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By Elizabeth Hofheinz, M.P.H., M.Ed.
As a consulting neurosurgeon to the Los Angeles Rams and the medical unit of ABC News, Dr. Carl Lauryssen, director of research and education at the Olympia Medical Center in Los Angeles, is somewhat inured to the graphic elements of the medical profession. Things were different, however, when he was a youth.
“I grew up in South Africa with a mother who worked as an artist and a father who designed television studios,” says Dr. Lauryssen. “Early on, there was little to suggest I would be headed for a career in medicine. At the age of 11, however, I was invited to observe an orthopedic surgical procedure, which turned out to be an amputation. I promptly passed out. That’s when I knew that too much blood was not a good thing for me. I turned my eyes towards the optical realm. At one point in my youth, I observed an eye surgery and was impressed by the power inherent in the procedure. You’re opening a new world to someone; the element of immediate gratification is also pleasing. Despite these factors, I intuitively knew that I should head in another professional direction. Once I completed medical school in South Africa, I left for Canada in 1989 to undertake what would be my first residency.”
The stillness of the Canadian landscape would prove a beneficial counterweight to the bustling pace of residency. Dr. Lauryssen: “From 1990 to 1991 I did a general surgery residency at the University of Saskatoon in Saskatchewan. During this time, one of my mentors, Dr. Jim Carter, suggested that I might be a good fit for neurosurgery. After a successful interview at the University of Calgary in Alberta, I enrolled in the school’s neurosurgery residency program in 1991. While there, my mentor, Professor Frank LeBlanc, integrated me into a basic science project on epidural fibrosis in a rat model. As part of this project I had the pleasure of working with Dr. Bruce Tranmer, now the head of neurosurgery at the University of Vermont. Thus for a long time, I spent my Fridays in the lab with rats trying to determine how to create and/or prevent spinal epidural fibrosis. I found myself increasingly interested in the world of spine. At that time there was no complex hardware being used in neurosurgery in Canada. Once I learned that 70% of a neurosurgeon’s work is spine, my path was set.”
For someone who has adjusted his ears from a South African accent to that of a Canadian, his next stops were no less challenging. Fortunately, spines have no accent. Dr. Lauryssen: “In 1995 I embarked on a fantastic spinal neurosurgery fellowship at the University of Alabama with Dr. Mark Hadley, past president of the Congress of Neurological Surgeons (CNS). Following this I was recruited to Washington University, where I worked with Dr. Ralph Dacey, at that time president of CNS. During my seven years there, Dr. Dacey fostered my neurosurgery career in a new subspecialty, spine surgery. Also while at Washington University I worked closely with three outstanding orthopedic surgeons, Larry Lenke, Keith Bridwell, and Dan Riew, with whom I formed a clinic and exchanged fellows.”
As the director of research and education at the Cedars-Sinai Institute for Spinal Disorders from 2003 to 2005, Dr. Lauryssen had the opportunity to master all aspects of running his own lab. And then he did the all-American thing … he went out on his own. “Starting my own lab gave me the experience of designing and managing the details of every research project. Housed at the 250-bed Olympia Medical Center, our $1 million lab enables us to conduct state-of-the-art research. We conduct high level biomechanical testing and in fact have one of only three multiaxial MTS machines in the country. In addition, in the past year, we have initiated nine FDA clinical trials through both my office and this hospital.”
A researcher at heart, Carl Lauryssen has twice been awarded the Young Investigator Award from the American Association of Neurological Surgeons for his work on cervical disorders and stem cell research. “My time in the lab has primarily focused on minimally invasive surgery and motion preservation. I’ve started working on tissue engineering, with Jing Wang, Ph.D., also of our lab, and worked on some general aspects of degeneration of the aging spine, including looking at the annulus and facet joints. An example is the development work with Spinal Elements (formerly Quantum Orthopedics) on the testing and development of their Zyre™ Facet System. This is a minimally invasive and tissue-preserving option which has been shown to have robust wear and mechanical performance. Clinical trials are being conducted outside the US and will expand worldwide in the near future. The idea behind this is that patients often have a normal disc on an MRI, but unilateral or bilateral facet pain is still present. We need to find ways to address this issue.”
As the first neurosurgeon to inject stem cells into a human spinal cord as part of an FDA clinical trial, Dr. Lauryssen is sold on cells. “Tissue engineering, stem cells … eventually we will conquer these arenas. We often do screening MRIs and find abnormalities in the disc. Going forward, we will harvest a small part of the disc, culture it, and find out if there are any genetic abnormalities. We will be able to do the engineering and solve the problem early on. Unfortunately, these activities seem to be far away, in part due to lack of funding.”
Due to his clinical and research clout, as well as his seat at the industry table, Dr. Lauryssen is exposed to the minutiae of the spinal world. Naturally, questions arise. “I am concerned that we are going so fast that we’re not answering questions thoroughly,” states Dr. Lauryssen. “Solid research requires long hours and detailed examination of the data. Take, for example, the work I’m doing with Dan Riew. We are conducting a prospective randomized study comparing laminectomy to laminoplasty for cervical spondylotic myelopathy. No one has ever done this. It’s particularly complex because no one knows how to treat it, i.e., anteriorly, posteriorly or a combination of both. This will take time, but all worthwhile research does.”
Continues Dr. Lauryssen: “Experts tell people in the field how to do things, but we must know beyond a shadow of a doubt that what we’re doing is on target. And reviewing one’s own results is not good enough. Look at the lumbar artificial disc—there are critics stepping forward who have never implanted one of these devices. Overall, some people are not paying attention to the indications; others are seeking exposure. The good news is that there is a significant role for appropriately conducted clinical trials. I have tested at least 15 products that are commonly available in the U.S. and elsewhere. The seemingly bad news is that product development is not always the right thing. In the end, however, if you’re keeping an inferior product away from patients, that’s a good thing.”
In addition to furthering patient care via research, Carl Lauryssen has put his creativity to use for patients via the internet. “Five years ago, I found myself thinking about how we explain surgery to our patients. It’s very difficult for patients to grasp the intricacies of a surgical procedure. I couldn’t help think that not only was it a bit boring for me to say the same thing over and over again, but there was no way to guarantee that we would explain a surgery the same way every time. I worked with Dr. Patti Gelnar, also a neurosurgeon, to develop a program to explain surgery to patients. We found an animator to create 3D animation and reviewed all the complication literature associated with the five most common spine surgeries. Once the surgeries were filmed, they were turned into animation; now they’re seen worldwide. Each patient receives a username and password in order to access the animations over the internet at www.graphicsurgery.com. We automatically document that they were online and track how often, and even who, watched the procedure (family, etc). As the word has spread about this program, my colleagues from other specialties have stepped forward to ask that it be developed for them. So far, programs have been created for hip and knee replacements, joint arthroscopies, general surgery and obstetrics, among other specialties. Some insurance companies are so convinced of its value that they increase reimbursements to physicians who use this program. In addition, surgeons who use it can get a discount from their malpractice carriers. In the end, the program works to protect surgeons ‘medicolegally.’”
Looking out over the landscape of medicine, Dr. Lauryssen sees a number of red flags. “In order to protect the profession from unnecessary litigation and insurance issues, our organizations and/or societies must work as one. This requires strong leadership on their part. On the reimbursement end of things, it’s frustrating that insurance companies remain the gatekeepers despite the increase of prospective randomized trials. The end result is that despite successfully completed and approved FDA devices, we’re still being denied authorizations for surgeries because the insurance companies feel the procedure is still experimental!”
As for educating fellows, Dr. Lauryssen has some straightforward advice: “Don’t get distracted by the business side of the profession and don’t get lost in bad literature. Unfortunately, there is a certain amount of garbage in the literature, meaning that one must really weed through it. When I teach the DePuy Spine course, which I have done for five years now, I tell the fellows, ‘If, during your fellowship, your research project provides the answer to just one really thoughtful and unanswered question, that’s better than 10 case reports or case series written up just for the sake of publishing—or padding your fellowship director’s CV. Remember, one solid answer.’”
Which is more than he’ll likely get from his newborn. “On the 9th of August, 2006, the most wonderful thing happened to my wife and me. Our son, Rex Riley, was born. Being a parent is an amazing experience, even more so because of the many well wishes we have received from friends around the globe. Up until I got married, the people in the spine world were my only family. Now I have two.”
Congratulations, Dr. Lauryssen … and enjoy your new, never-ending parental clinical trial that, according to most reports, requires substantial ongoing funding.