At NASS 2026 in San Antonio, the Early Career Advisory Council will host a luncheon roundtable session on Navigating the Transition to Early Spine Practice: Careers, Choices, and Sustainability. At this session, early career attendees have the opportunity to engage directly with experienced faculty in small-group discussions on topics not always covered during residency or fellowship.

To offer a preview of the conversation, the early career moderators for this session have asked the faculty assigned to their topic to answer some questions. Al Lawati: As spine care becomes increasingly multidisciplinary, what are the most effective ways surgeons and rehabilitation specialists can collaborate to improve patient outcomes across the continuum of care?

Schneider: The collaborating effectively starts with being intentional and initiating doing so. What this looks like can vary greatly depending on your practice environment. It can include formal interactions such as shared intra-mural educational offerings like multidisciplinary case conferences and informal interactions such as frequent direct conversations regarding shared patients. It is impossible to collaborate effectively when there isn’t a shared knowledge-base and open lines of communication.

Lantz: I believe there are many opportunities for collaboration between surgeons and rehabilitation specialists that can improve patient outcomes across the continuum of spine care through clinical practice, research, and education. Clinically, collaboration begins with open communication and shared decision-making. Regular discussions about patient goals, functional status, imaging findings, and treatment options allow each provider to contribute their expertise while ensuring the patient receives coordinated, individualized care.

Collaboration is equally important before and after surgery. Rehabilitation specialists can help optimize patients prior to surgery by addressing modifiable functional limitations, setting realistic expectations, and identifying patients who may benefit from continued conservative management. Postoperatively, close communication helps guide rehabilitation progression, monitor recovery, and identify complications or barriers to functional improvement early.

Beyond patient care, multidisciplinary research helps generate evidence on best practices across both surgical and non-surgical treatments, while collaborative teaching exposes trainees to different perspectives and fosters mutual respect between specialties early in their careers. Ultimately, the best patient outcomes occur when providers function as a cohesive team rather than as independent disciplines.

Al Lawati: From your perspective, what are the most common barriers to effective interdisciplinary spine care, and how can early-career clinicians help overcome them?

Lantz: One of the most common barriers is a limited understanding of the roles, expertise, and scope of practice of other healthcare professionals. This can lead to inappropriate referrals, delayed collaboration, or missed opportunities to provide comprehensive care. Another major barrier is ineffective communication, whether due to busy clinical schedules, fragmented health care systems, or lack of established interdisciplinary workflows.

Early-career clinicians can help overcome these challenges by making a conscious effort to learn from colleagues in other specialties. Participating in multidisciplinary conferences, asking questions, and seeking opportunities to observe other providers in clinic can build a better appreciation for each discipline's strengths. Consistent, respectful communication and a willingness to collaborate also help establish trust and improve coordination of care. Developing these habits early in one's career creates a strong foundation for lifelong interdisciplinary practice.

Schneider: A common barrier to effective interdisciplinary spine care is a lack of exposure to other disciplines during residency and fellowship training. Proper injection referrals inherently require an understanding of appropriate indications for the procedures. Similarly, surgical referrals require appropriate understandings of what the indications are for elective surgery and more importantly what pathology requires surgical intervention. Gaining this understanding is best done by direct exposure and interaction across disciplines which is best accomplished during training. Beyond this, patient pathways through the continuum of spine care are disjointed, which creates difficulties for physicians and patients alike. Optimizing how patients flow through a particular health care system can pay great dividends in collaborative and interdisciplinary spine care.

Al Lawati: How do you determine the appropriate timing for involving non-surgical specialists such as physical medicine and rehabilitation, physical therapy, pain management, or other disciplines in the care of spine patients?

Schneider: Ideally spine surgeons are involved with patient care when the patients may or definitively need surgery. On either end of the spectrum of care, collaboration with other disciplines is not only appropriate, but likely optimal. Presenting patients with spinal pain complaints can often be effectively managed by physiatrists with potential surgical patients being referred to a spine surgery when appropriate non-surgical care has not been successful. Initial care should often involve other disciplines such as physical therapy as well. On the back end, patients with chronic pain despite non-surgical and/or surgical management can benefit from being treated by interdisciplinary pain management services.

Lantz: The decision is guided by the best available evidence, the patient's individual presentation, and ongoing communication with other providers. Every patient is different, and treatment should be tailored to their symptoms, functional limitations, goals, and underlying pathology.

For many patients, conservative management involving physical therapy, physical medicine and rehabilitation, or pain management represents an appropriate first-line approach. Other patients may require earlier surgical evaluation because of progressive neurologic deficits, spinal instability, or other urgent pathology. Throughout the treatment process, maintaining open communication with non-surgical providers allows for timely adjustments to the management plan and ensures patients receive the right intervention at the appropriate time. Ultimately, interdisciplinary discussions help determine the optimal sequence and timing of treatments based on both evidence and individual patient needs.

Al Lawati: Can you share an example of a challenging spine case where interdisciplinary collaboration significantly changed the patient's outcome or management plan?

Lantz: One memorable case involved a patient who initially presented with symptoms of neck pain but was ultimately found to have bilateral subdural hematomas. The patient was referred from their primary care physician to physical therapy for acute neck pain. Upon taking a thorough history and physical examination, it was discovered that the patient had a fall 2 nights prior with undisclosed head trauma resulting in deficits on neurological examination. Radiology was contacted, and the patient underwent an immediate CT and was found to have bilateral subdural hematomas and admitted by neurosurgery. Fortunately, due to the smooth coordination of care, the patient was able to be managed conservatively and with resolution of hematomas in about 2 months. Close collaboration between the physical therapist, radiologist, and neurosurgery allowed the team to rapidly shift the diagnostic focus and develop an appropriate management plan.

This case reinforced the importance of maintaining a broad differential diagnosis and recognizing when a patient's presentation extends beyond a single specialty. It also highlighted how effective interdisciplinary communication can expedite diagnosis, avoid unnecessary interventions, and ensure patients receive the most appropriate treatment as quickly as possible.

Schneider: The most common clinical scenario I encounter in which patient care is directly optimized by interdisciplinary collaboration is in cases where there is diagnostic uncertainty and clarification of such determines potential surgical plans. For example, a patient with deep gluteal pain has a broad differential diagnosis and I have seen many patients that were referred from spine surgery clinics for lumbar and gluteal pain and after meticulous work up including diagnostic blocks ended up benefiting from a hip replacement.

Al Lawati: What advice would you give to early-career spine providers who want to build strong collaborative relationships with professionals from other disciplines?

Schneider: For physicians out of training but early in their career there are two things that can be done early in practice that will pay long-term dividends in having strong collaborative relationships. The first is educating yourself on the areas of interest and expertise of your colleagues. For example, a physiatrist can facilitate stronger working relationships by understanding what surgical partners have clinical focus on different surgical interventions such as endoscopic surgery or deformity surgery. Conversely, surgeons can facilitate these relationships by understanding what roles their colleagues have expertise in which can range from the initial work up and management of patients presenting with new spinal complaints to physicians that focus on long term management of chronic pain. The second simply comes down to building personal relationships. We all work better and more effectively when we have a personal connection with our colleagues.

Lantz: My biggest piece of advice is to be intentional about communication and remain genuinely curious about what colleagues from other disciplines bring to patient care. Take opportunities to learn from one another, whether by shadowing in each other's clinics, participating in multidisciplinary conferences, or discussing challenging cases together. These experiences help build mutual understanding and trust while broadening your own clinical perspective.

I also encourage early-career providers to collaborate beyond the clinic through research, quality improvement initiatives, and educational activities. Working together on shared projects strengthens professional relationships and advances the field as a whole. Ultimately, approaching collaboration with humility, respect, and a shared commitment to improving patient outcomes will benefit both providers and, most importantly, the patients they serve.