Thomas C. Schuler, MD, FACS is the CEO and founder of Reston-based Virginia Spine Institute. In addition to leading the nationally-recognized practice since 1992, Dr. Schuler is also credited with performing the first hybrid multi-level cervical artificial disc replacement with spinal fusion in the nation.
He talked with Becker's about his experience performing cervical arthoplasty, his experience as a patient, and about the future of the field.
Question: After performing your first disc replacement with spinal fusion, is there anything you do differently, now that you've had time to reflect?
Dr. Thomas Schuler: The only thing I do differently now is that I use a device that provides more variable sizes to accommodate different sized patients. The challenge with the Bryan disc that I used in my first hybrid case is that it only has one height, which makes it difficult to insert in smaller patients. This is critical for female patients, since many women have smaller discs.
The first one I did was on a woman, and a smaller implant may have been a better option for her. We used the Bryan, which is a great disc, but it only has one height. If the predetermined height doesn't fit your candidate, then you have to remove more bone to make room for the disc, which isn't optimal. Whereas the Mobi-C disc gives you flexibility in height, and hopefully future generations have even more options, rather than trying to have one implant fit all patients.
Question: How does having the perspective of being a patient allow you to relate to your patients?
TS: It’s an enormous benefit. As surgeons we tell our patients what to expect, but if we haven’t lived through it first-hand, we can’t fully understand the recovery process and healing.
Patients often inquire what I would do if I had their problem and needed treatment. The answer is simple. I would have surgery, and I did. For years this has been a theoretical answer for me, now I have a true first-hand answer. I had to make the choice that the patients have asked me for years: “What would you do if this was you or a loved one?”
This experience has enhanced my knowledge of what patients go through and increased my level of empathy immensely. More specifically, surgeons grossly underestimate how long it takes a patient to recover from a surgery. In reality, for many surgical procedures patients will continue to improve for two years after surgery. That was the biggest thing that I learned through the process. Having undergone several spine and hip surgeries has drastically changed my approach in counseling patients on what to expect postoperatively. Understanding recovery timelines is essential when I am treating professional athletes as well as amateurs. Patients love that I can relate to their impending experience.
Question: Do you think regenerative therapy will ever come to a point where it could surpass surgery as the primary treatment option?
TS: From a volume standpoint, absolutely! As we develop more advanced technology in regenerative treatments and our results prove successful, more patients will seek out this latest alternative to surgery.
When we determine the optimal approach and right combination, there will be far more people that can be treated with regenerative treatments as opposed to surgery. However, some people will still need surgery when it is the appropriate treatment for more advanced or severe conditions than regenerative therapy can treat.
For example, we're utilizing stem cell therapy to heal injured discs. It's a promising option in patients when surgery is not a good option. The future may reveal this as a better option than fusion surgery for patients suffering from severe neck or back pain.
Question: What do you think is the future of spinal surgery?
TS: The future is bright for spinal health care. The challenge is getting third-party payers and the government to agree that the expenditure is worthwhile. Although patients report that these treatments are life-improving, the government and third party payers are looking for ways not to pay for care and as a result are denying care. Payers want all procedures to be proven, prospective and randomized, but that's not realistic or ethical when it comes to spine patients.
It's our responsibility as established surgeons to produce appropriate outcomes data and to document the efficacy of spine surgery so that patients will have access to it. This is the exact mission I am leading as president of the Spinal Research Foundation.
As physicians, we need to continue to practice quality care, make quality decisions and perform precise surgical procedures to achieve success. If we do that, we can vastly improve patients’ lives with the minimally invasive and regenerative treatments we have available. Do what's best for the patients and spinal healthcare will thrive.
Learn more from Dr. Schuler at the 15th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine in June 2017! Click here for more information.
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