Scott Blumenthal (Plano, USA) is best known as the first surgeon to perform an artificial disc replacement in the USA. His pioneering research into these procedures has helped to change the landscape of back pain treatments in North America, where fusion is no longer the only surgical option. Blumenthal talks to Spinal News International about the mentors who have shaped his career, the excitement of working in sports medicine, and his latest research interest; disc regeneration.
Why did you decide to become a doctor and why, in particular, a surgeon?
When I grew up in the sixties and the seventies, medicine was the field at the top of the ladder if you were a good student—particularly if you were good at maths and science. I had my eye on medicine since being a young teen.
Then, when I got to medical school, it became very obvious which track to take, whether medical or surgical. I recently had a talk with a second-year medical student who happened to be in my hospital about this. She was trying to decide which track to take. I told her that it was lucky that she had gotten to see surgery early on because, as a discipline, it is either for you or it is not.
Perhaps I chose surgery because I am not into delayed gratification—we see things and we fix them. In medicine, on the other hand, when you have a problem, you say, “take this medicine”. You then have to wait and see whether it has worked or not a few weeks later. It is much easier to go in to surgery, to see the problem and fix it right away, then tell the patient when they wake up from surgery, “we got it.”
Your fellowship was in spinal trauma. Why did this area in particular appeal to you?
This was a very practical decision, because the surgery involved in spinal trauma gives you all the tools to fix any spinal problem—whether it is a disc problem, whether it is a tumour—it is just technically the best training for any field in spine surgery. It taught me how to operate on the spine from the front, from the back, on the thoracic, the cervical and the lumbar. You getall the tools you need for whatever subspecialties in spine you eventually want to go into.
Who have been your career mentors and what wisdom have they taught you?
I have learnt three particularly important lessons from a number of mentors; discipline, balance, and to keep an open mind when it comes to ideas.
It requires a lot of discipline to be a physician, a surgeon and of course a spinal surgeon. I have two mentors in mind that taught me the incredibly important tool of discipline in spine. These mentors would be my fellowship director, Paul Meyer, and my first partner in practice, Kevin Gill.
To be effective in any career, you also need to have balance. I have two mentors that were probably the best technical spinal surgeons I have ever seen, but they also had great balance in their lives. They had interests outside of spine, so they were not just all work, work, work. I learnt the importance of balance from David Selby and Matthew Scott-Young.
Finally, my orthopaedic programme director, Vert Mooney, taught me that there is no such thing as a bad idea. It is important not to immediately consider something a bad idea, but to investigate it more.
As well as these three key points, everything we are discussing now has been facilitated by being a member of the Texas Back Institute—an incredible practice. The thing I treasure here is the other doctors. Essentially we are a family, and I would be remissed if I did not talk about the importance of this group. The collegiality and support offered by the members of the institute have helped many of us to achieve incredible accomplishments.
What do you think has been the biggest development in spinal surgery during your career?
Hands-down, no-brainer—the biggest development during my career has been artificial disc replacement. This has eliminated the need to do fusions—an imperfect solution to many problems that we have used for decades—in many, many patients.
Not only in the field of spinal surgery as a whole, but in my practice itself, artificial disc replacement has been transformational. I have noticed huge clinical benefits in my patients. Now, my practice focuses on disc replacement.
You have been involved extensively with spinal research. Which piece are you most proud of, and why?
This has to be my work as the first surgeon to perform the first artificial disc replacement surgery in the USA, and to be the lead investigator on the research.
It was a fascinating process. We had to work with the company providing the disc to submit an application the US Food and Drug Administration (FDA) for permission to do the study. I then had to travel to Europe to learn the techniques, because they had been doing artificial disc replacement procedures in Europe for a decade or more before us in the USA.
I then had to tell patient number one that he was patient number one—not only for me as a surgeon, but for the country itself. What a brave guy. This was back in 2000—16 years ago. It has to be my most memorable case. I think that it even eclipses some of the surgeries I have performed in professional athletes.
You have worked as a consultant for both the Dallas Mavericks basketball team and the Dallas Texans American Football team, and are currently a US National Basketball Association physician. What is the most exciting thing about sports medicine?
I think there are two things which are particularly exciting about treating athletes. Number one is that you are basically working on thoroughbred horses—professional athletes have the best-conditioned bodies that can exist. Imagine if you were a veterinarian and you specialised in horses. Getting a racehorse to treat, is so exciting, because they are the at the top of the physical field.
Secondly, the motivation to get better displayed by athletes is incredible. Their healing time and their rehabilitation efforts are just superb.
What has been your most memorable sports case?
I performed surgery on the professional golfer Lanny Wadkins. It was a real achievement, because details of the surgery were published in the lay literature—in Golf magazine.
When Lanny Wadkins was inducted into the Golf Hall of fame, Golf published an in-depth article about his career. Watkins mentioned me and discussed the surgery I performed in the article. He even included a picture of the X-ray of his back!
That would have to be the most memorable sports case I have done, because of the article in the lay literature. Ironically enough, I actually performed a fusion in this case.
What are your current main research interests?
I think biologic disc regeneration will be the main research topic for me for the next ten years. There really is only one FDA trial going on, which is the Mesoblast trial. There are two phases, and I hope to participate in the second. My research team and I are about to apply for institutional review board approval for an autologous stem cell regeneration project. We are just getting off the starting line right now. The next ten years will focus on seeing if disc regeneration is the future, and I suspect it will be.
Outside of your own work, what has been the most interesting paper that you have seen in the last 12 months?
An animal study from Brian Freeman and colleagues from the University of Adelaide in Australia has basically laid the foundation for the idea that disc regeneration might actually be able to work. The researchers induced the degeneration of a disc in sheep, and then treated it with stem cells. I think that is the most interesting paper I have seen in the last 12 months.
You have been active in a number of prominent spinal societies over your career. Why do you think that such societies are important?
I think the people involved in societies are the most important element. These surgeons are at the top of their field; the networking and the international collegiality are fantastic.
Being involved in such societies also means that we get exposed to technologies before most other surgeons get exposed to them, which is a real privilege.
What are the three questions in spinal medicine that still need an answer?
- Is fusion for axial back pain really a viable solution?
- Can we regenerate a disc?
- Are all the spinal pelvic parameters that go into sagittal balance really the answer to treating patients with deformities?
What advice would you give to someone who was starting their career in spinal surgery?
I would say, “do what you have passion for, and have passion for what you do.”
Outside of medicine, what are some of your hobbies and interests?
I enjoy golf, I collect wine, and—when outside of the USA— I enjoy Cuban cigars.
One of the things that actually brings us back to societies, is my interest in travel. We tend to go and meet at very interesting places. I always try to leave enough time to see the lay of the land, and to travel around those places that we get to visit as part of our careers. One of the best places I have been for a spinal conference was Australia. And, in the last ten years, Asia has emerged as somewhere with a huge interest spinal surgery and societies. It is a fascinating place that was pretty exotic when I was younger—no-one I knew went there! And, obviously, you cannot beat travelling to Europe for the history.
Fact File
Education
1976–78 BSc in Medicine, Northwestern University, Evanston, USA
1978–82 MD, Northwestern University Medical School, Chicago, USA
1982 Fellowship in Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Chicago, USA
1982–83 Internship in General Surgery, University of Texas Health Science Center, Dallas, USA
1983–87 Residency in Orthopaedic Surgery, Internship in General Surgery, University of Texas Health Science Center, Dallas, USA
1987 Fellowship in Spinal Trauma, Midwest Regional Spinal Cord Injury Care System, Northwestern Memorial Hospital, Chicago, USA
Clinical appointments
1988–1991 Spinal Surgeon, Southwest Orthopedic Institute, Dallas, USA
1992–present Spinal Surgeon, Texas Back Institute, Plano, USA
1993 Spine Consultant, Dallas Mavericks, US National Basketball Association
1993 Spine Consultant, Dallas Texans, Arena Football League
1993 Spinal Surgeon, Wiltse Spine Institute, Long Beach, USA
2000–02 President, Medical Staff, Presbyterian Hospital of Plano, Plano, USA
Teaching appointments
1988–present Assistant Professor of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, USA
1990–91 Chief of Spine Service, Department of Orthopedics, Veterans Affairs Medical Center, Dallas, USA
Selected society involvement
2008–10 ISSLS, Central US Regional Representative
2008 ISASS, Poster Programme Committee
2012 ISASS, Chairman, Education Committee
2014–present NASS, Section Chair: Motion Preservation
2015–present National Basketball Association physicians
2017 ISSLS, Programme Committee
Current editorial review positions
European Spine Journal, Assistant Editorial Board
International Journal of Spine Surgery, Reviewer
