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. Smith: Have you begun or are you looking to adopt AI technology in your practice? If yes, how? If not, what makes you hesitate?

Sekhon: 100%. I use an AI Scribe that has made clinic a joy. We are integrating AI into our back office. I also have a startup - invaluable advisor. I use AI patient replies to enquiries.

Kleimeyer: AI is steadily integrating into my practice, though with circumspection and intention. AI ambient scribes, electronic medical record (EMR) tools, and automated patient messaging help to save time and streamline documentation. However, these tools are not fully autonomous; they still require extensive oversight and frequent manual revision to ensure accuracy and maintain the quality of patient care. Tools are increasingly available too for imaging review, analytics and risk analysis, referral triage, and outreach but require the same due diligence.

Adoption otherwise does run into regulatory and ethical concerns. Some patients do not wish to have a recording of their patient encounter, even if not uploaded to the cloud, and others would rightly balk at interacting with an AI agent instead of their physician. While we have access to a secure digital environment where data privacy concerns are strictly addressed, these institutional compliance guardrails often limit software usability and slow down deployment. Data-use agreements and strict institutional data-sharing policies present a constant bottleneck. Many tools still require validation. As these changes hit our field at a very fast pace, we do need to preserve our connections to patients and the quality of our work regardless of access to these tools.

Smith: How has your surgical technique evolved in the past 10 years?

Kleimeyer: Now several years into independent faculty practice, I am better able to identify areas of clinical success alongside areas where I am continuously refining my skills and expanding my exposure. This has led to a shift away from larger open decompressions and fusions toward less invasive or smaller-footprint strategies. Driven by both evolving clinical data and strong patient preference, our practice continues to pivot toward nonfusion and motion preservation whenever appropriate. We are leveraging predictive data and advanced analytics more than ever. Pre-operative planning and individualized risk assessment helps to optimize our goals now long before stepping into the operating room.

Sekhon: MIS outpatient navigated oblique lateral TLIF is my workhorse. More ASC work. 1-2 level fusions are now 23-hour stay.

Smith: What enabling technology has changed how you perform surgery the most?

Sekhon: Navigation. It’s not just screws. Robotics—not so much. Slows me down and navigation gets me 95% of the way.

Kleimeyer: Widespread integration of intraoperative navigation has had the most profound impact on my operative practice. Navigation has improved reliability and standardization of instrumentation placement. This can allow for safe and controlled expansion of graduated autonomy for our trainees under direct supervision. When utilized well, work flows also allow for improved efficiency while adding to the number of internal checks enhancing the safety margins of safe minimally invasive surgeries.

Smith: What area(s) do you foresee innovation changing how we perform spine surgery the most over the next 5 years?

Kleimeyer: Continued convergence of digital preoperative and intraoperative technologies with the enabling technology in the operating room. Navigation and robotics, segmental registration, augmented reality, preoperative and real-time AI-assisted interpretation of imaging and alignment, and patient-specific implants including cages, pre-bent rods, and alignment-specific instrumentation is gaining traction and continuing to iterate. These innovations come at a cost, however. Our responsibility is to continue to investigate these technologies and evaluate their role in improving patient outcomes.

Sekhon: More outpatient surgery; robotics as a commodity not as a luxury; better data on indications and outcomes; better understanding of materials and biomechanics; and more endoscopy.