Spine Surgery Today: What Is Changing? Fabio Tresoldi at the EUROSPINE 2026 Congress

EUROSPINE 2026: What Is Really Changing in Spine Surgery? I am in Gothenburg for EUROSPINE 2026, one of the leading international congresses dedicated to spine care. Endoscopy, cervical spine surgery, robotics, navigation and revision surgery: the technical possibilities available to us continue to expand. But for us as surgeons, this also means a greater responsibility to decide when and how these technologies should be used.

I am in Gothenburg for EUROSPINE 2026, one of the leading international congresses dedicated to spine care. Endoscopy, cervical spine surgery, robotics, navigation and new surgical techniques: the possibilities available to us continue to expand. But for us as surgeons, this also brings a greater responsibility to understand when and how these advances should genuinely be used in the best interests of the patient. Ultimately, the most advanced technology is only valuable when it helps us choose the right treatment for the right patient.

I am currently in Gothenburg to attend EUROSPINE 2026, one of the leading international meetings dedicated to spine surgery and spine care.

For those of us working in this field, exchanging views with colleagues from different countries, reviewing the outcomes of new techniques, and discussing their benefits and limitations are an essential part of our professional practice.

This year’s programme is particularly interesting, and several of the topics being discussed are closely related to my everyday clinical and surgical work: endoscopic spine surgery, complex cervical spine surgery, navigation, robotics and revision surgery.

I could simply tell you about the latest technologies being presented at the congress.

Instead, I would rather start with a different question:

What do these advances really change for the patient?

When we talk about endoscopy, robotics, navigation or minimally invasive surgery, it is easy to assume that the newest technology must necessarily offer the best solution.

That is not always the case.

These are extremely valuable tools, but they remain tools.

The starting point must always be the same: understanding the patient’s condition and identifying the most appropriate treatment for that individual patient.

Endoscopy and Minimally Invasive Surgery: Does a Smaller Incision Mean Better Surgery?

One of the topics being discussed at EUROSPINE 2026 is endoscopic spine surgery, including cervical and thoracic approaches.

This is a field I know well and one that, in recent years, has significantly expanded the range of options available to us.

In selected cases, endoscopic surgery allows us to reach the area requiring treatment through very small approaches, while minimising disruption to the surrounding tissues.

However, there is one important point I would like to make clear.

Minimally invasive does not automatically mean better.

This is a principle I have discussed before when explaining why minimally invasive surgery does not always mean better surgery.

When I see a patient, the first question is not:

“Can I perform this surgery endoscopically?”

The question is:

“What is the problem I need to address, and what is the best way to treat it?”

Only then do we choose the surgical technique.

We should not adapt the patient to the technology available.

We should do exactly the opposite: choose the technology that is most appropriate for that individual patient.

The real question, therefore, is not which technique is the newest, but how to choose the most appropriate surgical procedure for that individual patient and their specific spinal condition.

Cervical Spine Surgery: When a Few Millimetres Can Make a Major Difference

Here in Gothenburg, cervical spine surgery is also receiving considerable attention.

The programme covers advanced cervical stabilisation techniques, as well as other aspects of surgery in this particularly delicate region of the spine.

The cervical spine is anatomically complex. Within a relatively small area are the vertebrae, spinal cord, nerve roots and major blood vessels.

When surgery is required, particularly in more complex cases or when multiple vertebral levels are involved, precision is essential.

But even here, technical precision is only one part of our work.

First, I need to understand which structure is causing the symptoms, which level needs to be treated, and which surgical strategy offers the best balance between the expected benefit and the invasiveness of the procedure.

This is why I often emphasise the importance of a thorough preoperative assessment.

Highly precise technology can help us carry out exactly what we have planned.

But first, we need to make sure we have planned the right procedure.

This is particularly important when we are dealing with complex cervical spine neurosurgery, especially when the spinal cord, multiple vertebral levels or particularly delicate anatomical structures are involved.Robotica e navigazione: il chirurgo conta ancora?

It is a deliberately provocative question.

Robotics and navigation systems are becoming increasingly important in spine surgery and are among the topics being discussed here at EUROSPINE.

They can support us in planning and performing certain procedures and can play an important role in improving surgical precision.

But there is one distinction that I consider fundamental.

A robot can help me perform an operation. It cannot decide for me whether that operation should be performed in the first place.

It does not examine the patient.

It does not listen to their medical history.

It cannot, on its own, establish the relationship between the pain a patient describes and what we see on an MRI scan.

It cannot determine whether a disc herniation visible on imaging is actually responsible for the patient’s symptoms.

And, above all, it cannot replace clinical judgement.

So, when a patient asks me:

“Doctor, what technology will you use for my operation?”

I believe there is an even more important question to ask:

“Why is this operation the right treatment in my case?”

I Have Already Had Spine Surgery, but I Am Still in Pain

Another important topic in the international discussion is revision surgery — cases in which a patient has already undergone spine surgery but continues to experience symptoms, or develops symptoms again.

This is a situation I also encounter in my clinical practice.

A patient may come to see me and say:

“I have already had spine surgery, but I am still in pain.”

Or:

“I felt better after the operation, but now the pain has returned.”

The first thing I do in these cases is not to think about another operation.

It is to understand why that patient is still experiencing pain.

There may be several reasons.

The problem may involve the same level that was previously treated or a different level of the spine. There may be a new nerve compression, spinal instability, a recurrence of the original problem, or another cause that needs to be identified.

In my view, it is precisely in patients who have already undergone surgery that we need to resist the temptation to move too quickly towards another surgical solution.

Having already had spine surgery does not automatically mean that another operation is necessary.

When a second operation is proposed, particularly if it is complex, it can also be helpful to seek a Second Opinion in spine neurosurgery.

This is not necessarily about questioning what has already been recommended, but about gaining a clearer understanding of why further surgery is being proposed, what problem it is intended to address, and what alternatives may be available.

Our Images Are Increasingly Precise. But We Do Not Operate on an MRI Scan

Diagnostic technology has also become extraordinarily sophisticated.

MRI scans, CT scans, intraoperative imaging and surgical planning systems allow us to see the spine in ever greater detail.

But there is one principle that I believe remains important, even when considering the technologies we are seeing here at EUROSPINE:

We do not operate on an MRI scan. We treat a person.

A disc herniation, protrusion or spinal stenosis visible on imaging is not automatically the cause of a patient’s pain.

Two people may have very similar findings on their scans and yet experience completely different symptoms.

This is why I always need to bring several elements together:

the patient’s medical history, their symptoms, the neurological examination and the imaging findings.

Only when these elements are consistent with one another can we begin to seriously consider whether surgery is indicated.

This is also something patients should take into account when considering how to choose a spine neurosurgeon with confidence.

The question is not only which techniques a surgeon uses, but how they reach the diagnosis and determine whether a particular treatment or operation is appropriate.

So, What Is Really Changing in Spine Surgery?

From what I am seeing and hearing here in Gothenburg, the answer is: a great deal.

Surgical approaches are becoming less invasive.

Our ability to visualise anatomical structures is improving.

Navigation systems are providing us with increasingly sophisticated tools for surgical guidance and control.

Robotics continues to evolve.

Endoscopic surgery is steadily expanding the range of procedures that can be performed.

Research allows us to compare techniques, outcomes and complications across increasingly large numbers of patients.

But as the range of options available to us grows, I believe another skill becomes even more important:

knowing how to choose.

Choosing which technique to use.

Choosing how much intervention is truly necessary.

Choosing when a particular technology offers a genuine benefit.

And, above all, recognising when surgery is not necessary.

From EUROSPINE 2026: A Reflection for Patients

The theme chosen for this year’s meeting is “Spine in Motion”.

It is a phrase that aptly describes what is happening in our field.

Spine surgery is evolving rapidly, and international exchange is essential to explore new possibilities, compare outcomes and complications, and understand the limitations of different techniques.

This is one of the reasons why I consider being here in Gothenburg so important.

Keeping up to date does not simply mean learning how to use a new technology.

It means exchanging knowledge and experience with other specialists, reviewing the available evidence, discussing complex cases and, above all, understanding when a new technique truly represents a meaningful step forward for the patient.

New technologies are important when they allow us to provide better care.

Not simply because they are new.

Because ultimately, even when we have the most sophisticated robot or the most innovative surgical technique at our disposal, the fundamental questions remain the same:

What is causing this patient’s problem?

Does this patient really need surgery?

And, if surgery is necessary, what is the most appropriate and least invasive way to achieve the outcome we are aiming for?

These are the questions that must continue to guide our work, whatever technology we may have at our disposal.

What Is Happening to Me? Patients’ Questions

I have been advised to have spine surgery. Should I ask which surgical technique will be used?

Certainly, but that is not the only question I would ask. More importantly, I would want to understand why surgery is necessary, what problem it is intended to address, what alternatives are available, and what results can reasonably be expected.

Is endoscopic spine surgery always preferable?

No. Endoscopic surgery can offer significant advantages in selected patients and for specific conditions, but it is not necessarily the best option in every situation. The technique should be chosen according to the condition being treated, the patient’s anatomy and the objective of the procedure.

If a robot is used, does that make the operation safer?

Robotics and navigation can assist us during certain procedures and provide greater control during specific stages of surgery. However, they do not replace the surgeon’s experience, an accurate diagnosis or, most importantly, the correct indication for surgery.

I have already had spine surgery and I am still in pain. Do I need another operation?

Not necessarily. The first step is to understand why the pain has persisted or returned and to assess the relationship between the symptoms, the clinical examination and the latest diagnostic imaging.

When can a Second Opinion be useful?

A Second Opinion can be particularly useful when complex surgery has been recommended, when several treatment options are available, when the relationship between the imaging findings and the symptoms is unclear, or when a previous operation has not achieved the expected outcome.

Fabio TresoldiSenior Consultant Neurospine Surgeon

For information about specialist consultations or to request a Second Opinion in Neurospine Surgery, please visit the relevant sections of this website.