Today, Jin-Sung (Luke) Kim is right there on the top with the world's leading spine surgeons and best known as an international expert in minimally invasive spine surgery (MISS). But it wasn't always clear that this would be his path. Talking with Kim, AO Spine found a compelling story about what has guided his career choices and what he bases his treatment decisions on.
Well, it is normal for us to set specific goals and move towards them in designing our lives and careers. But things don't always go as we had planned. When I had decided to become a neurosurgeon and started my major career, I wanted to be an endovascular neurosurgeon.
"Becoming an expert in minimally invasive spine surgeon—specifically endoscopy—was the best choice for me."
However, after becoming a board-certified neurosurgeon, what was most important for me was my family. Working as an endovascular fellow at a university hospital, I realized it was not right for my wife and our three kids. We had married early and already had three kids at the time. They wanted to play with daddy every day! So, after considering the relatively small number of emergency surgeries, I became a spine specialist in the neurosurgery field.
I made a choice based on the environment in my life, but in retrospect, I thank God I did so! There is a saying in the Bible, "…so are my ways higher than your ways and my thoughts than your thoughts," and for me it is so. Becoming an expert in minimally invasive spine surgeon—specifically endoscopy—was the best choice for me.
I am greatly stimulated by thought leaders and seniors from completely different professions in life, not only by doctors living in the same era as I am. For example, I often wonder how one can find a perspective for the future such that it can change the times! Like Giotto di Bondone, the sovereign Italian master of painting in the 14th century, who is now recognized as the great artist who opened the Renaissance era.
Amongst my contemporary international surgeons, I must mention professors Roger Härtl from the Weill Cornell University; Michael Mayer from the Schön Klinik in Munich; Anthony Yeung, Desert Institute for Spine Care, Arizona, USA; Chun Kun Park, the Emeritus Professor of the Catholic University of Korea; and Yue Zhou from Xinqiao Hospital, Third Military Medical University in China.
I was introduced to minimally invasive spine surgery early. My biggest influence would have come from the clinical instructors in the Wooridul Spine Hospital in Seoul, driven by the guidance and supervision of doctors Sang-ho Lee, who is the founder of Wooridul Spine Hospital, Gun Choi, Byung-joo Jung, and Ho-yeon Lee.
When I first learned endoscopic spinal surgery, we encountered many difficulties and problems. The biggest challenge was being outside the mainstream of academic societies; it seemed to be hovering somewhere in the outskirts.
"The biggest challenge was being outside the mainstream of academic societies."
When I presented a sort of endoscopic topic at the conference, I was sometimes hurt by the tone of criticism from conservative professors, but at the same time, I was motivated to move forward by research.
Thanks to many colleagues who have a constant passion and love for endoscopic spinal surgery, I am proud and beyond happy to see that it has become the most desired surgical method globally and has secured a lot of academic evidence over time.
As noted, the academic and technical needs for minimally invasive surgery are global. This is not just a temporary attraction or popularity, but a move in direction of international standards.
"Shortly, the East is changing around the doctor's hands and the West around technology."
However, there is a difference between the East and the West. The East is developing around delicate and sophisticated surgical techniques and the surgeon's hands. The West on the other hand, including the USA and Europe, is developing with a perspective of the medical industry, focusing on technology and engineering. Shortly, the East is changing around the doctor's hands and the West around technology.
Although everything interesting falls under the umbrella of minimally invasive spine surgery, the contents are very different. There are also differences in the social environment and the cultures of the East and the West.
Medical insurance-related reimbursement is very different from country to country, and I would like to touch on it briefly.
South Korea, which is unusual, has government-controlled medical insurance coverage, which costs a lot less than other OECD countries, and the level of medical care is second to any other country in the world. It is the health caregivers who benefit the least from this health insurance system.
For example, a lumbar discectomy costs around USD 400 and an endoscopic discectomy is cheaper. Nevertheless, endoscopic surgery has developed in Korea because spine surgeons "love" endoscopic surgery. There is nothing that can beat a loved one.
"AI, Big Data Assemble"!
Like other areas, MISS and especially the endoscopic spinal surgery field need further development though evidence-based medicine. Furthermore, Artificial Intelligence based on Big Data in hospitals is drawing more and more interest. More evidence must be established on the basis of—not separate cases—but all cases together. Like Captain America's iconic catchphrase in the great movie "Avengers: Endgame", I would also like to call out "AI, Big Data Assemble"!
As a member of AO Spine MISS Task Force, we are creating MISS related curriculum assets with my team members. During the pandemic that has been raging around the world for over a year now, we are proud to see that our materials are of great help.
The metrics-based educational content that AO Spine is creating is likely to be used in education by other global spine societies, and I think designing such educational content is where AO Spine plays an important role. In addition, I highly recommend using flipped learning, Virtual Reality, and agile methodologies in medical training.
Most spine surgeons are aware that Prof Kim is the specialist of endoscopic spine surgery, it is of course true. But, sometimes, he's not...
"Endoscopic spine surgery is a tool within MIS; it cannot be a panacea for every patient."
When I meet my patients in my outpatient clinic, I always try to find the best solution based on MIS. From my point of view, endoscopic spine surgery is a tool within MIS; it cannot be a panacea for every patient. It could turn into something like a false religious belief in one's craft. Some surgeons have too much faith in endoscopic spinal surgery.
In my practice, I perform endoscopic spine surgery, MIS fusion, navigation, and other kinds of difficult surgery. Using a metaphor from battle and Roman military weapons, we need to have Pugio, Gladius, Spatha, Crossbow, all of them. Similarly, as a spine surgeon, we must be trained to have a range of surgical skills, like microscopic tubular surgery, endoscopic spine surgery, MIS TLIF, LLIF, deformity correction, and so on.
You must be a spine surgeon with outstanding skills, absolutely, and the benefit of minimally invasive spinal surgery should not be overlooked. But it is not all about the technical skills; it is about philosophical values. I don't think we should look at patients only from the perspective of "now".
Preoperatively, I want to understand what discomforts the patient might have been suffering from in the past, what symptoms they are most uncomfortable with now, and then I eventually choose a surgical procedure. Some patients want to be treated for the most severe current symptoms, but some want to be treated for past problems as well.
"We need to consider the present and the future of the patient, to understand their living and socio-economic environments, and provide customized health care accordingly."
The aggressive surgeries I am operating on today might be able to treat these spinal problems in tandem. I think minimally invasive spinal surgery, especially endoscopic surgery, has a great potential to treat patients from a chronological perspective.
It is not simple to surgically treat the patient's clinical and radiologic symptoms from the past and the present at once. In other words, we need to consider the present and the future of the patient, to understand their living and socio-economic environments, and provide customized health care accordingly.
Luke Kim is the Professor of the Department of Neurosurgery and Director of the Center of Medical Device at the Seoul St Mary’s Hospital, The Catholic University of Korea, in Seoul, Korea. Click here for a short CV in English. He has served as Principal Investigator for many randomized clinical trials to evaluate endoscopic spine surgery and AI Big Data in MSKD which are supported by the Korean Government.