Thirty years ago, there were no cell phones. We were just beginning to watch movies in our homes on VCRs. And computers were huge and found only in large corporations. Yet 30 years ago, Dr. Randall Dryer began doing spine surgery.

I had the opportunity to sit down with Dryer in his office at Central Texas Spine Institute to discuss his front-row seat in the changing field of spine surgery over the last three decades.

Q: Why did you choose to focus your career entirely on issues of the spine?

A: When I was in my residency, I was fascinated by the complexity of the spine, and the fact that very few good solutions were available for us in treating spinal conditions. Even those solutions were really in their infancy in terms of sophistication as compared to hips, knees and other types of orthopedics. It was a huge challenge, and I found it extremely interesting.

Q: You began your career in the military. How has that influenced your practice?

A: Because of the eight years that I spent at a large teaching hospital in [San Antonio’s] Wilford Hall Medical Center, I had the opportunity to teach younger physicians who were still in their training. It allowed me to have an enormous amount of experience surgically – more than I would have if I had started out in private practice. The military taught me a greater degree of accountability and instilled in me a great deal of pride for our military personnel.

Q: Tell me about the challenges you faced in treating patients when you started in practice.

A: When I started, many surgeries were “exploratory” because we had inadequate diagnostic technology. We were unable to determine the exact anatomy before a surgery was undertaken. The advent of the CT scan and MRI scan has changed that. Thirty years ago, CT scans were new. MRI scans have improved the diagnostic capabilities of all medicine, and no longer is a spinal surgery done in an exploratory fashion because with new imaging techniques such as MRI scan and CT scan, we know exactly what we are going to find. Few surprises occur.

Q: What are some of the most important changes and developments you have seen over your 30-year career?

A: There are so many, it is unbelievable. When I was first in training, we always thought that biological or chemical treatments would eventually improve our treatment of bone and joint diseases, and that, in fact, is happening. We have the development of bone morphogenic protein, which is a hormone that stimulates our bones to lay down new bone. That is revolutionary for fracture care, trauma care and spinal surgery. We have moving joint parts now for almost every part of the body, including the discs in the neck and lower back. Those were only considered dreams when I started 30 years ago, and now they have actually been commercialized and are readily available to the population. In general, the improvements in care of soft tissue injuries and trauma have really affected orthopedics. Nerve regeneration and spinal cord regeneration are the areas of concern now, and will probably be conquered over the next 30 years after I retire.

Q: What do those developments mean for patients?

A: The answer to that is improved outcomes, shorter recovery, lessened pain and suffering, improvement in function after surgery [and] more predictability of results. In addition, we are able to provide structural or surgical solutions for many patients [who] in the past could only be offered comfort care.

Q: You have been an active participant in the field of research. In fact, you have been the principal investigator in more than 10 clinical trials. Can you tell me about some of the developments resulting from your research?

A: The research has been always in a clinical fashion, involving the commercialization of implants or biological agents relative to the spine. I have participated in the clinical studies that proved the safety and efficacy of bone morphogenic protein. That is a naturally occurring polypeptide, which stimulates the differentiation of cells to form bone. This has revolutionized the treatment of spinal fusion. It has allowed us a much higher percentage of fusion, making spinal fusions much more predictable and with a higher success rate in a shorter period of time. It has also eliminated the need to harvest bone from the pelvis or other parts of the body so that we do not have to make a separate incision, which is as debilitating as the spinal incision. Next, we have movable parts such as replacements for the discs in the neck and lower back. We actually have new artificial replacements of the small joints of the spine called the facet joints, so spinal surgery has evolved much along the lines of hip and knee surgery, where we can, in fact, fully replace damaged body parts, which [were] previously not able to be treated successfully.

Q: Tell me more about your contribution to spinal research.

A: One of the things that I am proud of in my career is that by working with highly trained engineers in biomechanics, I have been awarded several different patents. The patents are as simple as the design of a screw that is made of carbon fiber to contributions in the use of polyester mesh in the development of soft tissue repairs for ligaments and discs. I have patent contributions in artificial disc technology, facet replacement technology and plate and screw technology. All of these patents are registered and have been incorporated into commercialized products.

Q: Why do you choose to participate in research?

A: Participation in research allows me access to the newest, most groundbreaking treatment options for my patients. It gives me an opportunity to stay engaged in a thoughtful way with the latest aspects of my specialty. It gives me an opportunity to collaborate with other physicians around the country and the world, developing the latest techniques that are not accessible without participation in research.

Q: How does that benefit your patients?

A: That benefits my patients because they are the recipients of the latest, best techniques and technology that are available worldwide, often at no expense to them. The sponsors for the research have the obligation to prove that their products are safe and efficacious, and as such, they typically help defray much of the expense for these types of investigational devices.

Q: Looking into the future, how do you see spine surgery being affected in the next decade?

A: On the horizon – and, in fact, in its infancy right now – is the use of stem cells. Stem cells will be used going forward to make bone, cartilage and perhaps regeneration of nerves. Stem cells are already being used in the treatment of degenerative disc disease and disc repair. It is possible that in the future, chemical and biological agents will be utilized instead of surgery to correct damaged, degenerative and injured tissues. I believe the future probably belongs in stem cells, genetics research and biological agents that will, in some instances, take the place of mechanical fixation devices. At least, that appears to be the trend at this time.

For more information, please contact Central Texas Spine Institute at 512-795-2225 or visit www.spine-ctsi.com.