Jeffrey Wang, MD, is a professor of orthopedic surgery and neurosurgery at the UCLA David School of Medicine. He is also the chief of orthopedic spine surgery service and spine fellowship director. 
Dr. Wang has worked with the North American Spine Society for more than 12 years and serves on the board of directors as the director of the education council. He completed his spine surgery fellowship at Case Western Reserve University Hospitals in Cleveland.
Here Dr. Wang discusses several current issues in spine surgery, including the need to seek data-driven treatments and prove the efficacy of biologics.
Question: Why did you choose to specialize in spine?
Dr. Jeffrey Wang: I was always fascinated by spine surgery — its complexity, and intricacy — during my training program. It seemed to be a more delicate type of surgery that required a lot of skill and steady hands. It attracted me the most out of the various specialties within my field. In addition, I had very strong and amazing role models in my training program that were in the field of spine surgery. I do attribute a lot of my interest in this area to the people that were already in this area. They were amazing, compassionate and highly-skilled surgeons, and certainly they had a large impact on me.
Q: Have you worked with any other spine surgeons or mentors who have shaped your practice?
JW: I was fortunate to work with two giants in the area of spine surgery. First, during my residency, I had the honor of working with Professor Edgar Dawson, MD. He was one of the most humble, caring and skilled surgeons that I have ever seen. His approach to spine surgery and his dedication to his patients touched me, and he was an enormous influence on me.
I then was honored to work with Professor Henry Bohlman, MD, for my spine fellowship. Dr. Bohlman was completely dedicated to teaching and shaping the lives of young surgeons. I experienced firsthand an individual who shaped my career and spent his time with my learning as his top priority. The way he approached his fellows and residents, his patients, and the long hours he put into ensuring that we learned all the salient points of patient care and the surgical skills were unmatched. I also saw firsthand, a surgeon who had completely mastered the skill of spine surgery. I am fortunate to have learned from these two talented surgeons.
Q: How has the practice of spine surgery changed since you first graduated from medical school?
JW: Spine surgery and medicine in general have changed tremendously since I graduated from medical school. When I graduated, the focus was on the patient. The well-being of the patient and their overall care was the top priority. We learned to put patient care first, often ahead of our own personal time and our own personal lives. Although the cost of medical treatment was an issue, it certainly did not take priority over the successful care of the patient.
In today's world, cost-efficient care of patients and standardized treatment pathways are becoming a top priority. Insurance companies are dictating more and more of the patient care, and we used to have to fight to get our patients the needed tests for their care. Now, it's an even tougher battle. I do think there are benefits to standardizing care, and many would argue that we can improve quality and reduce complications. However, the burden is increasingly placed on the physician practitioner.
Q: You run a spine surgery fellowship program. When working with fellows, how do you try to prepare them for the evolving industry they are joining?
JW: My primary message to them is to try to learn and anticipate the changes in medicine that are occurring. No one has all the answers and certainly no one can accurately predict the future. Just being aware that the medical environment is changing, will change, and is destined to change, is important. I always try to tell them that they need to understand the underlying motives, and try to look at the positive of the change. And, in some areas, that change will take place regardless of what anyone or any organization will do.
I also try to let them know that they will change. Their perspective on healthcare will change, along with the environment. They just need to be able to see all the different points of view, all the motives of the stakeholders, and be honest with themselves on their own priorities. There is no longer a standardized career path, either in academics or in private practice.
Q: What do you see as being the future of biologics in spine surgery?
JW: I think the future of many of our treatments will be optimizing the biological treatments of spinal disorders, first in continuing the research into the mechanism of disease progression and a greater understanding of how patients develop these spine problems. This will give a greater understanding of the disease progression and potentially what to expect for their patients in the future.
Next, we can optimize the biological technologies that we currently have. We have some great biologics currently available, but very little data on the efficacy of any one individual product or class of products. As surgeons, we are scientists, and we need to demand scientific data to prove that our current biological treatments and bone grafting extenders/options actually work. There is a huge discrepancy between the enormous number of biological products currently on the market and the amount of real, unbiased scientific data showing that these products actually work. We need to see data that proves efficacy. We should not be using products that have no proven preclinical data, or ones that are not at least gathering some data. This is a real problem in spine surgery today.
Lastly, there are many exciting longer-term basic science treatments that I feel with revolutionize spine surgery and the way we treat spinal disorders. These will still take some time to evolve into proven clinical treatments, but I do believe these are the areas where we will have the largest impact and benefit for our patients.
Q: Are you engaged in any spine research currently? What specifically have you been studying?
JW: I currently run a very busy basic science laboratory at the UCLA Spine Center. We are studying a number of biological treatments for spinal issues. We have several new osteoinductive proteins that I believe have enormous potential to safely and effectively heal a spinal fusion. We have been working with two such proteins and are fairly advanced with them. We recently discovered another new protein that we are extremely excited about. It is extremely potent and has minimal inflammatory side effects.
We also believe many of these will have the ability to work with disc regeneration, and we are currently testing them in disc regeneration models. We are also using these in combinations with stem cells, and the preliminary data is exciting. We have also developed a protein that shows the ability to stunt and inhibit spine tumor growth. Another area of interest is the ability to heal challenging spinal fusion environments, such as non-unions and in the aged population. It's too much to cover in specific detail, but suffice it to say, we are very excited about our research activities.
Q: How is the research landscape changing in light of medical device reforms and regulations?
JW: I believe new technology in the form of spinal devices and treatments have been stunted in recent years by the approval and insurance process. It's clear that the approval process and the ability to get compensated by insurance companies, has become a barrier for new technology. In some ways, this was probably needed, as there was an explosion of new spine devices and new spine companies in the last decade. We definitely need to find an appropriate balance between allowing new technology that has evidence to support efficacy, to become a part of clinical treatments. We also need to prevent unproven technologies from potentially leading to less successful treatments. There needs to be a balance in the future.
Q: What are the biggest challenges currently facing the industry?
JW: Increasingly stringent regulations are the largest challenge to the spine industry. However, the industry should rise to the challenge. If they have a new technology, they should do the proper studies to show efficacy. If this is shown, by well-performed and appropriately designed studies, then surgeons should be able to implement this into the treatments for their patients. We should be focusing on the science and doing what works, and getting rid of things that just don't work.
We also need to ensure that the press treats the spine field fairly. I see too often that negative studies are given a heightened awareness in the press. On the other hand, when really good studies that show efficacy of spinal treatments are not even covered in the press, one starts to feel that there is some potential bias that exists in the press.
Q: What is most fulfilling part of practicing as a spine surgeon?
JW: Treating my patients and teaching our young surgeons is enormously fulfilling and a huge part of why I remain in full-time academic practice. Another area of huge satisfaction is the professional medical societies that I work with. I am a member of many international spine societies. One of the most fulfilling positions is my work with the North American Spine Society. I am currently the Educational Council Director, and oversee the educational efforts for the NASS organization. Helping to organize and create these educational programs has enabled me to work with other surgeons, physicians in other specialties, and make an impact on the spine world.
Another organization is a Swiss-based foundation called AOSpine. As Chairman of AOSpine International, I have the ability to lead an organization that is dedicated to the spine education and research on a world-wide basis. We plan educational courses, educational events and have leading research programs on a global basis. These are just some of the activities that I find very fulfilling and help me feel that in some way we are trying to help the entire field of spine surgery.
More Articles on Spine:
Dr. Eric Woodard to Perform Surgeries in FDA Trial of InVivo Device
Study: 7 Challenges of Treating Spine Trauma in Obese Patients
Dr. Jeffrey Carlson Performs Procedure With SpineFrontier's FacetFuse Screw System
Dr. Wang has worked with the North American Spine Society for more than 12 years and serves on the board of directors as the director of the education council. He completed his spine surgery fellowship at Case Western Reserve University Hospitals in Cleveland.Here Dr. Wang discusses several current issues in spine surgery, including the need to seek data-driven treatments and prove the efficacy of biologics.
Question: Why did you choose to specialize in spine?
Dr. Jeffrey Wang: I was always fascinated by spine surgery — its complexity, and intricacy — during my training program. It seemed to be a more delicate type of surgery that required a lot of skill and steady hands. It attracted me the most out of the various specialties within my field. In addition, I had very strong and amazing role models in my training program that were in the field of spine surgery. I do attribute a lot of my interest in this area to the people that were already in this area. They were amazing, compassionate and highly-skilled surgeons, and certainly they had a large impact on me.
Q: Have you worked with any other spine surgeons or mentors who have shaped your practice?
JW: I was fortunate to work with two giants in the area of spine surgery. First, during my residency, I had the honor of working with Professor Edgar Dawson, MD. He was one of the most humble, caring and skilled surgeons that I have ever seen. His approach to spine surgery and his dedication to his patients touched me, and he was an enormous influence on me.
I then was honored to work with Professor Henry Bohlman, MD, for my spine fellowship. Dr. Bohlman was completely dedicated to teaching and shaping the lives of young surgeons. I experienced firsthand an individual who shaped my career and spent his time with my learning as his top priority. The way he approached his fellows and residents, his patients, and the long hours he put into ensuring that we learned all the salient points of patient care and the surgical skills were unmatched. I also saw firsthand, a surgeon who had completely mastered the skill of spine surgery. I am fortunate to have learned from these two talented surgeons.
Q: How has the practice of spine surgery changed since you first graduated from medical school?
JW: Spine surgery and medicine in general have changed tremendously since I graduated from medical school. When I graduated, the focus was on the patient. The well-being of the patient and their overall care was the top priority. We learned to put patient care first, often ahead of our own personal time and our own personal lives. Although the cost of medical treatment was an issue, it certainly did not take priority over the successful care of the patient.
In today's world, cost-efficient care of patients and standardized treatment pathways are becoming a top priority. Insurance companies are dictating more and more of the patient care, and we used to have to fight to get our patients the needed tests for their care. Now, it's an even tougher battle. I do think there are benefits to standardizing care, and many would argue that we can improve quality and reduce complications. However, the burden is increasingly placed on the physician practitioner.
Q: You run a spine surgery fellowship program. When working with fellows, how do you try to prepare them for the evolving industry they are joining?
JW: My primary message to them is to try to learn and anticipate the changes in medicine that are occurring. No one has all the answers and certainly no one can accurately predict the future. Just being aware that the medical environment is changing, will change, and is destined to change, is important. I always try to tell them that they need to understand the underlying motives, and try to look at the positive of the change. And, in some areas, that change will take place regardless of what anyone or any organization will do.
I also try to let them know that they will change. Their perspective on healthcare will change, along with the environment. They just need to be able to see all the different points of view, all the motives of the stakeholders, and be honest with themselves on their own priorities. There is no longer a standardized career path, either in academics or in private practice.
Q: What do you see as being the future of biologics in spine surgery?
JW: I think the future of many of our treatments will be optimizing the biological treatments of spinal disorders, first in continuing the research into the mechanism of disease progression and a greater understanding of how patients develop these spine problems. This will give a greater understanding of the disease progression and potentially what to expect for their patients in the future.
Next, we can optimize the biological technologies that we currently have. We have some great biologics currently available, but very little data on the efficacy of any one individual product or class of products. As surgeons, we are scientists, and we need to demand scientific data to prove that our current biological treatments and bone grafting extenders/options actually work. There is a huge discrepancy between the enormous number of biological products currently on the market and the amount of real, unbiased scientific data showing that these products actually work. We need to see data that proves efficacy. We should not be using products that have no proven preclinical data, or ones that are not at least gathering some data. This is a real problem in spine surgery today.
Lastly, there are many exciting longer-term basic science treatments that I feel with revolutionize spine surgery and the way we treat spinal disorders. These will still take some time to evolve into proven clinical treatments, but I do believe these are the areas where we will have the largest impact and benefit for our patients.
Q: Are you engaged in any spine research currently? What specifically have you been studying?
JW: I currently run a very busy basic science laboratory at the UCLA Spine Center. We are studying a number of biological treatments for spinal issues. We have several new osteoinductive proteins that I believe have enormous potential to safely and effectively heal a spinal fusion. We have been working with two such proteins and are fairly advanced with them. We recently discovered another new protein that we are extremely excited about. It is extremely potent and has minimal inflammatory side effects.
We also believe many of these will have the ability to work with disc regeneration, and we are currently testing them in disc regeneration models. We are also using these in combinations with stem cells, and the preliminary data is exciting. We have also developed a protein that shows the ability to stunt and inhibit spine tumor growth. Another area of interest is the ability to heal challenging spinal fusion environments, such as non-unions and in the aged population. It's too much to cover in specific detail, but suffice it to say, we are very excited about our research activities.
Q: How is the research landscape changing in light of medical device reforms and regulations?
JW: I believe new technology in the form of spinal devices and treatments have been stunted in recent years by the approval and insurance process. It's clear that the approval process and the ability to get compensated by insurance companies, has become a barrier for new technology. In some ways, this was probably needed, as there was an explosion of new spine devices and new spine companies in the last decade. We definitely need to find an appropriate balance between allowing new technology that has evidence to support efficacy, to become a part of clinical treatments. We also need to prevent unproven technologies from potentially leading to less successful treatments. There needs to be a balance in the future.
Q: What are the biggest challenges currently facing the industry?
JW: Increasingly stringent regulations are the largest challenge to the spine industry. However, the industry should rise to the challenge. If they have a new technology, they should do the proper studies to show efficacy. If this is shown, by well-performed and appropriately designed studies, then surgeons should be able to implement this into the treatments for their patients. We should be focusing on the science and doing what works, and getting rid of things that just don't work.
We also need to ensure that the press treats the spine field fairly. I see too often that negative studies are given a heightened awareness in the press. On the other hand, when really good studies that show efficacy of spinal treatments are not even covered in the press, one starts to feel that there is some potential bias that exists in the press.
Q: What is most fulfilling part of practicing as a spine surgeon?
JW: Treating my patients and teaching our young surgeons is enormously fulfilling and a huge part of why I remain in full-time academic practice. Another area of huge satisfaction is the professional medical societies that I work with. I am a member of many international spine societies. One of the most fulfilling positions is my work with the North American Spine Society. I am currently the Educational Council Director, and oversee the educational efforts for the NASS organization. Helping to organize and create these educational programs has enabled me to work with other surgeons, physicians in other specialties, and make an impact on the spine world.
Another organization is a Swiss-based foundation called AOSpine. As Chairman of AOSpine International, I have the ability to lead an organization that is dedicated to the spine education and research on a world-wide basis. We plan educational courses, educational events and have leading research programs on a global basis. These are just some of the activities that I find very fulfilling and help me feel that in some way we are trying to help the entire field of spine surgery.
More Articles on Spine:
Dr. Eric Woodard to Perform Surgeries in FDA Trial of InVivo Device
Study: 7 Challenges of Treating Spine Trauma in Obese Patients
Dr. Jeffrey Carlson Performs Procedure With SpineFrontier's FacetFuse Screw System