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Spine Research Informs Clinical Practice

Richard G. Fessler, MD, is a neurosurgeon at Rush University Medical Center in ChicagoAt a public lecture he once gave on scoliosis, neurosurgeon Richard G. Fessler, MD, PhD, was surprised to see in the audience a patient on whom he had operated just six weeks earlier.

The patient's case had been complicated: Her scoliosis had recently become debilitating, but a previous nephrectomy for renal cancer would make operating from the side — as Fessler planned to do — more difficult.

His extensive research, though, had prepared him for the task.

Fessler, who joined Rush in July, is one of the nation's leading spine surgeons and researchers. With interests that range from stem cell transplantation for spinal cord injury to the effect of patient expectations on outcomes, he is the newest addition to a deep lineup of orthopedic surgeons and neurosurgeons whose research informs spine care at the Medical Center and beyond.

Refining Minimally Invasive Techniques

One of Fessler's main research interests is the development of minimally invasive techniques. And the techniques he has developed — for example, he was one of the first surgeons to perform minimally invasive scoliosis surgery — have significant benefits.

"In scoliosis, our clinical outcomes are equal to open surgery but our infection rate is essentially eliminated, our complication rate is only about one-tenth of the complication rate for open surgery, and the cost drops dramatically," says Fessler, citing the preliminary results of research he is preparing to publish.

Still, he had not expected that his patient, whose coronal and sagittal deformities he had corrected to near-perfect, would be able to take public transportation and then painlessly walk six blocks to his lecture so soon after her operation. Her ability to do so illustrated another benefit of minimally invasive surgery: faster recovery times.

Mining the Data

Kern Singh, MD, an orthopedic spine surgeon at Rush, has decided to focus on such benefits as a part of a larger picture. "It's not enough to say ‘Great, this device or this procedure works better,'" he says. "If the cost is prohibitive and the incremental benefit to the patient is limited, then we shouldn't espouse that technology."

Over the past six years, Singh has analyzed the value of a broad range of spine procedures using the National Inpatient Sample and the American College of Surgeons National Quality Improvement Program databases. His work has resulted in dozens of studies that shed light on spine surgery outcomes, costs and risk factors for complications.

"The value of these studies is that we're looking at half a million to a million data points," Singh says. "We can determine, for example, the average cost of a given complication as well as identify risk factors to help prevent an event like a heart attack or a stroke following a given spine procedure."

Prompted by his findings, Singh has begun doing more in-depth preoperative evaluations of his patients to identify and help control factors, such as diabetes and hypertension, that heighten the risk of postoperative complications.

Building on a Solid Foundation

Howard S. An, MD, director of the Division of Spine Surgery, notes that Fessler and Singh are two among many spine researchers across the departments of orthopedic surgery and neurosurgery, all of them part of a long tradition. An oversees the Medical Center's spine biomechanics and spine biology labs, which for decades have been home to basic science research that seeks to illuminate spine problems. "From basic science to clinical studies," An says, "our research always aims at better patient care."

Rush Physician September/October 2013

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