From India to Sunset Boulevard
Dr. Anand: “In 1993 I headed to the U.S., completing my first spine fellowship in Gainesville, Florida, with Drs. Chet Sutterlin and Gary Lowery. My interest in deformity surgery heightened, I then undertook a scoliosis fellowship at Hospital for Special Surgery (HSS) where I was Dr. Oheneba Boachie’s first fellow. This extraordinary surgeon taught me that if you make a meticulous plan then nothing is impossible.”
That faith in planning would be tested, however, when Dr. Anand received those 135 rejection letters.
“At that point my options were to return to England or get another fellowship and apply again for an orthopedic residency spot in the States. Dr. David Helfet, HSS’ head of orthopedic trauma at the time, saw how sincere—and frustrated—I was, and offered me a spot in his fellowship.”
“Dr. Helfet impressed upon me the value of a superb work ethic. He stressed that you must have detailed discussions with patients, not just be good at technical execution. ‘You can’t just read the X-ray,’ he would say. ‘You must understand the fracture pattern.’”
Thrilled to be in the fellowship but still pining for a residency, Dr. Anand continued to send out applications.
Alas, zip, nada, crickets…
“He approached Dr Helfet and discussed the situation, whereupon he promptly reached out to several colleagues and I was accorded five interviews. I ranked in each one.
Then it was a veritable Groundhogs Day, with Dr. Anand matching at Albert Einstein College of Medicine where he did his third orthopedic residency. “I loved it! This was a high-volume center where we were allowed to work independently and had the opportunity to travel to other centers for our spine rotation. Part of this rotation was a three-month residency at the Texas Back Institute, where I got to learn from the venerable Dr. Stephen Hochschuler.”
Joining the MIS Spine Revolution
“I heard that Cedars-Sinai in Los Angeles was building a spine center and when I interviewed, I felt confident that this would be my new professional home. It was there that I was mentored by Dr. Robert Bray, who opened up a window into the nuances of neurosurgical techniques for spine—something that the majority of orthopedic surgeons never get the opportunity to incorporate into their practices.”
At the time, 2003, minimally invasive spine surgery was at an inflection point. A number of innovations were just coming through the FDA gauntlet and Cedars-Sinai was one of the most active centers for bringing these innovative procedures and technologies to patients. Dr. Anand found himself at the right place at the right time. Looking back, he recalls, “We were trying so many different technologies for the minimally invasive (MI) treatment of scoliosis because it is the most challenging surgery we do in spine. In 2003 we were using a lateral tubular approach to interbody fusion that I helped develop with NuVasive. But this option had two issues. First, we could not access L5-S1 from the lateral position because the pelvis was in the way. Two, you still had to put screws in the back so that still required a traditional open procedure.”
“TranS1 had developed the AxiaLIF, a truly novel and minimally invasive way of fusing L5-S1, so now the laterals we could do from L1-2,2-3,3-4, and 4-5 and L5-S1 use AxiaLIF. So, we adopted this early on and started to treat adult deformity patients in a MI fashion.”
But there remained the unsolved issue of the posterior screw and rods.
“In 2004 I approached Medtronic, which at the time had a minimally invasive system for one or two levels. When I asked them, ‘Why not multiple levels?’ they brought me on to help design a multilevel percutaneous screw and rod system that we could place MI throughout all of the spine.”
“At the time this was used and designed for trauma because there was no other MI way to place the screws. All that was available was a lordotic rod with the sextant system for use in thoracolumbar junction. So, in 2005 we developed a system for trauma that could stabilize patients in a MI way and yet be able to contour the rod into the appropriate sagittal contour. At that point, we had the technology and then started using it for spinal deformity. Hence, we are now able to truly perform circumferential minimally invasive surgery for adult spinal deformity—the lateral MI technique, the L5-S1 AxiaLIF and the MI trauma system for deformity. It made sense and we started doing smaller cases (3/4 levels) and built our experience over the years.”
I am probably one of those first patients. to have the non invasive surgery done by Dr. Anand sometime around 2003 or 2004. I recently had additional back surgery. Both were very successful. Dr Anand is very caring and kind. I always feel I am in good hands with him. My husband experienced some difficulty plus weakness in his legs so he saw his primary Dr., then saw a local orthopedic Dr. Who said he couldn’t see what was causing it. So we went to Dr.Anand and he said you have things wrong in your lower spine and in your neck, but you have no pain therefore I do not think you need surgery. Then he said you need to see a neurologist. How correct he was because my husband was subsequently diagnosed with ALS. How thankful we were that he did not have to have any unnecessary surgery which does happen to people who have unidentifiable ALS in the early stages. I am forever thankful to Dr. Anand.