By: 30 March 2021
Surgeon in Focus – Dr Ali H Mesiwala

Dr Ali H Mesiwala is a board-certified neurosurgeon specialising in the development of novel technologies and minimally invasive techniques for both spinal and cranial surgery. He is a fellowship-trained expert in complex spinal procedures, including deformity correction and revision surgery, as well as disc replacement operations. With more than 75 per cent of Dr Mesiwala’s cases now performed in the outpatient setting, he is focused primarily on optimising the patient experience, reducing recovery time through minimally invasive techniques and improving outcomes.

Since 2004, Dr Mesiwala has performed more than 8,000 operations in private practice, including more than 600 minimally invasive sacroiliac (SI) fusions, 700 disc replacements and 750 spinal cord stimulator surgeries. He now performs more than 200 disc replacements annually, primarily in the outpatient setting, and has one of the largest and most comprehensive sacroiliac practices in the world.

He has recently joined the DISC Sports & Spine Center in California, as part of the team of physician partners.


SSN: As a specialist in spine surgery, could you tell us more about your experience and training background in this field?

AM: My neurosurgical training was at the University of Washington, which included the joint Neurosurgical and Orthopaedic Spine service, as well as the Regional Spinal Cord Injury Center for the Veterans Administration. I had the privilege of learning from leaders in the spine world, such as Drs. Anderson, Chapman, King, Mirza and Shaffrey. My fellowship training included time spent at the UW, as well as Hannover, Germany, and UPMC and St Louis University. I worked for a year in the UK NHS, at the Atkinson Morely’s Hospital for Neurosurgery, and had the honour of working with Mr. Marsh and Johnson, as well. Upon completing my training, I served on the faculty at Cedars-Sinai Medical Center, and then established a comprehensive neurosurgical private practice in Southern California. My practice treats the full spectrum of spine pathology, including adolescent and adult problems, from the least invasive to maximal reconstructive surgeries.


SSN: What drove you to choose surgery as a career – and spinal surgery in particular?

AM: I always enjoyed tinkering with devices and computers as a child. I grew up on the Stanford campus, and Cupertino, the heart of Silicon Valley. I had the opportunity to visit the anatomy lab at Stanford when I was 14 years old, and found the brain, nervous system and associated bony structures fascinating. My father is an engineer, and this led me to research in neural networks as a teenager, and then biomedical engineering in college. My desire was to apply engineering to neurosurgery, and fortunately that carried through to medical school, residency and beyond. Medical device design began during my residency, and I was awarded an NIH grant to study and design ultrasound devices for neurosurgery and spine. As a practicing surgeon and engineer, I now consult for many spine companies and hold patents for several novel devices, and have designed new techniques for both minimally invasive and deformity spinal surgery. My goal is to apply engineering to spinal surgery, in order to streamline procedures, improve efficiency and safety, and ultimately provide better outcomes for patients.


SSN: It is clear that the healthcare industry has been greatly impacted by the Covid-19 pandemic, what has been the greatest impact within the orthopaedic and spinal surgery industry?

AM: It has refocused and emphasised the need to create less invasive and more efficient solutions to spinal pathology that can be applied in the outpatient setting. Hospitals should be places for patients who require inpatient care, close and comprehensive monitoring, and life saving treatment. As this pandemic has illustrated, hospitals are designed for this function. Elective surgery should be moved to the outpatient setting, primarily ASCs, relieving the burden on the healthcare system, and allowing patients to return home and to their lives as soon as possible.


SSN: What’s the best part of your job?

AM: Helping people, especially in their time of greatest need. You are entrusted with their life and function – it is simultaneously humbling and inspiring.


SSN: … and the worst?

AM: Realising that, despite your best efforts, the natural course of disease can often be impossible to alter.


SSN: What has been the highlight of your career so far?

AM: Saving lives. Even though I have been the primary surgeon in amazing reconstructive and trauma cases that have lasted 20-plus hours, and performed the first of a certain type of surgery in the outpatient setting, there is nothing that compares to having saved someone’s life.


SSN: Are you currently involved in any scientific research within your work?

AM: We are engaged in multiple clinical trials and investigational protocols for medical devices, as well as the development of novel techniques for spine surgery.


SSN: If you weren’t a spine surgeon what would you be?

AM: A wildlife photographer.


SSN: What would you tell your 21-year-old self?

AM: Enjoy the time spent with family and friends, and build lasting and meaningful relationships. Academic achievement and accolades will never replace them.


SSN: If you were Health Minister for the day what changes would you implement?

AM: Medical coverage and insurance, especially in the US, is often best for healthy patients, but inadequate or lacking for the poor and the most ill. I’d focus on establishing comprehensive coverage for everyone.


SSN: Away from the clinic and operating theatre – what do you do to relax?

AM: I love exploring the outdoors with my family, going for long, scenic drives, and trying out new restaurants. Once the travel restrictions are lifted, international travel and wildlife photography are always in the mix.


SSN: How do you think the future looks in the field of neurosurgery and spinal surgery and what are your predictions for the decade ahead?

AM: Both are wide open. We have only scratched the surface in terms of understanding the nervous system. New implants that can communicate with brain and spinal cord are being developed to augment and replace function. Novel materials and bioactive implants will allow us to preserve motion and function. Spinal deformities will be treated through non-fusion techniques. Hospitals will become institutions for the truly ill, while outpatient centres will perform most elective surgery in the brain and spine. And, we will finally have some reproducible and controllable stem cell therapies for dealing with degenerative disease.


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