I grew up in Highland Park, New Jersey, a small town in Central New Jersey not far from New Brunswick. After graduating from Rutgers Preparatory School and Rutgers University, I was awarded a M.D. Degree by Chicago Medical School/University of Health Sciences. I did an internship in general surgery at New York University Medical Center, Bellevue Hospital and residencies in Neurology and Neurosurgery at The Neurological Institute of New York at Columbia Presbyterian Medical Center. During my residency years, I was awarded a Fellowship from the International College of Surgeons to study in London, England at the National Hospital for Nervous Diseases (Queen’s Square) under Valentine Logue, one of Europe’s premier neurosurgeons. After completing my neurosurgery residency, I did two additional fellowships: a clinical fellowship at Memorial Sloan Kettering Hospital at Cornell University Medical College and a research fellowship in the use of electron microscopy on brain tumors at New York University School of Medicine under the direction of Dr. Joseph Ransohoff. Finally, after 4 years of medical school, 6 years of internship and residency and 3 years of fellowship training, I was appointed as an attending Neurosurgeon at both Lenox Hill Hospital and The Mount Sinai Hospital in New York. I still have attending privileges at both hospitals and now am a tenured Clinical Professor of Neurosurgery at the Mount Sinai School of Medicine.
Why did you choose Neurosurgery as your specialty?
Who was the one person or what was the program that inspired you the most? When I arrived at medical school I was not certain how I wanted to specialize. First, I made the choice to go into surgery, rather than medicine, and then I picked my surgical specialty. My first year neuro-anatomy course influenced my choice dramatically. We were required to develop a 3 dimensional model of the brain and to identify each of the different tracks. I used different colored strings to trace the tracks that control pain, motor function, and the senses of touch, of heat, and of position, etc. It was astounding to see in detail how complicated the structure of the brain is and to think about the delicacy of surgical touch needed to work within this complex organ and yet preserve the tracks which enable such a diversity of functions. It is amazing what the brain, along with the spinal cord which is barely the width of a No. 2 pencil, can control; from gross physical movement to the most refined thought process. I never lost this fascination with the central nervous system that this model-building exercise instilled in me.
What are your specialties in regards to spinal cord disorders and injuries?
My surgical focus is on reconstructing the spine to give it stability and, when possible, to reverse impaired neurological function. Most of my cases involve complex problems of the cervical and lumbar spine. Much of my practice involves treating fractures and contusions of the spine caused by trauma; treating primary tumors of the spine and secondary tumors caused by metastasis from another part of the body and treating spine problems related to degenerative disease where the goal is to relieve pain by taking pressure off the nerve and to return motor skills and sensory function to the extent possible. All spine cases, whether technically complex or relatively straightforward, are of interest to me because a successful procedure can make a dramatic contribution to the patient’s quality of life.
What project is of most interest to you now? Are there any projects you are currently working on?
My current project is preparing for the two international neurosurgical symposia in which I will be participating during 2011. The paper I will be presenting focuses on surgery of the cervical spine and a comparison of the advantage of either an anterior or a posterior approach. During my career we have learned how to treat spinal cord problems which were once thought to be untreatable. There’s more progress to be made. Hopefully my analysis will make a contribution to the field.
What are your views on: A cure for SCI? Regeneration of nerves? Stem cells?
During the next decades we hope to see significant gains in the treatment of acute as well as the chronic changes that occur in the spinal cord after injury. At the moment, though there have been advances, there is no single approach, nor treatment, that is certain to have dramatically positive results. The role that stem cells will play in this evolving scientific challenge remains unclear. Developing a technique for the regeneration of nerves to treat spinal cord and other central nervous system injuries continues to challenge neuroscientists worldwide. Both the National Institute of Health (NIH) and the Veterans Administration (VA) continue to make funding available for grants to researchers investigating the alternative ways to treat SCI. Through on-going research has been made, but is not likely to be immediately applicable to curing SCI. With continued focus progress will be made though probably much more slowly than one would want.
Even if there is a cure, recovery will take a long time. ATBF has therefore focused on Quality of Life. Do you agree that this is an important direction to head in?
Quality of Life issues are an extremely important part of the post-trauma recovery and resolving these issues takes a team effort. Professionals with expertise in diverse areas including physical therapy, occupational therapy, psychiatry, mechanical and prosthetic engineering and neuro-pharmacology must all be called upon. Practical counseling on the how-tos of daily living is equally essential. The ATBF focus is on assisting individuals suffering from SCI, and helping their families, to maximize their abilities and to improve their quality of life. ATBF provides unique insights in this arena and should continue to increase its support of these services.
My message to parents, spouses, children and friends of patients with spinal cord injuries is that they should never give into the initial sense of devastation. They should take advantage of organizations like ATBF and enlist medical professionals to assist in developing a program of care and for advice in managing the issues that confront people suffering from SCI on a daily basis. The emotional support of the entire family unit is important. They should not underestimate what can be accomplished. Through ATBF they can find many good examples of individuals who have not let their SCI prevent them from having complete and fulfilling lives.
Many health care companies have moved toward shortening the duration a patient can receive in-hospital rehabilitation. In your opinion, do you believe health care companies are fair to patients in terms of coverage for length of rehabilitation? Have you seen a reduction since you first became a neurosurgeon? Changes in health care dominate our conversations and fill newspaper columns daily. Unfortunately, it is not physicians but rather politicians who are making the decisions. Many political decisions are made with insufficient understanding of the medical issue being addressed. Many such decisions are focused on “bean counting” and not on quality of care. The politicians merely want to give something to everybody without worrying about exactly what is best for the patient.
A patient’s length of rehabilitation hospitalization should be dictated by his physiatrist and based on what is appropriate for that specific patient. The final say should not be in the hands of an employee of the insurance carrier who is motivated to increase the financial benefit to the insurance company by decreasing a patient’s length of hospital stay and services obtained. However, over my career I have seen that rehab stays have appropriately gotten shorter as technological advances have evolved. With today’s technology, light weight braces and modern techniques of instrumentation among other things, patients can regain mobility much more quickly than in the past. The “one size fits all” length of rehab stay concept is unfair. Each patient is unique and deserves to get the amount of rehabilitation that is appropriate for him or her.
What role does new technology play in your field?
Technology has an ever increasing role in the treatment of acute spinal cord injury patients. Once the gold standard of treatment was to place a patient on bed rest and stabilize his spine with cervical tongs. Then the halo brace was developed. It allowed the patient to be mobilized early but it had its drawbacks. The brace needed to be worn for a prolonged period of time to allow the bones to fuse and over time there was increasing risk of slippage of the brace and pins and of infection. Technology has benefitted our ability to diagnose the problem as well as to treat it. Clinicians working side by side with research and technology partners have developed imaging hardware and software that better visualizes the spinal anatomy and its motion. Also, more sophisticated imaging is now used during surgery to assist in the placement of the stabilizing instrument which results in a shortened procedure. The instruments used to stabilize and decompress the spinal cord have been refined. The new titanium plates, screws, rods, pins etc. allow earlier mobilization and a better quality of life for the patient.
Describe your typical day as a neurosurgeon?
There is no such thing as a “typical” day for a neurosurgeon. The only typical aspect of a neurosurgeon’s day is the variability and surprises; in-patient and out-patient emergencies and unexpected findings during surgery along with the normal vagaries of life make every day different.
However, there are typical activities that comprise a neurosurgical practice. On a day with surgery, most of the day is spent in the hospital. Often the day starts early with making rounds to see the in-hospital patients. Then there is surgery, starting with prepping the patient for surgery, the procedure itself, checking on the patient in the recovery room and talking to the family post-op. The day ends with follow up with other patients, reading CT scans and MRIs and returning calls to patient, families and collaborating physicians. On the hospital days, time also is spent training residents. And, there are numerous conferences to attend such as Grand Rounds, Radiology, Quality Assurance Tumor Board, and Journal Clubs. These meetings help me keep current on new developments in the field and provide an opportunity to get the perspective of other physicians on the treatment of specific patients and conditions.
A day in the office includes seeing new patients on consultation, meeting with pre-operative patients to prepare them for their elective surgery and following up with post-op patients. There also are the administrative issues that come with running a small business and the mountain of paperwork required by insurance companies.
Whatever time remains is filled with research, writing articles, lecturing and participating in local, national and international professional organizations. For me involvement in this aspect of a neurosurgeon’s day has led to a long bibliography of publications and my election as an officer in several NY State, US and international neurosurgical societies.
What is your advice to prospective neurosurgeons specializing in spinal cord injuries?
The young surgeons who go into the field of spinal surgery will find that they have entered a field that is challenging, gratifying and intellectually stimulating. In order to be well prepared for their career, each young surgeon must have exposure to sophisticated spinal surgery which may come in part through a residency program but is enhanced through a fellowship in spine surgery. A fellowship, when well chosen, can give a young surgeon an opportunity to become familiar with different approaches to treating diseases of the spine. Also, young surgeons need to be encouraged to keep an open mind and to think creatively; each patient is different and the treatment protocol must be adapted accordingly to provide maximum benefit to the patient.