Q: Please tell us about yourself?
I am a general orthopedic surgeon who subspecialized in endoscopic spine surgery partly because of an unfortunate surgical outcome on my mother who sustained complications of a nerve injury and destabilization of her spine following a translaminar decompression. I was convinced that other means of decompression such as foraminal endoscopic decompression would be more effective and have less surgical morbidity. Since gaining valuable experience with the endoscopic approach, I continued to develop this technique with scopes and instrumentation that faciitated the approach for others embracing my approach to spine care
Q: Please briefly describe your research. Why you chose this area of expertise?
I focused on endoscopic spine surgery when I realized that endoscopic spine surgery was as innovative as arthroscopic joint surgery, a technique that grew exponentially in orthopedics. iEndoscopic surgery also facilitated in “opening the door” to less invasive treatment of painful degenerative and traumatic conditions in the spine. I realized that I could see the physiologic effects of visualized patho-anatomy causing chronic pain. Vsualizing the foramen , the disc, and the epidural space with the endoscope with the pateint swake, and after adding laser and radiofrequency to augment decompressive surgery, I realized that I could treat conditions that were causes of painful conditions of the lumbar spine, especially the causes of failed back surgery syndrome. That were not taught in training programs.
Q: What is your greatest career accomplishment? What has surprised you the most about your career?
My greatest accomplishment is the discovery that I had the ability to visualize and correllate the patho-physiology of pain with the patho- anatomy of the pain generator when operating on my patients under local anesthesia. The ability to communicate with my patient during surgery helped me correlate endoscopic findings with pain generation and results of decompression, ablation, and irrigation. I identified “anomalous” nerves such as furcal nerves that communicated with nermal spinal nerves causing confusing a clinical persentation that was not detected by available imaging such as Mri. This accomplishment was met not just with headwinds due to non-acceptance or resistance from spine surgical colleagues, but with occasional rogue uninformed opinions when there was a medical legal senario involving patients being treated for painful conditions of the lumbar spine.
Q: Tell us how Neurosurgery and Spine related research is helping our community? Please share some interesting stats on Spine surgery & treatments.
As a result of my ability to treat the patho-anatomy of pain first, as a staged procedure, 75% of my patients who are otherwise candidates for fusion are able to avoid fusion for 2-10 years even in the face of proven mild instability or deformity. The treatment is visualized endoscopic decompression, ablation, and irrigation without causing the destablizing effects of the translaminar approach.
Q: What are the futures of Spine research? How it will helpful to our community? What kind of changes we will see in terms of technology developments & therapeutic advances?
The future is inhibited by the FDA creating expensive roadblocks in the name of patient safety. Other countries with less restrictive regulatory roadblocks are able to innovate much easier. If we can focus on the pain generator rather than the imaging, Very innovative advances such as intradiscal therapy, nucleus augmentation following discectomy, and biologics will will help provide much more cost effective means of treating back pain and sciatica. The future is bright if the payers and regulators adopt less roadblocks to the future of spine research.
Q: Briefly outline the future of spine research & clinical aspects of spinal disorders?
The future will be a move away from fusion. Fusion is too invasive and costly. The spine will naturally stabilize and “auto fuse” if given source of pain from aging and degeneration is treated timely. We have the capability of effectively treating spinal pain without the surgical morbidity associated with current spine surgical techniques.
Q: What are the key things we can all do to keep our brains safe?
Healthy lifestyles and nutrition will not only keep our brains “safe” but our bodies from aging as fast. Nutrition will keep cells and body parts healthy, but healthy habitat may also help fight off cancerous cells from from replicating in it’s very early stages.
Q: What advice do you have for young scientists?
Pursue areas of interest. It will drive you to heights due to being in your element, driving your interests and work.
Q: What are the potential upsides & downsides of spine and spinal cord in terms of research?
The area is so vast that the most significant research may be regeneration of the spinal cord and injured nerves. The downside is that progress is very slow. The upside is the focus on the treatment of the patho-anatomy and patho-physiology of pain is very doable. It is also the most common condition needing further development and research.
Q: What else would you tell medical students who are considering Spine? Do not get turned away from spine care because we are still in the infancy of spinal care, and the upside potential is great. Over use of drugs and the never ending prescriotion requirement of patients complaining of pain for which there little reward and professional satisfaction. Spine is not a subject for medical students as much as other more pressing conditions that are required in a core cirriculum.