'Why Not Me?' spine surgeon leads University Hospitals forward

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Spinal neurosurgeon Xiaofei (Sophie) Zhou, MD, is a pioneer within Cleveland-based University Hospitals. 

She started her 2025 by bringing endoscopic spine tools to the hospital and performed the institution's first endoscopic discectomy.

Dr. Zhou, who's also the associate program director of the neurosurgical residency at UH, spoke with Becker's about the milestone and why she believes a focus on education will make healthcare leaders stronger.

Note: This conversation was lightly edited for clarity.

Question: What is your journey with endoscopic spine surgery, and what was your pitch to University Hospitals, hospitals to invest in this new technology?

Dr. Xiaofei Zhou: I started not that long ago, and my initial interest was the fact that it's just what we're trending toward as spine surgeons and as surgeons in general. We're all looking for the smallest possible way of achieving the same results for our patients, and endoscopic spine is making huge waves in spine surgery. I hadn't seen anybody around me doing it, and I thought, "Well, I'm young. I could do it. Why not me?" 

One of my fellows was also interested. This is a great opportunity for me. It's a great opportunity for all of our residents. 

My pitch to University Hospitals was that we'll be the first in the area. Being the first in anything means that you get first dibs on all of the patients. You get ahead of the learning curve, and I think everybody wants to advance the field. That's one of the great things about being at UH — being at a place that really embraces innovation. Endoscopic spine is not our only thing that we push forward with. We also have robotics, and we have the latest microscope technology. My partners on the neurosurgery side also have the ROSA so embracing new things is our thing.

Q: For late-career spine surgeons this technology is still very new to them. As an early-career spine surgeon, how common was it that you were learning all these new technologies in your training? 

XZ: I think every generation has something new. When I first started training, even doing something like image guidance was relatively new, but now it's considered a standard. Every new step, every new innovation, starts fresh, and people might question it or have some adoption fears. But when tech is good, and when you adapt tech to the needs of the patient population, it has lasting power. Like with any technology the more you get to use it and the more you learn about it, the better it works. I'm sure those things that we do today with endoscopic technology are not going to be the stuff we do in 10 years. We're going to be so much more adept even with the same stuff just because we're going to be better at it.

Q: Where do you see endoscopic spine technology evolving in 10 years?

XZ: I think we'll be targeting more complex things. So, for example, I'm new to the field, so I'm not going to be, you know, the world class endoscopic spine surgeon that some of the leaders in the field currently are, but somebody, everybody has to start somewhere, right? And so where I see some of these people who are leaders in the field, they're targeting thoracic discs, they're targeting cervical discs, they're doing fusions. 

By pushing the envelope every time you do surgery, you're only going to make things better. That's where I see endoscopic spine going. 

I think it right now has limitations in what we can do because of the types of instruments we can fit into the scope. But as engineers come up with new things that surgeons observe, they start recognizing the missing links in surgery. We'll have better equipment to deal with the more complex surgeries, so we might be able to start doing more complicated fusions. We might be able to take more approaches. I think it'll give us just more breath in what kinds of cases we're willing to target.

Q: As a leader in UH's neurosurgery department, are you optimistic or nervous when you think about the spine surgeons that you're training?

XZ: I'm very optimistic. There will always be challenges, and the challenges evolve as we change in our society. But I think that overall every new generation comes out with more skill. We know more now about the spine than we did 20 years ago, and they'll know more in 20 years than we know now. Whatever challenges come through from the different aspects of healthcare, those are all things we can adapt to. Those are all things that will come into play in our practice now and in the future. I do think that people always adapt as long as we give our residents the tools.

Q: What are some other healthcare trends that you're following in 2025?

XZ: Things I'm really focused on are access to healthcare and equality in healthcare. We live in Cleveland, and we're really lucky. There are multiple hospitals with great healthcare, but there are also communities that don't have the fortune of having surgeons who are adept at multiple  types of surgery. They just don't have access to the breadth of healthcare that we fortunately have here in Cleveland. But that's part of the reason why I think residency training and training in general is so imperative because I can only help one patient at a time. But if I can train the next generation to embrace technology and embrace learning, then I think we're going to be able to put out doctors who are adept and can utilize whatever resources they have to help their community. The focus on education in medicine is something we have to return to in 2025.

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