Becker’s Healthcare -- Spine and Orthopedic 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
15 Jan 2026
Chapter 1: What is Dr. Roger Hartl's background and expertise in spine surgery?
this is carly beam with the becker spine and orthopedics podcast and i'm thrilled to be joined today by dr roger harlow with wild cornell medicine dr harlow thank you so much for being here today carly thanks so much for having me back on this podcast i'm very happy and i wish you a happy new year likewise likewise and dr harlem if you could just introduce yourself and tell us a bit more about your background just for anyone new who might be uh listening
Yeah, I'm happy to do that. I'm a neurosurgeon. I'm a spine neurosurgeon at this point in my career. I run the spine program at Weill Cornell Medicine in New York City, and I'm one of the co-directors of ArcSpine at New York Presbyterian Hospital in New York City.
And Dr. Haro, can you talk about the top three trends you're following in healthcare and in spine surgery today?
Sure. We have an integrated and very large program now. We're at New York Presbyterian Hospital in New York City. And what we've done over the last 10 years is really integrate the spine programs at Columbia Cornell under the umbrella of New York Presbyterian Hospital.
And in that role, of course, and I do this together with Larry Lanky, who's like Dean Cha, who are my main counterparts at the Columbia campus, and with Dan Ruh here at Cornell. But obviously working with a large group of healthcare providers, surgical, non-operative, from really multiple disciplines that are all importantly involved in the care of patients with back issues.
You know, there's so many things that come up all the time that are really relevant and sometimes directly related to surgery, sometimes a little bit outside surgery. But what I've seen over the last year has become really more and more interesting and I think relevant in our care of patients with back and neck issues is certainly, I would say there are three things.
There's artificial intelligence, of course, as in many aspects of life and health care.
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Chapter 2: What are the top three trends shaping spine care today?
What I see evolve more and more is biologics, you know, disc repair, especially for degenerative disc disease. I'm not talking about fusion biologics, really more biologics in terms of disc repair, disc regeneration, and sometimes even disc replacement.
And then finally, as a surgeon in the operating room who's very excited about minimally invasive spine surgery, I think that whole area of navigation and robotics is really fascinating. So those are the three. areas that I follow very closely amongst many others, but those are three areas within spine surgery and medicine, spine medicine, that I think are the most exciting.
Artificial intelligence, biologics, and the whole area of navigation and robotics.
You know, I want to hone in on what you're talking about with biologics. It's still, you know, very there needs to be a lot more research in this area and spine orthopedics. And I'm wondering what kinds of innovations in spine biologics could elaborate more on what's exciting you in that area and what you think will really define this year when it comes to spine biologics.
Yeah, I think the challenge with spine biologics is partially, obviously, the regulatory pathway that has really challenged our ability to pursue some of the fascinating strategies that come to mind when you're thinking about degenerative disc disease and biologics. I think we've got a lot of data now.
showing that augmentation of disease discs with various types of stem cells, autologous or allograft stem cells, holds a significant promise. What I'm very excited about is our current work on angular repair because, you know, one of the biggest untapped needs in spine surgery is that whole problem of recurrent disc herniation in patients who have a discectomy in the cervical or lumbar spine.
And then there's not much that we can do really to prevent the disc from further degenerating or even reherniating.
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Chapter 3: How is artificial intelligence transforming spine surgery?
So the whole area of recurrent disc herniation and the opportunity that I think biologics can potentially give us here to prevent that from really happening over time. I've done a lot of research in my lab. I work with a biomedical engineer up in Ithaca, Larry Bonassa. We've been working together for many years on disc repair, regeneration, replacement.
But what we've done now more recently is really try to bring to the forefront the whole area of annual repair. We use collagen glues, plus-minus cells. We just started a small company, a startup company, that will hopefully be able to bring this through the FDA into clinical trials. And that for me is really one of the most exciting things because it seems such a simple problem.
How do you prevent recurrent disc herniation? But it's really a totally untapped problem. We don't really have a good solution. And there's so many patients and hundreds of thousands of patients every year who have lumbar disc herniation who undergo surgery and they all ask the same question, you know, how can you prevent that disc from reherniating? And we just don't have an answer.
Chapter 4: What innovations are being made in spine biologics?
To me, this is one of the most basic issues in spine surgery currently. So I'm very excited about that. And I know we've got some mechanical solutions. You know, we've got Barricade. There's another small company from Israel, Spinol. that has a little implant that's not FDA approved at this point. But I'm not sure that implants are really the final solution.
I think there has to be some kind of biological intervention, either in isolation or together with some type of implant that help us regenerate and repair that annular defect. And that's something that I'm very excited about.
And I imagine everything with exploring these biologics, it sounds like you probably would need to have a lot of multidisciplinary collaboration and just kind of work with others just beyond just spine itself.
Yeah, I think that's crucial. And that brings me to another point. If you want to do this type of research, clinical research, you need a team of multidisciplinary specialists. And that's exactly why we started OxSpine. in New York City, which is really a combination of operative and non-operative providers.
Chapter 5: How does multidisciplinary collaboration enhance spine care?
We just opened, actually a year ago, exactly one year ago, we opened Prospiral, our spine center in Hudson Yards, where we have 60,000 square feet. And it's the first time that Columbia and Cornell doctors work together in one space. And we've got 25 surgeons. We've got 30 non-operative spine providers. We've got physical therapy, radiology.
So this type of research, if you want to do this type of research where you really include patients, you need a multidisciplinary team of specialists that all work together. And that's exactly what we have now.
Yeah, have there been any hurdles, any challenges when it comes to bringing together all these specialties or has it been smooth sailing for the most part?
Yeah, I wish it was smooth sailing. It's not. In our case, it really worked because I mean, as individual physicians, we all want to work together. The problem is then bureaucracy comes in the way and the bureaucracy in terms of the logistics, the infrastructure, the financial aspect.
In our case at Oxfam, it worked because it was really obviously envisioned by individuals, but then really supported and put into practice by the hospital and by the universities, you know? And I think that's really important.
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Chapter 6: What challenges arise in creating integrated spine programs?
If you want to build something like a multidisciplinary spine center, you need the support of the overarching structure. And in our case, that's the hospital and the university. And that's the key to success. And unfortunately, we've had that and we have that. But obviously, then you also need the individual subspecialties, departments and so forth to all be willing to work together.
Yeah, absolutely. And do you have any advice for hospital leaders who they see your example and they want to replicate that on their own? What would be the biggest piece of advice you'd have for creating a more integrated spine orthopedic neurosurgery program?
Yeah, that's a great question. It didn't happen out of the blue. On the Cornell side, we've had experience building a spine center since the early 2000s, and it was really initially just... a bunch of surgeons and non-operative doctors who had an interest in spine. And we started meeting every week, and we had a conference. We had a case conference.
We found a neuroradiologist with an interest in spine.
Chapter 7: How can AI improve surgical workflows and patient outcomes?
Then we had two surgeons, myself, somebody else. We had one of the pain management guys, one of the PM&R physiatry doctors. And a physical therapist and a neurologist, actually. And we all, you know, we were like similar age group. We all had an interest in spine. And we decided to meet up once a week and discuss cases that we had seen in clinic where we had some questions or we wanted input.
And that's really how the Spine Center started in our case here 20 years ago, 20 plus years ago. And then it slowly evolved. And then we decided to see actually patients together. So we moved our clinic schedules around and we found a location where we could actually see patients together within the hospital. And then slowly, and then we tracked volumes.
We tracked patient volumes, surgery volumes. We could show that it increased our productivity. And that's how the hospital started paying attention. And then slowly you get the hospital on board.
Chapter 8: What is the importance of patient communication in spine surgery?
So really just kind of looking at the numbers, it sounds like that's the key to everything.
Yeah. So it takes a long time. It's a slow process, but that's kind of how it worked in our case.
That's great. And, you know, I want to pivot back to what you're saying about AI as well. Obviously in 2025, AI in healthcare is a, you know, it's really exploded. It's huge, a huge talking point among, you know, physicians, leaders, and I'm wondering, you know, how, how are you using AI in your practice right now? What are you going to do the same, do differently?
Yeah, I mean, I think AI penetrates every aspect of our lives as individuals and as surgeons. And the key is to try to make it, you know, make it safe, make it effective, and to make sure you don't lose really some of the principles of how we take care of patients, of course. You know, I certainly, I mean, our practices, it's helpful for preoperative Evaluation of patients, literature reviews.
If you're not sure about what's out there in the literature, AI is a huge advantage in that regard. It can really help you review the literature very quickly, make certain decisions in terms of surgical procedures. Obviously, you always got to double check.
The other thing that I use AI for increasingly in working with some of the companies who are involved in navigation and in intraoperative, you know, stereotactic navigation and robotics is the whole area of AI and, for example, automated segmentation. Or, you know, I work with BrainLab, for example, to come up with a workflow
to use augmented reality through a microscope or exoscope to facilitate the workflow for MIS-T lift surgery, right? MIS-T lift surgery is a great operation because there are certain landmarks that you use with every operation.
And using AI and using intraoperative or preoperative imaging, you can automatically have the software identify these landmarks and then indicate or highlight these landmarks while you're doing the operation. And those landmarks become relevant at different parts of the surgery.
So you can literally then the AI have you guide through an operation from A to Z, depending on the landmarks when they become relevant. That's one of those things that I'm working on that I'm very excited about that goes way beyond just putting screws into the spine. This is really just facilitating the workflow.
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