Suken A. Shah, MD, is Vice Chair of the department of Orthopaedic Surgery, Division Chief of the Spine and Scoliosis Center, and Clinical Fellowship Director at Nemours Children’s Health, Delaware.
He is also Professor of Orthopedic Surgery and Pediatrics at Sidney Kimmel Medical College of Thomas Jefferson University and certified by the American Board of Orthopaedic Surgery.
His clinical interests include adolescent idiopathic scoliosis, early onset scoliosis, complex spinal deformities, kyphosis, spondylolisthesis and other problems of the spine, minimally invasive techniques for surgery, osteogenesis imperfecta, and cerebral palsy.
Dr. Shah is an innovator, researcher, and key opinion leader in spinal deformity surgery. He performs advanced correction techniques, such as vertebral column resection and vertebral body tethering – and trains residents, fellows, and visiting observers in these techniques.
Dr. Shah is an active member of international specialty societies, serving on the Scoliosis Research Society board, currently as Education Council chair and previously as chair of its committees on education, programs, growing spine, and safety and value. A member of the Pediatric Orthopaedic Society of North America, he has chaired its committees on Industry Relations and One-Day Courses. He is Director of the International Pediatric Orthopaedic Symposium, a member of multiple research study groups, and a board member of the Setting Scoliosis Straight Foundation, and the Harms Study Group’s Executive Committee.
SSN: What drove you to choose your career in orthopaedics – and spinal disorders in particular?
SS: Orthopaedics brings together surgery and biomechanics as well as relatively quick gains in relief of pain and restoration of function. Spine surgery is complex, and there is constant technologic innovation, creating a challenging dynamic to bring responsible iterations of improvement that actually bring value or improved outcomes to the patient.
SSN: It is clear that the healthcare industry has been greatly impacted by the pandemic, what has been the greatest impact for you within your research and the industry as a whole? How has your working practice changed over the past few years?
SS: The pandemic changed a lot of things: how we think about health care delivery, quality, value, and experience – the experience on both sides of the equation: patient and provider.
Research production and published manuscripts were up in 2020. However, if you were trying to recruit patients for a clinical trial, well, that wasn’t so good.
We learned that virtual meetings could work in many arenas – case conferences and resident/fellow education – but not in others. Large scientific meetings organized by societies are better in-person for the human interaction, networking, and hallway conversations that are so important for collaboration, outside-the-box thinking and intellectual fulfillment.
Telemedicine visits exploded in the spring of 2020 but, as soon as patients and families were given the live, in-person visit option with their doctor again, they came back.
SSN: What’s the best part of your job?
SS: Coming together with a family and talented team members to deliver high-quality surgical care to a complex patient. This may not be a situation unique to pediatric care specialists, but I think it is harder to recreate in the adult space. I also enjoy teaching residents and fellows the technical aspects of surgery, crucial conversations, and how to be better. Seeing the evolution through their training is very gratifying.
SSN: … and the worst?
SS: Issues related to third-party payors: preauthorization, authorizations, peer to peers (who, by the way, are actually not our peers), and then the dreaded denials.
SSN: What has been the highlight of your career so far?
SS: My involvement with the Harms Study Group as a core study group member and now a part of the leadership structure has been an amazing opportunity that I’m truly grateful for. The Group has taught me so much about scoliosis, put me in the room with masters of pediatric spine surgery, provided mentorship, sponsorship, and friendship – and perhaps, most of all, made me a better surgeon, educator, and researcher.
SSN: Can you tell us more about your recent research, discussing outlines for updated criteria for selecting the appropriate fusion level for surgical management of adolescent idiopathic scoliosis.
SS: Scoliosis is a three-dimensional condition, and yet our assessment and sometimes treatment continues to be focused on less than that. My latest article, in the Journal of the American Academy of Orthopaedic Surgeons, provides updated guidelines regarding selective fusion for adolescent idiopathic scoliosis, with 3D in mind. There is a new generation of research exploring outcomes of selective fusion, level selection, and the three-dimensional deformity of the spine. Current 3D analyses enhance our understanding of the scoliotic deformity and provide novel guidance on where to begin and end fusion constructs. For instance, there are subtle differences in axial rotation and plane of maximal curvature previously not detected using 2D imaging strategies. Such differences may explain variability in treatment success. These findings highlight the importance of 3D imaging on detecting subtle differences in spinal deformity, which can guide surgical decision-making and technique.
SSN: The new criteria takes into account new technologies and enhanced understanding of three-dimensional abnormalities? Can you tell us more information about these technologies.
SS: EOS imaging has really allowed us to analyze, in 3D, the spine in an erect posture that we would otherwise have to analyze with CT or MRI, in the supine (lying down) position, independent of gravity. As we continue to study this collection of 3D renderings, and as EOS imaging expands to more scoliosis treatment centers, we can start to make clinical decisions based on 3D models rather than 2D films. Furthermore, the imaging is acquired with low-dose radiation with better contrast and detail than was ever possible with conventional X-rays – a win/win for everyone. Combined with true 3D assessment are new tools for preoperative planning so that you can simulate alignment parameters and surgical strategies well before the patient is in the operating room under anesthesia.
SSN: What could this mean for the patient experience, management strategies and surgical outcomes looking forward?
SS: With our focus on selective fusion – the shortest spinal fusion to get the best durable result for the patient while maximizing postop motion and minimizing recovery – these technologies, updated criteria, and better postop assessment all mean that the patient wins. Becoming more standardized, limiting variability, and studying long-term outcomes from a surgical strategy are the fundamentals to improving.
SSN: Are you currently involved in any further research? If so, could you tell us more about it?
SS: We are looking at growth modulation/motion preservation technologies like vertebral body tethering (VBT) and how best to select appropriate patients, apply the implants, tension them, and avoid tether breakage until skeletal maturity. Clearly, the 3D effects on the vertebra are important, but in VBT there are effects on the intervertebral disks and on growth of the vertebra during peak growth of an adolescent. Growth can introduce unpredictability to the model and so shared numbers and pooled data, like open discussion in a study group, are the best methods for research evaluation.
We are also looking at best ways to predict and reduce complications in our most vulnerable and complex scoliosis patients: those with syndromes or neuromuscular conditions like cerebral palsy or spinal muscular atrophy. With quality of life of paramount importance for these patients and families, we can really move the needle on avoiding readmission, reoperation, and perhaps healthspan/lifespan with preoperative risk reduction and medical optimization and perioperative care with ERAS protocols in mind.
SSN: Are you planning to attend any medical events this year?
SS: Yes, and in person, of course. We just had our annual Harms Study Group Meeting where we vetted research ideas, discussed projects/strategic initiatives, and finalized research abstracts for submission to scientific society meetings. Pediatric Deformity: On the Cutting Edge is in its 10th version as a preeminent pediatric spine meeting (Miami, Florida; March 3-4), and I’m grateful to be on such an esteemed faculty list. The International Meeting on Advanced Spine Techniques (Dublin, March 23-25) will showcase innovation and new technologies in spinal deformity, adult degenerative and cervical spine surgery. The Scoliosis Research Society Annual Meeting (Seattle, Washington; September 6-9) is not to be missed and will be the meeting for adult and pediatric spine providers who are passionate about spinal deformity care and advancing the field. Lastly, this list would not be complete without mentioning the International Pediatric Orthopaedic Symposium (December 5-9; Orlando, Florida). This meeting is a comprehensive, hands-on course on all aspects of pediatric orthopaedics for all levels of learner: resident, fellow, and mid-career surgeon, as well as the advanced practice providers that are part of our teams.
SSN: If you didn’t work in spinal surgery what would you be?
SS: Throughout the years, I have enjoyed all aspects of pediatric orthopaedics. Spine surgery was a natural fit, but I would be happy doing anything in orthopaedics.
SSN: What would you tell your 21-year-old self?
SS: Hard work wins, be a student of history, and don’t mind the haters. Seek diverse opinions and solid mentors. Be patient and grateful, and appreciate luck.
SSN: If you were Health Minister for the day what changes would you implement?
SS: Put the decision making back in the hands of the providers. Make medical information and navigation easier for patients and families. Share medical records and diagnostic studies among institutions seamlessly. (I know, that’s a lot).
SSN: Away from the clinic and your research – what do you do to relax?
SS: Spending time with family, friends, our dog. We also like the beach, tennis, and travel.
SSN: How do you think the future looks in the field of spinal surgery and what are your predictions for 2023 and the next decade?
SS: The future of spinal surgery is bright. “Enabling technologies” is a new buzz-phrase as is “med-tech,” but what they really mean is that the field is moving beyond commoditized widgets and into more of an arena of improved performance, safer surgery, and tracking outcomes to improve the durability of surgical interventions to make patients better.