A conversation with Steven D. Glassman, MD

In this issue, Spine Surgery Today poses five questions to Steven D. Glassman, MD. He is a pediatric and adult spinal deformity surgery. He is Professor of Orthopaedics at the University of Louisville, in Louisville, Ky., and past president of the Scoliosis Research Society.

Dr. Glassman received his medical degree from Columbia University College of Physicians and Surgeons in New York City, and completed a general surgery internship and residency at Montefiore Medical Center in New York. His orthopedic surgery residency took place at Columbia University Medical Center in New York, and his spinal surgery fellowship was done in 1990 at the Leatherman Spine Center, in Louisville, Ky.

Steven D. Glassman

All of Dr. Glassman’s academic appointments to date, from 1992 to present, have been in the Department of Orthopaedic Surgery at the University of Louisville School of Medicine.

Dr. Glassman has been active in numerous professional societies throughout his career, including the American Academy of Orthopaedic Surgeons, American Medical Association and the North American Spine Society. This year, he received the Meritorious Award in Orthopaedic Surgery from the Section on Disorders of the Spine and Peripheral Nerves, a Section of the Congress of Neurological Surgeons and American Association of Neurological Surgeons.

Spine Surgery Today: Who has had the greatest influence on your career?

Steven D. Glassman, MD: My father had the greatest influence on my career. He was a pioneer in the development of anti-depressant drugs, and had a particular interest in the effect of those medications on cardiac function and arrhythmias. He was a winner of the American Psychiatric Association Lifetime Achievement Award.

Beyond his own field, he was always tremendously interested in learning and understanding how just about anything worked. He had almost unlimited patience (a trait I seem to have missed out on) and perseverance, which he focused not only on his academic pursuits, but on whatever challenged his intellectual curiosity. He instilled in me an interest in research and particularly a regard for high quality science.

Perhaps the most direct influence on my career was his approach to clinical science. He always strived to ask clinically relevant questions, ones that he believed might substantially impact treatment or advance the effectiveness of psychiatric care. This “big picture” view of clinical research has provided me with an ideal to pursue. While I doubt I have duplicated his success, it has definitely steered me in the right direction.

Spine Surgery Today: What was the defining moment that led you to your field?

Glassman: The moment – the case that led me to spine surgery – was early in my residency at Columbia Presbyterian/NYOH. I had the good fortune to work with Jean-Pierre Farcy, MD, one of a remarkable generation of spine surgeons who have led to our present 3-dimensional understanding of spinal deformity.

The case was a young artist from Harlem who had a post-traumatic kyphosis after a thoracolumbar burst fracture. Historically, these fractures were stabilized without correction, or with exacerbation of the kyphosis using distraction instrumentation, but Dr. Farcy was an early proponent of sagittal plane realignment. He described to me a plan for a simultaneous anterior and posterior approach with vertebrectomy, strut grafting and posterior segmental instrumentation.

Cotrel-Dubousset or CD instrumentation had been recently introduced into the United States, but was not routinely available. Dr. Farcy did not see this as a major obstacle. He told me, “You get the patient ready and I will go get ‘the stuff.’” It sounded a bit like a drug deal, but he took the supersonic transport to Paris and came back with enough CD screws, hooks and various connectors for us to do the case. It might as well have been a drug deal because I was hooked.

Spine Surgery Today : What area of research in spine surgery most interests you right now?

Glassman: Risk stratification is a term we are going to hear frequently in the next couple of years, and it seems to mean different things to different people. In its simplest form, risk stratification is what every surgeon does when he or she assesses a patient and tries to determine whether they are a good candidate for a given procedure. Today, we need to quantify that process.

One important aspect of risk stratification is that it may level the playing field as surgeons are increasingly being judged on the “quality” of their outcomes. If one surgeon treats adolescent idiopathic scoliosis and another takes care of neuromuscular scoliosis, we certainly would not anticipate equal complication rates. Risk stratification seeks to quantify the increase in complications that would be expected with a higher risk patient population.

Risk stratification also may be a tool for patient selection and shared decision-making. Surgeons frequently offer estimates of the risk of surgery or the likelihood of success based upon the patient’s pathology and comorbidities. These estimates are often based on general impressions and rarely on high-quality data. Risk stratification leverages our constantly improving base of patient reported outcomes, providing more accurate estimates which should lead to more reliable surgical outcomes.

Spine Surgery Today: What advice would you offer a medical school student today?

Glassman: I would offer three things. The first is trite, but still accurate. Pick something you really like. It is impossible to handicap the ups and downs of medicine, so don’t try to pick the specialty that will be most in demand or most lucrative. That is like trying to pick the top or bottom of a stock market cycle. A better plan is to find a specialty you enjoy, so going to work will be a positive experience despite the inevitable bumps in the road.

Second piece of advice is orthopedic surgery is a great field that offers a wide range of pathways and opportunities. In most cases, you are taking care of patients with problems that can be effectively treated and with the motivation to improve. Seeing patients get better after surgery, or with nonsurgical treatment, is a great feeling that never gets old.

My third piece of advice is a bit less philosophical. Learn about outcome measures and health care economics. Given the degree to which these factors are likely to influence medicine during the next few decades, I find it remarkable how little exposure medical students have to health care economics. Health care economics is not a black box containing some unknown obstacle waiting to be encountered. It is a science that doctors can influence, both to optimize patient care and to protect access to beneficial treatments.

Spine Surgery Today: What do you enjoy doing to relax?

Glassman: I have been told that relaxing is not in my skill set, but I enjoy playing golf, traveling and particularly eating. The traveling and eating have been a major focus during the past few years, as my role with the Scoliosis Research Society has given me the opportunity to visit an incredible array of people and places. Not so good for my golf game, but it does provide a workable excuse for my inconsistent play.

If relaxing is really on the agenda, then I guess the Sunday New York Times crossword puzzle would be my activity of choice. And then eating.

For more information:
Steven D. Glassman, MD, can be reached at 210 E. Gray St., Suite 900, Louisville, KY; email: sdg12345@aol.com.

Disclosure: Glassman reports he is an employee of/receives research funding from Norton Healthcare; he receives royalties from Medtronic Sofamor Danek; Nuvasive provides funds directly to a database company, but no funds were paid directly to the individual or individual’s institution; and he is past president of the Scoliosis Research Society.