Latest / Becker’s Healthcare Podcast / David L. Skaggs, MD, Co-Director of Cedars-Sinai Spine

Transcript

David L. Skaggs, MD, Co-Director of Cedars-Sinai Spine · Becker’s Healthcare Podcast

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  This is Carly Beam with the Becker Spine
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  and Orthopedics podcast. And today, I'm thrilled to
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  be joined by doctor David Skaggs, co director
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  of Cedars Sinai Spine.
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  Doctor Skaggs, thank you so much for being
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  here today.
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  Hello. Thanks for having me. Love Beckers. Love
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  keeping up with, what's new in spine.
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  Thank you. I'm glad to hear it. And
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  before we dive into our questions, can you
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  introduce yourself and tell us a bit about
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  your background?
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  Sure. Absolutely. I'm now the co director of
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  spine at Cedars Sinai along with doctor Alex
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  Tuchman, who's the neurosurgical co director. We probably
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  have about 30 spine surgeons here. We run
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  seven or eight spine rooms a day
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  and believe very deeply that a combination of
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  neurosurgeons and orthopedic surgeons working together deliver the
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  best spine care.
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  I was here for five years. Before that,
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  I was at Children's Hospital Los Angeles for
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  twenty five years,
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  And it's, been very invigorating and eye opening
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  to come to an adult spine center
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  and honestly learn about some of what we're
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  gonna talk about today, new technology and how
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  we could make spine care better for children
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  with new technology.
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  Absolutely. And so I know you have a
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  lot of expertise in pediatric
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  pediatric spine
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  area as well. Can you, go through some
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  of the the biggest innovations that you've seen
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  develop in,
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  last few years?
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  Yes.
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  So one of the biggest is just happening
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  right now.
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  It is getting a synthetic
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  CT
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  from an MRI.
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  And it's probably most important in children because
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  children are most,
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  susceptible
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  to radiation.
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  And what it is, it's one of the
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  few things I've seen in medicine where AI
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  actually makes a difference, you know, in practical
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  terms.
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  And now what happens is when we get
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  an MRI,
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  a CT
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  comes out. In addition,
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  really just doing one quick sequence, you know,
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  might take a few minutes longer, and you
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  can get an amazing quality CT that's accurate
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  to within one millimeter,
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  you know, including three-dimensional
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  reconstructions.
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  So for pediatrics, what this does, you know,
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  is save,
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  children from unnecessary
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  radiation.
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  But if we think bigger picture in adult
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  spine, what it could also do is save
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  people from getting two studies.
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  So instead of someone being sent for an
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  MRI and it is separate time being sent
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  for a CT,
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  it could all be done at once.
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  Mhmm. So sounds like it's a real win
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  win both for children
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  and adults as well. Yeah. And if you
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  don't mind, there's eve even more to this
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  one. Yeah. One of the biggest advances,
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  you know, in the past decade or so
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  in spine surgery has been using navigation
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  intraoperatively
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  and robotics
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  intraoperatively.
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  And up until now, that has required
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  a CT scan.
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  And now we can use this synthetic CT,
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  the proprietary,
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  name right now is called bone MRI.
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  We can load that up into navigation,
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  and or robotics.
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  And all of a sudden, we don't radiate
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  the patient,
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  at any point for navigation
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  or robotic usage,
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  which is a a complete game changer.
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  Yeah. And and I'm wondering, you know, when
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  working with pediatric patients, you're obviously
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  smaller patients that are also
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  still growing. What kind of
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  developments are you excited about in terms of
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  just having tools or navigation technologies that are
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  tailored to them?
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  Yes. Great question. So, you know, I have
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  to admit, I never even saw a robot
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  until I came to Cedars.
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  And next thing you know, I'm really just
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  trying to meet my colleagues and go into
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  the rooms and seeing, wow, they're doing
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  incredible surgery through tiny incisions.
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  And, one of my partners, doctor Corey Walker,
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  who was trained at Barrow Institute with Juan
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  Eirebi,
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  taught me how to use a robot.
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  And in,
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  young athletes, and I'll say, you know, kids
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  in college and high school, they frequently have
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  something called spondylolysis,
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  which basically means it's a fracture most commonly
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  of l five.
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  And in the old days, to fix this,
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  you had to open them up and put
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  in screws and rods and hooks. And now
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  with the use of a robot, we could
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  literally make a two centimeter incision or even
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  less
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  and put a screw or screws
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  perfectly across the fracture site. And I never,
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  you know, back in my days at Children's
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  Hospital, imagine I'd be doing outpatient
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  pediatric spine surgery.
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  But the use of robotics and navigation have
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  really changed what we can do.
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  And are there any lessons that you've learned
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  in your time working with adult patients and
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  your colleagues, you know, that you can carry
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  over to working with pediatric patients?
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  Yes. Absolutely. And,
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  one of the things that adult surgeons
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  have taught us
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  is how to align the spine
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  in a way that leads to long term
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  back health and avoiding back pain.
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  And, you know, not to be too technical
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  here, but when we do spondylolisthesis
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  surgery, probably the most important thing is we
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  get l four to s one to at
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  least a 35 degree, if not, you know,
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  40 or 45 degree angle. And as long
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  as we have the lower lumbar lordosis L4
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  through S1
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  to be 35 degrees or over, there's a
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  pretty good chance that we're setting the patient
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  up for long term back health and to
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  be, you know, free of significant back pain
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  due to malalignment.
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  And this is new. This comes from the
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  adult world. And if I wasn't, you know,
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  sitting in a bunch of meetings, learning from
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  my adult colleagues, I probably wouldn't be doing
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  as good of a job on children as
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  we are now.
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  That's really cool to hear. And so so
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  it sounds like less ray radiation,
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  new developments and tools, and just new approaches
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  is what's really
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  the future of pediatric spine.
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  Yeah. Yeah. I learned something interesting. I had
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  a spine fellow last year named Vivian Chan,
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  who's a neurosurgeon.
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  And when using different implants, she says, I
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  can't get my hands around this.
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  And I've now designed five lines of spinal
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  instrumentation. I realized every time I design
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  a tool, I put it in my hands.
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  I go, yep. This feels good. So I
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  have size eight hands and I realized, you
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  know, I owe everyone in the world with
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  small hands an apology.
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  Because without knowing I've been designing things for
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  people with big hands. And my fellow doctor
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  Chan had size five point five hands, so
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  she couldn't quite get her hands around things
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  designed for size eight hands.
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  So
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  I think that this is gonna become increasingly
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  important
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  as we have more women in spine surgery
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  and we have more people with small hands
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  in spine surgery. So I think the enlightened,
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  companies are gonna start designing
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  spine
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  tools for people with small hands.
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  So I I view that as, something I
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  have to apologize and we all have to
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  do better at. And doctor Scabs, there's one
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  other thing I wanted to ask you is,
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  you know, what can training programs for spine
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  surgeons do to better equip them to be
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  leaders
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  in, you know, adapting these pediatric spine tools?
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  So I think
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  one of the most
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  important parts about being a
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  pediatric spine surgeon is getting enough experience.
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  So the truth is there just aren't that
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  many children in the world who need spine
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  surgery, and there's not that many centers in
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  the world that do enough of it to
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  train someone.
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  So it's highly specialized with small numbers.
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  And if somebody really wants to be a
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  pediatric spine surgeon,
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  they either have to go to a pediatric
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  orthopedic fellowship with a huge amount of spine
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  experience,
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  and there's probably only a handful of those,
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  or do a true spine fellowship
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  and then do additional time,
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  at a busy pediatric spine center.
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  And I think this raises a larger question
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  of, you know, how are spine surgeons training?
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  And there's now so many new techniques that
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  many people are feeling increasingly you can't learn
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  it all in one year.
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  And here, I think the neurosurgeons were a
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  bit ahead of the orthopedic surgeons having enfolded
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  fellowships.
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  So So without increasing the length of a
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  fellowship,
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  neurosurgeons are able to do one year of
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  a spine fellowship during their residency.
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  And then if they wanna do something special
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  or go into academics, or I'd say probably
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  more common than not, they then do an
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  additional
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  post residency year fellowship.
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  So a lot are doing essentially two years
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  of spine fellowship.
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  And I think that, the next step for
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  orthopedics is if people are going into spine,
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  the PGY five years should probably be all
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  spine and then do an additional,
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  year of spine surgery. So I think increasingly,
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  if people are gonna subspecialize
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  in
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  endoscopy,
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  MIS, robotics, tumor, pediatric spine, you know, whatever
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  it is,
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  there's gonna have to be a little bit
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  of additional training because there's really just too
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  much to learn for one year to know
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  all of spine and really be good at
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  it all.
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  Right. And just sounds like really you wanna
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  be able to master the specific area and
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  type of surgery of the spine that you
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  wanna hone in on.
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  Yes. Yep. And, you know, it's just
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  like cardiac surgery
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  branched on its own, plastics did, vascular did.
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  You know, as we know more and more,
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  we have to admit that we're not experts
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  at everything. You know, the general practitioner
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  is not doing heart surgery, spine surgery and
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  vascular surgery.
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  Got it. And doctor Skaggs, my last question,
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  I wanna ask you, what are two or
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  three of the biggest healthcare trends that you'll
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  be following headed into 2026?
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  Oh, you know, people get tired of hearing
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  about
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  cutbacks in the government, but I think that
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  that's going to
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  affect us a lot over the oncoming years.
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  You know, there's been good studies in the
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  past showing that if
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  a doctor sees a patient on government insurance
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  such as Medicaid, they actually lose money
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  because their overhead is more than Medicaid pays.
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  So we're starting already from a bad place
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  of access.
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  And if
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  that government support is gonna be cut back
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  even more, I think the patients on Medicaid
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  are gonna have even more difficult time with
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  access to medical care. So I think that's
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  one of them. And, you know, throw on
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  top of it the academic centers are being
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  cut back on research.
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  You know, I think that it's gonna take
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  a long time of going downhill before we
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  have any possibility of unwinding this all. So
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  that's a negative.
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  The positive and it almost sounds trite to
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  talk about AI,
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  but I think that AI really is going
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  to offer us,
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  solutions
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  that are better,
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  faster, and less expensive than existing technology.
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  You know, I think radiology
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  may be leading the field in this. You
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  know, I could imagine many different options such
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  as neuro monitoring during spine surgery. You're doing
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  some great work at Columbia University with Michael
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  Vitale.
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  We're using
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  AI.
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  They could
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  predict
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  when
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  a surgeon is about to lose neuro monitoring,
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  you know, basically meaning the the patient is
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  going paralyzed.
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  You can predict it twenty minutes earlier if
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  AI interprets
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  compared to what we do today is having
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  a neuro monitoring technician, a human being look
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  at it. So I think that AI is
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  really gonna make things safer.
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  Absolutely.
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  Well, doctor Skaggs, thank you so much for
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  joining us today. It's been a pleasure speaking
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  with you, and I look forward to connecting
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  again down the line.
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  Thank you so much. It's great talking to
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  you. Hope we've helped. Have a great day.
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  Thank you.