No More Rods and Screws? Why Motion-Preserving Surgery Is Gaining Ground

A quiet disruption is taking place in spine surgery—one that may change how the country treats one of its most common medical problems. 

At the Neurosurgery & Spine Group (NSG), based in Los Angeles, neurosurgeons Dr. Jared Ament and Dr. Amir Vokshoor have developed a pioneering surgical approach known as 360-degree arthroplasty—a combination of artificial disc and artificial facet joint replacement that preserves spinal motion and function, rather than eliminating it through fusion. 

“Honestly, I don't feel like it was a stroke of genius. It just makes sense!” says Dr. Ament about the procedure’s origins. “If each device is designed to replace the diseased native anatomy and work physiologically and kinematically similar to the virgin anatomy, then why not stop limiting patients… and use them together?” 

He explains that the approach was born out of frustration, not novelty. Ament had been involved in multiple FDA trials for ADR and artificial facet joint systems but found each option constrained by the other’s absence. Fusing the spine, he believed, was an outdated fix. 

The result is the country’s first documented series of patients to undergo the 360 procedure—a group now being tracked with promising results. Sixteen patients with 18 months of follow-up. Not a single revision. Almost all patients have resumed normal activities by 3–4 weeks, light activity by 6 weeks, and high-level activity by 3 months. 

One such patient was a retired pediatrician in his 60s who struggled to stand at work and had abandoned the extreme sports he loved. Says Ament, “He is now 15 months post-op and just informed me that he skied 78 times last season.” 

Dr. Vokshoor shares that this moment, when a patient rediscovers their identity through healing, is what drives the work forward. “Our goal is not just pain relief, but the restoration of a person’s whole vitality,” he says. “To go from limitation to high-performance function—that is what regenerative spine surgery should strive for.” 

While fusion remains the default procedure across much of the United States, Ament and Vokshoor believe that needs to change. 

“Artificial Disc Replacement reproduces physiologic motion… It does not take away the motion of that segment,” says Vokshoor. “That’s the entire goal.” 

So why does fusion remain dominant? 

According to Ament, the answer is both structural and financial. “Fusion is so well established due to years of availability that it’s unanimously approved by most insurance companies,” he says. “It is also associated with many more billing codes… the potential for higher profits also likely incentivizes.” 

As a Harvard-trained health economist, Ament has seen the system from the inside. “I have sat around the table with insurance company representatives, often asking a very simple question: ‘Why don’t we make reimbursement the same for the technologies when treating a certain problem?’… Seems to fall on deaf ears.” 

Vokshoor adds that the early skepticism around motion-preserving technology lingers despite progress. “It has become a standard of care due to the high bar of investigating mobile devices and getting them approved through the FDA,” he explains. “It’s also important to note that the very early results of artificial disc in the early 2000s were not as favorable due to implant design issues, but that era is over, and more and more innovations are joining the revolution of motion preservation.” 

Together, the duo is determined to provide patients with options beyond what legacy systems offer. Determining whether someone is a candidate for ADR or fusion, they explain, involves both clinical judgment and broader context. 

“Many factors affect this decision,” says Vokshoor. “Initial mechanical assessment of the spine, dynamic imaging studies, bone health, nerve health, ability to move and exercise, and regain core strength… It’s very important to get the bone to be healthy again prior to surgery.” 

Dr. Ament underscores the data gap in traditional thinking: “Even when fusion works at the index level with respect to pain, it causes a cascade of future problems… Solving a problem by accelerating degeneration elsewhere just doesn’t make sense.” 

Their holistic mindset extends beyond the brain and spine itself. At NSG, the doctors practice what they call “integrative neurosurgery”—an approach that respects the whole-body impact of surgical trauma, the nervous system’s relationship to stress and inflammation, and the individual healing process. 

“I use this term to represent the functional and holistic part of our practice… the interconnected nervous system connections with the gut, immune system, and hormonal balance,” says Vokshoor. “An integrative approach is needed for the patient to have an optimal outcome!” 

Dr. Ament echoes that philosophy. “Understanding pathophysiology and anatomy must be married with appreciation and knowledge around environmental factors, the gut-mind relationship, stress, [and] holistic treatments.” 

Their work also branches into research and innovation. Together, they collaborate on projects with the nonprofit Institute of Neuro Innovation (INI), which Vokshoor founded to unite neuroscience disciplines and address what he calls the “four horsemen” of the nervous system: pain, trauma, depression, and dementia. 

“After my father contracted Alzheimer’s disease, I realized how the independent silos of applied neuroscience… need to truly collaborate to make a meaningful difference in patient lives,” he explains. “INI unites clinicians and scientists… and also serves as a philanthropic org for our integrative practice.” 

Ament, who sits on the INI advisory board, calls it a key part of their research ecosystem. “The INI team and I work very closely on countless research projects and will continue to expand their role and their impact in the future.” 

Their clinical research has also given rise to complementary wellness platforms like Neurovella, which supports patients before and after surgery through modalities like breathwork and neuromodulation. 

“Neurovella is a personal laboratory/observatory for the deep exploration of the mind and how it impacts everyday energy, performance, and healing,” says Vokshoor. “From simple breathwork to psychedelic-assisted therapy… we aim to enhance the lives of the brain spa clients.” 

He adds: “Ultimately, the nervous system can be enhanced by energy modulation electrically, chemically, and through the powerful pathway of neuroplasticity.” 

But at the core of their work is something far simpler. 

“We both would only want done unto others as we would want done unto ourselves,” Ament says. “A familiar rule.” 

Vokshoor reflects this same ethos: “The healing process is deeply sacred to us, and that’s what guides our innovations—not trends, not reimbursement models, but a commitment to elevate the entire patient experience.” 

And together, they’re hoping spine surgery—and healthcare at large—starts following that path. 

This article is for informational purposes only and does not substitute for professional medical advice. If you are seeking medical advice, diagnosis, or treatment, please consult a medical professional or healthcare provider.