Pasquale Montesano, MD, still trains hard enough that some mornings he wants to go back to bed afterward.
At 73, the orthopedic spine surgeon practices Jiu-Jitsu, does 80 push-ups and about 30 squats a day, and continues operating.
For Dr. Montesano, who practices at West Palm Beach, Fla.-based Montesano Spine & Sport and DISC Surgery Center at Palm Beach (Fla.), the connection is straightforward. Staying capable of performing spine surgery decades into a career requires taking care of the person doing it.
“I feel as though I can’t stop,” Dr. Montesano told Becker’s. “If I do stop, I feel as though all of this will be lost.”
His advice to younger surgeons, however, extends beyond exercise.
“Younger spine surgeons may underestimate the importance of family, the importance of your close friends and the importance of staying in good physical shape,” he said. “You need to have people around you that have a positive attitude and have a similar drive to exercise and eat healthy.”
Longevity starts long before 73
Dr. Montesano traces much of his endurance to a drive established decades before he became a spine surgeon. His mother developed multiple sclerosis and was paralyzed when he was young. His father, a family physician and World War II veteran, cared for her while maintaining a busy medical practice.
Watching both shaped his ideas about work, resilience and what constituted a legitimate reason to complain.
“I just didn’t have the right to complain,” he said. That sense of obligation followed him into medicine. After surgical training and two spine fellowships, Dr. Montesano joined the University of California, Davis. He entered spine surgery at a time when some of the instrumentation and approaches that would later become familiar were still developing.
He became an early adopter of upper cervical screw fixation and cervical plating and wrote textbook chapters on spinal trauma and fixation.
The technical landscape has changed dramatically since then. So has Dr. Montesano’s career. What has remained is his belief that continuing to operate should depend less on a surgeon’s age than on whether that surgeon can still perform at the level the work demands.
The black belt mindset
Jiu-Jitsu entered Dr. Montesano’s life as an interest and eventually became part of how he thinks about longevity.
He became fascinated with Brazilian Jiu-Jitsu after watching Royce Gracie, a former professional mixed martial artist, compete in the early Ultimate Fighting Championship events in the 1990s. He later trained with members of the Gracie family and ultimately earned a black belt.
“Jiu-Jitsu is a way of life,” he said. “It doesn’t end when you walk off the mat.” For Dr. Montesano, its value extends beyond exercise. The sport requires physical preparation, discipline and a willingness to keep confronting difficulty, qualities he also sees as essential to a long surgical career.
“If you approach anything, whether it be martial arts, spine surgery or day-to-day living, with a ‘black belt lifestyle’ and its inherent physical and mental discipline, you can achieve longevity,” he said.
His own routine remains demanding. He works out daily and continues practicing Jiu-Jitsu with people considerably younger than he is. Some sessions leave him exhausted.
“I think it’s just wanting to strive,” he said.
What younger surgeons may overlook
Physical conditioning is only part of Dr. Montesano’s prescription for a sustainable career. Asked what younger spine surgeons may underestimate, he started with the people around them.
“Family comes first,” he said. It is a lesson rooted in his own upbringing. Long before surgery or Jiu-Jitsu, Dr. Montesano watched his father care for his mother while maintaining his medical practice.
Decades later, he still views the people surrounding a surgeon as part of the foundation that allows a demanding career to endure.
Knowing when you still have it
There is another side to surgical longevity: knowing when longevity itself is no longer the goal. Dr. Montesano does not believe age alone should determine when a surgeon leaves the operating room. What matters, he said, is whether the surgeon can still perform at the level the work demands.
“When people who have no reason to flatter me stop telling me I’m one of the best technical surgeons around, then I might stop operating,” he said. “But I still think I have it.”
He has also experienced spine surgery from the other side of the operating table. Several years ago, after a car crash in Los Angeles, Dr. Montesano underwent spine surgery and later required another operation. The experience reinforced rather than diminished his determination to remain active.
“I’ve got to keep going, and I can’t complain,” he said. For now, he is still operating. Still training. Still testing whether he can meet the standard he has set for himself.
At 73, the question for Dr. Montesano is not simply how long he can remain a spine surgeon. It is how long he can remain the spine surgeon he believes his patients deserve.
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