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How Spine Surgery Can Support Mobility · Meaningful Medicine with Novant Health

• 0:04
  Carl (Host): Welcome to Meaningful Medicine, a Novant Health podcast,
• 0:06
  bringing you access to leading doctors who answer questions they wish you would ask.
• 0:11
  From routine care to rare conditions, our physicians offer tips to navigate medical
• 0:15
  decisions and build a healthier future.
• 0:18
  I'm Carl Moroni, and today we'll be talking to Dr.
• 0:20
  Alex Thomas, a neurosurgeon from Novant Health about spine surgery
• 0:25
  and how it can support mobility.
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  Doctor, welcome to the podcast.
• 0:28
  Alex Thomas, MD: Thanks for having me, Carl.
• 0:30
  Carl (Host): I'm glad to have you here and back pain is not an uncommon thing.
• 0:33
  What are some signs that it's more than ACHE's and pains and it's time
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  to be assessed by a specialist.
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  Alex Thomas, MD: Well, absolutely.
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  You said it, Carl.
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  I mean, I think, uh, particularly as we get older, back pain
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  affects more people than not.
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  for better or worse, uh, it certainly keeps the clinic busy.
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  and I think for the most part, And the vast majority of cases.
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  Back pain is just part of life.
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  it's not anything to worry about per se.
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  It certainly can be bothersome or even debilitating.
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  but generally it's not something to be afraid of, or fearful of.
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  When it can be an issue is when there's signs that there's neurological
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  issues along with the back pain.
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  So typically the back pain affects back pain, affects the low back or
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  the lumbar spine, And so we would be looking for symptoms, pain.
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  Numbness, weakness radiating down into the legs.
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  When you start having that, that could indicate, okay, maybe there's a more
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  significant structural issue going on, and maybe it's time, to seek attention.
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  Of course, your viewers are probably familiar with some of the red flags
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  that could indicate something very sinister, like an infection or cancer.
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  you know.
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  Fever, weight loss, night sweats, I'm not talking about those.
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  Those are obviously indications to seek help right away.
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  if you have back pain with those, with those other symptoms.
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  But I'm talking about general kind of degenerative, arthritic
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  back pain, the old, bad back.
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  That's what I'm talking about here.
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  Carl (Host): Sure, doctor, sometimes the path when it comes to healthcare
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  can be a little bit of a challenge.
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  generally, I would guess someone's gonna start with their primary care provider.
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  Is that generally true?
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  And, And then where may the journey go from there?
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  Alex Thomas, MD: Absolutely.
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  I mean, uh, just generic back pain is one of the most common reasons that patient's
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  go see their primary care physician.
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  So you're right.
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  the journey often starts at the primary care physician.
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  And so, And then, And that typically starts the chain of
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  events that usually leads to us.
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  Oftentimes, patient's will get referred first.
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  By the primary care doctor to physical therapy, maybe a chiropractor,
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  uh, or even pain management.
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  And then usually we're the next step from there.
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  Obviously, if there's a profound neurological issue, like leg weakness or
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  a foot drop, an astute PCP is gonna pick up on that and send that patient to us
• 2:53
  right away and bypass those other steps.
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  But for garden variety, back pain, yes, there's definitely a, a chain
• 3:00
  of events that happens before they get to a surgeon's office.
• 3:03
  Carl (Host): so maybe let's talk a little bit about, spinal surgery and
• 3:06
  who's a good candidate for surgery?
• 3:08
  Alex Thomas, MD: Right.
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  So I mean, spinal surgery, uh, to be fair that, that's a very wide net, that,
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  uh, describes a lot of different things.
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  So I'd say.
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  On the spectrum of surgeries that I do, it ranges anywhere from, almost a
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  kind of a very minor pain management procedure all the way up to an
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  extensive fusion at the front and back of the spine for a scoliosis.
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  So, so there's a wide range of things.
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  and typically patient's, kind of progress along that spectrum too.
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  Sometimes they start with just a disc herniation.
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  They require very small surgery, but unfortunately they're.
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  Their, their condition progresses, to need the bigger surgery.
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  So, I think to go back to your question about who needs these operations, it
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  really is kind of patient, dependent and who's the best candidate for this?
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  Obviously, if the patient has bad enough symptoms that we can clearly
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  attribute to an MRI or x-ray findings.
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  Yes, that patient is a suitable candidate.
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  Typically, we will make certain that we've exhausted all conservative measures
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  first, surgeries, particularly in the spine is not to be taken lightly.
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  And so we wanna be certain that patient has tried physical therapy, they've tried
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  injections, they've tried medication management, and despite all that, the,
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  their symptoms cyst, then we say, look, you have to be able to look at yourself
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  in the mirror and say, I tried everything.
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  Now I can go to the next step and, and, and take on this operation.
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  Carl (Host): And doctor, you specialize in minimally invasive surgeries.
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  Maybe you can share more about that approach and, and how
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  that benefits the patient.
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  Alex Thomas, MD: Absolutely.
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  So, Traditionally, you know, nobody ever wants to hear that
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  they need a spine operation.
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  So, when they come to my office, everybody has a horror story about
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  somebody that they knew who had a surgery on their spine that ended badly.
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  And so I'm already, I'm already up against that sort of propaganda
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  or these misconceived notions.
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  But, some of it's warranted.
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  I mean, traditionally.
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  Spine surgery used to be done with big midline incisions at the BA
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  on the back, and I'm certain your viewers haven't seen that, but it,
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  it is a barbaric thing to watch.
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  and it's a miracle that patient's ever get up and walk again.
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  So, so minimally invasive surgery was developed, you know, probably
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  about 20, 15, 20 years ago.
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  The goal of That is to.
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  Treat the pathology the problem in as specific a way as possible without
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  all of that extra collateral damage.
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  How do we treat the problem without causing other issues?
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  because unfortunately, traditional spine surgery could do that.
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  And, And so we've adopted that minimally invasive mindset to
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  all different types of surgery.
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  whether it's fusions, tiny little incisions, very, uh,
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  advanced corridors to the spine.
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  all the way to what I think is the most advanced way to do spine surgery these
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  days, the, the least invasive way.
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  And that's with an endoscope where we.
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  Through, an incision, the size of the tip of your pinky.
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  Come down to the spine, identify a problem with this high resolution
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  camera and treat the problem.
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  It's like you haven't disturbed the spine at all.
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  So, it really has come a long way, even in the, the short time that my career
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  has been since I started in 2010.
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  It's already changed so much and it's only, it only continues to change.
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  Carl (Host): Yeah, I understand you've been at the forefront of
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  offering lateral single position surgery for spinal fusions.
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  Talk a little bit about that technique.
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  Alex Thomas, MD: So lateral single position surgery is something
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  that we pioneered at Novant.
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  New Hanover Regional Medical Center.
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  So, one of the flagship minimally invasive fusion techniques is something that's
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  been around for about 20 years where, We approach the spine from the side.
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  that avoids, again, a lot of that collateral damage from.
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  Opening up someone's back.
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  The problem with That is, is that traditionally once you finished up on
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  the side, you would then take the time to take all the drapes off, reposition
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  the patient to do screws and rods or other work at the back of the spine.
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  sometimes if you have to come to the front of the spine, then you're repositioning
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  the patient all day long, and that's a surgery that can take all day.
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  And so in 2013, we thought.
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  Why are we wasting so much time?
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  Reposition the patient.
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  Why don't we just start to try to do the work at the back while the
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  patient's still on their side?
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  And that's really how it, it, it started.
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  And from there, it's only evolved to really allow us now to treat just
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  about all pathology of lumbar spine with the patient on their side.
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  And one thing that's really cool is.
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  For cases where we have to come to the front of the spine.
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  In the US we typically work with a general surgeon or a vascular
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  surgeon who does the approach to the front of the spine, to get us there.
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  And so what's cool about working with the patient on their side is
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  that while the surgeon's working on the front of the patient, I can be
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  working on the back of the patient.
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  So that simultaneous work allows us to do an operation that used to take six hours.
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  In an hour and a half the importance of that cannot be understated.
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  When you can save someone, a patient that much time under
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  anesthesia, you could imagine how much better That is for the patient.
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  The risk of complications just goes down significantly.
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  So that's something that we're especially proud of.
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  We, we keep trying to push the envelope there and I think our patient's are,
• 8:37
  are reaping the benefits of that.
• 8:38
  Carl (Host): Yeah.
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  From that standpoint, what are you hearing in terms of feedback from patient's?
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  Alex Thomas, MD: it really has allowed us to more successfully treat even the most
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  complex problems in the lumbar spine.
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  So, these are patient's where, You know.
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  They're going home in a day or two after a scoliosis surgery, for example.
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  and they're, they're, they're amazed at that fact.
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  but then, you know, they're coming back with, significant
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  reductions in pain, if not complete resolution of their back pain.
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  And so I think, The patient's really do well, and they appreciate that.
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  and, uh, I think the word's gotten out.
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  about what we're doing down here on the coast.
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  Carl (Host): then that's it.
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  Outcomes, if you're hearing great things about the outcomes the
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  patient's are having, that's, uh,
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  That's, impressive stuff.
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  When you're assessing a patient with back pain or mobility issues, how
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  does physical therapy come into play?
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  You talked about that a little bit earlier, but maybe you could
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  expand on how the, the process of physical therapy for those patient's.
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  Alex Thomas, MD: I think that This is really the mo one of the most
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  underappreciated aspects of, of the care of these patient's.
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  So, it may be surprising to some of your viewers, but as a surgeon,
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  particularly when it comes to these.
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  Even with these advanced techniques that we do, my goal is to avoid having
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  to do that operation on the patient.
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  so how do, how does that happen?
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  I am a huge believer in physical fitness strength, and physical therapy as
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  an avenue to accomplish those goals.
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  And so I, I have seen many patient's who have.
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  Profound structural issues in their spine really dedicate themselves to physical
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  therapy and strengthening of their body.
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  And they get profound benefits and, and a lot of them end up avoiding the operation.
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  I think unfortunately in this country there's the, you know, so many patient's,
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  particularly as they've gotten older, they've spent their whole lives working,
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  sitting in a chair at a desk And that.
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  Does profound damage to the supporting musculature of your spine.
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  And I'm not just talking about the core muscles that you see for, some muscle
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  man who's done a bunch of situps.
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  I'm talking about all the muscles that support the spine, not just the core, but
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  the legs, the glutes, all those things atrophy as we spend all this time sitting.
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  And so.
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  The therapist can help start the patient down that path, to begin,
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  strengthening and rehabilitating to build that strength back up.
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  Patient's when I tell them, look, I need you to dedicate six hard
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  months to therapy and strengthening.
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  Sometimes they roll their eyes, and they think, look, This is not gonna help.
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  This is dumb.
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  but it, it really is shortsighted.
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  'cause I have seen when patient's commit to, to strength training.
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  Commit to something like Pilates, the results can be remarkable.
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  And then you avoid the operation completely.
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  Carl (Host): Oh, well Doctor, you look like you practice what you preach.
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  'cause it, it seems like you're at a standing desk right now.
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  Are, are you
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  Alex Thomas, MD: I, uh, yes.
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  Yeah.
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  You're very stu.
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  Absolutely.
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  And I, and I bought standing desks for every member of my team too.
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  So, It, it's, it's, it's, it's very important.
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  But that's just one, that's just one of many things that are important.
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  Carl (Host): well, I'm, I'm gonna back up and ask about, technology.
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  Earlier you mentioned since you started practicing, so technology
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  is really advanced in this area.
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  And, and you mentioned that with the, the single position that you're
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  doing, where do you see it going?
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  Uh, are there things coming on the horizon that, uh, that you're excited about?
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  Alex Thomas, MD: So, uh, yes.
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  that's what's really cool about, about neurosurgery in the field that I am
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  lucky enough to, to find myself in it's evolving at such a rapid pace.
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  The technological advancements that are occurring in neurosurgery and
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  spine surgery, are truly amazing.
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  And so even, like I said, even since I've started in 2010, it's almost a completely
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  different field, since when I started.
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  And so the things that come to mind in terms of not surgical things,
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  I think we're getting a better understanding about how strength.
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  Contributes to the stability of the spine.
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  I think even compared to 2010, people are much more aware of, the importance
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  of fitness and strength, of course.
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  The GLP one, agonists, like Ozempic or wegovy have just in the past two years,
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  completely changed the landscape here.
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  So you're seeing patient's who were previously obese, previously
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  would require a, some sort of bariatric surgery now can take up.
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  Pill even and see dramatic weight loss.
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  So that in itself, it has some downsides And we, that's a whole
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  nother, uh, podcast episode.
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  but j just the, the profound weight loss that you see really has changed,
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  changed the game for, for spine surgery.
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  so then moving on to surgery, I talked about spinal endoscopy.
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  we are finding ways to treat spinal pathology.
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  Pretty much without even opening the patient up.
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  That's super exciting to me.
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  as an evolution in my career, we now have sophisticated navigation
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  technologies where we can take a CAT scan of a patient's spinal anatomy.
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  Input that into a system And then essentially use that system
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  to guide us straight to the anatomy, of their CAT scan.
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  I know I didn't explain that well, but if your viewers could see that,
• 13:57
  see that in the or, it really is.
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  it's amazing.
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  Previously you'd have to open a patient up and look at all their anatomy.
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  Now you can just use this 3D navigation.
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  and have.
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  Sub-millimeter accuracy when you're putting in screws and rods
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  or spacers into someone's spine.
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  the next thing I think is robotics.
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  Every, everybody, everybody's heard about spinal robotics now.
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  robots have made their way into spine surgery and are becoming more
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  and more useful to help us, treat spinal conditions more accurately.
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  And then last thing, it, it goes without saying any, any podcast on any topic now
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  is gonna mention artificial intelligence.
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  that's going to.
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  I think dramatically change how we diagnose conditions and make
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  sure that we offer the right treatment for the right patient.
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  I think what can still frustrate me sometimes for spine surgery
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  is I can pick a patient who I think is gonna be a good patient.
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  I can execute perfectly on the surgery and still they don't quite
• 14:57
  get the results that they want.
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  Thankfully, This is an exceptionally rare occurrence, but it still happens,
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  and That is really frustrating to be able to sit there and look at a
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  patient and realize you haven't helped them as much as they had hoped for.
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  And so why is that?
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  What are we missing there?
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  And I think.
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  Aggregation of big data with artificial intelligence is gonna help us
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  identify, alright, you know, there's something about this patient, that
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  you may wanna look out for that, may be a little bit of a pitfall here.
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  So that's, that's what's really exciting too.
• 15:25
  Carl (Host): well, doctor, you speak very passionately about all of it.
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  Uh, how did you choose neurosurgery as a specialty when you were
• 15:32
  considering, uh, what field to get into?
• 15:35
  Alex Thomas, MD: It's a funny story, that I tell medical students that I work with.
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  I knew I wanted to do something with my hands.
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  I like building things, taking things apart, And so I
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  knew I wanted to do surgery.
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  I had a lot of outside passions, And so something like neurosurgery was never on
• 15:50
  my radar because I wanted to have, I guess what they call a good work-life balance.
• 15:56
  at Georgetown where I went to medical school, you do six weeks of
• 15:59
  general surgery and three, two week blocks of specialty surgeries, and
• 16:03
  they're basically assigned to you.
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  I had ENT urology and neurosurgery completely arbitrary.
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  I decided I wanted to do something else and I tried to get out
• 16:15
  of the neurosurgery rotation.
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  I emailed the dean and I said, look, I want to do this other thing, anesthesia.
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  Can I get out of neurosurgery?
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  And they said, no, you've already been assigned to it.
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  Nobody else wants to do it.
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  We can't switch it around.
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  And here I am.
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  And so that's how, that's how, that's how arbitrary it can be.
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  I, you know, I, I went on the service.
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  I was blown away by the immediate impact these surgeries were having on people.
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  Everybody seemed happy.
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  And here I am.
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  it was just a, an unlikely path.
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  But, but sometimes those paths are predetermined for you, you know,
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  and you just kind of, you just kind of let let it take you there.
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  And, and, and I'm so thankful I can't, I can't imagine doing anything else now.
• 16:49
  Carl (Host): Dr.
• 16:49
  Alex Thomas, a great conversation.
• 16:51
  We appreciate all the information.
• 16:52
  I will, I will say you've left me feeling a little guilty that
• 16:55
  I'm sitting and you're standing.
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  So
• 16:57
  Alex Thomas, MD: Get yourself a standing desk, Carl.
• 16:59
  Carl (Host): I'm, gonna get a standing desk and I'm gonna try
• 17:01
  to do it right.
• 17:02
  but
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  but
• 17:02
  thanks so much for joining us.
• 17:04
  Alex Thomas, MD: Alright, Carl, take care.
• 17:06
  Carl (Host): To find a physician, visit novant health.org.
• 17:08
  For more health and wellness information from our experts,
• 17:11
  visit healthy headlines.org.
• 17:13
  If you enjoyed this podcast, please share it on your social channels
• 17:16
  and check out the entire podcast library of topics of interest.
• 17:20
  I'm Carl Morones and This is Meaningful Medicine.
• 17:22
  Thanks for listening.