Becker’s Healthcare -- Spine and Orthopedic Podcast
David L. Skaggs, MD, Co-Director of Cedars-Sinai Spine
01 Dec 2025
On this episode, David L. Skaggs, MD, Co-Director of Cedars-Sinai Spine, Executive Vice Chair of the Department of Orthopaedics at Cedars-Sinai, and Director of Pediatric Orthopaedics at Guerin Children’s, joins the podcast to discuss recent innovations in spine care, including synthetic CT scans generated from MRIs and the advancement of outpatient pediatric spine surgery. He also shares insights on developing surgical tools tailored for physicians with smaller hands, and looks ahead at healthcare trends, particularly how AI-driven solutions can make care more accessible and affordable.
Chapter 1: What is the main topic discussed in this episode?
This is Carly Beam with the Becker's Spine and Orthopedics Podcast. And today I'm thrilled to be joined by Dr. David Skaggs, co-director of Cedars-Sinai Spine. Dr. Skaggs, thank you so much for being here today.
Hello. Thanks for having me. Love Becker's. Love keeping up with what's new in spine.
Thank you. I'm glad to hear it. And before we dive into our questions, can you introduce yourself and tell us a bit about your background?
Sure, absolutely. I'm now the co-director of spine at Cedars-Sinai, along with Dr. Alex Tuchman, who's the neurosurgical co-director. We probably have about 30 spine surgeons here. We run seven or eight spine rooms a day and believe very deeply that a combination of neurosurgeons and orthopedic surgeons working together deliver the best spine care. I was here for five years.
Before that, I was at Children's Hospital Los Angeles for 25 years. It's been very invigorating and eye-opening to come to an adult spine center and honestly learn about some of what we're going to talk about today, new technology and how we could make spine care better for children with new technology.
Absolutely. I know you have a lot of expertise in pediatric spine area as well. Can you go through some of the biggest innovations that you've seen develop in the last few years?
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Chapter 2: What is Dr. David Skaggs' background in spine care?
Yeah, so one of the biggest is just happening right now. It is getting a synthetic CT from an MRI. And it's probably most important in children because children are most susceptible to radiation. And what it is, it's one of the few things I've seen in medicine where AI actually makes a difference, you know, in practical terms. And now what happens is when we get an MRI, a CT comes out.
In addition, really just doing one quick sequence might take a few minutes longer, and you can get an amazing quality CT that's accurate to within one millimeter, including three-dimensional reconstructions. So for pediatrics, what this does is save children from unnecessary radiation. But if we think bigger picture in adult spine, what it could also do is save people from getting two studies.
So instead of someone being sent for an MRI and at a separate time being sent for a CT, it could all be done at once.
So it sounds like it's a real win-win both for children and adults as well. Yeah.
And if you don't mind, there's even more to this one. One of the biggest advances, you know, in the past decade or so in spine surgery has been using navigation intraoperatively and robotics intraoperatively. And up until now, that has required a CT scan. And now we can use this synthetic CT, the proprietary name right now is called bone MRI. We can load that up into navigation and or robotics.
And all of a sudden we don't radiate the patient at any point for navigation or robotic usage, which is a complete game changer.
Yeah. And I'm wondering, you know, when working with pediatric patients are obviously smaller patients that are also still growing. What kind of developments are you excited about in terms of just having tools or navigation technologies that are tailored to them?
Yes. Great question. So, you know, I have to admit, I never even saw a robot until I came to Cedars. And next thing you know, I'm really just trying to meet my colleagues and go into the rooms and seeing, wow, they're doing incredible surgery through tiny incisions. And one of my partners, Dr. Corey Walker, who was trained at Barrow Institute with Juan Uribe, taught me how to use a robot. And in
Young athletes and I'll say kids in college and high school, they frequently have something called spondylolisis, which basically means it's a fracture most commonly of L5. In the old days to fix this, you had to open them up and put in screws and rods and hooks.
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Chapter 3: What recent innovations in spine care are being discussed?
And if somebody really wants to be a pediatric spine surgeon, They either have to go to a pediatric orthopedic fellowship with a huge amount of spine experience. And there's probably only a handful of those or do a true spine fellowship and then do additional time, uh, at a busy pediatric spine center. And I think this raises a larger question of, you know, how are spine surgeons training?
And there's now so many new techniques that. Martin Joh Hershock, Many people are feeling increasingly you can't learn it all in one year. Martin Joh Hershock, And here, I think the neurosurgeons were a bit ahead of the orthopedic surgeons having in folded fellowships.
Chapter 4: How does synthetic CT from MRI benefit pediatric patients?
Martin Joh Hershock, So without increasing the length of a fellowship neurosurgeons are able to do one year of a spine fellowship during the residency. Martin Joh Hershock, And then, if they want to do something special or go into academics right say probably more common than not, they then do an additional.
Daniel Katz- Post residency year fellowship so a lot are doing essentially two years of spine fellowship. Daniel Katz- And I think that the next step for orthopedics is if people are going into spine the PG y five years should probably be all spine and then do an additional. year of spine surgery.
So I think increasingly, if people are going to sub-specialize in endoscopy, MIS, robotics, tumor, pediatric spine, you know, whatever it is, there's going to have to be a little bit of additional training because there's really just too much to learn for one year to know all of spine and really be good at it all.
Right. And just sounds like really you want to be able to master the specific area and type of surgery of the spine that you want to hone in on.
yes yep and you know it's just like cardiac surgery branched on its own plastics did vascular did you know as we know more and more um we have to admit that we're not experts at everything you know the general practitioner is not doing heart surgery spine surgery and vascular surgery got it and dr skaggs my last question i want to ask you what are two or three of the biggest health care trends that you'll be following headed into 2026.
Oh, you know, people get tired of hearing about cutbacks in the government, but I think that that's going to affect us a lot over the oncoming years. You know, there's been good studies in the past showing that if a doctor sees a patient on government insurance, such as Medicaid, they actually lose money because their overhead is more than Medicaid pays.
Robert B. So we're starting already from a bad place of access and if that government support is going to be cut back even more. Robert B. I think the patients on medicaid are going to have even more difficult time with access to medical care. Robert B. So I think that's one of them, and you know throw on top of it, the academic centers are being cut back on research.
Daniel M. You know, I think that it's going to take a long time of going downhill before we have any possibility of unwinding this all so that's a negative. Daniel M. The positive and it almost sounds tried to talk about Ai, but I think that Ai really is going to offer us.
Daniel M. Solutions that are better faster and less expensive than existing technology, you know I think radiology may be leading the field in this. Martin Joh Hershock, You know I could imagine many different options, such as neuromonitoring during spine surgery you're doing some great work at Columbia university with Michael the tally we're using Ai they could.
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