BackTable Article

Getting Innovative with Spine Interventions

Lauren Fang

Lauren Fang • Feb 8, 2021

Interventional radiologist Dr. Douglas Beall discusses how he implements new methods into spine intervention practice as well as the benefits of innovation both for patients and IR professionals. By getting innovative and staying innovative, Dr. Beall has discovered many ways to advance techniques and treatments for vertebral augmentation.

We’ve provided the highlight reel in this article, but you can listen to the full podcast below.

The BackTable Brief

• Many patients with spine disease continue to suffer from recurrent symptoms, disc herniation or recurrent stenosis. Dr. Beall states he is always trying to identify the failures, think of ways to make every condition treatable, and perfect the technology to treat so that it is as minimally invasive as possible.

• Although he is in private practice, Dr. Beall stays active in research and publishes numerous research articles every year. He is on his sixth textbook now and continues to generate educational content through his interest in identifying and optimizing new therapies, tips, and techniques.

• Interventional radiology has made significant advancements in the diagnosis and treatment of peripheral vascular disease, cancer, and pain. However, burnout is on the rise within the IR profession. One way to combat this is to find value through innovation.

Table of Contents

How to Get Innovative

How to Stay Innovative

Innovation that Alleviates Burnout

Discoplasty and vertebral augmentation

Listen to the Full Podcast

How to Get Innovative

Innovation starts by recognizing the existing shortcomings, coming up with an idea to address the problem, and testing the idea rigorously through research. Focusing on failures and perfecting the technology so that patient conditions can be treated as minimally invasive as possible is the goal for Dr. Beall.

[Douglas Beall]
What I really would like to do is put my money where my mouth is and test this. Yeah, I think it's better, so let's test. Test the adverse events, safety and efficacy, put it down and record it for posterity. By doing that, we'll really be able to figure out if what we're doing is right, advance the science, and advance the treatment down the field. That's exactly what we need to be doing.

One of the criticisms I get a lot from my colleagues is that they say, "You're always focused on failures." That's true, because I don't want to focus on successes. There's nothing there, except an atta boy or a pat on the back. Trying to make each condition treatable in a minimally invasive fashion all the way down to the point where you're ultimately very successful at doing that, that's the goal. You take something like interspinous decompression spacers. That's a little bit of an arcane and esoteric topic. I don't care that the five-year outcome is 80% decreased leg pain, 65% decreased back pain and corresponding improvement on Westry disability function. Yeah, super. Hair tussle. But what about the people that have recurrent symptoms, people that have a disc herniation, recurrent stenosis, subsidence? What do we do about those? That's really where I focus to try to perfect the technology.

How to Stay Innovative

Dr. Beall stays on the cutting edge of innovation by publishing research papers and disseminating expert knowledge through textbooks and lectures. He emphasizes the need for high risk tolerance, strong understanding of the disease process, accurate diagnosis, early feasibility studies, and longitudinal follow up of patients. Where additional options for a patient are lacking is where advancement needs to be made and where opportunities for innovation lie.

[Michael Barraza]
Dr. Beall, you still manage to stay on the leading edge of innovation in this sector. How are you introduced to all these new devices and procedures, and how do you go from there to actually introducing them into your practice?

[Douglas Beall]
How I’m able to do some of the new stuff and stay up on the cutting edge is even though I’m in private practice... I still publish five or six Level 1 papers a year. I've written a textbook within the last year. I'm working on another one now. It's my sixth textbook. We publish 15 to 20 papers a year. We go to meetings. We speak. We try to be visible. I try to be visible because I want people to come to me with new things...I'm interested in new things. I'm interested in optimizing new things, and we've had a consistent stream of successes. For example, interspinous spacer that we've had a recent success here that people don't know about, but they will very soon. Intradiscal augmentation with mesenchymal stem cells combined with micronized disc material, big triple-arm randomized control trial, dramatic success at treating patients with discogenic back pain….As long as you have risk tolerance and you can control the complications and you know the disease process and the place that it's best placed, that's where I think we can really make a difference. Do something with early feasibility studies and know exactly that you're doing things on people, that you're giving them an opportunity that they don't have. You're not taking anything away from them. You've noticed that a lot of the things that I do don't have names and they're way out there. The only commonality that every single one of these things has is that these patients have been put through and given no option. It's either suffer or maybe we can try something that is a little bit out of the box to fix somebody. We do it, and we follow them along.

[Douglas Beall]
An example of this is we had somebody with a discitis L2-3. The discs were eroded and end plates fractured, horrible deformity. The patient was seen by three adult deformity surgeons, all of which said, "Nothing we can do to help you." I said, "I'm going to send you to one more whose opinion I value and trust. If he says no, then I'll do something to help you." She came back. We put a Spine Jack in the disc, stretched her out, submitted her from top to bottom in that segment and she got up and walked out of there. She hadn't been able to walk in six months, and that is the kind of scenario that is just fantastic. However, having the lack of additional things to be able to help that patient, I think that's where we live. That's where the bar is raised. That's where the advancements are made, and that's where the opportunity lies.

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Innovation that Alleviates Burnout

Burnout and dissatisfaction is increasing in IR. Lack of clear identity and underrecognition of value are two contributing factors. Dr. Beall states that one way to combat burnout in IR is to find value in the specialty through innovation.

[Michael Barraza]
Just from the cases that I've seen that you've shared on Twitter and from educational materials, I would have guessed you were an orthopedic surgeon or neurosurgeon.

[Douglas Beall]
Don't feel bad. I've known guys for 20 years that come up to me at parties and introduce me as the wrong specialty. There are patients of mine that still don't know what specialty I practice. One of the issues that I'm still dealing with, literally 20-plus years later… is what is an interventional radiologist? It doesn't seem like that's what I do at all...I want to talk about name and value. I don't know that what we do is named appropriately. I don't know whether you call it radiologic surgery. I don't know if you call it something else, but the public still doesn't really know what we do for a living. I think now that we've really advanced the field in a lot of different areas, peripheral vascular disease, interventional oncology, interventional pain, I think it's probably time to really rethink that. I love diagnostic radiology, but I'm worried about it. I think the satisfaction that I've seen has decreased by 20% in the most recent article I saw in JACR, and the burnout rate is up. For years, I worked away and didn't really understand. I just ignored it. I thought, "This is not true. It can't be true. I have high satisfaction level in what I do.” Then article after article about burnout. I think burnout has to do with a combination of feeling valued and maybe autonomy and independence. I think that's what gives value.

[Douglas Beall]
I remember the first year of residency, 1994, I looked up the word commodification because I thought about image interpretation becoming a commodity. Part of the reason I do what I do is because I didn't want to be a commodity. I wanted to preserve what we do as a specialty, maybe as an artful specialty. I'm doing exactly what I want to do now in the way that I want to do it, and it's tremendously rewarding. It hurts to see other people that have maybe burnout or don't feel valued... What I'd like to see is, with involvement of the specialties, people involved with things that really make a difference...If you put that together, you will not be burned out and you will experience the maximum possible value. You will never want to stop, because you'll be making people better at the highest possible rate for a very long period of time.

Podcast Contributors

Dr. Douglas Beall

Dr. Douglas Beall is the Chief of Radiology Services at Clinical Radiology of Oklahoma.

Dr. Michael Barraza

Host Dr. Michael Barraza is a practicing interventional radiologist (and all around great guy) with Radiology Associates in Baton Rouge, LA.

Cite This Podcast

BackTable, LLC (Producer). (2020, November 9). Ep. 94 – Innovation in Spine Interventions [Audio podcast]. Retrieved from https://www.backtable.com/podcasts

Medical Disclaimer

The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.