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23 JUNE 2017 CONFERENCE PREVIEW How Being a Patient Helped Virginia Spine Institute CEO Dr. Thomas Schuler Relate to His Patients By Eric Oliver T homas C. Schuler, MD, FACS, is the CEO and founder of Virginia Spine Institute in Reston, discusses how his approach to spine surgery and patients has changed over the years. 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: e only thing I do differently now is that I use a device that provides more variable sizes to accommodate different sized patients. e 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. is is critical for female patients, since many women have smaller discs. e 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. Q: How does having the perspective of being a patient al- low 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 under- stand the recovery process and healing. Patients oen inquire what I would do if I had their problem and needed treatment. e 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?" is experience has enhanced my knowledge of what patients go through and increased my level of empathy immensely. More specifically, sur- geons 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 aer surgery. at 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. Q: Do you think regenerative therapy will ever come to a point where it could surpass surgery as the primary treat- ment option? TS: From a volume standpoint, absolutely! As we develop more ad- vanced technology in regenerative treatments and our results prove suc- cessful, 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 op- posed to surgery. However, some people will still need surgery when it is the appropriate treatment for more advanced or severe conditions than regener- ative 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. e future may reveal this as a better option than fusion surgery for patients suffering from severe neck or back pain. Q: What do you think is the future of spinal surgery? TS: e future is bright for spinal healthcare. e challenge is getting third party payers and the government to agree that the expenditure is worth- while. 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 prov- en, 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 out- comes data and to document the efficacy of spine surgery so that patients will have access to it. is 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 inva- sive and regenerative treatments we have available. Do what's best for the patients and spinal healthcare will thrive. n Dr. Thomas Schuler will be speaking on "How Can Spine Surgeons, Orthopedic Surgeons and Pain Management Physicians Thrive in a Changing Market" at the conference Friday, June 23 at 1:05 p.m. mandates force them. It is but one example of loss of control. As a private practitioner/owner, it is becoming difficult to keep up with the endless maze of bureaucratic regulations. ACA architects clearly wished to see the end of private practice, especially smaller groups. There has been an 83 percent in- crease in hospitals buying physician practices. I, for one, have no desire to work for my hospital. Neurosurgery is hard enough clinically, technically and it is ever-changing. Adding more bureaucracy and rules to dis- cern when I could better spend my time learning new tech- niques is counterproductive. Having said all this, one thing remains true. I am blessed to be able to do what I do. I have wonderful, grateful patients. I abso- lutely love being in the operating room. Surgery is like comfort food for my soul. n Dr. Thomas Scully will be speaking on "Evolving Busi- ness, Clinical and Competitive Issues in Spine and Pain" at the conference Thursday, June 22 at 2:45 p.m. Dr. Thomas Schuler