Recently, I ran a tough 50-km. race, with more than half of it in loose sand. Subsequently, at the 20- km. point, I surged by my age group competitors, and once by them, I gave a smile and accelerated. I was in pain, and suffering, but I didn’t show it to my competitors because I wanted them to know that the race was over. I wanted to disrupt their mind and make them give up any hope and leave no doubt.
I went on to win my age group, finish 6 overall, and break the course age group record by more than an hour. Once I was in this potentially enviable position, I celebrated for a few hours and then went back to work for the next competition.
We can never rest on our laurels when there are more conflicts ahead, and I enjoy the battle. I enjoy being in “the arena” to quote Teddy Roosevelt.
Why do I bring up this potentially unrelated running story in the Chairman’s Corner this month? For those who practice interventional spine, we are in a complicated multistage race.
The race to have patient access for innovation that can be life changing. The race to make things less invasive, of lower risk, and with equal or better outcomes than the alternative larger surgeries, is a real struggle. The race to invent new options, establish a code, get through the RUC process, to win unfair local carrier determinations, and to grow and prosper as a field is a clear and present danger.
This is a call for my colleagues in our space to be disruptive. Disruption is defined as an act of interrupting or preventing something from continuing as normal. To put that in perspective, there are a lot of things that we need to disrupt. To name a few issues to consider:
- The Opioid Crisis. We have already made a huge impact on this with earlier and more successful interventions to reduce the number of patients who ever need to be treated with addictive substances. In the next 12 months, I will work with colleagues to publish big data showing how neuromodulation devices significantly reduce opioid requirements over a 60-month outcome period. The use of big data to create nonbiased and indisputable evidence is a critical part of our journey. In addition, we must train young physicians and referring doctors to consider proper interventions before going down the road of oral medications and medical management. More and more outcome studies show that medical management equals ongoing reduction in function.
- Minimally Invasive Spine (MIS) Procedures. When I performed the first non-surgeon based minimally invasive lumbar decompression 16 years ago, it was controversial and disruptive. Similarly, when Dr. Chris Kim and I joined the Vertiflex level one RCT, it was controversial and disruptive as we were the only group without a spine surgery background. Little did we know that we were in the beginning of a revolution. A revolution with new devices, indications, and patient selection requirements. In order to win this revolution, we need to continue to build data, improve education and mentoring, and be careful with our patient selection. We need to leave no doubt that in the correctly selected patient, MIS is the goal.
- Career Mentoring. The mentoring model in the United States and the international community is broken. We see young physicians leave training and often enter the abyss. A zone of stagnation where skill advancement is rare and outcomes remain in a static zone. The goal of ASPN is to disrupt this model. Working with the best in both the USA and worldwide, we will introduce a new model of mentoring in July that breaks the mold and will include an umbrella of training for the post fellow or post resident that is unbeatable and really makes an impact. Whether you serve as an expert and mentor or are getting mentored by someone, this will be a major positive disruption.
- Organized Medicine. Fixing the Broken Society Model. The society model is broken in pain medicine. We have too many societies, too many confusing agendas, and too many egos and personalities to ever fix our specialty. In addition, we have amazingly hypocritical society leaders who “have no conflicts” and do not like Industry in public. Privately, they ask Industry for large educational and meeting grants. And while they claim to have “no conflicts,” they stay in hotels funded by industry support, book travel paid for with industry money, and carry biases that last long after they’ve recused themselves from consulting. Our disruptive goals: ASPN will aspire to be the society of those who will partner with other physicians, APPs, neuroscientists, and Industry to help all of our members advance and succeed. This will be done in a transparent and open manner with bias towards none but enthusiasm toward all ethical and driven parties to move the field forward. This will be our disruptive mission. As for those societies who have lost their way or have lost the mission or become hypocritical in the process, Industry should vote with their support. Do not support those who do not want to make collaboration part of the culture.
- Collaboration. In addition to industry collaboration, we strive to increase collaboration with other specialties. Recently, we have had some huge wins by partnering with like-minded people. Our partnership with our friends in radiology and like-minded progressive spine surgeons has led to major advancements. In 2025, you will see world leaders in both areas join the board of directors for ASPN. Collaboration will be our new and ongoing disruption.
- International Outreach. We plan on disrupting the way education is done in the international community. Our work in Dubai last year was instrumental in meeting a new community of wonderful people. That goal continues in 2025 and beyond as we go to London, and then plan future meetings in Germany, Spain, the Netherlands, Middle East, and Latin America. ISPN will become an independent but aligned organization in 2026, and the revolution of disruption will continue in a worldwide way that will change spine and nerve care forever.