Dr. Garcia, congratulations on your Meritorious Award, Orthopedic Surgery at this year’s Spine Summit. Thank you for taking the time to allow me to interview you.
Most readers of our newsletter are neurosurgeons who might be less familiar with you and your accomplishments. Can you please tell us a bit about you, your upbringing, and your education?
I will try to tell you a little about myself, which I must admit feels a little awkward. I was born in Holguin, Cuba, which is in the eastern part of the island. We left Cuba when I was 2 years old due to the political situation there, and we were given asylum in Spain.
After two tough years in Spain we moved to Puerto Rico where I grew up. I went to high school in Puerto Rico, then attended college, medical school, and residency at Tulane in New Orleans. I graduated summa cum laude from college with a major in biology. I did a combined MD and MPH degree at Tulane, and was the Chief Resident of my graduating class in residency. I first became interested in research when I was in college. I volunteered doing research in endocrinology while a junior, and was lucky enough to get a letter of recommendation for medical school by Dr. Andrew Victor Schally, a Nobel laureate in Medicine.
How did you become interested in spine surgery, and who were your mentors?
My interest in spine was really the product of the mentorship of our program chairman, Dr. Thomas Whitecloud, III. Dr. Whitecloud was a wonderful human being and a great surgeon. I also decided to pursue spine surgery because I felt that in 1996, when I finished my residency, spine was still in the dark ages, and that the golden age of spine was yet to come.
I did my spine surgery fellowship in Chapel Hill, North Carolina, with two very busy deformity surgeons. We did our own anterior approaches including thoracotomies, and typical cases included long thoracolumbar fusions and pelvic fixation. I remember putting thoracic screws without fluoroscopy and awake cervical osteotomies for ankylosis spondylitis.
During my fellowship I first became interested in lumbar motion preservation. I asked my fellowship attendings about the idea and they told me I was insane, which made me more interested in the concept. I started doing research, which back then meant going to the library, and I found a couple of old articles about the Charite prosthesis. I was able to track a French surgeon, Dr. Thierry David, who agreed to let me visit him in the summer of 1999. Visiting Dr. David was a real career changing experience and my passion for lumbar arthroplasty was cemented.
After my fellowship in 1997, I joined an orthopedic group here in Miami, and have remained in the group for the last 21 years. I have served as Chief of the Orthopedic Department of Aventura Hospital, and also served on the Board of Trustees of the hospital. I have participated in six FDA trials mostly dealing with cervical and lumbar arthroplasty. While in private practice I have published four book chapters, and over 10 peer reviewed journal publications. I serve as the Chairman of the Continuing Medical Education Committee for the International Society for the Advancement of Spine Surgery, and Board Member for the International Advocates for Spine Patients.
Your expertise with lumbar arthroplasty is unparalleled. For our readers who may not perform this procedure (myself included), can you please detail the history, physical examination, and radiographic findings you have found to predict good outcomes after this procedure? In other words, on what kind of patient should this procedure be performed?
Patient selection is without question the most important factor for a successful lumbar arthroplasty. Ideal lumbar arthroplasty patients have normal bone density, single level disease at L4/5 or L5/S1, have mild to moderate disc space narrowing, normal or near normal facets, no pars defect, and BMI < 30. Patients should have primarily, if not exclusively, axial back pain. Patients with previous microdiscectomy with resolution of radicular complaints, but persistent axial mechanical back pain are good candidates, as long as minimal facet resection was done at the time of the microdiscectomy. Just like with cervical arthroplasty, a complete discectomy is important, and sometimes releasing or resecting the PLL is necessary to mobilize the segment. The importance of having ample exposure cannot be overstated. I have worked with the same access surgeon for 17 years. He is a cardiovascular surgeon. He started doing exposures with me, and now most of his practice is doing exposures for over 20 spine surgeons. Finally, doing lumbar arthroplasty is much like minimally invasive spine surgery. It requires a commitment from the part of the surgeon.
Where do you foresee spine surgery headed in the next 20 years?
I foresee the future of spine surgery to deal more with diagnosis and less on surgical techniques. I also expect a slow shift from mechanical to biological solutions.
Although you are in private practice, you have been able to be very involved in the field of spine surgery. What advice do you have for non-academic spine surgeons who wish to follow a similar path?
I encourage other non-academic spine surgeons to remain involved in clinical research by participating in clinical trials, by remaining active in specialty societies such as the CNS, and regularly attending society meetings such as the Spine Summit. I would like to say that it is a true privilege to receive this award.
What would you say has been your biggest contribution to the field of spine surgery?
I hope that my biggest contribution to the field of spine surgery is the legitimization of motion preservation as an established and proven technology for well selected patients through the dissemination of objective and well collected clinical research.
Last question: I recently heard that you are a wine expert. Would you agree with my assessment that Oregon pinots are the best in the world?
Oregon pinots can indeed be delicious, and my wife and I certainly enjoy their power, fruit, and finesse. We are particularly fond of Maggie Harrison’s Antica Terra. A few years ago, we traveled through Willamette Valley and were thoroughly impressed by the abundance of small and excellent producers. Having said that, in my mind (and in my palate) there is nothing as sublime as a well aged Burgundy, particularly a Grand Cru for a top producer. My favorite pinot of all times is the 1999 Domaine Comte de Vogue Musigny Vieille Vignes. It was like having roasted duck, with fully ripe black cherries, topped by vanilla ice cream.
Thanks again for your time Dr. Garcia, and congratulations on your award!