Christopher Shaffrey, Harrison distinguished professor, Neurological and Orthopaedic Surgery, University of Virginia, Charlottesville, USA, is the chair of this year’s International Meeting on Advanced Spine Techniques (IMAST, 18–21 July, Istanbul, Turkey). He talked to Spinal News International about his career and the key themes of IMAST 2012
Why did you choose a career in medicine and why, in particular, did you choose to specialise in spinal surgery?
I chose a career in medicine because it seemed to be the ideal opportunity to balance intellectual curiosity, technical skill development and community service. I have been extremely pleased that my views have turned out to be correct. While a medical student, I participated in a number of spinal cases while rotating on the neurosurgery and orthopaedic services. Although some of operations were successful, many were not. It appeared that a tremendous opportunity for substantial growth and development in the field of spinal surgery existed.
Who has inspired you in your career and why?
I had the opportunity to work with numerous inspiring individuals. John Jane Sr encouraged and helped develop the infrastructure to allow me to perform a combined orthopaedic and neurosurgery residency. He continually challenged me throughout the course of my training and was the principal inspiration for a career in academic medicine. Gwo-Jaw Wang, who was the chair of orthopaedic surgery during most of my residency, served as an inspiration for achieving technical surgical excellence and dedicated patient care. W Richard Winn was my chair during my time at the University of Washington. With Dr Winn’s guidance, I developed both the skills and opportunity to engage fully in academic spinal surgery. The boundless energy and enthusiasm he used to effectively serve in numerous leadership roles within organised neurosurgery set an incredibly high bar for service.
What do you think has been the most important development in spinal surgery during your career?
The widespread adopting of health-related quality of life indices to assess the outcomes of spinal surgical procedures. It has provided the opportunity to objectively compare the results of both operative and non-operative care and the different surgical procedures. You have won several awards during your career, which one did you think was the biggest honour and why? I recently received the honour of being the William S Keith visiting professor in Neurosurgery at the University of Toronto. The previous visiting professors are a virtual who’s who of neurosurgery over the past 40 years. My inclusion in this prestigious list was quite an honour.
You have actively been involved in spinal surgery research. Which piece of research are you most proud of and why?
I am most proud of our research into generating the best methods of surgical management of adult spinal deformity. Several of our presentations and articles have begun to alter clinical practice and improve surgical outcomes. Specifically, understanding the interplay of spinal balance, neural compression, restoration of lumbar lordosis and pelvic positioning in symptoms has permitted better results.
What are your current areas of research?
My current areas of research include the use of neuroprotective agents to potentially improve outcomes in spinal trauma, cervical spondylotic myelopathy and spinal deformity. I am also looking at the development of improved spinal implants that permit superior results and better safety, and the evaluation of new technologies, such as cervical arthroplasty, that might reduce the need for further surgery, probably by adjacent segment degeneration.
Of the spinal papers that have been published in the last year, which one did you find the most interesting and why?
Fehling et al’s “Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS)” (PLoS One 2012; 7:e32037. Epub 2012). The information contained in this paper demonstrates that early surgery for cervical spinal cord injury is safe and probably more effective compared with delayed surgery.
What are the three most important questions in spinal surgery that need an answer?
- How can we prevent/reduce adjacent segment degeneration or proximal junctional failure after spine fusion procedures?
- Can early interventions (surgical or biological) prevent the progressive degenerative cascade that occurs in certain individuals with ageing?
- What pharmacological or cellular therapy or group of therapies will best improve outcome following acute spinal cord injury?
As chair of this year’s IMAST, what are the key themes of the meeting?
The meeting will focus on evidence-based spinal care, complication avoidance, emerging technologies, and surgical technique advice from recognised international leaders in spinal surgery.
Which sessions will you be hoping to attend and why?
I am interested attending the presentations of the Whitecloud award nominees on clinical science and basic science, which respectively represent the top clinical and best basic science presentations at IMAST. Most of these papers are translational research and will probably soon influence the care of patients with spinal disorders.
The instructional course lecture “Adult deformity I: surgical management of lumbar degenerative deformity” will be of particular interest to me due to my strong interest in the management of adult deformity and the fabulous faculty of the session. Also, several of the complications series, which focus on presenters’ worst complications and how they were managed in different areas of spinal surgery, will be tremendously instructive. This series of talks includes the experiences of stellar surgeons such as Larry Lenke, Peter Newton, Sig Berven, Ziya Gokaslan, Michael Fehlings and FC Oner.
You said in an interview on the University of Virginia Spine Center’s website that your goal is to “treat patients as individuals and get to know them”. Why is this so important?
Much of the surgery I perform is large and complex. It is difficult to appropriately counsel a patient with a single visit. Getting to know patients allows you to understand their expectations and either tailor treatments to match expectations or provide a better understanding why the expectations are unlikely to be met.
What has your most memorable case been?
I recently saw a patient with severe spinal cord compression. She had been unable to walk for over a year and was losing the ability to even feed herself. She did well with surgery (despite the magnitude) and left the hospital for rehabilitation. Three months after the surgery, she walked into clinic. Clearly, both of us were very gratified.
Outside of medicine, what are your hobbies and interests?
My wife Katie and I have four children, who are very involved in sports. I spend much of my free time going to their sporting events or practising with them. We also enjoy skiing, hiking and travelling.
- 2008—present Harrison distinguished teaching professor of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, USA
- 2003–present Adjunct professor of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, USA
- 2003–present Professor of Neurological Surgery, University of Virginia School of Medicine, University of Virginia School of Medicine, Charlottesville, USA
- 2003–present Visiting clinical professor of Neurological Surgery, University of Washington School of Medicine, Seattle, USA
- 1982–1986 MD, University of Virginia School of Medicine, Charlottesville, USA (United States Navy Health Professions Scholarship
- 1982–1978 BS biology (Magna cum Laude), The Citadel, Charleston, USA
- 2012–present William S Keith visiting professor in Neurosurgery at the University of Toronto, Toronto, Canada
- 2006–2007 Who’s Who in Medicine and Healthcare, (6th edition)
- 2003 Excellence in Clinical Care Award, University of Washington
- American Academy of Neurological Surgery
- American Association of Neurological Surgeons (AANS)
- The Society of Neurological Surgeons
- Congress of Neurological Surgeons (CNS)
- American Academy of Orthopaedic Surgeons
- AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves
- North American Spine Society
- American College of Surgeons
- Scoliosis Research Society
- American Orthopaedic Association