Dr. Clifford Solomon and Dr. Steven Ludwig discuss the value of having both a neurosurgery and orthopedic perspective on spine surgery.
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The Value of Neurological and Orthopedic Perspectives on Spine Surgery
Featured Speakers:
Clifford Solomon, MD | Steven Ludwig, MD
Clifford Solomon, MD leads the neurosurgical program as the Director of the UM Baltimore Washington Spine and Neuroscience Center and Clinical Assistant Professor of Neurosurgery at the University Of Maryland School Of Medicine. He is also a member of the UM Spine Network. He received his medical degree at the Medical College of Pennsylvania in Philadelphia. He completed his residency and neurosurgery fellowship at Johns Hopkins Hospital with additional training at the University Hospital Zurich in Switzerland and a focus in neuro-oncology at Memorial Sloan-Kettering Cancer Center in New York, NY. Dr. Solomon is board-certified and a member of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.Steven Ludwig, MD is Chief of Spine Surgery at the University of Maryland Medical Center and a Professor of Orthopaedics at University of Maryland School of Medicine. Dr. Ludwig is an internationally distinguished academic orthopaedic surgeon. He is also Chair of the UM Spine Network. His areas of expertise include disorders of the cervical and lumbar spine, minimally invasive techniques, sports-related spine injuries, reconstruction of traumatically injured spines and tumor reconstruction. He received his medical degree at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, where he graduated first in his class. Dr. Ludwig completed his residency in Orthopaedic Surgery at Thomas Jefferson University Hospital, followed by a fellowship in Spine Surgery at Emory University School of Medicine.
Transcription:
The Value of Neurological and Orthopedic Perspectives on Spine Surgery
Alyne Ellis: Welcome to Live Greater, a health and wellness podcast brought to you, but the University of Maryland Medical System. We put knowledge and care within reach so you have everything you need to live your life to the fullest. This episode is sponsored by the UM Spine Network connected to the renowned University of Maryland School of Medicine. The UM Spine Network is home to the region's leading spine experts. With convenient locations throughout the State, UN Spine Network physicians collaborate to create comprehensive care plans for patients across the full spectrum of care. When you work with a UM Spine Network physician, you can expect to receive the high quality evidence based care that you deserve. I'm Alyne Ellis, and our topic today is about the value of having both neurosurgery and orthopedic perspectives on spine surgery. My guests are Dr. Steven Ludwig and Dr. Clifford Solomon. Dr. Ludwig is the Chief of Spinal Surgery at the University of Maryland Medical Center and a Professor of Orthopedics at University of Maryland School of Medicine. Dr. Clifford Solomon directs the UM Baltimore Washington Spine and Neuroscience Center and he's a Clinical Assistant Professor of Neurosurgery at the University of Maryland School of Medicine. Welcome gentlemen. Let's begin with what is the University of Maryland Spine Network? Dr. Ludwig?
Dr. Ludwig: Sure. University of Maryland Spine Network is a conglomerate of everybody in the system that practices spine surgery, so it's a combination of neurosurgical based spine surgeons from their education training and upbringing, as well as orthopedic spine surgeons from once again their training and upbringing with regards to their subspecialty training. But essentially at the end of the day what we're all on the same page about is patient safety and delivery of the highest quality of care with regards to spine surgery for patients that come into the University of Maryland Spine Network.
Host: And I want to start by saying that this is a topic that I'm personally really very interested in because my son Sean, who has spinal bifida has had three spinal surgeries and the last one in particular required both neurosurgeon and an orthopedic surgeon. And so I am particularly interested. Let's start with you, Dr. Ludwig, and how do these two medical disciplines compliment each other?
Dr. Ludwig: At the end of the day, both orthopedic and nuerosurgically trained spine surgeons do spine surgery. I don't necessarily think you want somebody that's not subspecialty trained in spine surgery, right? Whether or not they've entered spine surgery through the orthopedic network or background or through neuro surgical background, you want somebody that just concentrates on spine surgery. Clearly, there are things within each realm. For instance, Dr. Soloman can comment on this further, but there are certain procedures that are inside the spinal cord or what we call the Dura or the lining of the spinal cord or nerve roots, that are better taken care of by the neurosurgeons. And there are other things potentially that would be not taken care of by the neurosurgeons. But at the end of the day with folks that are listening want to ask their surgeon, is whether or not they concentrate on spine surgery. Most of the time it becomes irrelevant. I think if they've been trained from their background of orthopedic or neurosurgery,
Host: Dr. Solomon, maybe you can add something to that, including maybe what the differences are between neuro and ortho surgery, when it comes to spine treatment?
Dr. Solomon: I think that, you know, we all went to like grade 27 of schooling, always trying to be the best we could in our class to get to medical school and residency after medical school, which is four years. Then another seven years of residency training, thereabouts, and then fellowship training after that. So at the end of the day, both neurosurgeons and orthopedic spine surgeons have just a tremendous amount of experience just from time put in doing this crazy job that we have, you know, where we're trying to help people move forward in their life and get over their challenge, and kind of go on with their life. Kind of like being on a boat and we want them to not end up on [inaudible 04:34], but we want them to have their surgery, get off the boat, get on the other side of the land, and keep on with their life. And hopefully have really helped them. Down at a granular level you know, as Dr. Ludwig mentioned, if something is a tumor in the middle of the spinal cord, then that's probably going to fall under neurosurgery. Although in my career I have done spinal cord tumors in the cord and above where you breath with orthopedic spine because I tend to think that they do an amazing job with reconstruction.
And so sometimes we need to take away more bone to get to a tumor inside the covering of the spinal cord called the Dura, that Dr. Ludwig mentioned. And so often we'll work together if need be in these complex cases and there is a sharing of the work where we will do the work under the microscope, taking the tumor out from the spinal cord, and then they will do the reconstruction part. It's true that they could probably do our part, we can do their part. There's definitely overlap. But for the majority of things we do, we both can do them and do them well. And as they get more complicated, we tend to use each other and bounce things off each other pretty routinely. I routinely send people to Dr. Ludwig and his group who have had other surgeries at other hospitals outside the system where it's not always clear cut to me. And sometimes just having their perspective, seeing things differently than I see them is very helpful. And I think that that's what makes what we're doing as a network, what Steve really had this vision to do has really made us, I think, you know, one of the premier spine groups really in the nation because of that, this kind of, there's no ego in this. We just want the patients to do well.
Host: So Dr. Ludwig, how does a patient go about finding a good surgeon given his condition or needs?
Dr. Ludwig: I think a lot of what happens when people ask about who to go to for spine surgery. They'll talk of course to friends and family members. Right? That's one common thing, using the internet, right as a means of gathering information right, and a web based sort of introduction to physicians. And obviously they rely on their primary care physicians or other subspecialty folks or docs that they have seen to get a sense of who they should see. I think within the University of Maryland system, every hospital within the system as very well trained as Dr. Soloman alluded to, very well trained competent, safe, the highest quality to delivery neurosurgical or orthopedically based spine surgery to the citizens of Maryland.
Host: But now Dr. Solomon, I would assume that, and both of you would say that don't pick somebody just because they're an ortho or a neurosurgeon. It's also important to pick their training. Number of cases they may have had the outcomes of those cases, their reputation. How do we go about assessing something like the number of cases? We just ask the doctor or the outcomes? That doesn't seem like something I'd find on the internet.
Dr. Solomon: Yeah, it's a good question. It kind of self selects out and you're not good at doing this, you probably are not going to have a lot of numbers of doing these cases. If you're super aggressive, people aren't going to come to you. You know, I always tell people the best surgery we do is none. But I really find, and I always tell people that less is more. Word of mouth is huge and you just can't say enough about what friends, families, neighbors, coworkers say. And I would say the majority of the business that I know comes to Dr. Ludwig from me, came word of mouth. Someone said to me, Hey, you took care of so and so and so and so. And they know that if I'm not the right person that does that particular case, I will say, Steve, I think this would be something you would be wonderful at. Something that I love about our group is we have tremendous character as a group, as a fabric, as a tapestry in that we really care what happens to the individuals. It's true that our numbers are out there and you can see how we do. Our ratings are out there, if you look on the internet, you can see who's conservative, you know, who has less infections, who has, you know, low mortality morbidity. And to me that's huge. But equally as important is that if you want a surgeon you can talk to who is going to explain things, not in jargon but really in a language that you can understand and you want surgeons and other providers that work with the surgeons that are really going to work with you as a team. Meaning you know, it's great when everything works out perfectly, but what really tests your metal is when things aren't perfect, when you get [inaudible] and how you deal with that. And I know personally with Dr. Ludwig and with the neurosurgeons and the orthopedic spine surgeons, we work well if we have a problem, we all talk to each other and say, Hey, how would you go about this, this is something I've never seen before and I've done this for, you know, 30 years. And that attitude permeates the system. And that is not something you see routinely. But what I love is that our group has a huge heart and I think that goes a long way.
Dr. Ludwig: I just wanted to add to what Dr. Soloman was saying, the University of Maryland, our system meets bimonthly and as Cliff alluded to, there is somebody in the system amongst the 25 plus of us that do spine surgery that can help take care of any particular problem. And through the common communications, through our bimonthly meetings, through evaluations of our quality based metrics, our length of stay, any complications for instance, surgical site infection rates, we have a great understanding of, you know, the quality that we deliver and we're very confident in that. I think with regards to common disorders that we all treat. I think at the end of the day, mostly they're degenerative conditions of the cervical spine and lumbar spine. I think every hospital in the University of Maryland system that does spine surgery treats the majority of those types of disorders. And then over you know, over those, we all see tumors to the spine, both primary tumors and metastatic, traumatic injuries of the spine, we all see, and spinal deformities. And I think as Dr. Solomon alluded to before, we do a fair amount of throughout the system of revision work, right, surgical procedures that are done not only for the second time around but fixing other issues that may erupt as a result of their previous surgeries. Or new problems that erupt that are truant but unrelated to their previous procedure. We see the full gamut of not only adults but we also see pediatric cases as well.
Host: And I would assume that this means that you're referring now to probably the more highly advanced procedures that the UM spine network does.
Dr. Ludwig: Well, we not only do bread and butter types of procedures, but we do very complex adult reconstructive procedures as Dr. Soloman alluded to. And that's really the beauty of the system. We can work together, we can vet out cases. We often meet bimonthly and talk about more complex cases and issues that occur as a result of those cases, to bring a higher level of safety and quality to the network. But we can also talk amongst ourselves to find a better solution for patients with spinal problems.
Host: And finally gentlemen, if you would tell me how large is the UM Spine Network, but I have to go to Baltimore or could I go somewhere else in Maryland?
Dr. Solomon: You can address all the different hospitals we've gotten the system from Easton up to upper Chesapeake, Baltimore city and [inaudible] County with University of Maryland BWMC, where I spend most of my time. Charles regional, St. Joe's of course.
Dr. Ludwig: You can most likely find somebody as Dr. Solomon alluded to in almost every County, right? We're accessible to the delivery of care. So it's a hub where the center of the wheel we always is in the downtown University, right? University in Baltimore and then as Dr. Solomon alluded to, we have our folks above the center of the wheel that treat every community within the mid Atlantic area and have access to it.
Host: Thank you both very much. Is there anything either one of you would like to add?
Dr. Solomon: We really are constantly self examining our processes to be high tech, no question and high touch, no question. But we are looking at our own processes, like wound infections, like take back to the operating room, not knowing do we, I mean if I see somebody with that tremendous complex deformity case, you know, that's something that I just don't do a lot of anymore. So I will send it to Maryland and think no problem that he and his partners will take great care of that patient. But I love the fact that we all look at each other's work. We identify doctors. So when we look at our data, somebody is having a challenge. We kind of say, Hey, what's going on? And that's something that you do not see routinely in medicine today. We should. And I would like to think that Steve's really kind of set the bar high, that we're all doing that and we all buy into this concept that we don't make widgets. These are people's lives that are in our hands. And we're very humble about that. Thank God, every day that 99.9% of these folks wake up and do fine. But you know, I love that we care as a group that the mentality is the patient comes first.
Host: Thank you both for being here today. Dr Steven Ludwig is the Chief of Spine Surgery at the University of Maryland Medical Center and Dr. Clifford Soloman directs the UM Baltimore Washington Spine and Neuroscience Center. I'm Alyne Ellis. To learn more about the UM Spine Network, go to this website, UMMS.org/spine. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.
The Value of Neurological and Orthopedic Perspectives on Spine Surgery
Alyne Ellis: Welcome to Live Greater, a health and wellness podcast brought to you, but the University of Maryland Medical System. We put knowledge and care within reach so you have everything you need to live your life to the fullest. This episode is sponsored by the UM Spine Network connected to the renowned University of Maryland School of Medicine. The UM Spine Network is home to the region's leading spine experts. With convenient locations throughout the State, UN Spine Network physicians collaborate to create comprehensive care plans for patients across the full spectrum of care. When you work with a UM Spine Network physician, you can expect to receive the high quality evidence based care that you deserve. I'm Alyne Ellis, and our topic today is about the value of having both neurosurgery and orthopedic perspectives on spine surgery. My guests are Dr. Steven Ludwig and Dr. Clifford Solomon. Dr. Ludwig is the Chief of Spinal Surgery at the University of Maryland Medical Center and a Professor of Orthopedics at University of Maryland School of Medicine. Dr. Clifford Solomon directs the UM Baltimore Washington Spine and Neuroscience Center and he's a Clinical Assistant Professor of Neurosurgery at the University of Maryland School of Medicine. Welcome gentlemen. Let's begin with what is the University of Maryland Spine Network? Dr. Ludwig?
Dr. Ludwig: Sure. University of Maryland Spine Network is a conglomerate of everybody in the system that practices spine surgery, so it's a combination of neurosurgical based spine surgeons from their education training and upbringing, as well as orthopedic spine surgeons from once again their training and upbringing with regards to their subspecialty training. But essentially at the end of the day what we're all on the same page about is patient safety and delivery of the highest quality of care with regards to spine surgery for patients that come into the University of Maryland Spine Network.
Host: And I want to start by saying that this is a topic that I'm personally really very interested in because my son Sean, who has spinal bifida has had three spinal surgeries and the last one in particular required both neurosurgeon and an orthopedic surgeon. And so I am particularly interested. Let's start with you, Dr. Ludwig, and how do these two medical disciplines compliment each other?
Dr. Ludwig: At the end of the day, both orthopedic and nuerosurgically trained spine surgeons do spine surgery. I don't necessarily think you want somebody that's not subspecialty trained in spine surgery, right? Whether or not they've entered spine surgery through the orthopedic network or background or through neuro surgical background, you want somebody that just concentrates on spine surgery. Clearly, there are things within each realm. For instance, Dr. Soloman can comment on this further, but there are certain procedures that are inside the spinal cord or what we call the Dura or the lining of the spinal cord or nerve roots, that are better taken care of by the neurosurgeons. And there are other things potentially that would be not taken care of by the neurosurgeons. But at the end of the day with folks that are listening want to ask their surgeon, is whether or not they concentrate on spine surgery. Most of the time it becomes irrelevant. I think if they've been trained from their background of orthopedic or neurosurgery,
Host: Dr. Solomon, maybe you can add something to that, including maybe what the differences are between neuro and ortho surgery, when it comes to spine treatment?
Dr. Solomon: I think that, you know, we all went to like grade 27 of schooling, always trying to be the best we could in our class to get to medical school and residency after medical school, which is four years. Then another seven years of residency training, thereabouts, and then fellowship training after that. So at the end of the day, both neurosurgeons and orthopedic spine surgeons have just a tremendous amount of experience just from time put in doing this crazy job that we have, you know, where we're trying to help people move forward in their life and get over their challenge, and kind of go on with their life. Kind of like being on a boat and we want them to not end up on [inaudible 04:34], but we want them to have their surgery, get off the boat, get on the other side of the land, and keep on with their life. And hopefully have really helped them. Down at a granular level you know, as Dr. Ludwig mentioned, if something is a tumor in the middle of the spinal cord, then that's probably going to fall under neurosurgery. Although in my career I have done spinal cord tumors in the cord and above where you breath with orthopedic spine because I tend to think that they do an amazing job with reconstruction.
And so sometimes we need to take away more bone to get to a tumor inside the covering of the spinal cord called the Dura, that Dr. Ludwig mentioned. And so often we'll work together if need be in these complex cases and there is a sharing of the work where we will do the work under the microscope, taking the tumor out from the spinal cord, and then they will do the reconstruction part. It's true that they could probably do our part, we can do their part. There's definitely overlap. But for the majority of things we do, we both can do them and do them well. And as they get more complicated, we tend to use each other and bounce things off each other pretty routinely. I routinely send people to Dr. Ludwig and his group who have had other surgeries at other hospitals outside the system where it's not always clear cut to me. And sometimes just having their perspective, seeing things differently than I see them is very helpful. And I think that that's what makes what we're doing as a network, what Steve really had this vision to do has really made us, I think, you know, one of the premier spine groups really in the nation because of that, this kind of, there's no ego in this. We just want the patients to do well.
Host: So Dr. Ludwig, how does a patient go about finding a good surgeon given his condition or needs?
Dr. Ludwig: I think a lot of what happens when people ask about who to go to for spine surgery. They'll talk of course to friends and family members. Right? That's one common thing, using the internet, right as a means of gathering information right, and a web based sort of introduction to physicians. And obviously they rely on their primary care physicians or other subspecialty folks or docs that they have seen to get a sense of who they should see. I think within the University of Maryland system, every hospital within the system as very well trained as Dr. Soloman alluded to, very well trained competent, safe, the highest quality to delivery neurosurgical or orthopedically based spine surgery to the citizens of Maryland.
Host: But now Dr. Solomon, I would assume that, and both of you would say that don't pick somebody just because they're an ortho or a neurosurgeon. It's also important to pick their training. Number of cases they may have had the outcomes of those cases, their reputation. How do we go about assessing something like the number of cases? We just ask the doctor or the outcomes? That doesn't seem like something I'd find on the internet.
Dr. Solomon: Yeah, it's a good question. It kind of self selects out and you're not good at doing this, you probably are not going to have a lot of numbers of doing these cases. If you're super aggressive, people aren't going to come to you. You know, I always tell people the best surgery we do is none. But I really find, and I always tell people that less is more. Word of mouth is huge and you just can't say enough about what friends, families, neighbors, coworkers say. And I would say the majority of the business that I know comes to Dr. Ludwig from me, came word of mouth. Someone said to me, Hey, you took care of so and so and so and so. And they know that if I'm not the right person that does that particular case, I will say, Steve, I think this would be something you would be wonderful at. Something that I love about our group is we have tremendous character as a group, as a fabric, as a tapestry in that we really care what happens to the individuals. It's true that our numbers are out there and you can see how we do. Our ratings are out there, if you look on the internet, you can see who's conservative, you know, who has less infections, who has, you know, low mortality morbidity. And to me that's huge. But equally as important is that if you want a surgeon you can talk to who is going to explain things, not in jargon but really in a language that you can understand and you want surgeons and other providers that work with the surgeons that are really going to work with you as a team. Meaning you know, it's great when everything works out perfectly, but what really tests your metal is when things aren't perfect, when you get [inaudible] and how you deal with that. And I know personally with Dr. Ludwig and with the neurosurgeons and the orthopedic spine surgeons, we work well if we have a problem, we all talk to each other and say, Hey, how would you go about this, this is something I've never seen before and I've done this for, you know, 30 years. And that attitude permeates the system. And that is not something you see routinely. But what I love is that our group has a huge heart and I think that goes a long way.
Dr. Ludwig: I just wanted to add to what Dr. Soloman was saying, the University of Maryland, our system meets bimonthly and as Cliff alluded to, there is somebody in the system amongst the 25 plus of us that do spine surgery that can help take care of any particular problem. And through the common communications, through our bimonthly meetings, through evaluations of our quality based metrics, our length of stay, any complications for instance, surgical site infection rates, we have a great understanding of, you know, the quality that we deliver and we're very confident in that. I think with regards to common disorders that we all treat. I think at the end of the day, mostly they're degenerative conditions of the cervical spine and lumbar spine. I think every hospital in the University of Maryland system that does spine surgery treats the majority of those types of disorders. And then over you know, over those, we all see tumors to the spine, both primary tumors and metastatic, traumatic injuries of the spine, we all see, and spinal deformities. And I think as Dr. Solomon alluded to before, we do a fair amount of throughout the system of revision work, right, surgical procedures that are done not only for the second time around but fixing other issues that may erupt as a result of their previous surgeries. Or new problems that erupt that are truant but unrelated to their previous procedure. We see the full gamut of not only adults but we also see pediatric cases as well.
Host: And I would assume that this means that you're referring now to probably the more highly advanced procedures that the UM spine network does.
Dr. Ludwig: Well, we not only do bread and butter types of procedures, but we do very complex adult reconstructive procedures as Dr. Soloman alluded to. And that's really the beauty of the system. We can work together, we can vet out cases. We often meet bimonthly and talk about more complex cases and issues that occur as a result of those cases, to bring a higher level of safety and quality to the network. But we can also talk amongst ourselves to find a better solution for patients with spinal problems.
Host: And finally gentlemen, if you would tell me how large is the UM Spine Network, but I have to go to Baltimore or could I go somewhere else in Maryland?
Dr. Solomon: You can address all the different hospitals we've gotten the system from Easton up to upper Chesapeake, Baltimore city and [inaudible] County with University of Maryland BWMC, where I spend most of my time. Charles regional, St. Joe's of course.
Dr. Ludwig: You can most likely find somebody as Dr. Solomon alluded to in almost every County, right? We're accessible to the delivery of care. So it's a hub where the center of the wheel we always is in the downtown University, right? University in Baltimore and then as Dr. Solomon alluded to, we have our folks above the center of the wheel that treat every community within the mid Atlantic area and have access to it.
Host: Thank you both very much. Is there anything either one of you would like to add?
Dr. Solomon: We really are constantly self examining our processes to be high tech, no question and high touch, no question. But we are looking at our own processes, like wound infections, like take back to the operating room, not knowing do we, I mean if I see somebody with that tremendous complex deformity case, you know, that's something that I just don't do a lot of anymore. So I will send it to Maryland and think no problem that he and his partners will take great care of that patient. But I love the fact that we all look at each other's work. We identify doctors. So when we look at our data, somebody is having a challenge. We kind of say, Hey, what's going on? And that's something that you do not see routinely in medicine today. We should. And I would like to think that Steve's really kind of set the bar high, that we're all doing that and we all buy into this concept that we don't make widgets. These are people's lives that are in our hands. And we're very humble about that. Thank God, every day that 99.9% of these folks wake up and do fine. But you know, I love that we care as a group that the mentality is the patient comes first.
Host: Thank you both for being here today. Dr Steven Ludwig is the Chief of Spine Surgery at the University of Maryland Medical Center and Dr. Clifford Soloman directs the UM Baltimore Washington Spine and Neuroscience Center. I'm Alyne Ellis. To learn more about the UM Spine Network, go to this website, UMMS.org/spine. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.