Spinal News International talks to Professor H Michael Mayer about his views on the future of spine surgery, the current problems facing the procedure, and his interest in racing bikes.
When did you decide you wanted a career in medicine?
Actually I was not really sure what to do after having finished high school in 1973. My teachers thought I was good at teaching others and suggested that I should study physics or chemistry. So I first had to do my military duty which gave me enough time to think about my future. Fortunately, I did an internship in a small hospital before I went to the German Army and the first operation I could attend was a total hip replacement which was fascinating for me at that time. So I got ‘infected’ with the ‘surgery-virus’ and decided to study medicine after the military.
Why did you decide to specialise in orthopaedics, and why the spine?
I was studying at the Johannes-Gutenberg – University in Mainz which is one of the oldest Universities in Germany, and since my parents could not afford all expenses I did night-shifts on the Neurosurgical ICU. The 70s f the last century were a fascinating time in Neurosurgery because the first CT scanners allowed imaging of the brain, and the surgical microscope started to revolutionise this specialty. So I wanted to become a Neurosurgeon. I started my postgraduate scientific career at the Department of Neuropathology of the Free University in Berlin and then in 1983 I started my Neurosurgical training with Professor Mario Brock, also at the Free University in Berlin. At that time an innovative and minimally invasive technique to treat lumbar disc herniations swapped over from the US to Europe: Chemonucleolysis. Mario Brock and myself were the first to apply this technique in Germany. Although Chemonucleolysis was not a ‘real’ surgical technique, it made me get interested in spinal surgery.
Spine surgery was like a large white field on the map of surgery and seemed to me to be the specialty with the biggest innovative and scientific opportunities. The consequence for me was: if I want to become a ‘real’ spine surgeon, I have learn orthopaedic and trauma spine surgery as well. At that time I wasn’t really aware that the decision to get fully trained and board certified in neurosurgery as well as orthopaedic surgery would take ten years and would give me a new professional identity with all advantages (‘He is a ‘Specialist’) and disadvantages (Orthopaedic Surgeon said: ‘He is a Neurosurgeon’; Neurosurgeon said: ‘He is an Orthopaedic Surgeon’). However, it was the best decision I made in my professional life.
In your professional career, what have been your proudest moments?
There have been a few ‘proudest moments’ e.g. lately when I was elected as president of the European Spine Society (ESS) and the German Spine Society.
However, retrospectively I am most proud of the moment when I decided to attend the first course on percutaneous discectomy organised by Parviz Kambin in early 1987. Although I did not have the money, I overdrew my account, booked a flight to Philadelphia attended the course, purchased one of the first (rudimentary) instrument sets (which were not available outside the US), smuggled it through German customs and performed the first Percutaneous Endoscopic Discectomy in Germany in March 1987. This was actually the start of my career as a spinal surgeon and it focussed my interest on minimally invasive techniques.
Who have been you greatest influences?
I would like to mention one person: I owe my deepest thanks to my first mentor Professor Mario Brock (Chairman of the Department of Neurosurgery, Free University of Berlin, Germany) who motivated me to do scientific work and taught me to ‘think globally’. He also was the man who enlightened my enthusiasm for microsurgical techniques and the aesthetic aspects of surgery. But I must not forget all the other teachers I had in orthopaedics, neuropathology, anatomy and biomechanics who helped me to understand the anatomy and function of a complex system like the human spinal column.
Minimally invasive surgery appears to be offering patients a lot more in terms of less hospital stay, less blood loss, faster return to work etc. Technologically speaking, do you think we have reached the point where open surgery is slowly being pushed aside to allow for minimally invasive procedures to take the lead?
I would completely agree with that. However, we have to admit that this is more an evolution which takes place and which sometimes (like biological evolutions) can end up in dead-end streets. We have seen a lot of steps forward in the last twenty years but also steps backwards. E.g. in lumbar discectomy the world was divided into those who performed microsurgical and those who preferred ‘open discectomy’. The development of endoscopic discectomy has pushed a lot of surgeons to use a less invasive approach which ended up with more surgeons now using the surgical microscope and endoscopic discectomy. It is always like going two steps forward and one step back (which is still one step forward….).
But it is clear that minimally invasive techniques take the lead in spinal surgery. If we want to restore or preserve function by a surgical procedure, we have to respect tissues and anatomy. This means that we should approach our surgical target through the smallest entrance (into the human body) possible, we should follow natural pathways given by the individual topographic anatomy, perform an efficient target surgery (e.g. discectomy, tumour excision and leave the scene without leaving any traces. This is the ‘ideal’ surgical procedure and the driving force for less invasive surgical techniques.
What role will biologics, gene therapy and robotics play in the future? Because the cost of research is so high, do you think that such technologies will take decades to develop and if so, how do we get around this? When do you foresee patients successfully receiving such treatments?
I believe these are two completely different areas with a different future. Biologic and regenerative research will play an increasing role in the treatment and prevention of degenerative diseases, however, robotics and computer-assisted surgery will have to go a longer way. Gene therapy, growth factors, autologeous cell transplantation or stem cell transplantation will soon enter the file of spinal diseases and will give new opportunities to prevent pathologies.
Robotics and computer-assisted surgery still waits for the next big technological step ahead (e.g. automated permanent surface matching in computer assisted navigation). Since this is a small segment in spinal surgery technology with an unproven or not necessarily expectable influence on clinical outcome, I believe this technology will definitely take many more years to be further developed and to be accepted for routine use. With this technology it is just a question of how much revenues are to be expected for a given investment in research and development. If you look at the entertainment industry were technologies such as virtual reality or ‘augmented’ reality are still in use you can imagine how medicine could profit from these techniques in terms of improvement of surgical techniques or teaching.
How important do you think spine societies are to the field?
I believe the predominant role national and international spine societies will have to play is to guide scientific progress in our field and to do lobbying work for spine specialists in the different healthcare systems worldwide. This can only be done, if societies have a large membership so that they can speak for many spine specialists. And it requires scientific data. This is why one of the primary tasks of a spine society should be to acquire data about spinal treatment and surgical procedures, there outcomes and their quality. A good example in this sense is Spine Tango, the European spine registry initiated by the European Spine Society.
What do you think are the current challenges/problems facing spine surgery?
Fortunately spine surgery is a young subspecialty and in most countries the ‘Spine specialist Market’ is not yet saturated. Too many spine patients and too few specialists is the situation in most countries. It is in fact a specialty with a great future and great opportunities for young surgeons.
The major challenges for a practicing spine surgeon are to deal with the enormous amount of new scientific data on new surgical procedures and to keep up with latest technology in a competitive environment. The major challenges for the academic spine surgeon are to critically keep up with the large number of innovations with which we are flooded by the industry. Even for me it is sometimes difficult to find the balance between being innovative in my daily work and on the other hand stay within the standards of evidence-based medicine. This is why you continuously have to perform clinical studies.
What are you current areas of research?
It is still spinal microsurgery because this philosophy can be applied to a lot more new surgical procedures. Currently I am focussing on Interspinous Spacer technology because this technology will probably lead to paradigm shift in spinal surgery towards the acceptance of temporarily acting implants.
Of course we still continue our scientific activities in the filed of disc arthroplasty, non pedicle-screw-based fusion techniques, microsurgery of spinal stenosis etc.
Outside of medicine, what other interests to you have?
I am an enthusiastic soccer fan (FC Bayern Munich) since I played soccer on a higher level when I was younger. Now I love my racing bike and besides this I enjoy a good book (with a glass of good red-wine) on historical events. My two children, Lukas and Frizzi, keep me up to date with the latest music and with my wife, Isabel and I share my love for travelling (preferably to exotic places).
1975–1981 – Medical School: Johannes-Gutenberg University, Mainz, Germany
1980 – Doctoral Thesis at the Dept. of Neurosurgery Johannes-Gutenberg University
1981 – Graduation from Johannes-Gutenberg University
1990 – Board Certified Neurosurgeon
1994 – Board Certified Orthopaedic Surgeon
1981–1982 – Experimental Neurosurgery at Department of Neurosurgery, Johannes-Gutenberg University
1982–1985 – Resident, University Hospital Steglitz
1987–1992 – Department of Neurosurgery, University Hospital Benjamin Franklin, Free University of Berlin
1990 – Staff Surgeon Department of Neurosurgery, University Hospital Steglitz, Free University of Berlin
1991 – Habilitation at The Free University of Berlin Venia Legendi for Neurosurgery, PhD Senior Lecturer / Assistant Professor
1992 – Staff Surgeon Department of Orthopaedic Surgery, Free University of Berlin
1993 – Chief Staff Surgeon, Dept. of Orthopaedic Surgery, Free University of Berlin
1997 – Vice Director, Dept. of Orthopaedic Surgery, Free University of Berlin
1998 – Medical Director and Head, Orthocenter Munich
2006 – Visiting Professor Hospital of Special Surgery, Cornell University New York City
2006 – President and Congress Chairman German Spine Society
2006 – President European Spine Society
ISSMISS News, European Division
European Spine Journal
Operative Orthopädie und Traumatologie
Selected international memberships
Executive Committee European Spine Society
Secretary, Spine Society of Europe (1997–98 and 1999–2002)
President Spine Society of Europe (2006)
Spine Arthroplasty Society (Founding Member)
International Society for the Study of the Lumbar Spine (ISSLS)
International Intradiscal Therapy Society (IITS)
Chilean Society for Orthopedics and Traumatology (Corresponding Member)