2012 AANS Annual Report - page 11

Redefining Research:
Beginning with the Patient in Mind
Zoher Ghogawala, MD, FAANS
The most-skilled neurosurgeons understand that patient
engagement is necessary for reshaping the neurosurgical sphere.
For Zoher Ghogawala, MD, FAANS, patient care has been at the
forefront of his clinical and research efforts, even during his days as
a student at Harvard Medical School.
“I was intrigued by neurosurgery during my last year of medical
school, and saw how this particular specialty was engaged in the
union of high technology, complex surgery, and a close connection
between surgeon and patient,” Dr. Ghogawala said. Patient
connections have been at the center of his role as director of the
Wallace Trials Center at Greenwich Hospital in Greenwich, Conn.,
where he has served as the lead investigator on a number of studies
regarding the treatment of back pain and other spinal ailments.
“I was attracted to spine because of the uncertainty,” he said.
“I knew that spine was an area where I could make an impact
by tackling the big questions.” While an impetus in his research
interests, the ambiguity of spine research offers a unique set of
hurdles, and he noted that “spine results are not easy to measure.”
The research impediments presented by spinal treatments have not
deterred Dr. Ghogawala and groups such as the Collaborative Spine
Research Foundation (CSRF), a joint initiative of the Neurosurgery
Research and Education Foundation (NREF) and the Orthopaedic
Research and Education Foundation (OREF). Among the goals of
the CSRF is the advancement of high-quality spine care through
cooperative funding and clinical research advocacy.
“CSRF is uniquely positioned to develop an infrastructure for
answering questions regarding the effectiveness of spinal surgery,”
said Dr. Ghogawala, who serves as a CSRF board member and
describes the organization as a funding mechanism and a research
enterprise. “The NREF and the OREF are speaking with one voice to
put the questions of spinal research in front of scientists who have
the capability to answer the questions, but would otherwise lack the
infrastructure in which to address them.”
In 2011, Dr. Ghogawala led an inquiry evaluating the effectiveness
of laminectomies and spinal fusion surgeries. The SLIP Study, as it
is known, also demonstrated how treatment efficacy can be gauged
despite the challenges that accompany outcome assessment.
“The SLIP Study doesn’t identify one strategy that is superior
for all patients,” he said. “It identifies two characteristics of two
comparable strategies so that patients and neurosurgeons can
determine what option is best.”
Options create what Dr. Ghogawala considers a new realm for
neurosurgeons and their patients. “Neurosurgeons should
remain top-flight technical surgeons,” he said, “and they must be
scientifically sophisticated enough to choose the right procedure for
the right patients.”
Dr. Ghogawala, who also serves as co-chair of the National
Neurosurgery Quality Outcomes Database’s (N
QOD’s) Scientific
Advisory Committee, noted that the aim of both of these projects
is the same. “In the absence of high-quality data, many patients
may be treated with the wrong procedure,” he said. “[The research]
is about obtaining facts that patients and doctors can use in a
meaningful way.”
Dr. Ghogawala asserts that patient information is central to
the bottom line of research. “The ability of physicians to share
information is likely to result in better patient outcomes,” he
asserted. “Patients can set expectations in a reasonable context, and
they have a hand in advancing their own recovery.”
Dr. Ghogawala is the clinical assistant professor of neurological
surgery at Yale University School of Medicine in New Haven, Conn.
A graduate of Harvard Medical School, he completed his residency
training at Massachusetts General Hospital. He serves on the
executive committee of the AANS/CNS Joint Spine Section.
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