Once upon a time those suffering from back pain had to choose from an array of elixirs and potions. And, while things progressed over time, when a certain curious Swede made his first strides into orthopedic medicine years ago, he wondered, “Where is the science?” Dr. Gunnar Andersson, Professor and Chair in Spinal Deformities at Rush University Medical Center, has created much of the science of back care.
Dr. Andersson, who is credited with designing the seat in Volvo automobiles, first came to the U.S. on a research fellowship in 1976. “I was an assistant professor at Gothenburg University and my chair presented me with the opportunity to work at Rush for a year. The chair, Dr. Jorge Galante, had spent three years in Sweden, and I had had the privilege of working with him there.”
A former president of the Orthopaedic Research Society, Dr. Andersson hails from a little town in Sweden…a town so small that he was the only child born the year he entered the world. “I was the first in my family to attend high school, but because there were no secondary schools available in the area, I had to go to boarding school at the age of nine. It was my godfather, a general practitioner, who influenced me as far as a career in medicine. I was impressed by his ability to serve the local population and still maintain great sense of humor and a good quality of life.”
Dr. Andersson would go on to all that and more…he would find out what lays behind patients’ pain. When asked about the research he is most proud of, Dr. Andersson cites the work that won the Rush Spine Research Group this year’s Kappa Delta Award. “One of my NIH [National Institutes of Health] grants was to study lifting, twisting and other activities at work. From that I began working on disc degeneration and then more recently I have worked with others to use growth factors, cell therapy, and gene therapy to reverse degeneration…that is what led to the The Kappa Delta Award.”
“I continue to work on disc degeneration and am looking at how to tie degenerative changes occurring in the discs and elsewhere to the development of pain—and how to stop or reverse the progression of pain. The problem now is that while we know we can influence the process of disc degeneration in animals if we do it at the early stages of degeneration, once you get beyond a certain stage then the process doesn’t seem reversible. It will be a substantial challenge to move from animal work to humans; as of yet we have no approved clinical applications, nor FDA approval. This will happen in the next decade.”
Not forgetting where he came from, Dr. Andersson also looks back to his early years in Sweden for some of his most interesting work. “One of my first manuscripts involved studying people with hip replacements using different clinical methods of evaluating patients. In the process we found that my material was either the best or the worst ever published depending on the method used; I was pleased to be able to derive one appropriate outcome measure that was well received. I wanted the medical community to understand that published results depend on which outcome they used, i.e., you cannot compare one study to the next unless they use the same measures. In spine we have generally come to agreements about which methods to use.”
Dr. Andersson, who credits his “stubbornness” for much of his success, says, “I am proud of my initial work on measuring the loads on spine using disc pressure measurements and EMGs on back muscles. This work resulted in the development of several biomechanical models of the spine; in particular, the model that Al Schwartz and I developed which was the first biomechanical spine model with some degree of sophistication. We were able to validate our model using invasive methods such as disc pressure measurements.”
So how did orthopedics get lucky enough to attract the likes of Dr. Andersson? Pure chance, says he. “I was looking for a summer job during medical school and I ‘landed’ in the orthopedics department. In general surgery I had just been cutting and suturing, but in orthopedics I got to expand on that by using nails, screws, rods, etc. However, I rapidly learned that the science wasn’t there. Many things we were doing were not well documented. I said, ‘Here is an area of tremendous opportunity.’”
After the research fellowship at Rush, Dr. Andersson returned to Sweden, where he had already completed a Ph.D. program. This, says the good doctor, was life altering. “It was at the outset of my doctoral studies that I made a deep commitment to being a clinician-scientist. I enjoyed my Ph.D. program so much that I could hardly wait to get to work. I was studying how sitting affects the spine; I measured the mechanical effect of sitting using electrical activity of the muscles and the pressure inside the vertebral disc. I used a mathematical model to calculate loads that the spine was subjected to when sitting in different chairs.”
A practical, top drawer car manufacturer would only want a practical, top drawer researcher to further its attempts to make a better vehicle. Dr. Andersson: “This research, sponsored by Volvo, was the beginning of a long-term relationship I had with the company. I worked closely with the car designers, and I was very impressed that they wanted to create good seats; they didn’t limit me or our team in any way in terms of what we wanted to explore. They wanted to approach the issue of comfort with this question in mind, ‘Is there a physiologic basis for the features we are thinking of introducing?’ At that time few car seats had lumbar supports, so they were way ahead of the game. One of our primary findings was that lumbar support was really important to unload the spine when you sit. It is a combination of features in the seat that impact the spine loads; particularly important was the inclination of the backrest, the position and size of the lumbar support, and the inclination of the seat pan.” (Dr. Andersson thinks of these things even years later as he drives his Volvo around Chicago.)
Moving to the U.S. permanently in 1985, Dr. Andersson joined Rush and got to work deciphering his new environment. “When I moved to the U.S. it was quite a change to go from a socialized medical environment to one where there is a business and legal aspect to most of your decisions. I prefer this, however, because I think the U.S. medical environment stimulates people to work harder and better.”
As a leader, Dr. Andersson is not afraid to share the spotlight. Indeed, says he, that is what good leaders do. “I have never been interested in micromanaging, but instead I prefer to visualize the future and chart its direction. I like to allow others to develop and expand—and as a consequence everything gets better. Early on I learned that one of the keys to success is surrounding yourself with people who are more talented than you because they make you look better.”
Describing a “career highlight, ” Dr. Andersson reflects on his time as president of the Orthopaedic Research Society (ORS). “I had always loved the mission of the ORS, namely, to promote basic science, so I was incredibly honored to be named president in 2000. While we are on the verge of new era characterized by an increasing emphasis on biologic solutions to musculoskeletal problems, it is hard to know how long it will take. Ten years ago I thought we would be further along than we are today. One problem with biologics is that it has been difficult to find a way of providing the appropriate amount of growth factor to stimulate bone healing at the right time in the process and at the right dose. Side effects are always a concern; also, if the dose is not high enough then it will not have an effect. Ultimately, this work is an issue of resources…when the funding community sees the laborious regulatory pathway people step back and say, ‘Why should we take a risk in this area when there are other areas where the risk is smaller?’”
When asked what words of wisdom he would offer to future generations of orthopedic surgeons, Dr. Andersson states,
If I were young today I would go into spine. It is simply fascinating, with a substantial amount of interesting technology, and a lot of room for growth. It is still an area where a young surgeon can contribute scientifically. At the same time it is an area where fewer people get completely well than in many other areas of orthopedics. If you’re looking for 100% in outcomes…avoid spine.
An active athlete, Dr. Andersson says that in his youth he actually skied to school for three months a year. “I still enjoy skiing and running, and sometimes do these activities with my wife and two children. My wife? Well, she makes me look good. And our children—a son who is in banking and a daughter who works for a non profit—are just a delight. We all enjoy good food and wines, and I enjoy rummaging through my wine cellar, rotating bottles and taking note of what I should drink in the next several months and what can keep longer.”
Dr. Gunnar Andersson…better with time.
