From minimally invasive spine surgery to the advent of the internet, seven spine surgeons share what the last real game changers were in their careers, and why.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
Next week's question: Who is the spine surgeon who has had the biggest impact on your career?
Please send responses to Alan Condon at email@example.com by 5 p.m. CDT Wednesday, Nov. 4.
Note: The following responses were lightly edited for style and clarity.
Question: The term "game changer" is thrown around a lot in the industry. What was the first real game changer in your career?
Alexander Vaccaro, MD, PhD, and Bryce Basques, MD. Rothman Orthopaedic Institute (Philadelphia): While spinal instrumentation underwent rapid development at the beginning of my career, from a practice management standpoint, the first real game changer was the growth of the internet, and now the second is telemedicine, particularly with regard to patient education and choice. Patients are now much more discriminating than ever in terms of who they select for their spine surgery, which I attribute to the ease of access to information about spine surgery and spine surgeons.
Second opinions for spine surgery are now the norm, as opposed to the exception they were years ago, and a large proportion of my patients are self-referrals. More recently, I have seen telemedicine break down barriers for patients, much like in the early days of the internet. I predict that this will be a massive game changer going forward.
Todd Lanman, MD. Lanman Spinal Neurosurgery (Beverly Hills, Calif.): The first real game changer in my career was surrounding the development of artificial disc replacement and the FDA approval of them. This provided us with a modality to preserve the motion of a patient's spine through surgery, instead of proceeding with fusions, limiting their function and movement.
More excitedly, through the advent of artificial disc replacement or disc arthroplasty, or the expanded indications of arthroplasty — which include reversing fusions and restoring motion in previously immobilized spines — we have been able to augment a patient's motion, improve their ability to function and retain an enjoyable life, as well as retain their employment by keeping full range of motion of their neck, which is required in many lines of work.
John Burleson, MD. Hughston Clinic Orthopaedics (Nashville, Tenn.): The first real game changer for me was seeing navigation for the first time. It allowed surgeons to see past what the physical operating field would allow them to see. It changed our ability to do some complex revision cases and allows us to do things like placing screws much more safely in certain situations.
Issada Thongtrangan, MD. Microspine (Phoenix): For me, the first real game changer was the early development of the minimally invasive spine surgery era. Now it is accepted worldwide and is the gold standard for modern-day spine surgery. Another game changer in my career is a lateral approach. It changes how I do revision surgery, deformity surgery and it works well for me as a minimally invasive spine surgeon. I predict that the endoscopic platform to be a real game changer as it gains popularity worldwide outside North America. Research on this is exploding and looks very promising. The only problem is the cost and the acceptance of surgeons in the U.S.
Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): The first and most significant game changer in my career was learning minimally invasive spine surgery. I trained in MIS techniques in 2012 and have been performing MIS surgery almost exclusively since 2013. It made a huge difference for my patients. Since MIS surgery is less stressful to the body, I am able to offer it to a wider variety of patients, even those who would have been poor candidates for traditional spinal fusions. My patients usually go home the next day and rarely need admission to a rehab facility or even home health.
Their pain is significantly less and they are able to stop taking pain medications much sooner after surgery. The complication rates are significantly lower — 10-times less blood loss and five-times lower rates of infection on average. While MIS surgery is more technically demanding and requires separate training and utilization of more technology, it offers significant benefits to patients, making the surgery safer, with quicker recovery and better outcomes.
Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Admittedly, the "game changer" in any career is having a path clearly defined and potentially obtainable. The game changer moments for my career fortuitously occurred three times:
1) First, H. Richard Winn, MD, supported my pursuit of neurosurgery whilst an intern at the University of Washington in Seattle. His deportment, bearing and tireless encouragement was evident in his selfless instruction and support of my aspirations. His graciousness allowed for next steps.
2) Next year, Kim Burchiel, MD, emeritus chairman at Oregon Health Science University in Portland offered me a postgraduate training position in neurosurgery. His self-sacrificing commitment to academia, mentorship and work ethic allowed me and so many others to formalize our training and further our careers. His foundations with Arthur Ward, John Raaf and Harold Paxton, dated back to the direct teachings of Dandy and Penfield. A shared and gifted legacy of titans and innovators in our storied field of neuroscience.
3) The next game changer occurred at the complex spinal disorders fellowship at Barrow Neurological Institute in Phoenix with Volker Sonntag, MD, the distinguished professor and vice chairman. Assuredly, having this opportunity exemplified excellence in patient care and the resounding focus in neurosurgical training. Being a small part of such a prodigious legacy conjures extreme pride and humility for a person whose singular question at my entry interview was, "are you a hard worker?" His acceptance phone call to me was one of the proudest moments of my career.
These men in all their individual greatness contingently allowed me and others to be a part of their lives and master craft. I am continually and forever grateful and appreciative of their contributions to neuroscience, their universities and the many patients and communities.