This is Carly Beam with the Becker Spine
Orthopedics
podcast. And today, I'm thrilled to be joined
by doctor Sophie Zhou at University Hospitals.
Sophie, thank you for being here today. To
start, can you tell me a little bit
about your background and what you do?
Yeah. Absolutely. Thank you so much for having
me. It's always really nice to have any
conversation about spine, especially with you.
So I am a
neurosurgeon.
I specialize in
ICU care as well as spine care. Mhmm.
One of my current,
current passions is spinal education
and how do we pass on our knowledge
and train the next generation.
So right now, I am the associate program
director for neurosurgery
at
and
I am really invested invested in, you know,
how do we
build upon the great education that I received
here and how do we keep pushing forward.
Excellent. And can you talk about your top
priorities going into, you know, the 2025?
Yeah. So I think 2025 has been a
huge year for me. This is obviously the
year that I started doing endoscopic spine surgery.
So it's,
definitely
a
year that is very memorable. The second half
of the year, as as you know,
I am pregnant, so I'm going to be
focusing on that a little bit on a
personal note. But in terms
of growth for my practice
and growth for education, I really am focused
on how do I create opportunities for my
fellows.
We currently have two cast accredited
fellowship
spots at
for spine surgery. So how do I
incorporate endoscopic
spine
into
not just my own education, but in the
education of our fellows?
Yeah. Well, first off, congratulations.
It's excellent news. I'm here about, your upcoming
baby. And can you talk about just how
you're
how are you planning to
leave the endoscopic
spine
program while you're away for a bit coming
up?
So I'm actually really excited about this. There
is,
two things specifically that we're doing. Right? Because
you can't fill the program being the only
person.
So a lot of my partners are actually
going to also become trained
in
endoscopic
surgery. So I'm not the only one. We
can continue doing these kinds of ultra minimally
invasive surgeries
and offer it to the patients in Cleveland
even when I'm out on maternity leave. I
think that is the basis of a great
program. It's that one person does not make
the program.
And then so that's something we're really focused
on. And number two, we're really focused on
is education.
So I, myself, am enrolled in a course
through NeoMed,
which is a medical college here in Northeast
Ohio.
It's called Fame e. It's a fellowship in
academic medicine
where we are where I'm trying to workshop
my ideas
of how to build a successful
endoscopic program,
and, specifically,
how do I translate,
this kind of education for adult learners?
So it really sounds like you're passing out
the torch, then you're gonna come back, and
the the endoscopic spine program is gonna be
even stronger than it
is now.
I know when we first talked in January,
you had talked about just kind of the
importance of also health care access and training
that next generation in spine care. I was
wondering, you know, what are the most important
values you're instilling in the folks that you're
training?
I think this is the same thing that's
been taught to me
when I was in training,
which is it's all about indications.
And the
more you have in your arsenal, the more
you have in your toolbox,
then the more indicate you can treat. I
think with endoscopic spine specifically,
you know,
I'm obviously at the
beginnings of my
career with endoscopic spine. But as you get
more adept at anything, the indications become much
more broad.
But I think the thing that we all
have to keep in mind is that you
can't try to shoehorn a patient into
a specific procedure. Right? Like, not every procedure
is made for every patient.
But
once you have
a
much,
you know, bigger toolbox
of
surgeries at your disposal,
and I think you're much more adept at
handling the different kinds of patients that may
come into your clinic.
Yeah. And what's your strategy on determining, you
know, which patient is best for endoscopic versus
open versus other minimally invasive, techniques?
So, actually, one of the great things that
we do,
is that people are much more they're much
more savvy nowadays.
They know that there is no one surgeon
in the area. Right? You don't just go
to someone because they're the only one there.
People
look around. They ask for second opinion, third
opinion,
however many number of opinions that they need
before they feel comfortable.
And I think that as a
as a surgeon, we owe it to those
patients to,
you know, really talk about each case and
make sure that whatever it is that we're
thinking,
we get collaboration on. So we actually have
a weekly spine conference where we discuss all
of our complex patients, all of the different
kinds of cases we encounter
with all of the spine surgeons in our
practice.
And we bring up films, we talk about
the complaints, you know, the symptoms that the
patients have, and we kinda discuss, you know,
there are
definitely more than there's definitely more than one
way to do any kind of surgery.
But given the patient's history and their patient
specific
findings,
there's almost always a bed better
way of doing things. So I think for
us, it's all about collaboration, and it's really
good for education. Right? Because our fellows and
our residents participate in these kinds of meetings,
and they really get to learn, well, what
are the nuances of each technique and how
do we think about
each patient. But
I think at the core, it's that you
have to look at
the patient specifics, not just what's on their
imaging.
Absolutely. And, you know, obviously, technologies like endoscopic
spine surgery, they're they've been crucial in moving
more patients to the outpatient setting, the ASC.
So how do you envision the role of
inpatient spine care evolving, and how is University
Hospital's spine program adapting to that?
Yeah. There's always a push towards,
getting patients out and home sooner. I think
it's
patients almost always heal better when they're in
their own environment, but we definitely have to
counterbalance that with patient safety.
You don't want to send somebody home who
may not be able to handle it, especially
in a patient population that tends to veer
on a little bit older
and
for patients who mobility may be an issue.
So I think that there is,
for for example, for these ultra minimally invasive
surgeries or for just minimally invasive surgeries, patients
tend to bounce back a lot faster because
they're smaller
procedures. And those are the first ones that
we should think about,
putting into an ASC
or into a
situation where the patient could be discharged same
day. But I think there should also be
guardrails. Right? You should also understand that just
because someone
has an endoscopic surgery or just because someone
has a minimally invasive surgery in their particular
scenario,
which may not even be medical, which may
be social,
it might be beneficial for the patient to
stay a day,
just for observation.
So I think that, like anything else,
we have
very we have a good framework of what
to do for each patient.
But at the end of the day, it
has to be individualized.
Got it. And last question for you right
now, when you think about endoscopic spine surgery
in the next two to three years, what
do you think this coming generation of endoscopic
spine technology
will look like?
I think that it's going
to expand in terms of its
abilities.
I think that the technology,
is limited right now by maybe the kinds
of tools that are at your disposal.
And as we get more adept at
entering the spine and this totally new view,
we might be able to handle things that
are a lot more complex, and we might
be able to handle things that
include
fusions. Right now, I mean, there's obviously endoscopic
t lifts, but I think there are
other avenues that we can explore.
But I think it also begs the question,
how many people actually need fusions if we
can
do a a minimally
disruptive
type of surgery and preserve the anatomic elements
that are, you know, good about the patient.
There obviously there's obviously a role for
scoliosis surgery, large deformity corrections,
and that's certainly not,
something I think endoscopic spine is going to
venture into in the next two, three years.
But I think
as we get more adept at seeing what
the outcomes are and what's gonna push the
boundaries, we might be able to see
new ways of
utilizing endoscopic spine. So, for example, one of
the things that,
I've done recently,
which I see on PubMed is really just
case reports,
is a removal of a epidural abscess,
for
for a patient. And for that patient,
she was
diabetic, had poorly controlled diabetes, was overweight,
and, you know, had all the hallmarks of
being a poor surgical candidate.
But
you don't want to have someone who's already
infected with a epidural abscess with a huge
surgical scar that may never heal. So by
utilizing
the endoscope, I was actually able to take
out the entire epidural abscess through an incision
that is typical of endoscopic spine. Right? It's
the size of my fingernail,
and
this patient healed beautifully. She was able to
take her antibiotics. Her pain was gone. Her
nerves are decompressed. She started regaining some of
the function that she had lost due to
the compression of this abscess.
So I think
as we get more adventurous,
as we see new avenues for use,
the it's gonna be a very organic,
it's gonna be a very organic growth of
endoscopic spine.
And for sure, with
more and more residencies,
fellowships adopting endoscopic spine,
people are gonna learn it not like me,
you know, in the middle of my practice,
but they're going to learn it
as just
part of their
general surgical training. And they're gonna be the
ones who push the envelope
because
it's something that they're familiar with. Right? They're
not
trying to learn it from scratch. They're
constantly using it and already seeing different evolutions
of the technology.
Absolutely. And I love that word you used
to describe the future
adventurous with endoscopic spine. Sounds like some real
exciting times ahead.
Yeah. For sure. For sure. I mean, I'm
I'm just thinking about my own growth. Right?
Like, in January, I did my first case,
and now it's, like, 15%
of my practice. It's,
it's not where I thought I was gonna
be. There's no way I thought, like, 15%
of my practice would suddenly become endoscopic.
But there there's a real need for it,
and there's it's a
I think, it's only gonna grow.
Absolutely.
Well, Sophie, thank you for joining us today.
It's been a pleasure speaking with you, and
I look forward to connecting again down the
line.
Yeah. Absolutely. Thank you so much for having
me.