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This is Carly Beam with the Becker Spine

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Orthopedics

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podcast. And today, I'm thrilled to be joined

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by doctor Sophie Zhou at University Hospitals.

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Sophie, thank you for being here today. To

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start, can you tell me a little bit

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about your background and what you do?

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Yeah. Absolutely. Thank you so much for having

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me. It's always really nice to have any

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conversation about spine, especially with you.

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So I am a

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neurosurgeon.

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I specialize in

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ICU care as well as spine care. Mhmm.

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One of my current,

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current passions is spinal education

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and how do we pass on our knowledge

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and train the next generation.

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So right now, I am the associate program

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director for neurosurgery

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at

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and

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I am really invested invested in, you know,

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how do we

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build upon the great education that I received

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here and how do we keep pushing forward.

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Excellent. And can you talk about your top

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priorities going into, you know, the 2025?

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Yeah. So I think 2025 has been a

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huge year for me. This is obviously the

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year that I started doing endoscopic spine surgery.

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So it's,

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definitely

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a

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year that is very memorable. The second half

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of the year, as as you know,

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I am pregnant, so I'm going to be

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focusing on that a little bit on a

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personal note. But in terms

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of growth for my practice

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and growth for education, I really am focused

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on how do I create opportunities for my

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fellows.

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We currently have two cast accredited

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fellowship

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spots at

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for spine surgery. So how do I

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incorporate endoscopic

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spine

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into

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not just my own education, but in the

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education of our fellows?

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Yeah. Well, first off, congratulations.

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It's excellent news. I'm here about, your upcoming

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baby. And can you talk about just how

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you're

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how are you planning to

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leave the endoscopic

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spine

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program while you're away for a bit coming

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up?

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So I'm actually really excited about this. There

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is,

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two things specifically that we're doing. Right? Because

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you can't fill the program being the only

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person.

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So a lot of my partners are actually

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going to also become trained

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in

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endoscopic

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surgery. So I'm not the only one. We

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can continue doing these kinds of ultra minimally

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invasive surgeries

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and offer it to the patients in Cleveland

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even when I'm out on maternity leave. I

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think that is the basis of a great

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program. It's that one person does not make

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the program.

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And then so that's something we're really focused

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on. And number two, we're really focused on

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is education.

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So I, myself, am enrolled in a course

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through NeoMed,

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which is a medical college here in Northeast

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Ohio.

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It's called Fame e. It's a fellowship in

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academic medicine

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where we are where I'm trying to workshop

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my ideas

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of how to build a successful

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endoscopic program,

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and, specifically,

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how do I translate,

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this kind of education for adult learners?

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So it really sounds like you're passing out

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the torch, then you're gonna come back, and

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the the endoscopic spine program is gonna be

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even stronger than it

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is now.

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I know when we first talked in January,

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you had talked about just kind of the

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importance of also health care access and training

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that next generation in spine care. I was

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wondering, you know, what are the most important

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values you're instilling in the folks that you're

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training?

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I think this is the same thing that's

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been taught to me

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when I was in training,

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which is it's all about indications.

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And the

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more you have in your arsenal, the more

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you have in your toolbox,

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then the more indicate you can treat. I

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think with endoscopic spine specifically,

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you know,

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I'm obviously at the

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beginnings of my

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career with endoscopic spine. But as you get

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more adept at anything, the indications become much

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more broad.

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But I think the thing that we all

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have to keep in mind is that you

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can't try to shoehorn a patient into

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a specific procedure. Right? Like, not every procedure

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is made for every patient.

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But

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once you have

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a

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much,

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you know, bigger toolbox

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of

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surgeries at your disposal,

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and I think you're much more adept at

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handling the different kinds of patients that may

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come into your clinic.

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Yeah. And what's your strategy on determining, you

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know, which patient is best for endoscopic versus

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open versus other minimally invasive, techniques?

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So, actually, one of the great things that

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we do,

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is that people are much more they're much

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more savvy nowadays.

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They know that there is no one surgeon

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in the area. Right? You don't just go

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to someone because they're the only one there.

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People

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look around. They ask for second opinion, third

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opinion,

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however many number of opinions that they need

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before they feel comfortable.

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And I think that as a

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as a surgeon, we owe it to those

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patients to,

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you know, really talk about each case and

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make sure that whatever it is that we're

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thinking,

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we get collaboration on. So we actually have

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a weekly spine conference where we discuss all

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of our complex patients, all of the different

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kinds of cases we encounter

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with all of the spine surgeons in our

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practice.

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And we bring up films, we talk about

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the complaints, you know, the symptoms that the

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patients have, and we kinda discuss, you know,

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there are

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definitely more than there's definitely more than one

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way to do any kind of surgery.

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But given the patient's history and their patient

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specific

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findings,

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there's almost always a bed better

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way of doing things. So I think for

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us, it's all about collaboration, and it's really

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good for education. Right? Because our fellows and

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our residents participate in these kinds of meetings,

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and they really get to learn, well, what

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are the nuances of each technique and how

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do we think about

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each patient. But

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I think at the core, it's that you

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have to look at

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the patient specifics, not just what's on their

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imaging.

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Absolutely. And, you know, obviously, technologies like endoscopic

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spine surgery, they're they've been crucial in moving

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more patients to the outpatient setting, the ASC.

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So how do you envision the role of

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inpatient spine care evolving, and how is University

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Hospital's spine program adapting to that?

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Yeah. There's always a push towards,

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getting patients out and home sooner. I think

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it's

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patients almost always heal better when they're in

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their own environment, but we definitely have to

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counterbalance that with patient safety.

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You don't want to send somebody home who

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may not be able to handle it, especially

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in a patient population that tends to veer

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on a little bit older

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and

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for patients who mobility may be an issue.

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So I think that there is,

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for for example, for these ultra minimally invasive

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surgeries or for just minimally invasive surgeries, patients

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tend to bounce back a lot faster because

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they're smaller

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procedures. And those are the first ones that

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we should think about,

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putting into an ASC

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or into a

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situation where the patient could be discharged same

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day. But I think there should also be

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guardrails. Right? You should also understand that just

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because someone

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has an endoscopic surgery or just because someone

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has a minimally invasive surgery in their particular

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scenario,

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which may not even be medical, which may

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be social,

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it might be beneficial for the patient to

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stay a day,

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just for observation.

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So I think that, like anything else,

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we have

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very we have a good framework of what

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to do for each patient.

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But at the end of the day, it

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has to be individualized.

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Got it. And last question for you right

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now, when you think about endoscopic spine surgery

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in the next two to three years, what

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do you think this coming generation of endoscopic

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spine technology

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will look like?

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I think that it's going

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to expand in terms of its

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abilities.

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I think that the technology,

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is limited right now by maybe the kinds

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of tools that are at your disposal.

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And as we get more adept at

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entering the spine and this totally new view,

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we might be able to handle things that

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are a lot more complex, and we might

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be able to handle things that

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include

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fusions. Right now, I mean, there's obviously endoscopic

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t lifts, but I think there are

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other avenues that we can explore.

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But I think it also begs the question,

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how many people actually need fusions if we

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can

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do a a minimally

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disruptive

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type of surgery and preserve the anatomic elements

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that are, you know, good about the patient.

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There obviously there's obviously a role for

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scoliosis surgery, large deformity corrections,

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and that's certainly not,

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something I think endoscopic spine is going to

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venture into in the next two, three years.

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But I think

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as we get more adept at seeing what

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the outcomes are and what's gonna push the

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boundaries, we might be able to see

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new ways of

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utilizing endoscopic spine. So, for example, one of

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the things that,

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I've done recently,

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which I see on PubMed is really just

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case reports,

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is a removal of a epidural abscess,

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for

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for a patient. And for that patient,

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she was

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diabetic, had poorly controlled diabetes, was overweight,

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and, you know, had all the hallmarks of

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being a poor surgical candidate.

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But

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you don't want to have someone who's already

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infected with a epidural abscess with a huge

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surgical scar that may never heal. So by

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utilizing

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the endoscope, I was actually able to take

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out the entire epidural abscess through an incision

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that is typical of endoscopic spine. Right? It's

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the size of my fingernail,

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and

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this patient healed beautifully. She was able to

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take her antibiotics. Her pain was gone. Her

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nerves are decompressed. She started regaining some of

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the function that she had lost due to

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the compression of this abscess.

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So I think

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as we get more adventurous,

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as we see new avenues for use,

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the it's gonna be a very organic,

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it's gonna be a very organic growth of

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endoscopic spine.

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And for sure, with

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more and more residencies,

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fellowships adopting endoscopic spine,

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people are gonna learn it not like me,

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you know, in the middle of my practice,

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but they're going to learn it

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as just

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part of their

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general surgical training. And they're gonna be the

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ones who push the envelope

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because

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it's something that they're familiar with. Right? They're

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not

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trying to learn it from scratch. They're

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constantly using it and already seeing different evolutions

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of the technology.

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Absolutely. And I love that word you used

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to describe the future

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adventurous with endoscopic spine. Sounds like some real

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exciting times ahead.

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Yeah. For sure. For sure. I mean, I'm

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I'm just thinking about my own growth. Right?

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Like, in January, I did my first case,

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and now it's, like, 15%

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of my practice. It's,

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it's not where I thought I was gonna

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be. There's no way I thought, like, 15%

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of my practice would suddenly become endoscopic.

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But there there's a real need for it,

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and there's it's a

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I think, it's only gonna grow.

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Absolutely.

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Well, Sophie, thank you for joining us today.

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It's been a pleasure speaking with you, and

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I look forward to connecting again down the

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line.

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Yeah. Absolutely. Thank you so much for having

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me.