorable Moments

• "Right now, if you ask five different spine surgeons how to approach a case, you might get five different answers. How do we utilize AI to help standardize decision making for spine surgeons and help choose the best option for each unique patient?" – Dr. Mooney [01:58]
• "It's easy to talk about, but actually instituting it is a lot bigger of a challenge." – Dr. Mooney on value-based care [05:29]
• "Then anytime you operate on a patient, if you fuse a segment of the spine, you're subjecting the rest of the spine to more motion and potential breakdown and need for future surgery." – Dr. Mooney [09:59]
• "There’s not going to be one single factor, but a combination of all these things that are intersecting at such an exciting time." – Dr. Mooney [10:53]

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Key Timestamps

• 00:33 – Dr. Mooney’s background and training
• 01:15 – 04:48 – Trends in spine surgery: AI, value-based care, minimally invasive techniques
• 05:29 – 06:23 – Challenges of transitioning to value-based care
• 06:39 – 08:09 – Real-world AI applications at VCU Health
• 08:16 – 10:33 – Importance of dual training in complex and minimally invasive spine surgery
• 10:43 – 11:38 – Predicting the next disruptor in spine surgery and plans for VCU growth
• 11:38 – 14:17 – Detailed outline for clinical, research, and educational expansion at VCU

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Conclusion

Dr. James Mooney provides an insider’s look at the future of spine surgery, emphasizing a thoughtful, patient-centered approach that blends cutting-edge technology with personalized care. He underscores the importance of collaboration, innovation, and adaptability—qualities he aims to embed within VCU’s evolving spine program. This episode offers a concise yet comprehensive overview of where academic spine surgery is headed and what it takes to be at its forefront.

Transcript

[A]

This is Carly Beem with the Becker Spine and Orthopaedics podcast. And today I'm thrilled to be joined by Dr. James Mooney, a spine surgeon at Virginia Commonwealth University. Dr. Mooney, thank you so much for being here today.

[B]

Thanks for having me, Carly. I've listened to Becker's in the past, and I think you guys do a great job covering the healthcare system, so really appreciate the opportunity.

[A]

Absolutely. And thank you for your kind words as well. Before we dive into our questions, can you just introduce yourself and share more about your background?

[B]

Yeah. My name is James Mooney. I'm a complex and minimally invasive spine surgeon here at Virginia Commonwealth University in Richmond, Virginia. I'm a new faculty. I did my training down in Birmingham, Alabama at the University of Alabama for seven years in neurosurgery residency. And then I was up in Pittsburgh, Pennsylvania for a complex and minimally invasive spine deformity fellowship. So excited to be in Richmond and growing the program here.

[A]

Yeah. And it sounds like, you know, you have a lot of expertise and just the full gamut of spine surgery. Can you talk about some of the biggest spine trends that you're following in healthcare?

[B]

Yeah, of course. So I think, you know, with any field, artificial intelligence is at the forefront of everyone's minds. And so from my standpoint as a complex spine surgeon, you know, I think about what are the areas that AI is going to assist us with in the or. And so I think there's a number of categories as far as planning for these bigger spine deformity surgeries. So, you know, that ranges from radiographic planning to the execution of complex spine surgeries. You know, ultimately I think we're heading towards a future where every surgery is ultimately planned and executed according to evidence based algorithms. And that's, you know, multifactorial, where AI can, number one, you know, help us choose who to operate on, number two, help us construct our surgical plans, and then lastly, help us execute the plan in the OR and monitor our progress towards our preoperative goals intraoperatively. And then I think really the next frontier for artificial intelligence and healthcare as a whole and, you know, specific to spine surgery is incorporating these AI paradigms into our clinical decision making. Right now, if you ask five different spine surgeons how to approach a case, you might get five different answers. How do we utilize AI to help standardize decision making for spine surgeons and help choose the best option for each unique patient? I also think it's important to monitor the safety of these algorithms. So having resources that are devoted to making sure these technologies are used safely. So I think that's the number one area I'm following. I think number two is the shift sort of from RVU based metrics towards value based care. And specifically for spine surgery, I think it's important to make sure the right surgeries are being done for the right patients. And shifting from a RVU incentive based setup where surgeons are compensated based on volume of surgery, how do we shift things to more of a patient centered outcome? And ultimately registries and health system analytics will help us progress towards that point where we're determining which patients are benefiting from which surgery and rewarding surgeons for their outcomes. And then lastly, I think an area that's been of particular interest to me is.

The expansion of minimally invasive as well as patient specific technologies and precision medicine. And for spine surgery in particular, the growth of ultra MIS surgery and endoscopic spine surgery I think is really interesting. It's one of those revolutions. They've been doing it in Asia for long periods of time, but in the US it's relatively new. But I think it's something that's here to stay. And it's important for a center that provides spine care to be able to, to offer the full gamut of care ranging from the most minimally invasive approach with an endoscopic surgery to a big deformity correction. And I think tailoring that surgery to the specific patient is incredibly important and we can't lose sight of that. And then the Last thing is 3D printed implants and patient specific technologies I also think are the future as well. I haven't incorporated them yet, but that's something we're hoping to, to bring on as we grow at vcu.

[A]

Yeah, those all really fascinating, exciting areas of just kind of what's ahead for future spine, especially all the ways that AI sounds like it's really making. It's helping to bring patient care in a more streamlined and effective way. And one thing I want to circle back to one things you said about this shift from RVU to vbc. I'd love to hear your insights on what, what you think is going to be needed from surgeons, from hospitals, practice leaders, et cetera, for this shift to really be effective and to take off.

[B]

Yeah, I mean, I think it's easy to talk about, but actually instituting it is a lot bigger of a challenge. And so I'm right at the beginning of my career and these are just things I've been following early on, but I think it's going to take a massive overhaul really of the way things are set up currently, just given that we've been following the specific, you know, metrics and ways of compensating surgeons for years. So.

I don't have the specific solution, but I think it's going to take a lot of, you know, lobbying from our organizations and participation from spine surgeons that are at the front line to really make this a reality. You know, people talk about it a lot, but, you know, putting that into action is a lot more difficult. And hopefully, you know, I can help be a part of that moving forward as well.

[A]

Got it. And, you know, I'd love to, you know, hear more about just kind of your own how you're using AI in both your complex and minimally invasive spying care, whether it's in the or outside. What are you using it the most for?

[B]

Yeah, you know, I think all aspects of care can be utilized. Again, I think safety is key, particularly for evaluating and working up a patient for documentation. You know, EPIC has specific AI.

Workflows that can be used to generate clinic notes, and that's been incredibly helpful with streamlining clinic appointments and then moving into the or. We've just incorporated patient specific rods and software into our surgical planning. And that software actually will take a patient's preoperative scan, you know, plan your surgery out in conjunction with engineers and allow you to generate a rod that at least radiographically would generate a good outcome for the patient. The software, it also will track patient outcomes over time as well, as did your actual surgical outcome radiographically match what was planned preoperatively? And there's a massive amount of data that can be acquired over time using those paradigms. So for intraoperative planning or preoperative planning, it's been very helpful. I think the next forefront is really incorporating it into the intraoperative. You know, are we achieving the correction that we planned preoperatively as well as helping us to standardize decision making? And again, those things are a little further, further off, but, you know, not too far off.

[A]

Yeah, thank you for breaking that down. And I want to ask you, I know you have, you have a unique perspective.

Training both complex spine surgery and minimally invasive. And obviously we're seeing more technologies and trends towards minimally invasive surgery. But why is it important for minimally invasive spine surgeons to understand the complex end and vice versa?

[B]

Yeah, that's a terrific question. And so I think my, the one of the reasons I did a fellowship was to really understand which patients to operate on in terms of who is, who's right for a particular procedure. And, you know, in my mind, starting out as a surgeon, my goal is to offer the patient the least invasive surgery that we can offer to achieve the goals of surgery. And so a lot of times in these cases, you know, I'm being sent patients that have big scoliotic deformities or, or, you know, issues that radiographically you would want to, if you didn't know, hear about the patient's symptoms, you. You could offer a large surgery. But when you actually talk to the patient and figure out that this might be a single nerve that's affected, that minimally invasive decompression could give them years of relief before they need a big surgery. And having that minimally invasive training has been very helpful in working these patients up and being able to offer them that the least invasive approach. Then anytime you operate on a patient, if you fuse a segment of the spine, you're subjecting the rest of the spine to more motion and potential breakdown and need for future surgery. Really, my deformity training has helped me understand angles and preoperative planning. Even for a small single level surgery, it's really important to get that correction. Even if you're doing, you know, a single level 5, 1 or 4, 5 fusion in the grand scheme of things, if you get that wrong, you're setting the patient up for many future surgeries. So I think that's where my minimally invasive training, uab, has combined with, you know, the deformity training to really help me be able to offer a full gamut of spine procedures to patients.

[A]

Definitely. And I was wondering, what do you think will be the one true disruptor to spine surgery next year?

[B]

Yeah, within the next year, I think AI is going to continue.

Improving outcomes. And.

You know, I. It's yet to be seen the full extent of where ultra minimally invasive surgery is going to head. I'm actively following that as well, but I think it's going to be, you know, not one single factor, but a combination of all of these things that are intersecting at such an exciting time where you have, you know, new technologies, data collaboration between surgeons, engineers, scientists, and. Yeah, I don't think it's going to be one specific thing, but really a combination of all of these things we're talking about.

[A]

And then just my last question for you, Dr. Mooney, how are you thinking about growth headed into 2026?

[B]

Yeah, for sure. You know, it's a really exciting time for me being a new faculty at vcu. There's really three categories that I think of in terms of growth over the next two years. And that's from a clinical standpoint, from an academic standpoint, and then from an educational standpoint. And so, you know, clinically, our goals as a spine department are to increase access to care. You know, historically, UVA and Duke have been the major centers in the area. And our goal is to really offer patients in the Richmond area access to total spine care, including, you know, complex as well as MIS spine surgery. And to achieve that, we're, you know, expanding our reach to different areas. In Fredericksburg, Virginia, I've been going to Williamsburg, where William and Mary is, to, you know, work with athletes there and increase our sports medicine exposure. And we've been getting referrals and expanding our reach in those areas, which has been great.

Second is to increase, you know, capabilities in the or. And so we've brought in MIS systems over the past few months to help achieve those goals. I mentioned the UNID patient specific rods which we've been incorporating into surgery as well. And then all of the AI planning, robotics and enabling technologies that are really going to help transform things at vcu.

Improving collaborations goes along with that. So with orthopedics, endocrinology, ent, pmnr, pt, Pain medicine, oncology, and really incorporating all those departments to make VCU a spine center of excellence. And then from an academic standpoint, we're trying to really grow our research footprint, looking into predictive analytics, outcomes data. And I've been partnering with the engineering department to help preoperative planning with 3D printing as well for bigger deformity operations. And then we're working to get involved in the American Spine Registry over the next few months where we can, you know, longitudinally collect large amounts of data over time. And then lastly, you know, from educational standpoint, we want to improve education for the residents, improve their exposure to complex techniques and enabling technologies, and ultimately potentially get a fellowship down the road. So those are the main categories I'm really excited about.

[A]

Got it. Well, you know, thank you so much, Dr. Mooney, for joining us today. It's been a pleasure speaking and I look forward to connecting again down the line.

[B]

Of course. Thanks so much for having me. I appreciate it.