Radek Kaiser is a Clinical Spinal Fellow at Oxford University Hospitals NHS Foundation Trust, and Associate Professor of Neurosurgery at Charles University Prague, Czech Republic. His research focus looks at the anatomical variations of peripheral nerves and alternative reconstruction techniques in the surgical treatment of peripheral nerve injuries, degenerative spine disorders and spinal oncology.
SSN: What drove you to choose a career in spinal surgery and medical research?
RK: I have wanted to be a doctor since primary school, and during medical school, I knew I wanted to pursue a surgical specialty. I chose neurosurgery after a detailed exposure during a summer internship in Vienna after my fifth year of medical school. Following my residency in Prague, I completed a clinical research fellowship at The Centre for Spinal Studies and Surgery in Nottingham, after which I joined the Military University Hospital Prague as a spine surgery specialist.
Additionally, I specialized in peripheral nerve microsurgery, which gave me the incredible opportunity to combine major spinal surgery with the most delicate neurosurgery. Early in my career, I worked on research involving neurotrophins in peripheral nerve regeneration as part of my PhD in neuroscience. My passion for science has remained a fundamental part of my practice ever since, continuing to drive my enthusiasm for medical research and advancements in spinal surgery.
In 2023, I had the opportunity to join the Spinal Unit in Oxford, where I am furthering my education in the areas of spinal deformities and oncological spinal surgery.
SSN: In a recent news article, we looked at research highlights of the role of SPECT/CT in identifying pain generators in degenerative spine disease. Could you tell us more about your research?
RK: Our research has shown the potential of SPECT/CT in identifying pain sources in degenerative spine disease. SPECT/CT has proven to be a valuable tool, particularly for patients with unclear MRI findings, aiding in more accurate diagnoses and tailored treatments. We found it to be more precise than MRI in diagnosing facet arthropathy and guiding treatment decisions.
The SPINUS I study published in Acta Neurochirurgica demonstrated significant improvements in pain and disability among patients undergoing spinal fusion for SPECT/CT-positive lumbar degenerative disc disease. We also examined the correlation between MRI findings and SPECT/CT positivity in chronic low back pain patients. The results indicated a strong correlation between SPECT/CT positivity and more severe degenerative changes. However, not all severely affected segments showed positivity on SPECT, suggesting that SPECT may only identify the “active” degeneration causing pain. This supports SPECT/CT as a valuable tool in managing degenerative spine disease by providing additional functional data, enhancing the understanding of pain mechanisms, and aiding in tailored treatment plans.
This research underscores the importance of integrating SPECT/CT into clinical practice to enhance treatment outcomes and improve the quality of life for patients with degenerative spine conditions.
SSN: What could your findings mean to help support the treatment of spinal degeneration and what will be the effect on patient experience?
RK: Our goal is to make SPECT/CT a standard part of the comprehensive evaluation for patients with chronic back pain, especially when MRI cannot clearly identify the source of pain. Future studies will determine whether this approach is also applicable to patients with chronic neck pain, where MRI only shows degenerative disc disease without associated disc herniation, spinal canal stenosis, or foraminal stenosis.
In cases where all conservative treatments have been exhausted, such patients could be treated using spinal fusion. By incorporating SPECT/CT into routine diagnostics, we aim to enhance the precision of pain source identification and improve treatment outcomes, thereby significantly enhancing the patient experience.
SSN: What is planned for the next stage of your research?
RK: We have established an informal group called the Oxford – Prague Spine and Nerve Research Group, through which we will continue our research in applied neuroanatomy, focusing particularly on the relationship between nerve and vascular structures in specific spinal surgeries. Additionally, we have begun collaborating with the Oxford Neuroscience group on research into radicular pain and functional studies of the dorsal root ganglion (DRG).
SSN: How does the future look in the treatment of spinal injury?
RK: Efforts to translate some marginal successes in spinal injury treatment on animal models into clinical practice have proven to be entirely futile. A fundamental neuroscientific insight is that the spinal cord lacks the ability to regenerate. One strategy to partially mitigate the impact of spinal injury involves nerve transfers in the upper limbs of tetraplegics. However, looking ahead, the utilization of various neuroprosthetics appears to be a much more effective approach. These advancements hold promise for significantly improving the quality of life for patients with spinal injuries.
SSN: What’s the best part of your job?
RK: Although it may sound like a cliché, I genuinely believe that the greatest reward for any doctor is a satisfied patient. While adequate financial compensation is necessary—as we all work to make a living—the gratitude expressed by patients or their families for saving a life, restoring mobility, alleviating pain, or enabling someone to return to work is akin to an actor receiving applause. This heartfelt appreciation is, without a doubt, the most fulfilling aspect of my job.
In spinal surgery, there’s the added advantage of often seeing results relatively quickly, sometimes even immediately. This immediate impact further enhances the rewarding nature of the work, making it incredibly satisfying.
SSN: … and the worst?
RK: I would say the increasing administrative burden, which affects healthcare in general, is one of the less enjoyable aspects. The growing amount of paperwork and bureaucratic processes can sometimes detract from the primary focus of patient care and medical advancements.
SSN: Are you planning to attend or speak at any medical conferences or events in 2025?
RK: As with every year, I will be attending the EUROSPINE Annual Meeting in Copenhagen in 2025. I am proud to serve as the Chair of the Meeting Council Education Programme Committee, actively contributing to the organization of the programme for this prestigious congress. EUROSPINE is one of the largest and most prestigious conferences in the fields of spinal surgery and neurosurgery, providing an excellent platform for sharing knowledge, discussing advancements, and connecting with fellow professionals.
SSN: If you didn’t work in the health industry, what would you be?
RK: I have never envisioned myself in any career other than neurosurgery and spine surgery. The field has always been my true calling, and I find immense satisfaction in both clinical practice and research. I am highly content and fulfilled in my specialty, combining patient care with the ongoing pursuit of medical knowledge.
SSN: Have you ever considered working as a humanitarian doctor?
RK: I am a very adventurous person, and I have to admit that I was interested. Unfortunately, one of the few medical specializations that Doctors Without Borders do not have interest in is neurosurgery. This makes sense, as the treatment of patients with brain or spinal injuries requires specialized equipment and ongoing care. However, I made up for it somewhat with a one-month internship after my fifth year of medical school in Sudan, specializing in orthopaedics. There, I witnessed severe injuries, rare exotic diseases, and the humility with which local doctors cared for patients coming to Khartoum from across the country. I believe this experience has influenced my entire professional life.
SSN: If you were Health Minister for the day, what changes would you implement?
RK: As Health Minister for a day, I would prioritize empowering patients to take greater responsibility for their own health. This includes launching nationwide campaigns focused on smoking cessation and weight management.
For example, just as we have speed limits on highways to protect passengers and mandates to use seat belts, we should offer strong recommendations to limit the consumption of unhealthy food and drinks. An emphasis on guidelines and educational initiatives, rather than strict regulations, would promote healthier lifestyles. Unhealthy habits significantly impact many medical conditions, so encouraging better nutrition and wellness practices is essential.
SSN: How do you think the future looks within the field of spinal surgery and treatments and what are your predictions for 2025 and the next decade?
RK: I believe the future of spinal surgery will increasingly incorporate the role of robots, particularly in complex spinal operations. While these robotic systems offer enhanced precision, they still require meticulous human planning. The most challenging aspects of complex spinal surgeries are not merely the insertion of spinal screws but the decompression of spinal structures, correction of deformities, and most importantly, the indication and planning of the surgical procedure. These tasks demand the expertise and judgement of skilled surgeons, which robots and AI will not be able to fully replicate in the near future. Thus, while technology will continue to advance, the collaborative efforts of human surgeons and robotic systems will be vital for achieving optimal outcomes.
Image submitted by the author. Credit:MAFRA-MICHAL SVÁČEK
