A conversation with Charles L. Branch Jr., MD

In this issue, Spine Surgery Today poses five questions to Charles L. Branch Jr., MD. He is the professor and chair of the Department of Neurological Surgery at Wake Forest Baptist Medical Center, in Winston-Salem, N.C. Dr. Branch earned his medical degree from the University of Texas Southwestern Medical School in Dallas in 1981 and completed his neurosurgical residency in 1987 at what was then called Bowman Gray School of Medicine and now is Wake Forest Baptist, in Winston-Salem. He completed a fellowship in neurological surgery at the University of California, San Francisco in 1987, as well.

Dr. Branch received his board certification in neurological surgery in November 1991 and has been with Wake Forest University School of Medicine for his entire career, from his initial employment in 1987 to the present. He was appointed chair of the Department of Neurological Surgery as an interim position in July 2000. His permanent appointment was in July 2001, and he currently holds that position.

Dr. Branch was a cirector of the American Board of Neurological Surgery (ABNS) from 2005 to 2011 and was the chair of ABNS from 2010 to 2011. He was president of the North American Spine Society (NASS) from 2008 to 2009. Dr. Branch was the second Editor in Chief of The Spine Journal and helped take the publication from a formative journal to one with a top-five scientific index rating.

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

Charles L. Branch Jr., MD: One of the unsung heroes in spinal neurosurgery is Ralph B. Cloward, MD. Dr. Cloward advanced the field of reconstructive surgery for degenerative spinal disease and was not well received early in his career. This demonstrated to me that sometimes one has to be persistent at enduring challenges to make progress. Subsequently, my father, Charles L. Branch, MD, who trained as a classical neurosurgeon with Wilder Penfield, MD, embraced Dr. Cloward’s experience and developed an expertise in spinal surgery, in particular the posterior lumbar interbody fusion (PLIF). This influenced my career path as my training with David L. Kelly Jr., MD, at Wake Forest was evolving. Both of these men had a major impact in that while Dr. Kelly and the faculty at Wake Forest embedded quality spine surgery expectations in me, it was my dad who helped me appreciate the value of fusion and reconstructive surgery that has been a hallmark of my career. He also helped me develop the capacity to have a balance between work, family, church and missions, and then outside activities on the farm. My current hero is Volker K. Sonntag, MD. His leadership in spinal neurosurgery through the formative years and subsequent leadership in NASS helped me develop an appreciation for the great value of the collaborative efforts between orthopedic and neurosurgical spine surgeons. He has influenced our field in many ways I believe are still under-appreciated. Every successful spine surgeon or physician has a group of trusted friends and associates who both stimulate and ground us in our day-to-day work. Kevin T. Foley, MD;Sigurd Berven, MD,Steven D. Glassman, MD; and Christopher I. Shaffrey, MD, have been great friends and mentors in this regard.

Spine Surgery Today: What was the defining moment in your career?

Branch: I was trained in a traditional neurosurgical program where quality spine surgery was decompression for degenerative and other diseases and fixation or reconstruction for trauma The concept of spinal reconstruction for degenerative spinal failure was just not in our mindset. My decision to review my father’s patients who had undergone a PLIF for recurrent lumbar disc disease or the failed back syndrome, and the realization this approach changed the outcomes dramatically for these otherwise difficult patients, helped drive me up a career path of not only learning the PLIF and transforaminal lumbar interbody fusion techniques, but helping to improve them and enhance them as minimally invasive techniques.

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

Branch: I believe the golden age of medicine is ahead of us and not behind us. New technology and outcomes research are rapidly developing. These give young physicians tools to help patients in ways that we never dreamed of when I was a student. Political, socioeconomic and regulatory issues have always been a drag on our health care delivery. The current challenges, in many ways, are not new and should not be seen as an impediment to a great career. Another cautionary note would be, to be wary of letting technology become a wedge between you and your relationship with your patient. The most fulfilling aspect of medicine has been and will be your involvement in someone’s life in a highly meaningful way and, to derive from that benefit you have, the opportunity to get to know your patients.

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

Branch: Soon after beginning my practice, my wife and I purchased a tract of land just outside of Winston-Salem and, during the years we have devoted time and energy to developing this into a hybrid working farm and recreational park or nature preserve. While this involves physical work, the pleasure we derive from seeing the positive changes in the land and the enjoyment other people can derive from being in a truly special, natural place has been a great source of joy during the years, especially as our children have grown up and continue to enjoy this special place. It also is a great reminder that even a spine surgeon can grow a crop of soybeans.

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

Branch: I am fascinated by the development of robotic guidance technology and wonder if this technology will advance minimally invasive spine surgery. This field of research and development is exciting as it ultimately has the potential to increase precision and decrease radiation exposure allowing less invasive approaches with the opportunity for optimal segmental global alignment. Many of our research areas intersect in this area of interest, and so I wonder whether the robotic guidance technology will be a passing fad or bring value. Another area of interest is the development of a softer interface between rigid fixation and the mobile spine, especially in the aging spine. The current proximal junctional kyphosis rates are too high and research that delivers a consistent answer to this problem will be of great value to all of us.

For more information:

Charles L. Branch Jr., MD, can be reached at Wake Forest Baptist Health Medical Center, Medical Center Blvd., Winston-Salem, NC 27157; email: cbranch@wakehealth.edu.

Disclosure: Branch reports he is an educational and product development consultant to Medtronic and receives royalties through licensing agreements with Wake Forest Innovations.