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Becker’s Healthcare Podcast
Roger Hartl, MD, Director of Neurosurgery Spine at Weill Cornell Medicine, and Neurosurgical Director of Och Spine at NewYork-Presbyterian/Weill Cornell Medical Center
00:17:55
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- [00:00]
A
This is Carly Beem with the Becker Spine and Orthopedics podcast and I'm thrilled to be joined today by Dr. Roger Hartl with Weill Cornell Medicine. Dr. Harto, thank you so much for being here today.
- [00:11]
B
Carly, thanks so much for having me back on this podcast. I'm very happy and I wish you a happy new Year.
- [00:18]
A
Likewise, likewise. And Dr. Hartle, if you could just introduce yourself and tell us a bit more about your background, just for anyone new who might be listening.
- [00:27]
B
Yeah, I'm happy to do that. I'm a neurosurgeon. I'm a spine neurosurgeon at this point in my career. I run the spine program at Weill Cornell Medicine in New York City and I'm one of the co directors of ARC Spine at Newark Presbyterian Hospital in New York City.
- [00:48]
A
Dr. Haro, can you talk about the top three trends you're following in healthcare and in spine surgery today? Sure.
- [00:57]
B
You know, we have a integrated and very large program now. We, you know, we're at New York Presbyterian Hospital in New York City and what we've done over the last 10 years is really integrate the spine programs at Columbia Cornell under the umbrella of New York Presbyterian Hospital. And in that role, of course, and I do this together with Larry Lanky who's like, and Dean Chow who are my main counterparts at the Columbia campus and, and with Dan Ruh here at Cornell. But obviously working with a large group of healthcare providers, surgical non operative, from really multiple disciplines that are all importantly involved in the care of patients with back issues. You know, there's so many things that come up all the time that are really relevant and sometimes directly related to surgery, sometimes a little bit outside surgery. But what I've seen over the last years become really more and more interesting and I think relevant in our care of patients with back and neck issues is certainly, I would say there are three things. There's artificial intelligence, of course, as in many aspects of life and healthcare, what I see evolve more and more is biologics, disc repair, especially for degenerative disc disease. I'm not talking about fusion biologics, really more biologics in terms of disc repair, disc regeneration and sometimes even disc replacement. And then finally as a, as a surgeon in the operating room who's very excited about minimal invasive spine surgery, I think that whole area of navigation and robotics is really fascinating. So those are the three areas that I follow very closely amongst many others. But those are three areas within spine surgery and medicine, spine medicine that I think are the most exciting Artificial intelligence, biologics, and the whole area of navigation and robotics.
- [02:58]
A
I want to hone in on what you're talking about with biologics. It's still very. There needs to be a lot more research in this area in spine orthopedics. And I'm wondering what kinds of innovations in spine biologics could elaborate more on what's exciting you in that area and what you think will really define this year when it comes to spine biologics.
- [03:24]
B
I think the challenge with spine biologics is partially, obviously, the regulatory pathway that has really challenged our ability to pursue some of the fascinating strategies that come to mind when you're thinking about degenerative disc disease and biologics. I think we've got a lot of data now showing that augmentation of disease discs with various types of stem cells, autologous or allograft stem cells, holds a significant promise. What I'm very excited about is our current work on angular repair, because, you know, one of the biggest untapped needs in spine surgery is that whole problem of recurrent disc crenation in patients who have a discectomy in the cervical or lumbar spine. And then there's not much that we can do, really, to prevent the disc from further degenerating or even re herniating. So the whole area of recurrent disc hernation and the opportunity that I think biologics can potentially give us here to prevent that from really happening over time. You know, I've done a lot of research in my lab. You know, I work with a biomedical engineer up in Ithaca, Larry Bonassa. We've been working together for many years on disc repair, regeneration, replacement. But what we've done now, more recently is really try to bring to the forefront the whole area of annual repair with we use collagen glues, plus minus cells. We just started a small company, a startup company, that will hopefully be able to bring this through the FDA into clinical trials. And that, for me, is really one of the most exciting things, because it seems such a simple problem. You know, how do you prevent recurrent disc herniation? But it's really a totally untapped problem, you know, totally. We don't really have a good solution. And there's so many patients and hundreds of thousands of patients every year who have lumbar disc hernation, who undergo surgery, and they all ask the same question, you know, how can you prevent that disc from re herniating? And we just don't have an answer. To me, this is one of the most basic issues in spine surgery currently. So I'm very excited about that. And I know we've got some mechanical solutions. You know, we've got barricade. There's another small company from Israel, Spinol, that has a little implant that's not FDA approved at this point. But I'm not sure that implants are really the final solution. I think there has to be some kind of biological intervention, either in isolation or together with some type of implant that help us regenerate and repair that annular defect. That's something that I'm very excited about.
- [06:23]
A
I imagine everything with exploring these biologics, it sounds like you probably would need to have a lot of multidisciplinary collaboration and just kind of work with others just, you know, beyond just spine itself.
- [06:37]
B
Yeah, I think that's crucial. And that's. Yeah. And that brings me to another point. If you, if you want to do this type of research, clinical research, you need a, a team of multidisciplinary specialists. And that's, that's exactly why we started OX Spine at, in New York City, which, which is really a combination of operative and non operative providers. We just opened actually a year ago, exactly one year ago, we, we opened Perspiral, our spine center in Hudson Yards where we have 60,000 square feet. And it's the first time that Colombia and Cornell doctors work together in one space. And we've got, you know, 25 surgeons, we've got 30 non operative spine providers, we got physical therapy, radiology. So this type of research, if you want to do this type of research where include patients you need, you need a multidisciplinary team of specialists that all work together. And that's exactly what we have now.
- [07:38]
A
Yeah. Have there been any hurdles, any challenges when it comes to bringing together all these specialties or has it been smooth sailing for the most part?
- [07:48]
B
Yeah, I wish it was smooth sailing. It's not. In our case it really worked because, I mean, as individual physicians, we all want to work together. The problem is then bureaucracy comes into, comes, comes in the way. And the bureaucracy in terms of the logistics, the infrastructure, the financial aspect, in our case at Oxpine, it worked because it was really obviously envisioned by individuals, but then really supported and put into practice by the hospital and by the universities, you know, and I think that's really important. If you want to build something like a multidisciplinary spine center, you need the support of the overarching structure. And in our case that's the hospital and the university and that's the key to success. Fortunately, we've had that and we have that, but obviously then you also need the individual subspecialties, departments and so forth to all be willing to work together.
- [08:50]
A
Yeah, absolutely. And do you have any advice for, you know, hospital leaders who, you know, they see your example and they, and they want to replicate that on their own? What would be the biggest piece of advice you'd have for creating a more integrated spine orthopedic neurosurgery program?
- [09:08]
B
Yeah, no, that's a great question. I, you know, we've, it didn't happen out of, out of the blue. You know, we, we had at, at, on the Cornell side. We've had experience building a spine center since the early 2000s. And it was really initially just a bunch of surgeons and non operative doctors who had an interest in spine. And we started meeting every week and we had a conference, we had a case conference. You know, we found a neuroradiologist with an interest in spine. Then we had two surgeons, myself, somebody else. We had one of the pain management guys, one of the PMNR physiatry doctors, and a physical therapist and a neurologist actually. And we all, you know, we were like similar age group, we all had an interest in spine and we decided to meet up once a week and discuss cases that we had seen in clinic where we had some questions or we wanted input. And that's really how the spine center started in our case here, 20 years ago. 20 plus years ago. And then it slowly evolved and then we decided to see actually patients together. So we moved our clinic schedules around and we found a location where we could actually see patients together within the hospital. Then slowly we tracked volumes, we tracked patient volumes, surgery volumes. We could show that it increased our productivity and that's how the hospital started paying attention. And then slowly you get the hospital on board.
- [10:40]
A
So really just kind of looking at the numbers, it sounds like that's the key to everything.
- [10:44]
B
Yeah. So it takes a long time. It's a slow process, but that's kind of how it worked in our case.
- [10:50]
A
That's great. And I wanted to pivot back to what you're saying about AI as well. Obviously in 2025, AI and healthcare is really exploded. Huge talking point among physicians, leaders. And I'm wondering, how are you using AI in your practice right now? What are you going to do the same, do differently?
- [11:15]
B
Yeah, I mean, I think AI penetrates every aspect of our lives as individuals and as surgeons. And the key is to try to make it, you Know, make it safe, make it effective and to make sure you don't lose really some of the principles of how we take care of patients. Of course, you know, I certainly, I mean our practices, it's helpful for preoperative evaluation of patients, literature reviews, you know, if you're not sure about, you know, what's out there in the literature. AI is a huge advantage in that regard. It can really help you review the literature very quickly make certain decisions in terms of surgical procedures. Obviously you always got to double check. The other thing that I use AI for increasingly in working with some of the companies who are investing, involved in navigation and in intraoperative stereotactic navigation and robotics is the whole area of AI and for example automatic automated segmentation or you know, we work, I work with Brain Lab for example to come up with a workflow to use augmented reality through a microscope or exoscope to facilitate the workflow for mis tela surgery. Right. Mr. Surgery is a great operation because there are certain landmarks that you use with every operation. And using AI and using intraoperative or preoperative imaging, you can automatically have the software identify these landmarks and then indicate or highlight these landmarks while you're doing the operation. And those landmarks become relevant at different portion, different parts of the surgery. So you can literally then the AI have you guide through an operation from A to Z depending on the landmarks when they become relevant. That's one of those things that I'm working on that I'm very excited about. That goes way beyond just putting screws into the spine. This is really just facilitating the workflow. And TLIF is a great example. But any spine operation could really be benefiting from this type of automatic segmentation and integration through microscope or the exoscope or even the endoscope and then project this information into the visual field of the surgeon. So that's, that's AI in the operating room and then, and then there's obviously AI that you can use for post operative assessment, write manuscripts, I mean help you in an intelligent way improve the quality of your manuscript. And I mean there's so many and then scribes, right. We discuss it currently at AUX spine, you know, is there a need for AI scribes, for example? You know, and that's something that we're discussing. I know a lot of institutions have that implemented already. I think they're pros and cons, but sooner or later it's going to be, it's going to be common practice, I'm sure.
- [14:19]
A
Well, yeah, let's break down those Pros and cons. You mentioned there. What, what do you think could be done, you know, to improve, to improve the pros and, you know, smooth out the cons?
- [14:31]
B
Yeah. So, you know, the cons are obviously you want to make sure that whatever, whatever you do is, is accurate, safe, ethical. Right. So I think those are, those are in general with AI, so you gotta, you gotta be very, very careful. A good example is writing a manuscript, right? People discuss the pros and cons, what's ethical, what's not ethical. Right. I think there are ways of using AI to create an outline for a scientific manuscript, for example, to review the literature, to critically review the quality of your own writing and improve that potentially. But I think you always got to make sure that you check and double check and triple check. You know, that's, that's the most important part. But I think that we're going to get better at this and eventually I think it's going to be more and more common practice.
- [15:27]
A
Definitely. And then, Dr. Hartle, the last question I had for you right now is what's something that all spine surgeons, whether they're working the health system independently, what should all spine surgeons be doing to thrive this year?
- [15:43]
B
To thrive this year is, I think that, you know, personally, in my own practice and to, I think, for spine surgeons is general. In general, what I find the most important part this year, but probably also last year and next year, is really communicate with patients. Right. I think at the end of the day, what we provide as a service is try to help patients get through a very, very difficult time in their lives, sometimes with neurological deficit, but frequently with pain. And that's a very, very unique problem. There are very few specialties in medicine that really have to deal with the complexity of symptoms that we have to deal with. Neurological problems, pain, the psychological impact that that has on patients and their families. And I think no matter how good the technology is, no matter how much you're using, navigation, robotics, biologics, AI, I think at the end of the day, you got to take the time to communicate with your patients and be available. And that's really, that's. I think that's the biggest challenge. And I think as we, as we become more involved with technology, I think this personal note or this kind of art that you develop this feeling for your patient and the ability to communicate is only going to become more important because it's going to become more important because it's going to help you differentiate yourself, let's say, from your competition. It's also going to be more important because it helps you avoid conflict with patients. Know, if something goes wrong, let's say. So it's really an old principle. It's nothing new, but it's just even more important now than it used to be, I think. Communication, empathy, and sometimes just taking a step back and think about the basics.
- [17:40]
A
Very well said. Well, Dr. Hartle, thank you so much for joining us on today's podcast. It's great to connect and I look forward to chatting in the future. Future.
- [17:48]
B
Carly, thank you so much. And again, happy New Year and thanks for having me.