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Originally published March 12, 2026
Last updated March 12, 2026
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John C. Liu, MD, is a neurosurgeon and co-director of the USC Spine Center, part of Keck Medicine of USC, who is considered one of the pioneers of minimally invasive surgical techniques for spine surgery. He also serves as a professor of neurosurgery and orthopedic surgery for the Keck School of Medicine of USC. Here, he discusses spine surgery’s dynamic nature and how its ongoing evolution is bringing major benefits to patients and practitioners alike.
I often tell my residents and fellows that if I’m doing the exact same thing 10 years from now, I’ll be disappointed. And many agree. Perhaps it’s because there’s something about being a scientist and a healer that demands consistent growth, whether through scientific advances, enhanced methodologies or even a clearer understanding of patient-doctor relationships.
Years ago, when I was deciding on a specialty, I kept coming back to the field where techniques and modalities were constantly evolving. Spine surgery is as dynamic as a medical specialty can get.
In my 25 years of practice, I’ve watched the field of spine surgery evolve almost nonstop, with exceptional growth happening in the past few years. The resulting changes have been more than fascinating — they’ve offered clear, substantial benefits to both our patients and our practice.
For decades, spinal fusions have been the gold standard for treating diseases of the spine, such as degenerative disc disorder. They do, however, restrict motion in that part of the spine. Over time, it’s common for the neighboring areas of the spine to degenerate, eventually leading to more surgeries.
Currently, the leading alternative is artificial disc replacement, which can preserve motion — and possibly the overall health — of both the cervical and lumbar spine.
Artificial disc technology is a form of motion preservation that has come a long way in the past 10 years, and more people are recognizing the advantages this approach has over traditional fusion surgeries.
An artificial disc replacement allows for a quicker return to normal activities, without the need for a collar for cervical patients. Once the incisions heal, most patients can move as they did before the disc in question began to degenerate.
Minimally invasive surgeries are smaller-incision surgeries that result in faster recovery, shorter hospital stays and reduced risks of infection. As I write this, minimally invasive fusion and spine decompression procedures continue to advance, and we’ve expanded the indications to involve bigger spine surgeries. Even situations involving tumors or spinal trauma are being resolved through minimally invasive procedures.
Additionally, the surgical techniques themselves are becoming more efficient, safer and more effective each year. As a result, complication risk is significantly reduced in comparison to where it was 10 years ago, particularly in terms of postoperative infection risk.On average, healing time is a fraction of what it used to be, which is both a contributor to and the result of these reduced risks.
The newest, shiniest toys aren’t always necessary, but making intelligent use of assistive technology as it continues to evolve plays a major role in the success of minimally invasive surgery, both in immediate recovery and long-term quality of life.
A major example of this can be found in the use of spinal navigation tools to help us position spine hardware with enhanced safety and precision. And at Keck Medicine, the use of robotics assists us even further, greatly increasing the likelihood of faster recovery.
With a rise in minimally invasive methodologies comes an increase in patients eligible for outpatient surgeries. Many surgical treatments that required patients to spend three to five days in the hospital have either evolved or been replaced by a technique that allows for same-day discharge. This is happening across all kinds of surgery, but this progress has been particularly notable in spine surgery. Currently, the common prediction among my peers is that, in the years to come, the fastest growth in outpatient surgery will be for spine.
The push to widen the application of outpatient procedures is understandable. While reducing cost and keeping beds available for incoming patients with more complicated conditions are beneficial, the real advantage can be found in recovery.
When a patient can recover at home, they feel more comfortable, more relaxed, they sleep better and their loved ones are available for emotional or logistical support whenever it’s needed. This results in reduced stress, which strengthens the immune system and promotes healing.
While there are some procedures that we may never be able to transition to an outpatient methodology, it’s exciting to see an increasing percentage of spine surgery patients able to go home the day of their procedure.
Minimally invasive techniques, motion-preservation technologies, outpatient surgery and procedures that are less likely to result in readmittance (whether in the short term or long term) all result in reduced medical costs for the patients, the providers who care for them and the institutions where the surgeries happen. Additionally, reduced cost means greater accessibility to care overall, helping more people get back to the activities they love.
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