Precision Is More Than Technology

Spine surgery has come a long way. We now have robotic systems, 3D navigation, and real-time imaging that allow us to operate with incredible accuracy. But as much as I rely on those tools in the operating room, I believe there’s something else that plays just as big a role in a successful outcome, surgical finesse.

It is the little things. The way a patient is positioned. The exact angle of an implant. The choice to make an incision just a few millimeters to the left. These decisions are not always obvious but they have a major impact on how patients feel and function after surgery.

Spine surgery is part science, part engineering, and part art. It is in those small adjustments that we often see the biggest improvements.

Why the Details Matter

The spine is not a uniform structure. It is a living, moving, complex system where each part affects the others. Small changes in one area can shift the entire alignment, which means that every decision matters.

When I place an artificial disk or a fusion cage, I am not just thinking about pain relief. I am thinking about:

• How the spine will move tomorrow
  
• How weight will be distributed over time
  
• How to avoid putting extra stress on nearby joints
  

A five-degree tilt in the implant can mean the difference between balanced posture and years of discomfort. That is not something a robot can always decide. It takes experience, intuition, and a deep understanding of anatomy.

Patient Positioning Sets the Stage

Before the first incision is ever made, I spend time making sure the patient is positioned perfectly.

In minimally invasive surgery, we often use small incisions and narrow working channels, which means we have less room for error. If the spine is not aligned properly on the table, everything else becomes more difficult.

By adjusting the head, shoulders, or pelvis even slightly, I can:

• Create better access to the surgical area
  
• Reduce the need for tissue retraction
  
• Improve the angle for implant placement
  
• Decrease the risk of nerve irritation
  

I have seen cases where a small change in table tilt or neck rotation has made the difference between a routine procedure and a challenging one. Positioning is one of those subtle factors that patients never see but always benefit from.

Implant Angle and Depth Influence Everything

When I implant an artificial disk or a screw, I do not just look at whether it fits. I think about how it will function over time.

Placing a disk just slightly too far forward can limit motion. Angling a screw a few degrees off-center can affect spinal stability. Even the depth of a spacer can alter nerve root pressure and disk height.

In the cervical spine especially, where the margin for error is so small, I pay attention to every detail:

• Is the implant centered?
  
• Does it match the contour of the vertebrae?
  
• Will it maintain alignment when the patient sits or stands?
  

These choices can seem minor during surgery but they shape how the spine behaves afterward. They influence motion, posture, and long-term outcomes.

Planning Is Part of the Procedure

Good outcomes start long before the patient enters the operating room. Surgical planning is where small decisions begin to take shape.

I spend time studying each patient’s images, reviewing motion studies, and mapping out different approaches. Sometimes I simulate the surgery virtually or walk through it step by step with my team.

I consider:

• Which levels to address and which to leave alone
  
• Whether to preserve motion or create fusion
  
• What implant sizes and materials are most appropriate
  

One example is deciding between a one-level and two-level artificial disk replacement. That call can depend on the patient’s activity level, disk height, and facet joint wear. There is no one-size-fits-all answer. It comes down to surgical judgment and attention to detail.

The Difference Patients Feel

The beauty of these small adjustments is that they translate into big results for patients.

A patient might not know that I angled their implant five degrees more than planned or positioned their body with extra care. But they feel it when:

• Their recovery is faster
  
• Their pain is lower
  
• Their motion is smoother
  
• Their spine stays healthy for longer
  

I remember one patient who had a two-level cervical ADR. The key to her outcome was restoring her natural neck curve. That came down to placing each implant at the right angle. She walked into her follow-up appointment with full motion, no pain, and a big smile. That is the art of spine surgery at work.

Where Art Meets Innovation

Technology will continue to advance and I welcome every tool that makes surgery safer and more precise. But no technology can replace surgical intuition.

It is the small choices, the ones guided by experience and a deep respect for anatomy, that often make the biggest impact.

As surgeons, we are not just technicians. We are craftsmen. We are engineers of movement. And we have the privilege of helping people live better lives through the choices we make, one careful adjustment at a time.

Spine surgery will always be complex. But in the right hands, even the most complex procedure can become something refined, thoughtful, and effective, not just because of what we do, but because of how we do it.