5 Questions with Spine Surgery Today

A conversation with Anthony L. Asher, MD, FACS, FAANS

In this issue, Spine Surgery Today poses five questions to Anthony L. Asher, MD, FACS, FAANS. Dr. Asher is Clinical Professor, Department of Neurological Surgery at the University of North Carolina, Co-Medical Director, Carolinas Healthcare System Neuroscience Institute and Neurological Surgery Residency Program Director at Carolinas Medical Center.

ANthony Asher

Anthony L. Asher

Dr. Asher attended Wayne State University School of Medicine, where he was awarded one of the original Howard Hughes Medical Institute-National Institutes of Health (NIH) Research Scholarships. He completed an internship and residency at the University of Michigan Hospitals and subsequently served as a Staff Fellow in the Surgery Branch of the National Cancer Institute (NCI) in Bethesda, Md. Since the completion of his residency and fellowship training, Dr. Asher has been a member of the Charlotte, N.C.-based Carolina Neurosurgery and Spine Associates where his primary practice interests include neuro-oncology and minimally invasive spine surgery. He has held numerous national leadership roles including President, Congress of Neurological Surgeons. He is currently a director of the American Board of Neurological Surgery and a director-at-large for the American Association of Neurological Surgeons.

Dr. Asher has established cooperative cancer and spine research programs with clinical and laboratory scientists at community and academic institutions across the United States. His current academic focus is the development of clinical outcomes databases and related programs to facilitate quality improvement efforts across all practice settings. Dr. Asher co-founded and is presently Director of the National Neurosurgery Quality and Outcomes Database (N2QOD). He is co-chairman of the National Task Force on Quality Initiatives in Neurosurgery and presently chairs the Privacy and Research Task Force of the American Medical Association National Quality Registry Network Council. He is a member of the National Quality Forum Surgery Committee and serves as an advisor to the Health and Human Services Secretary’s Advisory Committee on Human Research Protections on matters pertaining to the intersection of human subjects, research and quality improvement.

Spine Surgery Today: Who has had the greatest influence on your career?

Anthony L. Asher, MD, FACS, FAANS: Julian T. (Buzz) Hoff, MD, was unquestionably the most inspiring presence in my early career. Dr. Hoff was my chairman at the University of Michigan. He was the classic triple threat academic surgeon: a superb clinician, a great teacher, and an Academy of Science caliber researcher. Perhaps most importantly, Dr. Hoff possessed what Osler described as a “good natured equanimity” that allowed him to gracefully respond to the pressures of being an academic surgeon while reserving space in his soul for the all of the other important influences, such as friends and family, that make life worth living. He was a great doctor and a great man. A generation of Hoff trainees have attempted to live up to his profound example.

Spine Surgery Today: What was the defining moment that led you to your field?

Asher: Prior to matching in general surgery at the University of Michigan, I had already invested almost 2 years in cancer immunotherapy research at the NCI. My intent entering residency was to pursue a career as a cancer surgeon working in translational melanoma and sarcoma research. However, while rotating through the Department of Neurosurgery I was fortunate enough to observe an intricate microsurgical procedure involving the brain stem and cranial nerves. It was a profound event, and following similar experiences, I concluded that a major career adjustment was necessary. During my staff fellowship at the NIH, I re-matched in neurosurgery and was delighted to return to Dr. Hoff’s department at University of Michigan.

Spine Surgery Today: Have you ever been fortunate enough to witness or to have been part of medical history in the making?

Asher: My primary research mentor, Steven Rosenberg, MD, PhD, developed the first effective immunotherapies and gene therapies for patients with advanced cancer. His contributions to medical science have been immense. When I was a Hughes Scholar in Steve’s lab at the NCI, it seemed as if history was being made every- day. I distinctly recall a constant, palpable energy and an intense sense of common purpose which fueled around-the-clock investigations by Steve’s team of international investigators. One morning, I was going over some data with Dr. Rosenberg, when one of his co-investigators burst into his office with a graph that suggested he had isolated a form of T-cell that had 100 times greater anti-tumor potency than any of the cellular agents identified to that point. Ultimately, these “tumor infiltrating lymphocytes” gave rise to an important and entirely novel field of investigation. It was an honor and an incredible privilege to be present in his laboratory during one of its most productive periods.

Spine Surgery Today: What area of research in spine surgery most interests you right now? Why?

Asher: Most of the research that I and my co-investigators are presently conducting involves data obtained from the (N2QOD). This comprehensive, cooperative national spine outcomes registry was primarily designed to facilitate quality improvement. However, the N2QOD is also proving to be an important resource to facilitate retrospective, hypothesis-driven analyses.

My current research is focused on analyzing the combined contribution of patient variables to defined outcomes following spine surgery. I am specifically interested in using predictive analytics to facilitate informed decision making and promote more effective utilization of spine care resources. In addition to developing predictive models for the outcomes of care in patient sub-populations, we also intend to use the national registry data to identify opportunities for large scale, prospective practice improvement programs.

High-quality clinical data are of critical importance as we work to improve the effectiveness of health care and inform the allocation of increasingly scarce health care resources. The cost and rapid growth of surgical procedures for spinal disorders have made this an area of special opportunity in quality science. In this environment, prospective observational methods such as the N2QOD hold significant promise as meaningful sources of data to facilitate continuous improvement, clearly define the most appropriate treatment options, and increase the overall value of surgical spine care.

Spine Surgery Today: What is next for you?

Asher: Going forward, I intend to work with our colleagues in neurosurgery, orthopedic surgery, physical medicine and rehabilitation, and other multidiscipline spine care providers to develop increasingly advanced, cooperative methods to objectively assess, improve and report the value of spine services. I am specifically interested in developing methods to intelligently scale these programs, and make them both relevant and sustainable for individuals in all practice settings. I am also very interested in harnessing existing registry infrastructures to facilitate a variety of essential prospective research programs, such as comparative effectiveness research. Ultimately, it is our goal to provide all spine care stakeholders — purchasers, patients and providers — with high-value data that promote informed decision making and continuous quality improvement.

For more information:

Anthony L. Asher, MD, FACS, FAANS, can be reached at Carolina Neurosurgery & Spine Associates, 225 Baldwin Ave., Charlotte, NC 28204, email: asher@cnsa.com.

Disclosure: Asher is director, National Neurosurgery Quality and Outcomes Database; is on the board of directors for the American Association of Neurological Surgeons; is director of the American Board of Neurological Surgery; is on the Surgery Steering Committee, National Quality Forum; and chairman, Privacy and Research Task Force, AMA National Quality Registry Network.

In this issue, Spine Surgery Today poses five questions to Anthony L. Asher, MD, FACS, FAANS. Dr. Asher is Clinical Professor, Department of Neurological Surgery at the University of North Carolina, Co-Medical Director, Carolinas Healthcare System Neuroscience Institute and Neurological Surgery Residency Program Director at Carolinas Medical Center.

ANthony Asher

Anthony L. Asher

Dr. Asher attended Wayne State University School of Medicine, where he was awarded one of the original Howard Hughes Medical Institute-National Institutes of Health (NIH) Research Scholarships. He completed an internship and residency at the University of Michigan Hospitals and subsequently served as a Staff Fellow in the Surgery Branch of the National Cancer Institute (NCI) in Bethesda, Md. Since the completion of his residency and fellowship training, Dr. Asher has been a member of the Charlotte, N.C.-based Carolina Neurosurgery and Spine Associates where his primary practice interests include neuro-oncology and minimally invasive spine surgery. He has held numerous national leadership roles including President, Congress of Neurological Surgeons. He is currently a director of the American Board of Neurological Surgery and a director-at-large for the American Association of Neurological Surgeons.

Dr. Asher has established cooperative cancer and spine research programs with clinical and laboratory scientists at community and academic institutions across the United States. His current academic focus is the development of clinical outcomes databases and related programs to facilitate quality improvement efforts across all practice settings. Dr. Asher co-founded and is presently Director of the National Neurosurgery Quality and Outcomes Database (N2QOD). He is co-chairman of the National Task Force on Quality Initiatives in Neurosurgery and presently chairs the Privacy and Research Task Force of the American Medical Association National Quality Registry Network Council. He is a member of the National Quality Forum Surgery Committee and serves as an advisor to the Health and Human Services Secretary’s Advisory Committee on Human Research Protections on matters pertaining to the intersection of human subjects, research and quality improvement.

Spine Surgery Today: Who has had the greatest influence on your career?

Anthony L. Asher, MD, FACS, FAANS: Julian T. (Buzz) Hoff, MD, was unquestionably the most inspiring presence in my early career. Dr. Hoff was my chairman at the University of Michigan. He was the classic triple threat academic surgeon: a superb clinician, a great teacher, and an Academy of Science caliber researcher. Perhaps most importantly, Dr. Hoff possessed what Osler described as a “good natured equanimity” that allowed him to gracefully respond to the pressures of being an academic surgeon while reserving space in his soul for the all of the other important influences, such as friends and family, that make life worth living. He was a great doctor and a great man. A generation of Hoff trainees have attempted to live up to his profound example.

Spine Surgery Today: What was the defining moment that led you to your field?

Asher: Prior to matching in general surgery at the University of Michigan, I had already invested almost 2 years in cancer immunotherapy research at the NCI. My intent entering residency was to pursue a career as a cancer surgeon working in translational melanoma and sarcoma research. However, while rotating through the Department of Neurosurgery I was fortunate enough to observe an intricate microsurgical procedure involving the brain stem and cranial nerves. It was a profound event, and following similar experiences, I concluded that a major career adjustment was necessary. During my staff fellowship at the NIH, I re-matched in neurosurgery and was delighted to return to Dr. Hoff’s department at University of Michigan.

Spine Surgery Today: Have you ever been fortunate enough to witness or to have been part of medical history in the making?

Asher: My primary research mentor, Steven Rosenberg, MD, PhD, developed the first effective immunotherapies and gene therapies for patients with advanced cancer. His contributions to medical science have been immense. When I was a Hughes Scholar in Steve’s lab at the NCI, it seemed as if history was being made every- day. I distinctly recall a constant, palpable energy and an intense sense of common purpose which fueled around-the-clock investigations by Steve’s team of international investigators. One morning, I was going over some data with Dr. Rosenberg, when one of his co-investigators burst into his office with a graph that suggested he had isolated a form of T-cell that had 100 times greater anti-tumor potency than any of the cellular agents identified to that point. Ultimately, these “tumor infiltrating lymphocytes” gave rise to an important and entirely novel field of investigation. It was an honor and an incredible privilege to be present in his laboratory during one of its most productive periods.

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Spine Surgery Today: What area of research in spine surgery most interests you right now? Why?

Asher: Most of the research that I and my co-investigators are presently conducting involves data obtained from the (N2QOD). This comprehensive, cooperative national spine outcomes registry was primarily designed to facilitate quality improvement. However, the N2QOD is also proving to be an important resource to facilitate retrospective, hypothesis-driven analyses.

My current research is focused on analyzing the combined contribution of patient variables to defined outcomes following spine surgery. I am specifically interested in using predictive analytics to facilitate informed decision making and promote more effective utilization of spine care resources. In addition to developing predictive models for the outcomes of care in patient sub-populations, we also intend to use the national registry data to identify opportunities for large scale, prospective practice improvement programs.

High-quality clinical data are of critical importance as we work to improve the effectiveness of health care and inform the allocation of increasingly scarce health care resources. The cost and rapid growth of surgical procedures for spinal disorders have made this an area of special opportunity in quality science. In this environment, prospective observational methods such as the N2QOD hold significant promise as meaningful sources of data to facilitate continuous improvement, clearly define the most appropriate treatment options, and increase the overall value of surgical spine care.

Spine Surgery Today: What is next for you?

Asher: Going forward, I intend to work with our colleagues in neurosurgery, orthopedic surgery, physical medicine and rehabilitation, and other multidiscipline spine care providers to develop increasingly advanced, cooperative methods to objectively assess, improve and report the value of spine services. I am specifically interested in developing methods to intelligently scale these programs, and make them both relevant and sustainable for individuals in all practice settings. I am also very interested in harnessing existing registry infrastructures to facilitate a variety of essential prospective research programs, such as comparative effectiveness research. Ultimately, it is our goal to provide all spine care stakeholders — purchasers, patients and providers — with high-value data that promote informed decision making and continuous quality improvement.

For more information:

Anthony L. Asher, MD, FACS, FAANS, can be reached at Carolina Neurosurgery & Spine Associates, 225 Baldwin Ave., Charlotte, NC 28204, email: asher@cnsa.com.

Disclosure: Asher is director, National Neurosurgery Quality and Outcomes Database; is on the board of directors for the American Association of Neurological Surgeons; is director of the American Board of Neurological Surgery; is on the Surgery Steering Committee, National Quality Forum; and chairman, Privacy and Research Task Force, AMA National Quality Registry Network.