Satish Rudrappa shares the positive changes he has witnessed in spine surgery and stresses the importance of lifelong learning, both for individual surgeons and the profession as a whole.
Is this there where you thought you would end up? If you had it to do it all over again, would you still choose to become a spine surgeon?
There has been a noticeable paradigm shift since my career as a spine surgeon began, with many positive changes. I was always minded to work in a field that holds the praise and appreciation of my peers, where co-operative learning takes place, and contributions to future generations is monumental. Despite my career still having a long way to go, I believe I have achieved what I envisioned for myself. However, I’m continuously learning & believe there is still much to contribute. Spine surgery is a field with a lot of challenges especially with cases involving degenerative spine requiring significant refinement in the field.
Why did you choose spine surgery?
35–40% of work in any busy neurological center is related to spine surgery, including cases of intradural and intermedullary work. During my time as a resident doctor, most spine disorders were treated with laminectomies and foraminotomies, irrespective of the type of disorder. While this did provide short-term relief, it was highly unstable in the long run. This shortcut solution perturbed me a great deal and inspired me to be well versed in spine diseases as a whole. To achieve this, I took a clinical fellowship in the USA. This helped me to reinvent myself as a spine surgeon, and the spectrum of patients we have in India made me reasonably well versed in any type of spine surgery.
What achievement you are most proud of?
Spine surgery was considered a domain of orthopedic surgery in most of the Asian countries, but I’ve always considered it to be a separate specialty. During the creation of AOSpine India, we introduced separate positions for education officers in orthopedics Spine surgery was considered a domain of orthopedic surgery in most of the Asian countries, but I’ve always considered it to be a separate specialty. During the creation of AOSpine India, we introduced separate positions for education officers in orthopedics and neurosurgery. This created a harmonious culture of spine education, which was patient-centric, and yielded greater levels of co-operation between the specialties.and neurosurgery. This created a harmonious culture of spine education, which was patient-centric, and yielded greater levels of co-operation between the specialties. In fact, over 90% of fellows who have graduated under me are orthopedic-trained specialists.
I have great belief that spine surgery should not be restricted just to spine, but also to intradural and intramedullary procedures. I perform and teach spine and spinal cord surgeries, including scoliosis, and have trained all of my fellows to learn these procedures too. During combined spine and spinal cord procedures, the barrier between orthopedic and neurosurgical disappears. I have propagated this message to my fellow peers and hope to see this concept present worldwide.
Another achievement of which I am proud, is inculcating ethics in the practice of spine surgery every step of the way. It is my vision to see every fellow follow these principles throughout not just their careers, but also through life.
Who has had the greatest influence on your career? Who was the most inspiring person in your life, and why?
My parents and Mahatma Gandhi are the most inspiring people in the world for me.
My mother—the most intelligent person I have encountered in my life—taught me that ‘knowledge is enlightenment’, and this always reverberates in my mind. She put wonderful discipline in me during my formative years. On the other hand, my father was a great soul who could help anyone in need at any time. I learned “micro philanthropy” through his selfless acts. Today, I teach my residents and fellows the principles of “Individual Social Responsibility” (ISR).
Mahatma Gandhi is a leader I always looked up to—a stubborn leader who worked with great conviction, which was both futuristic and inclusive. I always followed his principle of honesty and to work for the society we live in.
My wife and our two children are positive enforcers to me. Their immense encouragement and adaptability to my schedule has contributed significantly to my work.
How does a typical work day look like for you? How many surgeries do you perform and what is your most frequent operation?
Most working days begin around 8am. I typically operate five days a week, and run an outpatient clinic every day from the early hours of the evening to past 9pm. I teach fellows and residents every day “There has been a drastic improvement in the quality and skill of spine surgeries in India and Asia, in the last three decades. Crediting to the large Asiatic population and economic growth in the region, spine surgery has taken a great leap.”during in-patient rounds. Once a week we have resident teaching sessions, Journal clubs. On a yearly basis, I operate close to 600 surgeries, 60% of which are spine-related. The remaining 40% are brain surgeries.
With regards to spine surgeries, I typically perform degenerative cases, CVJ (Cranio-Vertebral Junction) pathologies and tumor surgeries. I have formed a team that is efficiently capable of performing a great number of surgeries, in an effective manner. ‘Team Work’ is a motto that radiates amongst all the members of the team and is the key for success in our department.
What do you consider your biggest learning as a surgeon?
Learning to perfection is key to any surgeon—more so with spine surgery as a small error can lead to disaster. With keen learning we speak less about complications to patients, which indirectly improves patient and community confidence in spine surgery.
How would you characterize spine surgery in India today?
There has been a drastic improvement in the quality and skill of spine surgeries in India and Asia, in the last three decades. Crediting to the large Asiatic population and economic growth in the region, spine surgery has taken a great leap. There are a good number of trained spine surgeons practicing in every major center in the country. There are vibrant spine societies propagating standardized care. I should credit AOSpine for taking an active part in collaborating with many spine surgeons in the country and helping to teach excellent principles of spine surgeries, especially to budding spine specialists.
What do you believe to be the emerging challenges and developments coming in the next five years?
The biggest challenges we face are the lack of uniformity in training programs, and an over reliance on minimally invasive surgeries. Minimally invasive word is being misconstrued and over “My advice to every young spine surgeon is to learn the procedure to the finest details under good teachers and mentors, and to remain patient-centric, rather than radiology-centric.”advertised, which can confuse patients and even lead to medicolegal problems. I think we have to be cautious when advising available options to patients, depending on their disease pattern, instead of stressing MISS procedures alone.
In the next five years I believe spine surgery will evolve as a separate specialty, with new training programs which will involve every aspect of spine surgery, including the Intradural pathology. In addition, navigation and robotic surgery will refine, further improving accuracy and patient safety.
What is the biggest change you have faced in spinal surgery over your career?
Spine navigation techniques and neuromonitoring techniques have increased surgeons accuracy and confidence, especially in deformity and intramedullary surgeries.
Outside of your own research, what has been the most interesting paper that you have seen in the past twelve months?
It was a paper concerning the use of robotics & Artificial intelligence (AI) techniques for rehabilitation of para- and quadriplegics to improve their quality of life.
What advice do you give to your young spine surgeons?
My advice to every young spine surgeon is to learn the procedure to the finest details under good teachers and mentors, and to remain patient-centric, rather than radiology-centric.
How do you inspire and mentor your fellows? In your opinion what makes a good leader?
I stress the concept of lifelong learning, mental and physical fitness and a mental attitude towards positivity are the ingredients to remain as active leaders in spine surgery. Propagating what we imbibed from others and keeping an innovative and open mind are some other crucial elements of the leaders in spine surgery.
How did you get involved in AOSPINE?
In 2004, AOSpine came to India, just as spine surgery was evolving as a new specialty. I got actively involved in the education “AOSpine is an excellent platform to teach and learn simultaneously. It is the only education organization which remains transparent and gives equal opportunity to every member. It is an organization which refined me as a good teacher and a leader. I would recommend other surgeons to join this AOSpine family, not just to learn but also develop as leaders of the future.”programs across India, conducting seminars and recruiting new members. It was a turning point, with excellent feedback on our teaching modules and many new surgeons enrolled. With increased membership we developed a governance module and AOSpine India became the first registered organization in the world.
When for the first time the AOSpine convention was conducted away from Davos, I introduced the first specimen course at Kuala Lumpur. In the last 15 years I have contributed to various new and innovative programs in the Asia pacific region. I thank AOSpine for giving me this opportunity.
What does being a member of AOSpine mean to you personally? Why would you recommend becoming a member?
AOSpine is an excellent platform to teach and learn simultaneously. It is the only education organization which remains transparent and gives equal opportunity to every member. It is an organization which refined me as a good teacher and a leader. I would recommend other surgeons to join this AOSpine family, not just to learn but also develop as leaders of the future. It is the only worldwide organization which invests in developing its members, something that remains unique to AOSpine.
Dr Satish Rudrappa is a well-known and distinguished Senior Neurosurgeon in India. An M.B.B.S graduate from Karnataka Medical College, Hubli (1990), he pursued his M.Ch in Neurosurgery from the prestigious National Institute of Mental Health and Neurosciences (NIMHANS, 1995) and was awarded the Gold Medal for graduating as the “Best Outgoing Student”. Since, he has successfully performed over 13,500 cases in the fields of both Neurosurgery as well as Spine Surgery.
He has numerous fellowships namely,
Furthermore, he is a visiting professor in universities such as the University of Hokkaido, Japan; as well as a history of teaching with the Louisiana State University, Shreveport, USA. His expertise lie in Spine Surgeries instrumentation, Spinal Cord tumors, Skull-Base surgery and Cadaver Dissection Techniques which have been key topics of choice and extensively taught through the timeline of his career.
He has presented in multiple national and international forums on topics related to both Spine Surgery as well as Neurosurgery and frequently conducts video-based live surgeries as well as demonstrations for international spine organizations such as AOSpine, of many others.
His repute as a skilled Neurosurgeon and Spine Surgeon has paved the way for many young surgeons to learn from him both Spine & Skull Base Surgery techniques. Dr Satish was twice Education officer (Neuro) of AOSpine India and elected as the Education Officer of Neurosurgery, AOSpine Asia Pacific and has since educated many young Fellows as well as students worldwide. Till recently he was an active member of AOSpine education commission.
His areas of interest include Complex Spine Surgeries of junctional pathologies, especially Craniovertebral Junction, Spine & Spinal cord Tumors, in addition to various Skull base Tumors.
The other Key Achievements are:
He currently serves as the Director—Institute of Neurosciences and as the Head—Department of Spine Surgery at Sakra World Hospital, Bengaluru, Karnataka, India.
Newsletter 22 | August 2019