As Vice Chair of The Department Of Orthopedics and a Senior Spine Surgeon at the University Of Colorado Hospital, Dr. Evalina Burger brings a unique voice to the medical industry by offering both the perspective of an active surgeon and a senior administrator.

During a recent visit to Colorado, we were able to speak to Dr. Burger about the rapidly changing world of spine surgery, her thoughts on patient-specific care, and what it takes to bring a new product to the University Of Colorado Hospital.

While a veteran in her field, Dr. Burger is certainly no stranger to embracing new technologies and companies that are looking to innovate. She sees this as a way to make healthcare more streamlined and above all, as a way to benefit her patients. Read the interview below to learn more about Burger and her role at CU Spine Center.

 

What can you say about spine surgery as it’s practiced now vs. how far it’s come?

I was privileged to be able to train even as Harrington Rods were just phasing out. Harrington Rods were the first stainless steel rods that we implanted for patients with deformities, and then in the early 90’s we got pedicle screws which made a quantum leap difference for spine surgery. As we progressed, we began to understand how patients are malaligned, and what we can do to make them better and not just look at the X-rays. This is just a very exciting time to be in spine surgery to see all the new developments. I hope that in my lifetime I’ll be able to look back and ask “What was I thinking?” because the advantages we are already making now are amazing.

 

From your vantage point, what can you say about patient-specific care?

We are definitely realizing that one size does not fit all. We are beginning to understand that there are different nuances for patients as they grow older. I think the biggest advantage we are realizing is that patients need to be in balance. It’s not about fixing the X-rays, which is a picture on a flat surface, but it’s about looking at the patient three-dimensionally. You know the old song “The hip bone’s connected to the thigh bone?” Well, it’s really true, and we are beginning to appreciate the balance of the whole body.

 

What can you say about some of the difficulties that take place both before and after the operation in terms of communicating with patients?

We service a very big population. It’s not just patients in Denver. We are the only medical school for four states, so we drain almost everything from here to the Canadian border. The average distance that patients travel to our clinic is 300 miles. We do have local patients, but that’s just the way Colorado is. It’s a big ranching and rural community. We also see many patients that have never had the chance to receive specific care. So when they come to our clinic we try to get as much information in the visit and get all the necessary X-rays and MRIs. We present the patient with options.

The patient then goes home to discuss their different options with family, and then we will try to diminish the traveling for the patient by working with them online and over the phone. Then we will bring them back one more time and explain the surgery, do the planning, and order the rods. We have specific protocols to prevent infections and our infection rates are .7% for spine. The national average is anywhere from 1.7% to 4.7% so we are really below that. The patient also sees an anesthesiologist during the pre-op visit. We always do the team surgery approach which has given us an amazing outcome, compared to when I was young and you did it by yourself and it was anywhere between 10-14 hours. We can now get these big surgeries done in 7 hours, which is very important because our transfusion rate in lower and our infection rate is lower. Most of our patients leave the hospital by day four or five.

“We are definitely realizing that one size does not fit all.”

What innovations could you benefit from that would make your life easier as a surgeon?

In the future, we need secure websites that we can actually email clinical pictures and deliver X-rays directly to the hospital and rule out mailing. That will make a huge difference. I know there is software available for that, but it’s very costly at the moment. I get a fair amount of CDs every week in the mail with a long letter from patients asking “Can you please take a look at my X-rays?” That becomes very time consuming. I do not treat X-rays, I treat patients. I usually give them a call and say “I’ve looked at your imaging. I realize that you live far away and I would like to have a phone consult with you.” The diagnosis of the problem lies in what the patient tells you, not necessarily what the X-rays look like. Having an app that you can could get a picture of a patient that is secure would be really helpful.

 

In your role at the hospital, what is the process like of companies approaching you with a new product?

Whenever a company approaches me for a new product, they make an appointment either through my clinic or through my assistant. If there’s an interest from my side, then I see it as another way to benefit our patients. Then I would meet with the company and look at the product. I do not like to experiment on patients so I would always get the data and figure out who has used it. I speak to other providers before I jump on the bandwagon to use it.

Sometimes I’ll ask to have a training session if it’s a new product. We are part of University Of Colorado Health and we have different committees and I work closely with the hospital to make sure the costs of new products are in line. They usually give us a trial and say “Here are 5 or 10 cases to try.” They track the costs and they track the outcomes, and that’s how you get a new product through.