By: 6 December 2022
Surgeon in Focus with Brian Fiani

Brian Fiani is recognised as a world-renowned expert Neurosurgeon at Weill Cornell Medicine/NewYork-Presbyterian Hospital with subspecialty focus on minimally invasive spinal surgery.

His neurosurgery residency training was completed at Desert Regional Medical Center in California, serving as Chief Resident and was elected President of the hospital’s resident population by his peers. He received the prestigious Resident Achievement Award presented to the best graduating resident of any surgical specialty in the United States based upon their residency career. Dr Fiani then continued his training with an Ivy-League sub-specialty fellowship in minimally invasive spine surgery at Weill Cornell Medical Center featuring medical staff privileges at NewYork-Presbyterian Hospital and appointments with the Cornell Medical College as instructor of neurological surgery and assistant attending neurosurgeon at NewYork-Presbyterian Hospital’s Department of Neurological Surgery. While treating patients at Weill Cornell/NewYork-Presbyterian Hospital, the hospital was ranked number 1 in the world for neurosurgery by Newsweek and number 2 in the world overall hospital by US News and World Report. He has over 120 peer-reviewed publications, authored the leading textbook on medical laser technology, and is the invited speaker at many Regional and National conferences. He was selected to the American Osteopathic Association’s Board of Trustees at only age 31. Further, he serves as Vice Chair of the Bureau of Emerging Leaders for the American Osteopathic Association and holds positions on several committees for Regional and National organizations such as North American Spine Society, New York State Osteopathic Medical Society, and the Spine Committee of the American Osteopathic Association. 


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

BF:  I was driven to spine surgery because I love impacting patients’ lives with a hands-on approach and witnessing immediate patient satisfaction from good outcomes. I fell in love with the gratification I felt from seeing patients go from being unable to stand-up straight to running marathons after quick operations. The profession feels empowering — to know you can help someone improve from debility to highly functional with the right procedure choice and technical prowess to perform it.


SSN: It is clear that the healthcare industry has been greatly impacted by the pandemic, what has been the greatest impact for you within the spinal industry?

BF: The pandemic’s greatest impact for me within the spinal industry was the understanding that shorter hospital stays or no hospitalisation after surgery has many benefits. First, patients feel much more comfortable with the idea that they will go home the same day. During the pandemic, patients were rightfully concerned that hospitals were understaffed for their needs and filled with patients that had Covid who could potentially transmit the virus. Therefore, when patients learned that they could go home the same day, it felt reassuring to them. Second, surgery at ambulatory surgery centers has become extraordinarily appealing. Patients are comforted to know that their surgery will be at an alluring surgical center rather than the intimidating hospital environment.


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

BF: The best part about my career as a neurosurgeon sub-specialising in spine surgery is making an impact. “Impact” has always been the key motivating word to me. I want my career to have a positive change on as many lives as possible, which is how I quantify the impact of a career.


SSN: … and the worst?

BF: There are no bad days…except days off. I like to stay very busy.


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

BF: The professional achievement I am most proud was being elected to the American Osteopathic Association (AOA) Board of Trustees. I am honoured by this leadership role with the AOA because it is a representation of the trust and respect from my colleagues to lead the physician community and guide the decision-making that shapes the future for physicians and how care is delivered to patients throughout the United States and globally. I am honoured to hold the esteemed position and I look to encourage growth and make any necessary improvements for all individuals including medical students, residents, fellows, and attendings/practicing physicians. I believe the organisation is one of activism and advocacy which aligns with my goal to unite and inspire. This achievement in my early career gives me great excitement for the potential that the future holds with the ultimate goal of serving on the North American Spine Society’s Board of Directors and participating in medical corresponding for large television networks, extending medical education into homes across the country and having a largescale impact.


SSN: Are you currently involved in any research or work with emerging technologies?

BF:  Yes, innovation and technology has been my area of interest to me in spine surgery all my career.


SSN: Please can you tell us more about the research and what it could mean to patient experience and outcomes?

BF: My research focuses on minimally invasive surgery (MIS) technologies and techniques. I patented a dural closure device to be used during tubular microsurgery. It is a single-handed device making dural closure less cumbersome. I have been the first to publish technical notes on revolutionary minimally invasive techniques. I am very passionate about my recent research with laser technology for photobiomodulation for tissue regeneration. I authored the definitive textbook on this emerging technology. My hope for the future is to translate that same technology for intervertebral disc regeneration. Why remove it when you can improve it!


SSN: Are you planning to attend any orthopaedic or spinal events this year?

BF: I will be attending the North American Spine Society (NASS) event in Los Angeles, California in 2023. I am very proudly involved with this organization. I currently sit on 5 committees for the organization and have the goal to be President of the society one day in the future. The international annual event for NASS is in Bankok, Thailand and that is very intriguing to me. The Global Spine Congress of AO Spine Foundation will be in Prague and that, too, is appealing to me.


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

BF: I was always fascinated by evolutionary biology, archeology, and paleontology. If I was not a spinal surgeon, I suppose I would see myself as the present-day Indiana Jones travelling the world with a sense of adventure and a curious mind about ancient times.


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

BF: At 21 years old, I was in my third year of medical school. At that time many people around me were asking why I skipped years of school and went to medical school so early without taking any time off. What I realised was: those same people, just a few years later, were asking how I managed to do it. So what I would tell myself would be “first they ask why, then they ask how”, which would encourage me that when you have much to accomplish in life, no time should be wasted. At first, people will be skeptical of you, then they will be enamored by you.


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

BF:  Leadership in the health industry means making the difficult decisions to increase access to healthcare with affordability. With my leadership roles, I am a strong advocate for providing the most esteemed healthcare services with accessibility. To successfully implement this model, one must first investigate fall-outs in the industry by asking why patients are not making it to their physicians and what can we do to make it more reachable. Establishing local satellite clinics or surgical centers might be a solution. Other options include transportation for those without means.


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

BF:  I have always been an athlete. I work-out twice daily and enjoy playing tennis on weekends. I am fueled by a competitive drive and fitness has always reminded me that there is more to my life than work. Physical fitness provides me with a sense of accomplishment outside of the clinic/operating theatre.


SSN: How do you think the future looks in the field of orthopaedic and spinal surgery and what are your predictions for 2023 and the next decade?

BF: The future is bright! Collaboration between private equity and the medical industry has resulted in premier surgical groups offering vertically integrated services for comprehensive spine care. Further, surgical techniques and technologies are advancing at a fast pace. Augmented reality for navigation, robotic assistance, and artificial intelligent will become much more prevalent and accessible in the next decade. For these reasons, competition will grow in the marketplace..