What have been your most memorable cases and why?
I have had several memorable cases, including a 22-year-old male whale trainer from Sea World. He was crushed between two whales and the impact essentially ripped him partially apart through his middle. He presented with femur fractures, perineal tear and pelvic separation with a traumatic isthmic L5 spondylolisthesis, sagittal sacral and L5 fractures with some separation. His first operation was an emergency laparotomy and colostomy. We then placed his femur in traction and performed posterior L2-S1 screw/rod (first generation modular) instrumentation, realigning his sagittal split of his sacral and L5 body fractures and pulling L5 back over the sacrum and fusing him. We then “rodded” his femur. After all that he remained neurologically intact. He eventually healed all areas (though he developed a flat back later in life). He became an orthopaedic device distributer, is married and has children, and someone I see on a fairly regular basis (he does not sell spinal instrumentation).
Another memorable case was a 19-year-old freshman [first-year university student] who was a star swimmer for Notre Dame University (Indiana, USA). She had severe paraparesis as the result of a team bus crash. She underwent surgery in a local hospital with posterior instrumentation and fusion, without cord decompression or spinal realignment. She had some minor functional recovery, but could not ambulate, though she could transfer with help, and did not have normal bowel or bladder function. Over a six-month course her recovery stabilised, at a minimal level, but the rods started to cut out of the bone. After researching spinal surgeons, her father and Notre Dame sent her to me in San Diego, about the time the rods punctured through her skin. We performed staged procedures, first removing her posterior instrumentation and then performing an anterior thoracotomy, corpectomy, cord decompression, and strut fusion, followed by posterior instrumentation and fusion (this was with hooks and rods as thoracic pedicle screws were not yet used in this country). She had a remarkable recovery and regained almost all function, though she still had a neurogenic bladder, but now only catheterises twice a day as she regained spontaneous urination and relatively normal bowel function. A few years later she invited me to her wedding. During the father-daughter dance she left her father and came to me to dance and she whispered in my year “you are the only reason I am dancing at my wedding”.
You are renowned for your patient care, being recognised by America’s Top Doctors as one of the country’s best orthopaedic surgeons. In your view, what are the basic tenets of good patient care?
There are several tenants to good patient care, including listening to patients’ complaints and examining patients, giving adequate time to each patient, and responding, as appropriate, to their hidden concerns (ie, many patients with back pain feel they have cancer and ordering X-rays and MRIs may alleviate those fears). Also, appropriately using available clinical/basic science studies when developing treatment plans, and/or to assess new treatment plans/devices.
As the incoming president of the International Society for the Advancement of Spine Surgery (ISASS), what will be your goals when you become president?
During my one-year term as president, I would like to focus on the following goals:
- Continue ISASS’s growth, stature and reputation, and evolve to the point that we are perceived as the “go to” society for spinal surgeons, internationally as well as in the USA. This involves positioning us not only as an educational resource for surgeons, but also as the best place to turn to learn about new technologies and innovative solutions to spinal disorders.
- Accelerate our expansion internationally. Spinal surgeons gathering from countries around the world have much to learn from, and teach, each other.
- I would like to see ISASS evolve as a society intent on creating and nurturing a community that highlights the incredible value that appropriate spinal surgeries can bring to improve patients’ lives. We need to continue to focus on the advances in the field that bring real clinical benefits to patients.
Outside of medicine, what are your hobby and interests?
Hobbies and interests outside of medicine? You have got to be kidding! Fortunately for me I work in an academic institution, in academic spinal surgery. I have a huge clinical practice. However, if I get bored with that I can fall back to teaching and research and/or the dreaded administrative work which never ends. As chairman of a highly rated Department of Orthopaedic Surgery with an exceptionally active clinical (clinic and surgery) practice, these four areas never give me a lot of free time. I do, however, travel a lot, though almost always for meetings, but it does allow me to get to wonderful places to see friends and take advantage, to some degree, of the opportunities of travel. We do live in San Diego which has many more nice days than not, just to be outside. It allows me to jog on a regular basis outdoors, on the edge of the water (bay or ocean) and kayak from our house in the summer. Having said that, we have a new, and first, grandson who may change (and in fact already is) everything and hopefully will expand, or in reality give me, interests “outside of medicine”.
Fact File
Appointments
2011–present Distinguished professor and chairman, Department of Orthopaedic Surgery, University of California, San Diego, USA
1996–2011 Professor and Chairman, Department of Orthopaedic Surgery, University of California, San Diego, USA
1989–1996 Professor, Department of Orthopaedic Surgery, University of California, San Diego, USA
Training
September 1982 Board certification, American Board of Orthopaedic Surgery
1980–81 Fellowship (disorders of the spine), Pennsylvania Hospital, Philadelphia, USA
1975–79 Residency (orthopaedic surgery), University of California, San Diego, California, USA
1973–75 Military Service, US Public Health Service
1972–73 Internship (surgery), University of California, San Diego, USA
Awards (selected)
2009 Distinguished Service Award presented by the Western Orthopaedic Association
2005–2011 San Diego Physicians of Exceptional Excellence—Top Doctors in San Diego, San Diego Magazine
2003 North American Spine Society, David Selby Award for Contributing Greatly to the Art and Science of Spinal Disorder Management through service to NASS
2002–present America’s Top Doctors, The Best in American Medicine, America’s Top Doctors and Hospitals, Castle Connolly Guide
2000 North American Spine Society, Wiltse Award for Leadership in the Field of Spine
Research papers awards
NASS (2), ISSLS (2), CSRS (2), ORS (1)
Societies (selected)
- American Academy of Orthopaedic Surgeons
- American Orthopedic Association
- California Orthopaedic Association
- Cervical Spine Research Society
- Creta Club (International Spine Discussion Group)
- International Society for the Study of the Lumbar Spine
- International Society for the Advancement of Spine Surgery
- North American Spine Society
- Orthopaedic Research Society
- Western Orthopaedic Association
