On March 16, 2019, you received from the DSPN the meritorious award for your work in the field of peripheral nerve surgery. What did this honor mean to you?

I am very humbled and appreciative. It is an honor shared by only two other very prestigious DSPN members, Dr. David Kline and Dr. John McGillicuddy. From a historical point of view, I did receive the Mayfield basic science award in Miami early in my career at the DSPN meeting, and now over 25 years later, I am being recognized for my service and commitment to the DSPN and the field. It is truly a great privilege to be recognized by my peer group.

It is also about all the friendships that have prevailed over the years, which I will cherish.

What is the paper that you are the most proud of?

The JNS is celebrating their 75th year anniversary (1944-2019). I was asked by editor-in-chief, Dr. James Rutka, to contribute to this edition and review the evolution of peripheral nerve surgery over the last
century. Along with Dr. Grochmal, I did write this paper that was just published this month in the JNS and titled “Surgery for nerve injury: current and future perspectives.” (J Neurosurg. 2019 Mar 1;130(3):675-685. doi: 10.3171/2018.11.JNS181520.)

What will be the next steps in our field?

Nerve transfers will continue to evolve with further anatomical and clinical work in the field. The application of brief electrical stimulation as an adjunct for nerve regeneration will also be further explored and likely implemented. Advancements in the field of pharmacological and biological therapy that will aid in the promotion of nerve regeneration are on the horizon. Robotic engineering, along with neurosurgical expertise, will help patients with complete flail arm by the development of a next generation of functional prosthetic limb driven by patients’ own neuromuscular control.

Any comments for the young peripheral nerve clinician?

This is a very exciting field with the opportunity to work with an interdisciplinary team of providers: rehabilitation physicians, hand therapists, engineers, scientists, other surgeons and a host of experts in their sub-specialized fields.

This interdisciplinary approach to nerve care will allow us to offer the best outcomes possible for patients with nerve injuries. Without hesitation, I can testify to the fact that the field of peripheral nerve surgery and care is still in the process of evolution with many future discoveries to come.

For the neurosurgery resident who would like to advance the field in nerve surgery, a one-year fellowship is highly advisable and encouraged, especially if your residency program did not provide peripheral nerve surgical exposure. The possibility of completing a condensed 6-month training may be satisfactory, with access to a mentor in the first years of practice.

What is the future of the DSPN Peripheral Nerve division?

There have been significant advances in the spine surgery field with technology, tools and approaches. Peripheral nerve surgery has a natural boundary with spine surgery. Spinal cord injury and focused nerve transfer, along with dumbbell peripheral nerve sheath tumors of the spine, are examples. The unification of both fields will improve the training of the future generations of surgeons. An increased focus on pain would be a very useful adjunct to patient care, along with more evidence-based guidelines. This has been a challenge because of the overlap with orthopedic surgery, hand surgery and plastic surgery. Meaningful studies with a focus on specific metrics will be very important.

Other Comments?

In order to increase greater peripheral nerve publications and participation at our meetings, each of us should engage at least one resident and or medical student in our neurosurgical programs. I take each opportunity to engage them in reviewing and writing papers, along with assisting in book chapter writing. This will help us to further develop our field. The Kline Research Award and the Kline Lectureship will continue to
be a priority for our group.