Jeffrey Goldstein

When did you decide that you wanted a career in medicine and why specifically in orthopaedic surgery?

Many people in medicine are strongly influenced by their parents or close relatives when they are young. My parents are both retired teachers and they impressed upon me the necessity to excel in school. From high school, I attended Colgate University with a desire to progress on to medical school. At Colgate, I had a strong liberal arts curriculum and then attended medical school. Initially, I anticipated a career in reconstructive surgery but then gained exposure to orthopaedic surgery early in my internship.

Most of what we do in orthopaedics has a positive effect on quality of life. Our patients are generally healthy and appreciative of the opportunity to gain improved function. I had the opportunity to train with Henry Bohlman at University Hospitals in Cleveland. It was at that point that I had my first exposure to spine surgery. Dr Bohlman’s exemplary approach to patient care and leadership in orthopaedic science served as an example that I wanted to emulate, and I sought out further training in spinal surgery in Baltimore with Paul McAfee.

Which technique or technology has had a profound effect on your career?

Motion preservation and artificial disc replacement of the cervical and lumbosacral spine provided me with my first opportunity to participate in a level one research project. Not only we were able to demonstrate the beneficial effects of artificial discs for the treatment of cervical radiculopathy and degenerative disease of the lumbar spine, but we also were able to acquire level one data that demonstrated the benefits of anterior cervical discectomy and fusion for patients with neck and arm pain as a result of cervical radiculopathy. We also showed the benefits of spinal fusion for the treatment of recalcitrant low back pain.

Additionally, my participation in the Prodisc trials has given me the opportunity to share in the publication and presentation of some of the strongest evidence we have regarding the benefits of spinal surgery for our patients. During the past 10 years, I have shared ideas and learned from, as well as formed lifelong relationships with, many outstanding spinal surgeons, thought leaders, and academics. I have had the opportunity to teach and learn from others around the world and share our experiences of artificial disc replacement.

Who has inspired you in your career and what advice of theirs do you remember today?

I have had both the pleasure and privilege of working with several leaders in orthopaedic surgery. They have contributed to our field in different and unique ways. Dr Bohlman trained a group of leaders who I have had the opportunity to train with and learn from during my residency and fellowship. I did my fellowship training with Paul McAfee, who is also an innovator. Presently I work closely with Joseph Zuckerman, who is chairman of the Orthopaedic Department at New York University (NYU) Hospital for Joint Diseases and a past president of the American Academy of Orthopaedic Surgeons. I also work with Thomas Errico, who is the chief of the division of spine surgery at NYU Hospital for Joint Diseases and past president of the International Society for the Advancement of Spine Surgery (ISASS) and NASS. Both Dr Zuckerman and Dr Errico continue to serve as my mentors and have demonstrated the leadership qualities and confidence that allow them to achieve their goals while letting others participate and excel.

At the NYU Hospital for Joint Diseases, I partner with an esteemed group of spinal surgeons and each of them is accomplished in the spinal field. It is gratifying to collaborate with them as we learn from each other. Our group works well together and we routinely collaborate in the treatment of our patients. We have been successful in regularly attracting to our training programme talented and motivated spine fellows who have also gone out into the community and into academics to take care of patients with spinal disorders. There are many very smart and talented spinal surgeons who I have had the privilege of associating with and learning from.

As a keen inventor what have been your proudest moments?

We have developed a unique surface structure morphology, which allows us to promote and to control fusion and bony ingrowth into spine and orthopaedic implants and devices and thus, increase fusion success and implant stability. By understanding the wound healing process, we are able to control and manage it with our surface morphology to create a better fusion and tissue ingrowth environment.

How has orthopaedic surgery evolved since you began your career?

When I was a resident, one of my professors used to say “I do not need a study…. I know it works”. Well, he had a breadth of experience and was usually right and his patients had good results. However, the same does not hold true today inasmuch we now understand the necessity to use knowledge based on level one data to treat patients. Another one of my professors used to ask during our conferences “Is this what you know or what you believe?” What this meant to me is “Do we have the data to support what we believe to be true?” We have developed an array of treatment modalities for our patients. However, experience alone is no longer adequate support for deciding on treatment algorithms for our patients.

What are the three big questions in orthopaedic surgery that you would like to see the answers to?

• How can we diagnose the source of low back pain?
• Once we identify the source of a patient’s pain, when is surgery an appropriate treatment option and what type of surgery should be used?
• In today’s economic and regulatory environment, how are we going to develop and prove new technologies and who is going to pay for them?