How did I get started? Part One

“I was a sports surgeon for my first 16 years of practice”

My first 16 years of orthopedic practice, which began in the early 80’s, was devoted to sports medicine and joint replacement in Long Beach, California. Both of these specialties had “built-in” directives, like “early range of motion” and “minimize collateral soft tissue damage with surgery”. Arthroscopic surgery of the knee and shoulder, performed on an “outpatient basis” made this possible.   

During that 16 years, I was asked to join a very busy 6 man spine group in Long Beach to treat orthopedic problems that were not related to the spine. I was overjoyed because I didn’t completely understand back and neck pain and wasn’t really interested in treating it. 

In addition to not understanding all the causes of back and neck pain, I was at a loss when it came to the language that described the diagnosis and treatment of painful spine conditions. There were conditions like facet syndrome, stenosis, spondylolisthesis and instability. Some of these problems crossed over into what I was familiar with although there was much that didn’t.. 

This Long Beach spine group was not a “regular” spine office. It was one of the first offices chosen by the FDA to perform pedicle screw fixation and there was a fellowship program incorporated into the practice, so there was a constant emphasis on teaching that I was exposed to. Of course I would frequently assist with surgery, so I really got to see it all. I would also make rounds on the weekends to see the 10-20 patients who were admitted for back and neck pain, as well as post surgery. 

For 10 years, I was able to view the treatment of painful spines from an orthopedic surgeon’s perspective, without ever operating on a spine. Over the years, it became very obvious that the rules that guided surgical treatment of the painful spine were very different from the rules to treat knees, shoulders, hips, and the other peripheral joints. Could the spine be that much different from all the other joints in the body ?

I noted two obvious differences between my surgical approach to the major joints of the body and my partner’s surgical approach to the spine. The two differences were not subtle. 

One difference was (and still is) the concept of fusion that is based on the idea that “if there is no motion, there shouldn’t be any pain”, but any review of the fusion literature shows that this is not a valid conclusion. 

The other major difference was the treatment of the soft tissue envelope. Care was taken in my practice to preserve and balance the soft tissues that attach to the bone, whereas in open spine surgery, the soft tissues were just stripped off the bone to access the pathology. I got the sense that all the stripping of the soft tissues resulted in varying degrees of instability. Instability that might require a fusion.  

So what did I do …

Tune in for part 2 next week.