Dr Charles Branch, President of the North America Spine Society (NASS), talks about the importance of spine societies, new technologies and the development of his wildlife presence.
When did you decide you wanted a career in medicine?
I probably decided in high school. My father is a Neurosurgeon who enjoyed his work. In retrospect, this was a very powerful influence on me and my decision to pursue a career in medicine.
Why did you decide to specialise in Neurosurgery, and why the spine?
Longer answer on this one. I grew up in Montreal, Canada where my father was training with and ultimately an associate of Wilder Penfield and Theodore Rasmussen, pioneers in Epilepsy surgery. This environment was special and gave me a sense of the greatness of Neurosurgery even as a young person. We moved to the States in the late 1960’s when the French Separatist movement in Quebec was raging. My father had to change his special area of interest to Spine because of the needs in San Antonio, Texas, where we relocated. During Medical School at the University of Texas – Southwestern in Dallas, I found Neurosurgery to be the favourite of all my medical school experiences, in spite of a conscious effort to look at other specialties. My father was working too hard I thought and I wasn’t sure I wanted to follow that same path. In any event, I chose Neurosurgery and a training programme in North Carolina with Eben Alexander and David Kelly at the Bowman Gray/Wake Forest program. The emphasis on Spine at this programme, my father’s own interest, and the opportunity to change Neurosurgical Spine from a decompression and never fuse approach to a subspecialty that embraced all of the deformity correction and stabilisation options, are all the forces that led me to a career in Spine.
In your professional career, what have been your proudest moments?
I have been blessed with many! Two of our children are currently enrolled in Medical School and my oldest son just recently announced that he will pursue Neurosurgery as a specialty after graduation in May. My father was awarded the Humanitarian Award from the American Association of Neurological Surgery for his medical mission work in Nigeria. I was awarded the patents for an expandable minimally invasive portal or retractor system and an interbody fusion system that are mainstays of the Medtronic product lines in those areas. It was a distinct honor to be appointed as the Editor in Chief of The Spine Journal. Most recently, the public announcement of the Childress Institute for Pediatric Trauma Research of which am I proud to be a cofounder.
Who have been your greatest influences?
In addition to those special influences already noted above, I must add Volker Sonntag. He has been a role model in Neurosurgical Spine development and leadership for me. Ralph Cloward and Paul Lin really paved the way for Neurosurgery to help transform spine care in the United States. Frankly, I must also add Bob Whitaker, a missionary physician and surgeon in Aba, Nigeria. For over 20 years, he and his wife have labored in a very challenging hospital work, and this dedication always reminds me of what a true physician should be.
As incoming President of the North American Spine Society (NASS), what do you hope to achieve?
My personal theme for my year as President is building bridges. There are a multitude of medical societies and special interest groups that deliver spine care in the US. We have for too long been working independently, and at times against each other, when in fact we have a common goal. I hope to foster the delivery of quality spine care through the conscious effort to build bridges among as many of these major groups as possible. The bridge between Neurosurgery and Orthopedic Spine is better than ever, but it must be improved. The bridges between the surgical and medical and interventional fields of spine care must be built and be functional. NASS is in a unique position to accomplish these goals and I hope to advance that during my presidency.
How important do you think spine societies are to the field?
Spine societies are critically important. Spine societies must collaboratively determine what quality spine care is! Especially in the US where many forces are eroding or challenging our care delivery system and compensation system, the spine societies must provide the clear guidance for governmental and other healthcare systems. Societies must not only collaborate and clearly identify quality care, but they must be careful not to let unhealthy dependence on industry and personal agendas dilute their influence and pursuit of truth.
Do you believe that lifestyle plays an important role in problems relating to the spine, particularly low back pain?
I believe that lifestyle is a contributor. Unfortunately, genetic influences are possibly even more significant. Certainly the combination of genetic predisposition to spine problems and an unhealthy spine lifestyle is a recipe for a life of spinal misery.
Do you think that obese patients tend to take longer to recover after surgery than non-obese patients? Do they lose weight after surgery, remain the same, or gain more weight? Is the obesity problem causing more and more people to undergo surgery for back pain? If so, how do we tackle this problem?
Obesity most certainly plays a role in the outcomes from spine care, surgical and nonsurgical. Again, I must inject the genetic and the activity combination into this equation. I have some very large patients who are genetically predestined to “greatness” from their family. Yet, these people are very active and motivated to recover from spine surgery, decompression and or fusion, minimally invasive or wide open. Their recovery is as good or better than some of the more slender patients who aren’t as motivated to resume activity.
A poorly motivated obese patient with spine problems is more likely to gain weight and lose function after spine surgery and that must be factored into the initial decision to operate. It is safe to say that in general, spinal health and obesity are inversely related. A universal agenda to reduce the incidence of obesity, especially in the young population is a must. Another concern is the growing use of “heavy” book bags in school age kids who are also growing in girth. I would like to see paediatric and spine societies work on a collective agenda to change the use of over the shoulder book bags in developing children to prevent a generation of adults with accelerated spinal degeneration.
What technologies do you think have positively influenced spine surgery? What technologies could change the face of spine surgery in the future?
Minimally invasive approaches to spine surgery are great advances along with image guidance and technical improvements. Yet, probably the improvements in anaesthetic and intra-operative physiologic care allow us to perform more extensive surgical corrections in an aging population. I am routinely doing spinal corrections in 70 and 80 year olds that 10–15 years ago were daunting. The combination of improved surgical fixation technology and fusion technology along with the enhanced anaesthetic care are a major advance especially in the aging population.
Motion preservation is destined to change spine care, but it is still in its nascence. The real goal is the early identification of spinal degeneration and the prevention of advanced spine disease through minimally invasive or physiologic interventions.
What are the problems/challenges facing spine surgery today?
In the US, a major concern is the restriction of access to spine surgery as a cost saving strategy. This approach will not advance care, but retard it and certainly depress research that develops the best therapies for the future.
What are your current areas of research?
While I have had a strong interest in the development of minimally invasive technology and posterior interbody fusion technology, my current focus is on outcomes research. As the Co Chair of the Degenerative Spine Study Group and a former Chair of the Section of Spinal Disorders of the AANS/CNS, I am most interested in our developing credible, profession wide outcomes efforts to determine the effect of our treatments over large populations.
Outside of medicine, what other interests do you have?
I am very involved in a land conservation effort in and around our homestead in North Carolina. We have developed a wildlife preserve that we hope will enhance our local community. My family and I participate in medical mission or relief efforts in South and Central America and in Africa and Eastern Europe. My wife and I are blessed with five children and a son in law who are all in various stages of their graduate and postgraduate education so we are quite busy helping them with their lives! Recently I was appointed to the Board of Regents of Pepperdine University in Malibu, California so my involvement in University education both in North Carolina at Wake Forest University and elsewhere is an important part of my life.
Montreal, Quebec, Canada
1977 – 1981 – Doctorate, University of Texas Southwestern Medical School, Dallas, Texas, USA
1981–1982 – Internship, Department of General Surgery, North Carolina Baptist Hospital
1982–1987 – Resident, Section on Neurosurgery, North Carolina Baptist Hospital
1985 – Rotation in Neurosurgery, Mayo Clinic; Chief Resident, Section on Neurosurgery, Bowman Gray School of Medicine
1987 – Chief Resident, Clinical Fellowship, Department of Neurological Surgery, University of California, San Francisco
1991 – Certified American Board of Neurological Surgeons
1987 – Instructor, Department of Surgery, Section on Neurosurgery, Bowman Gray School of Medicine, Wake Forest University
1988–1993 – Assistant Professor, Division of Surgical Sciences, Department of Neurosurgery, Bowman Gray School of Medicine, Wake Forest University
1993–2000 – Associate Professor, Division of Surgical Sciences, Department of Neurosurgery, Wake Forest University School of Medicine
2000–2001 – Acting Chairman, Division of Surgical Sciences, Department of Neurosurgery, Wake Forest University School of Medicine
2001 – Chairman, Division of Surgical Sciences, Department of Neurosurgery, Wake Forest University School of Medicine
2002 – Eben Alexander, Jr Professor, Division of Surgical Sciences, Department of Neurosurgery, Wake Forest University School of Medicine
1988–1993 – Neurosurgery, Reviewer
1993–1996 – Clinical Orthopaedics and Related Research, Reviewer
1998 – Journal of Radiosurgery, Editorial Board
1998 – Neurosurgical Focus, Topics Editor
1998 – Journal of Spinal Disorders, Editorial Board
2000–2004 – The Spine Journal, Deputy Editor
2004 – Spinal Surgery: Official Journal of the Japanese Society of Spinal Surgery, International Advisory Board
2004–2009 – The Spine Journal, Editor-in-Chief
2006 – National Committee for Quality Assurance Spine Care Recognition Program Advisory Committee
2007 – Society of Neurological Surgeons Outcomes Committee
2007 – Neurosurgery Research and Education Foundation Executive Council
Honours and awards
1987 – Evelyn and Paul Bucy Fellowship
1987 – Congress of Neurological Surgeons Clinical Fellowship
1994 – The Southeastern Chapter of the American Association of Physicists in Medicine Award for best paper of 1993
2007 – Best Doctors in America 2007–2008