Alex Vaccaro is the immediate past president of the Cervical Spine Research Society (CSRS) and a member representative for AO Spine. He talks to Spinal News International about his career in spine care, how the field has changed since he began practicing, the increasing importance of cost considerations in the treatment of spinal conditions, and his work as a spine consultant for the Philadelphia Eagles.
Why did you decide to become a doctor and why, in particular, did you decide to specialise in the spine?
I decided to become a doctor when I was eight years old when I developed a close relationship with my family physician, Frank Ferraro, a man of great integrity, wisdom and knowledge. I decided to specialise in spine when I worked with one of my mentors, Jerome Cotler, whom I consider one of the finest and most compassionate spinal physicians I have ever met.
Have you had important mentors throughout your career? What have they taught you?
I have had several important mentors in my career. Dick Rothman taught me how to think in a logical manner and to provide evidence-based care in a methodical manner to improve the quality of life of those suffering from orthopaedic ailments. Steve Garfin taught me how to manage an extremely busy academic career and how to do complex spinal surgery, and Jerome Cotler taught me the principles of extreme hard work, sacrifice and commitment to excellence in orthopaedics.
How has the field changed since you started your career, and what do you feel has been the most important development?
The most important change that I have noted over my career is the explosion of technology, which has made our ability to provide better care to patients with all sorts of orthopaedic ailments. In spinal surgery, this involved the creation of segmental spinal instrumentation, biologics to improve bony healing, computer-imaged technology to navigate the spine, registries, big data and the appreciation of age-related changes in spinal posture. Later in my career, I have developed an appreciation of the importance of understanding the business of medicine to improve efficiency and decrease the cost of care, minimise redundancy, and wasted variation in treatment.
What do you think are the main challenges facing spine care at the moment? What are the potential solutions?
The main challenge facing spine care at the present time is cost. We have several unanswered challenges that will cost society a lot of money to better understand. This includes the optimal management of spinal deformity in ageing, a cure for spinal cord injury and the optimal management of symptomatic degenerative disc disease. Each one of these challenges costs a significant amount of money. Faced with the growing expense of healthcare, which at present uses approximately 19% of gross domestic product (GDP), this will be very challenging unless we shift the cost curve for medical care for our ageing population in the near future.
What are your current research interests, and what are your future priorities for research?
My current research interests lie in trying to discover the cure for spinal cord injury and the use of advanced technologies to make spinal deformity surgery safer, more efficient and less costly. My institution will continue to look for biological solutions for disc regenerative and novel ways to manage spinal trauma and spinal cord injury.
What is the most interesting piece of research you have read recently?
The most interesting piece of research I have read recently was the use of functional magnetic resonance imaging (MRI) following repetitive head trauma in collision athletes in order to assess for subclinical traumatic brain injury. This has great importance for me as I am the team spine physician of the Philadelphia Eagles football team, and it is obligatory for us to find ways to minimise the long-term effects that repetitive head trauma may pose to young athletes participating in collision sports.
In your opinion, what are the most exciting new developments in spine care that we can expect in the next five to 10 years?
I think the most important development that we can expect in spinal care is the improvement of minimally invasive strategies of accessing the spine through robotic technology, allowing the surgeon to navigate critical neural and vascular structures with the aid of neurophysiological tools to more safely manage complex spinal deformities and minimise the risk of neurologic injury.
You have been an active member of a number of leading spine organisations; how has this helped to shape your career?
I have been involved in many important organisations. I have developed a great appreciation for the importance of leadership and mentorship training through the American Academy of Orthopaedic Surgery and its mission to train young orthopaedic leaders. I am the past president of the American Spinal Injury Association, and I was recently the president of the Cervical Spine Research Society. I greatly enjoy my attendance at the Scoliosis Research Society, and I have found these meetings to be a wonderful venue to connect and network with academic spine surgeons, and to come up with innovative research programmes that are mutually beneficial to all spinal care providers.
You recently served as the president of the CSRS, what do you feel you were able to accomplish in the role?
Our number one goal was to kick-start a cervical spine registry. The importance of collecting data in a registry format will allow study of treatment trends and complications of cervical spinal care. There is interest in combining the efforts of the orthopaedic and neurologic communities to develop a comprehensive spine registry allowing the CSRS to lead the development of the cervical module. Another major achievement was the seamless transition of changing the management company to Executive Director Incorporated (EDI) which was a monumental task and one that went seamlessly.
You have been elected to serve as member representative for AO Spine in 2020. What are your priorities for the position?
As a member representative of AO Spine, I will have the opportunity to contribute to the worldwide strategy of spine surgeon education, training and research. In addition to networking, the international board will prioritise research money allocation, topic and location selection for the yearly meeting, and continued educational course development throughout the world.
What is your proudest career achievement to date, and why?
My proudest achievement along with my wife Lauren, is the upbringing of our children Max, Alex, Julianna, Christian, and Mia. Watching them develop with kindness, compassion and curiosity with an interest in sports, academics, and humanity has been our most cherished achievement.
What advice would you give to someone hoping to start a career in spinal surgery?
If someone wanted to start a career in spinal surgery, I would ask them to figure out what area of spinal care has been least explored and developed. I would spend time developing research protocols and enlisting stakeholders from all areas of science to explore solutions to these unanswered questions. This would include robotic surgery, spinal cord regeneration, and the use of stem cells in intervertebral disk degeneration.
What would you have been if you had not been a medical doctor?
If I had not been a medical doctor, I probably would have become an artist. I used to spend a great deal of time drawing and painting. Now, as a surgeon and father I no longer have the time to enjoy something that was very important to me when I was younger.
Outside of medicine, what are your hobbies and interests?
Outside of medicine I have several hobbies; collecting mint US stamps; travelling; participating in sports and most importantly, raising my children and participating in their activities.
2015 MBA, Temple Fox School of Business
2007 PhD, University of Utrecht, The Netherlands
1993 Spine Fellowship, University of California, San Diego, USA
1992 Resident, Orthopaedic Surgery, Thomas Jefferson University Hospital Affiliated Programs, Philadelphia, USA
1988 Surgical Internship, Cedars-Sinai Medical Center, Los Angeles, USA
Professional positions (selected)
Chairman of Orthopaedics, Sidney Kimmel Medical College, Thomas Jefferson University
Elected president, Rothman Institute
Professor of Orthopaedics and Neurosurgery, Thomas Jefferson University Hospital
- Cervical Spine Research Society (Immediate past president)
- North American Spine Society
- Scoliosis Research Society
- American Academy of Orthopaedic Surgery
- American Orthopaedic Association
- International Society For The Study Of The Lumbar Spine
- International Society for the Advancement of Spine Surgery (ISASS)
Vaccaro AR, Baron EM, Sanfilippo J, et al: Reliability of a novel classification system for thoracolumbar injuries: The thoracolumbar injury severity score. Spine; 2006; 31(11): S62–69.
Vaccaro AR, Hulbert RJ, Patel AA, et al: Spine Trauma Study Group: The subaxial cervical spine injury classification system: A novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine; 2007; 23: 65–74.
Vaccaro AR, Lim M, Hulbert RJ, et al: Surgical decision making for unstable thoracolumbar spine injuries. J Spinal Disord Tech; 2006; 19: 1–11.
Vaccaro AR, Sahni D, Pahl MA, et al: Long-term magnetic resonance imaging evaluation of bioresorbable anterior cervical plate resorption following fusion for degenerative disk disruption. Spine; 2006; 18: 2091–2094.