Paul Ho, MD

I started my orthopedic residency in 1980, and the spine training at that time was mostly on the adult service for herniated discs and the pediatric service for spinal deformity. Spinal instrumentation was primarily with Harrington rods, while Luque rods were just being introduced.

Hand microsurgery was at its prime, so after completing orthopedic residency, I served a one-year hand fellowship and then served as a hand surgeon in the U.S. Navy. My first job after the Navy was in private practice in Des Moines, Iowa. I also staffed the residents at the Des Moines VA, and while there, newly minted spine surgeon Dennis McGowan got me interested in pedicle screw fixation—an emerging mainstream technology enabling ever-increasing methods of surgically treating many spinal conditions.

A few years later, I took a new job as faculty at Boston City Hospital, Boston University Medical Center, to cover orthopedics and hand surgery. However, the department also needed spine surgery backup, so I felt it was the perfect time to take a sabbatical during the transition to get more spine training.

I was able to spend two months as an AO Spine Fellow in St. Gallen, Switzerland, with Professor Fritz Magerl and his associates. They were master spine surgeons, great teachers, and true gentlemen. Professor Magerl’s translaminar screw fixation technique to stabilize unstable lumbar motion segments using basic, readily available Synthes bone screws still seems like such a simple and elegant technique.

I later had the privilege to spend a three-month fellowship under Dr. Hansen Yuan—another giant in spine surgery. This broad experience really rounded out my spine training.

During this time and the following years, spine surgery underwent what seemed like an arms race in developing ever more sophisticated and varied spinal instrumentation systems. Every company representative wanted to present their system, and every spine meeting had multiple exhibits of new spinal instrumentation systems.

The discussion of spine surgery during this period is incomplete without mentioning the evolution of minimally invasive spine surgery. I had the opportunity to spend several visits at the clinic of Dr. Anthony T. Yeung to observe and learn from his pioneering work using the endoscope to treat spinal pain generators and to witness the many successful patients he treated using this technique.

There are many tools available to the spine specialist; however, we must be careful to avoid the adage that “when one has a good hammer, everything starts looking like a nail”.

As physicians we have pledged to make the health and wellbeing of our patients our priority. There are many procedures that we can perform, ranging from minor to major, that if not tailored to the patient’s medical condition or specific needs, may not solve the patient’s problem, and at least can cause inconvenience, but in the worst can cause financial hardship or ruin the patient’s life.

The many cases of failed back surgery is a case in point. Many of these patients would have been better off not having had major spine surgery. We as physicians must weigh our treatment decisions carefully and not be seduced by any considerations, not to mention personal gain, financial or otherwise.

Many patients frequently trust their doctors and have the impression that their doctor has the “magic bullet “to effect a successful cure of their illness. They will follow the surgical procedures you recommend. We as physicians must keep this in mind when making recommendations. Additionally, treating a patient with compassion and respect is an important aspect of their path to recovery and also how they view you as a physician.

Developing evidence-based spine care.

I was told to follow the three A’s when I started practicing medicine. Availability, Affability and Ability. I think that it will still hold in 2065.