Latest / Becker’s Healthcare Podcast / James Mooney, a complex and minimally invasive spine surgeon with VCU Health

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James Mooney, a complex and minimally invasive spine surgeon with VCU Health · Becker’s Healthcare Podcast

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  This is Carly Beam with the Becker Spine
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  and Orthopedics podcast. And today, I'm thrilled to
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  be joined by doctor James Mooney, a spine
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  surgeon at Virginia Commonwealth University.
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  Doctor Mooney, thank you so much for being
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  here today.
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  Thanks for having me, Carly. I've listened to
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  Becker's on the past, and I think you
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  guys do a great job covering the health
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  care system. So I really appreciate the opportunity.
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  Absolutely. And thank you for your kind words
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  as well.
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  Before we dive into our questions, can you
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  just introduce yourself and share more about your
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  background?
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  Yeah. So my name is James Mooney. I'm
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  a complex and minimally invasive,
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  spine surgeon here at Virginia Commonwealth University
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  in Richmond, Virginia. I'm a new faculty.
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  I did my training down in Birmingham, Alabama
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  at the University of Alabama,
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  for seven years in neurosurgery residency, and then
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  I was up in Pittsburgh, Pennsylvania
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  for a
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  complex and minimally invasive,
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  spine deformity fellowship.
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  So excited to be in Richmond and, growing
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  the program here. Yeah. And it sounds like,
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  you know, you have a lot of expertise
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  in just the full gamut of, spine surgery.
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  Can you talk about some of the
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  biggest spine trends that you're following in health
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  care?
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  Yeah. Of course. So I think, you know,
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  with any field,
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  artificial intelligence is at the forefront of, everyone's
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  minds. And so from my standpoint as a
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  complex
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  spine surgeon, you know, I think about what
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  are the areas that,
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  AI is going to assist us with in
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  the OR. And so,
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  I think there's a number of categories as
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  far as planning for these bigger spine deformity
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  surgeries. So, you know, that ranges from radiographic
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  planning to the execution of complex spine surgeries.
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  And, you know, ultimately, I think we're heading
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  towards the future where every surgery,
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  is ultimately planned and executed according to evidence
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  based
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  algorithms.
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  And that's, you know, multifactorial
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  where AI can, number one, you know, help
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  us choose who to operate on. Number two,
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  help us construct our surgical plans, and then,
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  lastly, help us execute the plan in the
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  OR and monitor our progress towards our preoperative
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  goals intraoperatively.
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  And then I think really the next frontier
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  for artificial intelligence and health care as a
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  whole and, you know, specific to spine surgery
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  is,
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  incorporating these AI paradigms into our clinical decision
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  making.
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  You know, right now, if you ask five
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  different spine surgeons, you know, how to approach
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  a case, you might get five different answers.
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  So, you know, how do we utilize
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  AI to help standardize decision making for
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  spine surgeons and help choose the best option
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  for each unique patient.
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  I also think it's important to monitor the
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  safety of these algorithms. So having,
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  resources that are devoted to, making sure, you
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  know, these technologies are used safely.
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  So I think, you know, that's the number
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  one area I'm following. I think number two,
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  is the
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  shift, sort of from RVU based metrics towards,
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  value based care and specifically for spine surgery.
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  I think
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  it's important to, you know, make sure the
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  right surgeries are being done for the right
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  patients and shifting from
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  a RVU incentive based,
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  you know, setup where surgeons are compensated based
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  on volume of surgery. You know? How do
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  we shift things and,
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  to more of a patient centered outcome?
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  And, ultimately, you know, registries and health system
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  analytics will help us
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  progress towards that point where we're determining, which
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  patients are benefiting from, which surgery,
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  and,
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  rewarding surgeons for their outcomes.
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  And then lastly, I think an area that's
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  been a particular interest to me is,
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  you know, the expansion of minimally invasive as
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  well as patient specific technologies and precision medicine.
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  And for spine surgery, in particular,
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  the growth of Ultra MIS,
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  surgery and endoscopic spine surgery, I think, is
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  really interesting.
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  You know, it's one of those revolutions, and
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  they've been doing it in Asia for long
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  periods of time.
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  But in The US, it's relatively new, but
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  I think it's, something that's here to stay,
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  and it's important for a center that provides
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  spine care to be able to offer the
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  full gamut of care ranging from,
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  you know, the most minimally invasive approach with
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  an endoscopic surgery to, a big deformity correction.
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  And I think, you know, tailoring that surgery
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  to the specific patient is incredibly important, and
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  we can't lose sight of that.
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  And then the last thing is, you know,
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  three d printed implants and patient specific technologies,
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  I also think are,
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  the future as well. I haven't incorporated them
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  yet, but that's something we're hoping to to
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  bring on as we grow at VCU.
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  Yeah. Those all really fascinating, exciting areas of
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  just kind of what's ahead for future spine,
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  especially all of the ways that
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  AI sounds like it's really making,
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  is bring helping to bring patient care in
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  a more,
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  streamlined and effective
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  way. And
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  one thing I wanna circle back to one
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  things you said about, this shift from RVU
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  to VBC. I'd love to hear your insights
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  on what you think is gonna be needed,
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  from surgeons, from hospitals, practice leaders, etcetera, for
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  this shift to
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  really be effective and to
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  to take off?
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  Yeah. I mean, I think it's easy to
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  talk about, but, you know, actually instituting it
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  is a lot,
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  bigger of a challenge. And so, you know,
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  I'm right at the beginning of my career,
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  and these are just things I've been following
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  early on. But I think it's gonna take
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  a, you know, a massive overhaul really of
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  the way things are
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  set up currently,
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  just given that we've been following the specific,
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  you know, metrics and ways of compensating surgeons
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  for years. So,
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  I don't have the specific solution, but I
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  think it's gonna take a lot of, you
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  know, lobbying,
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  from our organizations
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  and,
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  participation
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  from,
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  spine surgeons that are at the front line
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  to really make this a reality. You know,
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  people talk about it a lot, but, you
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  know, putting that into action is a lot
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  more difficult. And, hopefully, you know, I can
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  help be a part of that moving forward
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  as well.
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  Got it. And, yeah, I'd love to, you
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  know, hear more about just kind of your
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  own,
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  how you're using AI in both your complex
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  and minimally based in spine care, whether it's
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  in the OR or outside.
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  What are you using it the most for?
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  Yeah. You know, I think
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  all aspects of of care,
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  can be utilized. Again, I think safety is
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  key,
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  particularly
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  for,
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  evaluating and working up a patient for documentation.
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  You know, Epic has specific AI
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  workflows that can be used to generate clinic
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  notes, and that's been incredibly helpful with streamlining
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  clinic appointments.
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  And then moving into the OR, we've just
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  incorporated,
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  patient specific rods and,
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  software into our surgical planning, and that software
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  actually
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  will, take a patient's preoperative scan,
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  you know, plan your surgery out in conjunction
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  with engineers and allow you to generate a
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  rod that,
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  at least radiographically
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  would generate a good outcome for the patient.
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  The software, it also will track patient
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  outcomes over time as well as,
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  did your,
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  actual surgical
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  outcome radiographically
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  match what was planned preoperatively, and there's a
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  massive amount of data that can be
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  acquired over time using those paradigms.
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  So for intraoperative planning for preoperative planning, it's
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  been very helpful. I think the next forefront
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  is really incorporating it into,
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  the intraoperative,
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  you know, are we achieving the correction that
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  we planned preoperatively,
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  as well as helping us to standardize decision
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  making.
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  And, again, those things are a little further
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  further off, but, you know, not too far
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  off.
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  Yeah. Thank you for breaking that down. And
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  I wanna ask you, I know you have
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  you have a unique perspective having,
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  training in both
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  complex
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  spine surgery and minimally
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  invasive. And, you know, obviously, the, there is
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  we're seeing more technologies and trends towards,
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  minimally invasive surgery.
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  But, you know, why is it important
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  for
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  minimally invasive spine surgeons to kind of understand,
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  the complex and and vice versa?
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  Yeah. That's a terrific question. And so, you
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  know,
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  I think my the re one of the
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  reasons I did a fellowship was to really
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  understand,
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  understand, which patients to operate on in terms
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  of,
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  who is who is right for a particular
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  procedure. And, you know, in my mind starting
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  out as a surgeon,
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  my goal is to offer the patient the
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  least invasive surgery that we can
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  offer to achieve the goals of surgery. And
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  so a lot of times, in these cases,
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  you know, I'm being sent patients that have
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  big scoliotic deformities
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  or or,
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  you know, issues that radiographically
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  you would want to,
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  if you didn't know hear about the patient's
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  symptoms, you you could offer a large surgery.
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  But when you actually talk to the patient
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  and figure out that this might be a
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  single nerve that's affected, that, minimally invasive decompression
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  could give them years of relief before they
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  need a big surgery.
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  And having that minimally invasive training has been
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  very helpful,
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  in working these patients up and being able
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  to offer
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  them that, the least invasive approach. And then,
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  you know, anytime you operate on a patient,
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  if you fuse a segment of the spine,
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  you're subjecting the rest of the spine to
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  more motion and potential
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  breakdown and need for future surgeries. So, really,
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  my deformity training has helped me understand angles
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  and,
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  preoperative planning even for a small single level
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  surgery.
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  You know, it's really important to get that
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  correction,
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  even if you're doing an, you know, a
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  single level five one or four five fusion.
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  In the grand scheme of things, if you
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  get that wrong, you're setting the patient up
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  for many future surgeries. So I think that's
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  where my minimally invasive training,
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  UAB has combined with the, you know, the
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  deformity training to really,
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  help me be able to offer a full
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  gamut of spine, procedures to patients.
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  Definitely. And, yeah, I was wondering, what do
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  you think will be the one true disruptor
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  to spine surgery next year?
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  Yeah. Within the next year, I think AI
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  is going to continue
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  improving,
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  outcomes. And,
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  you know, I
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  it's yet to be seen the full extent
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  of where ultra minimally invasive surgery is going
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  to head.
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  I'm actively following that as well.
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  But I think it's gonna be, you know,
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  not one single factor, but a combination of
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  all of these things that are,
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  intersecting. It's such an exciting time,
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  where you have, you know, new technologies,
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  data,
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  collaboration,
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  between surgeons, engineers, scientists.
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  And,
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  yeah, I I don't I don't think it's
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  gonna be one specific thing, but really a
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  combination
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  of all of these things we're talking about.
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  Got it. And then just my last question
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  for you, doctor Mooney. How are you thinking
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  about growth headed into 2026?
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  Yeah. For sure.
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  You know, it's it's a really exciting time
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  for me being a new faculty at VCU.
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  There's really three categories that I think of
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  in terms of growth over the next, two
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  years, and that's from a clinical standpoint,
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  from an academic standpoint, and then from an
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  educational standpoint. And so, you know, clinically,
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  our goals as a spine department are to,
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  increase access to care. You know, historically,
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  UVA,
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  and Duke have been the major centers in
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  the area.
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  And our goal is to to really offer
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  patients in the Richmond area access to total
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  spine care,
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  including, you know, complex as well as MIS,
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  spine surgery.
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  And to achieve that, we're, you know, expanding
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  our reach to different areas,
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  in Fredericksburg, Virginia. I've been going to Williamsburg,
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  where William and Mary is to,
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  you know, work with athletes there,
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  and increase our sports medicine exposure, and we've
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  been getting referrals and expanding our reach in
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  those areas, which has been great.
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  Second is to increase, you know, capabilities in
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  the OR. And so we've, you know, brought
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  in MIS systems over the past few months
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  to help achieve those goals.
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  I mentioned the unit,
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  patient specific rods, which we've been incorporating into
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  surgery as well,
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  and then all of the AI planning, robotics,
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  and enabling technologies,
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  that are really going to help transform things,
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  at VCU.
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  Improving collaborations
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  goes along with that. So with orthopedics, endocrinology,
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  ENT, PM and R, PT, pain medicine, oncology,
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  and really, you know, incorporating all those departments
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  to make VCU,
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  a spine center of excellence.
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  And then, you know, from an academic standpoint,
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  we're trying to really grow our research footprint,
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  looking into predictive analytics,
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  outcomes data.
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  And I've been partnering with the engineering department
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  to help
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  preoperative planning with three d printing as well
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  for, bigger deformity
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  operations.
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  And then we're working to get involved in
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  the American Spine Registry over the next, few
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  months where we can,
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  you know, longitudinally
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  collect large amounts of data over time.
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  And then lastly, you know, from educational standpoint,
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  we wanna improve
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  education for the residents,
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  improve their exposure to complex techniques
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  and enabling technologies and ultimately,
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  potentially,
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  get a fellowship down the road. Mhmm. So
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  those are the main categories I'm really excited
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  about.
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  Got it. Well, you know, thank you so
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  much, doctor Mooney, for joining us today. It's
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  been a pleasure speaking, and I look forward
• 14:24
  to connecting again down the line.
• 14:26
  Of course. Thanks so much for having me.
• 14:28
  I appreciate it.