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Becker’s Healthcare Podcast
Dr. Xiaofei Zhou, Associate Program Director of Neurosurgery at University Hospitals
00:12:31
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- [00:00]
A
This is Carly Beam with the Becker Spine and Orthopedics podcast. And today I'm thrilled to be joined by Dr. Sophie Zhou at University Hospitals. Sophie, thank you for being here today. To start, can you tell me a little bit about your background and what you do?
- [00:17]
B
Yeah, absolutely. Thank you so much for having me. It's always really nice to have any conversation about spine, especially with you. So I am a neurosurgeon. I specialize in ICU care as well as spine care. One of my current, current passions is spinal education and how do we pass on our knowledge and train the next generation. So right now I am the associate program director for neurosurgery at uh and I am really invested, invested in, you know, how do we build upon the great education that I received here and how do we keep pushing forward?
- [01:04]
A
Excellent. And can you talk about your top priorities going into, you know, the second half of 2025?
- [01:11]
B
Yeah. So I think 2025 has been a huge year for me. This is obviously the year that I started doing endoscopic spine surgery. So it's definitely a year that is very memorable. The second half of the year, as you know, I am pregnant, so I'm going to be focusing on that a little bit on a personal note, but in terms of growth for my practice and growth for education, I really am focused on how do I create opportunities for my fellows, which currently have two CAST accredited fellowship spots at UH for spine surgery. So how do I incorporate endoscopic spine into not just my own education, but in the education of our fellows?
- [02:00]
A
Yeah. Well, first off, congratulations. It's excellent news. I'm here about your upcoming baby and talk about just how you're. How are you planning to leave the endoscopic spine program while you're away for a bit coming up?
- [02:18]
B
So I'm actually really excited about this. There is two things specifically that we're doing right, because you can't fill the program being the only person. So a lot of my partners are actually going to also become trained in endoscopic surgery. So I'm not the only one. We can continue doing these kinds of ultra minimally invasive surgeries and offer it to the patients in Cleveland, even when I'm out on maternity leave. I think that is the basis of a great program. It's that one person does not make the program. And then so that's something we're really focused on. And number two, we're really focused on is education. So I myself am enrolled in a course through NeoMed, which is a medical college. Here in Northeast Ohio. It's called Fame E. It's a fellowship in academic medicine where we are. Where I'm trying to workshop my ideas of how to build a successful endoscopic program and specifically how do I translate this kind of education for adult learners.
- [03:26]
A
So it really sounds like you're passing out the torch. Then you're going to come back and the endoscopic spine program is going to be even stronger than it is now. I know when we first talked in January, you had talked about just kind of the importance of also healthcare access and training, that next generation in spine care. I was wondering, what are the most important values you're instilling in the folks that you're training?
- [03:52]
B
I think this is the same thing that's been taught to me when I was in training, which is it's all about indications. And the more you have in your arsenal, the more you have in your toolbox, then the more indicators you can treat. I think with endoscopic spine specifically, you know, I'm obviously at the beginnings of my career with endoscopic spine, but as you get more adept at anything, the indications become much more broad. But I think the thing that we all have to keep in mind is that you can't try to shoehorn a patient into a specific procedure. Right. Like, not every procedure is made for every patient. But once you have a much, you know, bigger toolbox of surgeries at your disposal, and I think you're much more adept at handling the different kinds of patients that may come into your clinic.
- [04:51]
A
Yeah. And what's your strategy on determining, you know, which patient is best for endoscopic versus open versus other minimally invasive techniques?
- [05:01]
B
So actually, one of the great things that we do is that people are much more. They're much more savvy nowadays. They know that there is no one surgeon in the area. Right. You don't just go to someone because they're the only one there. People look around, they ask for second opinions, third opinion, however many number of opinions that they need before they feel comfortable. And I think that as a surgeon, we owe it to those patients to really talk about each case and make sure that whatever it is that we're thinking, we get collaboration on. So we actually have a weekly spine conference where we discuss all of our complex patients, all of the different kinds of cases we encounter with all of the spine surgeons in our practice, and we bring up films, we talk about the complaints, you know, the symptoms that the patients have, and we kind of discuss, you know, there are definitely more than there's definitely more than one way to do any kind of surgery, but given the patient's history and their patient specific findings, there's almost always a better way of doing things. So I think for us, it's all about collaboration and it's really good for education. Right. Because our fellows and our residents participate in these kinds of meetings and they really get to learn, well, what are the nuances of each technique and how do we think about each patient. But I think at the core it's that you have to look at the patient specifics, not just what's on their imaging.
- [06:37]
A
Absolutely. And obviously, technologies like endoscopic spine surgery, they've been crucial in moving more patients to the outpatient setting, the asc. So how do you envision the role of inpatient spine care evolving? And how's the University Hospital's spine program adapting to that?
- [06:56]
B
Yeah, there's always a push towards getting patients out and home sooner. I think it's. Patients almost always heal better when they're in their own environment, but we definitely have to counterbalance that with patient safety. You don't want to send somebody home who may not be able to handle it, especially in a patient population that tends to veer on a little bit older. And for patients who mobility may be an issue. So I think that there is, for example, for these ultra minimally invasive surgeries, or for just minimally invasive surgeries, patients tend to bounce back a lot faster because they're smaller procedures. And those are the first ones that we should think about putting into an ASC or into a situation where the patient could be discharged same day. But I think there should also be guardrails. Right. You should also understand that just because someone has an endoscopic surgery or just because someone has a minimally invasive surgery in their particular scenario, which may not even be medical, which may be social, it might be beneficial for the patient to stay a day just for observation. So I think that like anything else, we have a good framework of what to do for each patient. But at the end of the day, it has to be individualized.
- [08:19]
A
Got it. And last question for you right now. When you think about endoscopic spine surgery in the next two to three years, what do you think this coming generation of endoscopic spine technology will look like?
- [08:33]
B
I think that it's going to expand in terms of its abilities. I think that the technology is limited right now by maybe the kinds of tools that are at your disposal. And as we get more adept at entering the spine and this totally new view, we might be able to handle things that are a lot more complex, and we might be able to handle things that include fusions. Right now. I mean, there's obviously endoscopic T lists, but I think there are other avenues that we can explore. But I think it also begs the question, how many people actually need fusions? If we can do a minimally disruptive type of surgery and preserve the anatomic elements that are, you know, good about the patient there obviously, there's obviously a role for scoliosis surgery, large deformity corrections. And that's certainly not something I think endoscopic spine is going to venture into in the next two, three years. But I think as we get more adept at seeing what the outcomes are and what kind of push the boundaries, we might be able to see new ways of utilizing endoscopic spine. So, for example, one of the things that I've done recently, which I see on PubMed, is really just case reports, is a removal of a epidural abscess for. For a patient. And for that patient, she was diabetic, had poorly controlled diabetes, was overweight, and, you know, had all the hallmarks of being a poor surgical candidate. But you don't want to have someone who's already infected with a epidural abscess with a huge surgical scar that may never heal. So by utilizing the endoscope, I was actually able to take out the entire epidural abscess through an incision that is typical of endoscopic spine. Right. It's the size of my fingernail. And this patient healed beautifully. She was able to take her antibiotics. Her pain was gone, her nerves were decompressed. She started regaining some of the function that she had lost due to. To the compression of this abscess. So I think as we get more adventurous, as we see new avenues for use, the. It's going to be a very organic. It's going to be a very organic growth of endoscopic spine. And for sure, with more and more residencies, fellowships, adopting endoscopic spine, people are going to learn it. Not like me, you know, in the middle of my practice, but they're going to learn it as just part of their general surgical training. And they're going to be the ones who push the envelope because it's something that they're familiar with. Right. They're not trying to learn it from scratch. They're constantly using it and already seeing different evolutions of the technology.
- [11:43]
A
Absolutely. And I love that word you use to describes the future adventurous with endoscopic spine. Sounds like some real exciting times ahead.
- [11:53]
B
Yeah, for sure. For sure. I mean, I'm just thinking about my own growth. Right. Like in January, I did my first case, and now it's like 15% of my practice. It's, it's not where I thought I was going to be. There's no way. I thought, like, 15% of my practice would suddenly become endoscopic. But there's a real need for it and there's, it's a. I think it's only going to grow.
- [12:16]
A
Absolutely. Well, Sophie, thank you for joining us today. It's been a pleasure speaking with you, and I look forward to connecting again down the line.
- [12:25]
B
Yeah, absolutely. Thank you so much for having me.