June 12, 2026, Providence Staff Writer
When you ask a spine surgeon about the biggest challenge facing their field, you might expect to hear about complex surgical techniques, emerging technologies, or shifting reimbursement models. But when we sat down with Dr. Shaleen Vira — Chief of Orthopedic Spine Surgery at Banner Medical Center in Phoenix — at Spine Summit 2026, his answer highlighted a more fundamental crisis: modern healthcare is failing to provide timely patient access to spine care because the underlying spine care pathways and routing systems are broken.
"Patient access to spine care is still the major issue," Dr. Vira told us. "Which is rather surprising given that in a major city, there are lots of doctors, lots of healthcare providers. The marketplace is wide. But people with these sorts of complex problems don't get the access that they need, or they don't get the right person to treat their problems."
In this exclusive interview clip, Dr. Shaleen Vira breaks down why expanding patient access to spine care requires a structural overhaul of how we route complex pathologies.
The gap in patient access to spine care matters because the patient population is enormous—and growing exponentially. According to data from the World Health Organization (WHO), an estimated 619 million people worldwide live with low back pain, making it the leading cause of disability globally. Furthermore, research published in The Lancet Rheumatology projects that number will climb to more than 800 million by 2050, driven largely by population growth and an aging global demographic.
This isn't a problem of rare conditions slipping through the cracks. It's the single most common musculoskeletal complaint in the world struggling to find a clear path to appropriate treatment.
What does this access problem actually look like for patients? In Dr. Vira's experience, traditional, uncoordinated healthcare routing creates massive delays between the onset of symptoms and an initial expert evaluation.
"There's still so much of a delay between symptom onset and seeing someone like me — or someone like a physical therapist, or the right physiatrist or pain doctor who could provide non-invasive types of treatments, including injections," he explained.
When health systems rely on fragmented spine care pathways, the entire pipeline suffers from a double penalty:
Extended Lead Times: Spine surgeons surveyed by Becker's Spine Review point to growing appointment lead times as a top barrier, with patients in some markets facing waits of six weeks or more just for an initial evaluation.
The 80% Surgical Mismatch: Research published in Chiropractic & Manual Therapies notes that ill-defined referral processes create immediate administrative bottlenecks. Spine assessment programs report that roughly 80% of patients referred directly to a surgeon by a primary care physician turn out to be non-surgical candidates.
Truly surgical patients end up stuck waiting in line, while non-surgical patients occupy highly specialized clinical slots that don't match the conservative treatments they actually need.
Dr. Vira didn't mince words about how this operational friction feels from the patient's side of the equation.
"The pathways for patients to get the care that they need is still the most challenging, the most frustrating, and probably the most confusing thing that's out there in this very complex healthcare marketplace," he said. "Getting the patient with their problem to the right doctor — the right healthcare professional — is still the biggest runaround, and is the biggest barrier."
It's worth noting that this systemic failure doesn't fall evenly across demographics. Studies have found that spine patients with lower socioeconomic status are significantly more likely to miss in-person appointments—in one analysis, 42% more likely than higher-income patients—often due to transportation limitations, inflexible work hours, or family obligations. When we fail to build clear, equitable spine care pathways, a confusing clinical journey becomes a barrier so high that many vulnerable patients give up entirely.
The encouraging news is that leading health systems are treating care navigation as a solvable operational challenge rather than an unavoidable feature of modern medicine. Dr. Vira pointed to active, intentional efforts at his own institution:
"That's an active area that Banner works on greatly in terms of care pathways. Lots of health systems around the country are actively working on it — and it's very much a work in progress."
To effectively scale patient access to spine care, modernized hospital networks are redesigning their triage structures in three specific ways:
None of these care navigation solutions are completely finished, but the fact that access and clinical pathways have become a strategic priority for major health systems suggests the industry is finally looking upstream.
Ultimately, solving the access crisis requires innovation at every stage of the continuum. While health systems build smarter spine care pathways to get the right patients to the surgical suite, medical technology must focus on efficiency inside it. Delivering tissue-sparing, predictable surgical solutions that optimize OR time and support outpatient or ASC (Ambulatory Surgery Center) transitions ensures that once a patient finally achieves access to the right door, the care they receive is as streamlined as the journey that brought them there.
This video is the opinion of the presenting physician and not medical advice. Consult a healthcare professional for individual diagnosis and treatment.
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