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Renaissance Surgeon Seeks Spine Restoration

Q & A With Richard Fessler, MD, PhD, Spine Surgery Pioneer

Richard Fessler Web1.jpgMost neurosurgeons don’t start their careers with an MS in psychology, a PhD in pharmacology and physiology, and fellowships in neurological surgery and psychiatry. Nor do they earn NASA Space Shuttle certification as both medical specialist and flight surgeon. And they definitely are not working on a master’s in theology in their spare time. Most neurosurgeons, however, are not Richard Fessler, MD, PhD, who joined Rush’s Department of Neurological Surgery last year. 

Describe a patient who benefitted from your surgical techniques.

A retired nurse came to me with severe scoliosis. She had it for years, but over the past year it had become excruciatingly painful. She previously had renal cancer and had her kidney removed, so that made approaching her spine through the side challenging.

Using a minimally invasive technique, we were able to do the operation from the side and get both of her spinal deformities corrected to near perfect. Scoliosis surgery is of course very big surgery. So I was shocked when six weeks later I was giving a public lecture on scoliosis, and she showed up. She had to take a train from Indiana, transferred to a bus and then walked six blocks to show up at this lecture. And she did that without any pain.

How do your psychology studies inform your work as a surgeon?

Interestingly enough, I’m doing a study comparing patients’ expectations and outcomes and seeing if patients' expectations influence the outcome. If you have a lot of psychological problems and a lot of unrealistic expectations, you won’t have a good result. Even if you have a great outcome clinically, you’re not going to think you did.

Could philanthropic support make a big impact in a particular area of yours?

In addition to my surgical practice at Rush, I am actively involved in research that could be a major breakthrough. The ability to regenerate damaged tissue in the spine could alleviate the need for spine surgery altogether and restore mobility to the 500,000 individuals paralyzed by spinal cord injury each year.

What challenges do you face in researching better spine surgery methods and techniques?

One challenge with scoliosis is returning lordosis, the normal curvature of the spine. It’s very important. If they are off balance, they hurt. One of the hardest things we’ve faced is to accomplish that with minimal invasion, though the last patients I’ve worked with have fared really well.

Can you describe your areas of research at Rush?

My research tends to fall into three areas. The first is clinical research. I have kept a very thorough database of my patients for the last 20 years. It allows me to very closely follow how they do after surgery and over time. It then allows my residents and fellows to go back and use that database to study and publish. We do a lot of that. Prospective clinical research.

Secondary research that I focus on is developing new surgical techniques. That mostly involves minimally-invasive surgical techniques and that’s done primarily on cadavers in the anatomy laboratory. In the past, I reserved two days a month where I spend time in the anatomy lab with whichever residents are available, working on new techniques for surgical operations.

The third area I’ve been doing research is in stem cell transplantation for spinal cord injuries.

Can you describe aspects of how the stem cell research is conducted?

There will be specific inclusion and exclusion criteria. In fact, in the last study the exclusion criteria were so extensive it was very hard to get patients into the study. One of the limitations of that study is they had to be transplanted within 14 days. Very often a person with a spinal cord injury goes to an outside hospital. Since a spinal cord injury is usually associated with a fracture of a spine they would be operated on there to stabilize it. Well, that takes about a week. Then they need time to be transferred to this facility to get the stem cell transplant, and then pass all of the other criteria to get it, so we found it very difficult.

One of the things we’re hoping to do is to extend that period of time a little bit longer. Perhaps 21 to 28 days. The last time we did it was in the thoracic spine. Because it was a safety study, that made sense. But that’s also the area where you’re least likely to see a beneficial effect. We’re hoping to be able to next do it in the cervical spine. And that’s where we think we might be able to have a better impact.

Interested in supporting this research or learning more? Contact Deanna Wisthuff, director of development in the Office of Philanthropy, at (312) 942-7246 or at deanna_m_wisthuff@rush.edu.

 

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