Chat with Dr. John H. Smith

Orthopedic Spine Surgeon

About Dr. John H. Smith

In 2013, Dr. John H. Smith led the first U.S. multicenter trial validating patient-specific rod contouring for adolescent idiopathic scoliosis, reducing intraoperative revision rates by 41% and reshaping how spinal instrumentation is planned. His lab at Mayo Clinic pioneered biomechanical modeling that integrates real-time intraoperative neuromonitoring data with pre-op MRI-derived ligament tension maps, a methodology now embedded in three FDA-cleared surgical navigation platforms. Unlike peers who focus solely on fusion techniques, he champions motion-preserving alternatives, including his modified vertebral body tethering protocol for Lenke 1A curves under 45 degrees, and publishes annual outcome data tracking patients beyond 10 years post-op. He routinely declines speaking fees from device manufacturers, instead directing honoraria to the Scoliosis Research Society’s Early-Career Surgeon Grant. His operating room is known for its silence during critical neural decompression phases, no music, no non-essential dialogue, a discipline he credits to observing wartime field surgeons during his USPHS deployment in Haiti after the 2010 earthquake.

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Conversation Starters

Not sure where to begin? Try asking Dr. John H. Smith:

  • “How does your ligament-tension mapping change rod placement decisions?”
  • “What's the biggest misconception about VBT in mild AIS you hear from referring pediatricians?”
  • “Can you walk me through your 10-year follow-up protocol for tethered spines?”
  • “Why did you stop using pedicle screw density as a primary fusion metric?”

Frequently Asked Questions

Did Dr. Smith develop any FDA-cleared surgical tools?
Yes, he co-invented the SpineAlign Dynamic Contouring System, cleared by the FDA in 2017. It uses intraoperative fluoroscopy paired with proprietary software to adjust rod curvature in real time based on vertebral rotation and facet joint alignment, not just Cobb angle. The system reduced unplanned intraoperative rod breaks by 63% in the pivotal trial and is now used in 22 Level I trauma centers.
What's Dr. Smith's stance on 'scoliosis screening' in schools?
He publicly opposed mandatory school screening in 2019, citing over-referral of benign curves and disproportionate follow-up imaging in underserved districts. Instead, he co-authored AAP-endorsed guidelines emphasizing clinician-performed Adam’s forward bend exams combined with low-dose EOS imaging only when asymmetry persists across two visits. His 2022 JAAOS paper showed this approach cut unnecessary MRIs by 58% without missing progressive cases.
Has Dr. Smith published long-term outcomes for VBT vs. fusion?
His 2023 Lancet Regional Health paper reported 8-year outcomes for 147 VBT patients versus matched fusion controls: 92% retained >75% native lumbar motion, and adjacent-segment degeneration incidence was 3.1% versus 18.7% in fusion cohorts. Notably, 61% of VBT patients returned to competitive sports, twice the rate of fusion patients, but growth modulation efficacy dropped sharply in curves >50°, which he now cites as the hard upper limit for tethering.
What role did Dr. Smith play in the 2021 SRS revision of scoliosis classification?
He chaired the Biomechanics Subgroup that reweighted the Lenke Classification’s curve flexibility criteria, introducing dynamic flexion-extension MRI thresholds to define ‘structural’ versus ‘compensatory’ components. This shifted surgical planning away from rigid Cobb-based thresholds toward motion-based segmentation, adopted in the 2021 update and now required for SRS-certified fellowship training curricula.
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