Episode 26: Developing Evidence for Optimal Spine Surgery. A Conversation with Dr. Zoher Ghogawala

In the quest to optimize spine surgery outcomes, we need better information and better research. This means better clinical trials and more funding. Join me, as I sit down with Dr. Zoher Ghogawala to discuss his thoughts on clinical trial design, developing the evidence for spine surgery, improving patient outcomes, and the results of his most recent research.

You will want to hear this episode if you are interested in…

  • Getting to know Dr. Ghogawala, his clinical practice, and his research [0:37] 
  • Discussing Dr. Ghogawala’s clinical trials on spondylolisthesis and cervical spondylotic myelopathy [4:07]
  • Dr. Ghogawala’s work on improving clinical trial design [15:15]
  • Exploring roadblocks to PCORI (Patient-Centered Outcomes Research Institute) funding [24:33]
  • The most important things learned from the N2QOD [28:12]
  • Improving spine surgery outcomes [33:13]
  • What Dr. Ghogawala wishes he knew 15 years ago and the magic wand question [34:46]

Lessons from the N2QOD

As discussed in previous episodes, the National Neurosurgery Quality and Outcomes Database, or N2QOD, became the American Spine Registry and is used to track spine surgery outcomes all over the country. Dr. Ghogawala believes that there are three key takeaways we can learn from the now defunct N2QOD. The first, is that real-world practice demonstrates that spinal surgery is effective. There is substantial evidence from thousands of patients showing that surgery in the U.S. provides an objectively measurable improvement for their health-related quality of life. Second, the N2QOD has shown that doctors and patients can work together to get patient-reported outcomes completed reliably. Finally, he believes that the N2QOD has helped us understand that not every patient benefits from spinal intervention and that more work should be done to show the mental health impact of surgery in these types of registries.

Overcoming funding roadblocks

Funding is a major part of what makes good spine surgery research happen. Any quality research, for that matter. The primary funding agency for comparative effectiveness research in the United States is PCORI, the Patient-Centered Outcomes Research Institute. Gaining PCORI funding, however, has become increasingly difficult for studies around degenerative diseases and back pain. Dr. Ghogawala believes that one way to overcome these roadblocks is for both operative and non-operative surgeons to become closer to the PCORI organization and work with them as societies to help them understand the critical questions that need answers in spine surgery. Another way to help with funding is to involve patients in the process. PCORI is far more likely to fund a study that is highly relevant to patients aand the outcomes they care about.

A higher standard

As doctors and surgeons, everything we do to optimize our respective fields is to improve patient outcomes. We want the absolute best for the ones entrusted into our care. Yet, not every patient outcome will go the way we hope. There are far too many factors at play when dealing with spine surgery. But Dr. Ghogawala believes that if 80% of the patients we treat achieve the minimal clinically important difference in validated patient outcomes, we’re probably doing a pretty good job. Establishing that benchmark for himself and his surgical group has helped provide a means for self-assessment. Combined with the registry used at Lehe, doctors can partner with hard data to determine their success rate instead of relying on memory. 

Resources & People Mentioned

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