Latest / 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

Transcript

Roger Hartl, MD, Director of Neurosurgery Spine at Weill Cornell Medicine, and Neurosurgical Director of Och Spine at NewYork-Presbyterian/Weill Cornell Medical Center · Becker’s Healthcare Podcast

• 0:00
  This is Carly Beam with Becker Spine and
• 0:02
  Orthopedics podcast, and I'm thrilled to be joined
• 0:04
  today by doctor Roger Hardell with Weill Cornell
• 0:07
  Medicine. Doctor Hardell, thank you so much for
• 0:10
  being here today.
• 0:11
  Carly, thanks so much for having me back
• 0:13
  on this podcast. I'm very
• 0:15
  happy, and I wish you a happy New
• 0:16
  Year.
• 0:17
  Likewise. Likewise. And, doctor Harlow, if you could
• 0:20
  just introduce yourself and tell us a bit
• 0:22
  more about your background just for, you know,
• 0:24
  anyone new who might be, listening.
• 0:27
  Yeah. Yeah. Yeah. I'm happy to do that.
• 0:28
  I'm I'm a neurosurgeon. I'm
• 0:31
  a a spine neurosurgeon at this point in
• 0:34
  my career.
• 0:35
  I run the spine program at Weill Cornell
• 0:38
  Medicine in New York City, and I'm one
• 0:40
  of the co directors of ArcSpine
• 0:43
  at New York Presbyterian
• 0:44
  Hospital
• 0:45
  in New York City.
• 0:47
  Mhmm. And, doctor Haro, can you talk about
• 0:49
  the top three trends you're following in health
• 0:53
  care and in spine surgery today?
• 0:55
  Sure. You know, we have a
• 0:58
  integrated
• 0:59
  and very large program now. We, you know,
• 1:01
  we're at New York Presbyterian Hospital at, in
• 1:04
  in New York City.
• 1:05
  And and now what we've done over the
• 1:08
  last, you know, ten years is really integrate
• 1:10
  the
• 1:11
  spine programs at Columbia Cornell under the umbrella
• 1:14
  of New York Presbyterian Hospital.
• 1:16
  And in that role, of course and I
• 1:18
  and I do this together with Larry Lanky,
• 1:20
  who's like Bandin Shah, who are my main
• 1:22
  counterparts at the Columbia campus, and with Dan
• 1:25
  Rule here at Cornell.
• 1:27
  But obviously working with a large group
• 1:30
  of health care providers, surgical,
• 1:32
  nonoperative,
• 1:34
  from really multiple disciplines that are all importantly
• 1:38
  involved in the care of patients with back
• 1:40
  issues.
• 1:41
  You You know, there's so many things that
• 1:43
  come up all the time that are really
• 1:45
  relevant and sometimes
• 1:46
  directly related to surgery, sometimes a little bit
• 1:49
  outside surgery.
• 1:51
  But what I've seen over the last year
• 1:52
  has become really more and more interesting and
• 1:55
  I think relevant
• 1:56
  in
• 1:58
  our care of patients with back and neck
• 2:00
  issues
• 2:00
  is certainly I I I would say there
• 2:03
  are three things. There's artificial intelligence, of course,
• 2:05
  as as in many aspects
• 2:08
  of life and and health care.
• 2:10
  What I'm
• 2:11
  what I see evolve more and more is
• 2:13
  biologics,
• 2:14
  you know, disc especially for degenerative disc disease.
• 2:18
  I'm not talking about fusion biologics, really more
• 2:22
  biologics in terms of disc repair, disc
• 2:25
  regeneration, and sometimes even disc replacement.
• 2:28
  And then finally, as a as a surgeon
• 2:30
  in the Operating Room who's very excited about
• 2:32
  minimally invasive spine surgery, I think that whole
• 2:34
  area of navigation and robotics
• 2:37
  is really fascinating. So those are the three
• 2:40
  areas that I follow very closely amongst many
• 2:43
  others, but those are three areas within spine
• 2:46
  surgery and medicine, spine medicine
• 2:49
  that I think are the most exciting,
• 2:51
  artificial intelligence,
• 2:53
  biologics,
• 2:54
  and the whole area of navigation and robotics.
• 2:57
  Yeah. You know, I wanna hone in on
• 2:59
  what you're talking about with biologics. It's still,
• 3:01
  you know, very
• 3:03
  there needs to be a lot more
• 3:05
  research in this area in spine orthopedics. And
• 3:08
  I'm wondering
• 3:09
  what kinds of
• 3:11
  innovations in spine biologics could elaborate more on,
• 3:15
  what's exciting you in that area and what
• 3:17
  you think will
• 3:19
  really define this year when it comes to
• 3:21
  spine biologics.
• 3:23
  Yeah. I think the challenge with spine biologics
• 3:26
  is partially,
• 3:27
  obviously, the the regulatory pathway that that has
• 3:30
  that has really
• 3:32
  challenged our ability to,
• 3:35
  pursue some of the fascinating
• 3:37
  strategies that that come to mind when you're
• 3:40
  thinking about degenerative disc disease and biologics.
• 3:43
  You know, we're very, I think we've got
• 3:44
  a lot of data now,
• 3:46
  showing that augmentation of diseased discs with
• 3:50
  various types of stem cells, autologous or
• 3:53
  or or allograft stem cells
• 3:56
  holds holds a significant promise.
• 3:59
  What I'm what I'm very excited about is
• 4:02
  our current work on angular repair because,
• 4:05
  you know, one of the biggest untapped needs
• 4:08
  in spine surgery
• 4:10
  is that whole
• 4:11
  problem of recurrent disc herniation in patients who
• 4:14
  have a discectomy in the cervical or lumbar
• 4:17
  spine.
• 4:18
  And then there's not much that we can
• 4:20
  do really to prevent the disc from further
• 4:23
  degenerating
• 4:24
  or even reherniating.
• 4:26
  So the whole area of the current disc
• 4:28
  herniation
• 4:29
  and the opportunity that I think biologics
• 4:32
  can potentially give us here to prevent that
• 4:34
  from really happening over time.
• 4:38
  You know, I've I've done a lot of
• 4:39
  research in my lab to you know, I
• 4:41
  work with a a biomedical engineer up in
• 4:44
  Ithaca, Larry Bonasa. We've been working together for
• 4:46
  many years
• 4:47
  on disc repair, regeneration, replacement.
• 4:50
  But what we've done now more recently is
• 4:53
  really try to bring to the forefront the
• 4:56
  whole area of of annual repair with,
• 4:59
  we use collagen glues, plus minus cells.
• 5:02
  We just started a small company, a start
• 5:04
  up company
• 5:05
  that will hopefully be able to bring this
• 5:08
  through the FDA into clinical trials.
• 5:11
  And and that for me is really one
• 5:12
  of the most exciting things because
• 5:15
  it seems such a simple problem. You know?
• 5:17
  How do you prevent recurrent discreditation?
• 5:19
  But it's really an a totally untapped problem.
• 5:23
  You know? To totally we we don't really
• 5:25
  have have a good solution.
• 5:26
  And there's so many patients, you know, hundreds
• 5:28
  of thousands of patients every year who have
• 5:31
  lumbar disc herniation,
• 5:33
  who undergo surgery,
• 5:35
  and they all ask the same question. You
• 5:37
  know, how can you prevent that disc from
• 5:39
  reherniating? And we just don't have an answer.
• 5:42
  To me,
• 5:43
  this is one of the most basic issues
• 5:45
  in spine surgery currently.
• 5:47
  Mhmm. So I'm I'm very excited about that.
• 5:49
  And I you know, we've got some mechanical
• 5:51
  solutions.
• 5:53
  You know, we've got Barricade.
• 5:55
  There's another small company from Israel, Spinal,
• 5:59
  that that has a little implant that's not
• 6:01
  FDA approved at this point.
• 6:03
  But I'm not sure that implants are really
• 6:05
  the final solution. I think there has to
• 6:07
  be some kind of biological
• 6:09
  intervention,
• 6:10
  either,
• 6:12
  in isolation or together with some type of
• 6:14
  implant
• 6:15
  that help us regenerate and repair that annular
• 6:18
  defect. And and that's that's something that I'm
• 6:20
  very excited about.
• 6:22
  And I imagine everything, with Exploins Biologics, it
• 6:26
  sounds like you
• 6:29
  multidisciplinary
• 6:30
  collaboration
• 6:31
  and just kind of work with others just,
• 6:33
  you know, beyond just spine, itself.
• 6:36
  Yeah. I think that's crucial, and that's
• 6:39
  yeah. And that brings me to another point.
• 6:41
  If you if you wanna do this type
• 6:42
  of research, clinical research, you need a a
• 6:45
  team of multidisciplinary
• 6:47
  specialists. And that's
• 6:49
  that's exactly why we started Oxpine
• 6:52
  at in New York City, which which is
• 6:54
  really a
• 6:56
  combination of operative and nonoperative
• 6:58
  providers that we just opened. It's actually a
• 7:00
  year ago. Exactly one year ago, we we
• 7:02
  opened Prospero, our spine center
• 7:05
  in Hudson Yards,
• 7:07
  where we have 60,000
• 7:08
  square feet, and it's the first time that
• 7:11
  Columbia and Cornell doctors work together in one
• 7:13
  space.
• 7:14
  And we've got, you know,
• 7:17
  25 surgeons. We've got, 30 nonoperative
• 7:20
  spine providers. We've got physical therapy, radiology.
• 7:24
  So this type of research, if you wanna
• 7:26
  do this type of research where you really
• 7:27
  include patients, you need you need a
• 7:31
  a multidisciplinary
• 7:32
  team of specialists that all work together, and
• 7:35
  that's exactly what we have now.
• 7:37
  Yeah. And, you know, have there been any,
• 7:40
  any hurdles, any challenges when it comes to,
• 7:42
  you know, bringing together all these specialties, or
• 7:45
  has it been smooth sailing for the most
• 7:46
  part?
• 7:48
  Yeah. I wish it was smooth sailing. It's
• 7:50
  not. It's,
• 7:51
  no. In our case, it really worked because
• 7:55
  I mean, as individual physicians, we all wanna
• 7:57
  work together. The problem is then
• 8:00
  bureaucracy comes into
• 8:03
  comes,
• 8:04
  comes in the way and the bureaucracy in
• 8:06
  terms of the logistics, the infrastructure, the financial
• 8:09
  aspect.
• 8:10
  In our case, at Oxpawn, it worked because
• 8:13
  it was really obviously envisioned by individuals, but
• 8:16
  then really
• 8:18
  supported and put into practice by by the
• 8:20
  hospital and by the universities. You know? And
• 8:23
  and I think that's really important. If you
• 8:25
  if you wanna build something like a multidisciplinary
• 8:28
  spine center, you need the support of the
• 8:30
  overarching structure. And in our case,
• 8:33
  that's the hospital and the university, and that's
• 8:35
  the the key to success.
• 8:38
  Absolutely. Unfortunately, you know, we we've had that,
• 8:40
  and we have that.
• 8:42
  But, obviously, then you also need the individual
• 8:44
  subspecialties,
• 8:45
  departments, and so forth to all be willing
• 8:47
  to work together.
• 8:49
  Yeah. Absolutely. And do you have any advice
• 8:51
  for,
• 8:52
  you know, hospital leaders who, you know, they're
• 8:55
  they see your example and they and they
• 8:58
  want to replicate that on their own? What
• 9:00
  would be the biggest piece of advice you'd
• 9:02
  have for creating a more integrated spine orthopedic
• 9:06
  neurosurgery
• 9:06
  program?
• 9:08
  Yeah. No. That's a great question. I you
• 9:10
  know, we've and it it didn't happen out
• 9:12
  of out of the blue.
• 9:14
  You know, we we had at at on
• 9:16
  the Cornell side, we've had experience building a
• 9:19
  spine center since the early two thousands, and
• 9:22
  it was really
• 9:23
  initially just
• 9:25
  a bunch of,
• 9:26
  surgeons and nonoperative doctors who had an interest
• 9:29
  in spine.
• 9:30
  And we started meeting every week, and we
• 9:32
  had a conference. We had a case conference.
• 9:34
  You know, we found a neuroradiologist
• 9:36
  with an interest in spine, then we had,
• 9:39
  two surgeons, myself, somebody else. We had one
• 9:42
  of the pain management guys, one of the,
• 9:45
  PM and R physiatry doctors,
• 9:48
  and and a physical therapist and a neurologist,
• 9:50
  actually. And and we all, you know, we
• 9:52
  were, like, similar age group. We all had
• 9:54
  this an interest in spine, and we decided
• 9:56
  to meet meet up once a week and
• 9:59
  discuss cases that we had seen in clinic
• 10:01
  where we had some questions or we wanted
• 10:03
  input.
• 10:04
  And that's really how the spine center started
• 10:07
  in in our in our case here twenty
• 10:09
  years ago, twenty plus years ago.
• 10:12
  And then it slowly evolved, and then we
• 10:14
  decided to
• 10:15
  see actually patients together. So we we moved
• 10:18
  our clinic schedules around, and we found a
• 10:21
  location where we could actually see patients together
• 10:23
  within the hospital.
• 10:25
  And then slowly, we and then we tracked
• 10:27
  volumes. We tracked patient volumes, surgery volumes. We
• 10:30
  could show that it
• 10:32
  increased our productivity,
• 10:34
  and that's how the hospital started paying attention.
• 10:37
  And then slowly, you get the hospital on
• 10:39
  board.
• 10:40
  So really just kind of looking at the
• 10:41
  numbers, it sounds like. That's the key to
• 10:43
  everything. Yeah. So it takes a long time.
• 10:45
  It's a slow process, but that's kinda how
• 10:47
  it worked in our case.
• 10:49
  That's great. And, you know, I want to
• 10:51
  pivot back to what you're saying about AI
• 10:53
  as well. Obviously, in 2025,
• 10:54
  AI and health care is, you know, it's
• 10:57
  really exploded. It's huge,
• 10:59
  huge talking point among, you know, physicians, leaders.
• 11:02
  And I'm wondering,
• 11:04
  you know, how how are you using
• 11:07
  AI in your practice right now? What are
• 11:09
  you going to,
• 11:11
  do to same, do differently?
• 11:14
  Yeah. I mean, I think AI penetrates every
• 11:17
  aspect of
• 11:18
  our lives as individuals
• 11:21
  and as surgeons, and the key is to,
• 11:24
  try to make it,
• 11:27
  you know, make it safe,
• 11:29
  make it effective,
• 11:30
  and, and and to make sure you don't
• 11:32
  lose really
• 11:33
  some of the principles of how we take
• 11:35
  care of patients, of course.
• 11:37
  You know, I I certainly I mean, our
• 11:39
  practices, it's helpful for preoperative
• 11:43
  evaluation of patients' literature reviews. You know, if
• 11:45
  if you're not sure about, you know, what's
• 11:47
  out there in the literature, AI is a
• 11:49
  huge advantage in that regard. It can really
• 11:52
  help you,
• 11:53
  review the literature very quickly, make certain decisions
• 11:56
  in terms of surgical procedures. Obviously, you always
• 11:59
  gotta double check.
• 12:00
  The other thing that I use AI for
• 12:03
  increasingly in working with some of the companies
• 12:05
  who are involved in navigation
• 12:07
  and in,
• 12:09
  intraoperative,
• 12:10
  you know, stereotactic navigation and robotics
• 12:13
  is the whole area of AI
• 12:16
  and, for example, automatic,
• 12:19
  automated segmentation.
• 12:21
  Or, you know, we work I work with
• 12:22
  Brainlab, for example,
• 12:24
  to come up with a workflow,
• 12:27
  to use augmented reality through a microscope or
• 12:30
  exoscope
• 12:31
  to facilitate the workflow for MIS telus surgery.
• 12:35
  Right? MIS telus surgery is a great operation
• 12:38
  because there are certain landmarks that you use
• 12:40
  with every operation.
• 12:42
  And using AI and using intraoperative or preoperative
• 12:45
  imaging,
• 12:46
  you can automatically
• 12:48
  have the software identify these landmarks and then
• 12:51
  indicate or highlight these landmarks
• 12:54
  while you're doing the operation.
• 12:56
  And those landmarks become relevant at different portion
• 12:59
  to different parts of the surgery.
• 13:01
  So you can literally then the AI have
• 13:03
  you guide through the through an operation from
• 13:05
  a to z depending on the landmarks when
• 13:08
  they become relevant. That that's that's one of
• 13:10
  those things that I'm working on that I'm
• 13:12
  very excited about that goes way beyond just
• 13:15
  putting screws into the spine.
• 13:17
  This is really just, facilitating the workflow.
• 13:20
  And a T Lift is a great example,
• 13:22
  but any any spine operation could really be
• 13:25
  benefiting
• 13:26
  from this type of,
• 13:28
  automatic segmentation and integration through
• 13:32
  microscope or the exoscope or even the endoscope
• 13:35
  and then project this information
• 13:37
  into the visual field of the surgeon. So
• 13:40
  that's that's AI
• 13:42
  in the operating room.
• 13:44
  And then and then there's obviously AI that
• 13:46
  you can use,
• 13:49
  for postoperative
• 13:50
  assessment,
• 13:51
  write manuscripts,
• 13:53
  I mean, help you in a in a
• 13:54
  in a intelligent way, improve the quality of
• 13:57
  your manuscript.
• 13:58
  And, I mean, there's so many and then
• 14:00
  scribes. Right? We we discuss it currently at
• 14:03
  Oxpine. You know? Is there is there a
• 14:05
  need for AI
• 14:07
  scribes, for example? You know? And that's something
• 14:09
  that we're discussing. I know a lot of
• 14:11
  institutions have that implemented already. I think there
• 14:13
  are pros and cons, but sooner or later,
• 14:15
  it's gonna be it's gonna be common practice,
• 14:18
  I'm sure. Oh, yeah. Let's start let's break
• 14:20
  down those pros and cons you mentioned there.
• 14:22
  What
• 14:23
  where what do you think could be done,
• 14:24
  you know, to improve to improve the pros
• 14:27
  and, you know,
• 14:29
  smooth out the cons.
• 14:31
  Yeah. So, you know, the cons are, obviously,
• 14:33
  you wanna make sure that whatever
• 14:35
  whatever you do is is accurate, safe,
• 14:38
  ethical.
• 14:39
  Right?
• 14:40
  So I think those are those are in
• 14:42
  general with AI. So you gotta you gotta
• 14:44
  be very, very careful.
• 14:46
  A good example is writing a manuscript. Right?
• 14:50
  People discuss the pros and cons, what's ethical,
• 14:52
  what's not ethical. Right? I think there's I
• 14:55
  think there are ways of
• 14:57
  of using AI
• 14:59
  to create an outline for a scientific manuscript,
• 15:02
  for example,
• 15:04
  to review the literature,
• 15:06
  to critically
• 15:07
  review the quality of your own writing and
• 15:10
  improve that potentially.
• 15:11
  But But I think you always gotta make
• 15:13
  sure that you check and double check and
• 15:14
  triple check. You know, that's that's the most
• 15:16
  important part.
• 15:18
  It it But I think that, we're we're
• 15:20
  gonna get better at this. And, eventually,
• 15:24
  I think it's gonna be more and more
• 15:25
  common practice.
• 15:27
  Definitely. And then, doctor Hartle, the last question
• 15:29
  I have for you right now is what's
• 15:31
  something that all spine surgeons, whether they're working
• 15:35
  with the health system independently,
• 15:38
  what should all spine surgeons be doing
• 15:40
  to thrive this year?
• 15:43
  To thrive this year is
• 15:46
  I think that,
• 15:48
  you know, personally, in my own practice
• 15:51
  and
• 15:52
  to I think for spine surgeons is gen
• 15:54
  in general, what I find the most important
• 15:56
  part this year,
• 15:58
  but probably also last year and next year,
• 16:00
  is really communicate with patients. Right?
• 16:03
  I think at the end of the day,
• 16:05
  the the what we provide as a service
• 16:08
  is
• 16:09
  try to help patients get through a very,
• 16:11
  very difficult time
• 16:13
  in their lives, sometimes with neurological deficit, but
• 16:16
  frequently with pain.
• 16:17
  And that's a very, very unique problem. There
• 16:19
  are very few specialties in medicine that really
• 16:22
  have to deal with the complexity
• 16:25
  of symptoms that we have to deal with,
• 16:27
  neurological problems, pain, the psychological
• 16:30
  impact that that has on patients and their
• 16:32
  families.
• 16:34
  And I think no matter how good the
• 16:35
  technology is, no matter how how much you're
• 16:38
  using navigation, robotics, biologics,
• 16:41
  AI,
• 16:41
  I think at the end of the day,
• 16:43
  you gotta take the time to communicate with
• 16:45
  your patients and be available.
• 16:47
  And that's really that's I think that's the
• 16:49
  biggest challenge. And I think
• 16:51
  as we as we become
• 16:54
  more involved with technology,
• 16:56
  I think this
• 16:57
  personal note of this kind of art that
• 16:59
  you develop, this
• 17:01
  feeling for your patient and the ability to
• 17:04
  communicate
• 17:05
  is only gonna become more important because
• 17:08
  it's gonna become more important because it's gonna
• 17:10
  help you differentiate yourself, let's say, from your
• 17:13
  competition.
• 17:14
  It's also gonna be more important because it
• 17:16
  helps you avoid conflict with patients, you know,
• 17:20
  if something goes wrong, let's say.
• 17:22
  Mhmm.
• 17:23
  So it's really an old principle. It's nothing
• 17:25
  new, but it's just even more important now
• 17:27
  than it used to be, I think. Communication,
• 17:31
  empathy,
• 17:33
  and,
• 17:33
  sometimes just
• 17:35
  taking a step back and think about the
• 17:38
  basics.
• 17:39
  Very well said. Well, doctor Hardo, thank you
• 17:42
  so much for joining us on today's podcast.
• 17:45
  It's great to connect, and I look forward
• 17:46
  to chatting in the future.
• 17:48
  Carly, thank you so much. And, again, happy
• 17:50
  New Year, and thanks for having me.