Becker's Spine Review

Spine Surgeon Leadership 9 How Spine Surgeons Can Succeed With Consensus Building: Q&A With Dr. K. Daniel Riew By Laura Miller K . Daniel Riew, MD, is the Mildred Simon Professor of Orthopedics, Professor of Neurosurgery, and Chief of cervical spine surgery for Washington University Orthopedics. He founded the Orthopedic and Rehabilitation Cervical Spine Institute in 2007, dedicated to the operative and nonoperative treatment of cervical spine disorders. DR:  I think that the personalities involved are key. All our spine specialists, both operative and nonoperative, work well together. The surgeons in both neurosurgery and orthopedics are also fellowshiptrained in spine. We keep the lines of communication open and are willing to help and cover each other when needed. There is great mutual respect amongst all our operative and non-operative colleagues, which makes a huge difference. Dr. Riew has been a member of the board of directors for the Cervical Spine Research Society and currently serves as president. He is also the Chair of the AOSpine Research Commission through 2015. Q: Do you see more spine centers across the country adapting more of a collaborative approach to spine care? Q: What were your goals as you formed the Cervical Spine Institute? Dr. Daniel Riew: Our first goal was to establish a specialty institute for cervical spine surgery. There were other spine centers, but not one dedicated just to cervical spine. The first question was whether we needed a cervical spine-only institute, which was answered very quickly and definitively, as we began to draw patients both nationally and internationally. The second objective was to provide operative and non-operative care within the same facility. At the present time, we are initiating a major effort to integrate orthopedic, neurosurgery and non-operative spine care. Eventually we hope to bring everyone under one roof for a unified spine care facility. We are fortunate in that we have a very good relationship between orthopedic surgeons and neurosurgeons, and we all have joint appointments in both departments. Q: When bringing together several specialists for a multidisciplinary spine center, what does it take to make these relationships successful? Dr. K. Daniel Riew DR: The majority of centers in the United States have specialists working separately and the care is fragmented. I think that for patient outcomes to improve, it's worthwhile to work in a comprehensive, multispecialty spine care setting where you bring in physical medicine and rehabilitation specialists, pain management, psychologists, chiropractors, physical therapists, radiologists, orthopedic spine and neurosurgical spine surgeons. I think that's the wave of the future. Q: Where are the biggest opportunities for spine surgeons to make an impact on the field and improve patient care? Q: Many spine surgeons across the country aspire to leadership roles within their organizations or national societies. What qualities have served you well as a spine surgeon leader? DR: I think research provides the greatest potential for surgeons to make an impact on spine. If we all get together and try to figure out what is the best way to handle a given situation for patient outcomes, we'd be far better off. DR: I think that the best leaders have a vision for the future of the society, an ability to articulate that vision in a way that makes sense to people, and a personality that gets along with people so that they can build consensus and get things done. I aspire to be the type of leader who seeks different perspectives, builds consensus, acts as a team player and maintains a positive outlook on things. I try to be as creative as possible to bring fresh perspectives and ideas to any organization that I am part of. I also don't think we have enough training for spine. Surgeons train in orthopedics or neurosurgery and then go on to a fellowship. I think that it would be better to have multidisciplinary training so that one trains in both neurosurgery and orthopedics and to spend several years just training in spine. The entire educational system for spine surgery can be improved and we need to build consensus regarding the standard of care. n NASS to Washington Post: Don't Condemn All Spinal Fusions By Laura Miller T he North American Spine Society Executive Committee has penned a letter to the Washington Post in response to a story about the necessity of spinal fusions. The article, titled "Spinal fusions serve as case study for debate over when certain surgeries are necessary," ran in the Washington Post earlier this week. While the letter recognized unnecessary surgery as a "serious issue," the authors felt it inappropriate to condemn all spinal fusions. "As in ALL surgical procedures, the key is the surgical indication for the individual patient. Overuse or underuse are both bad medicine and do the patient a disservice. There is universal support for spinal fusion in cases of instability, fracture, tumor, infection and deformity," the letter notes. The letter also outlined NASS efforts to partner with payers on developing evidence-based guidelines for surgical intervention and mentioned spinal fusion as undergoing rigorous scrutiny. n

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