By: 1 August 2023
Surgeon in Focus Q&A with Farah Musharbash

Farah Musharbash, MD, is an orthopaedic surgery chief resident at the Johns Hopkins Hospital in Baltimore, Maryland.

Dr Musharbash received his undergraduate degree in Physiology from McGill University in Montreal, Canada, followed by his medical degree from Washington University School of Medicine in St Louis, where he was inducted into the Alpha Omega Alpha Medical Honor Society. He is currently a Chief Resident in Orthopaedic Surgery at the Johns Hopkins School of Medicine and will be starting his Spine Surgery fellowship at the Hospital for Special Surgery in New York City next summer.

Dr Musharbash’s research interests include clinical outcomes following spine surgery including oncologic, deformity and endoscopic spine surgery. He has around 40 peer-reviewed publications and book chapters and has served as an editor for the Bone & Joint Journal and a reviewer for The Spine Journal, Bone & Joint Journal and the Global Spine Journal. He is a member of the North American Spine Society and the American Academy of Orthopaedic Surgeons.


SSN: What drove you to choose a career in orthopaedic and spinal surgery?

FM: While a teenager in my home country of Jordan, I had to undergo surgery for a recurring bone cyst in my arm and became friends with the orthopaedic surgeon who operated on me. He was a general orthopaedic surgeon and I fell in love with the specialty as I began shadowing him in the operating room and clinic. What drew me to the subspecialty of spine surgery is the complexity of its clinical decision making and anatomy, as well as the continuous technological innovation in the field.


SSN: You recently conducted a new study and scoring system called the H2-FAILS score, regarding whether or not to get surgery for metastatic spine disease, could you tell us more about what the research involved and what outcomes you discovered?

FM: As many know, the spine is the most common site of cancerous bony metastasis, and deciding whether to perform surgery for metastatic spine disease is a complex decision-making process because of the many factors involved. In our recently published study, we developed a new clinical tool to help surgeons decide whether to perform surgery or not in these situations. The scoring system, called H2-FAILS, predicts the risk of death within 30-days after surgery for metastatic spine disease. We believe that a high-risk of mortality in the first 30 days after surgery is one of the most, if not the most, influential factor in helping decide whether to perform surgery or not.

H2-FAILS is an acronym for the following risk factors which make up the score: Heart failure (2 points), Functional dependence, Albumin deficiency, INR elevation, Leukocytosis, and Smoking (1 point each). The points are added based on the patient’s history and lab values, and the risk of 30-day mortality can then be predicted. The predicted risk of 30-day mortality goes from 1.8% for a score of 0 to 78% for a score of 6. In our study, we show that the H2-FAILS score is predictive of 30-day mortality and performs better in this patient population than other currently available risk-stratification systems.


SSN: What could your findings mean to the spinal industry and the patient experience?

FM: We believe our scoring system is useful to the patient, spine surgeon, medical oncologist and referring physician. It provides numerical predictive data to help support the shared decision-making process in a typically complex clinical scenario. We presented our findings at the Scoliosis Research Society meeting last year and received very good feedback about the utility of the score.


SSN: What’s next? Are you currently working on any new research articles, or developing work with emerging technologies?

FM: Yes we have a few research projects that are currently ongoing in the domains of adult spinal deformity, spinal oncology and endoscopic spine surgery.


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

FM: In the adult deformity scope, we are interested in factors that reduce complications after adult spinal deformity, specifically the complication of pseudarthrosis (non-union). Identifying such factors, whether preoperative or intraoperative, can help improve the rates of union and consequently, patient outcomes. We are also interested in studying trends in the utilization of endoscopic spine surgery in the US, which has seen growing interest among surgeons and patients alike. In terms of spinal oncology, we are currently planning to further study our H2-FAILS scoring system in different oncology patient populations for further validation and optimization.


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

FM: While performing surgery is one of the most exciting parts of the job, I would say the best part is seeing patients do well and feel better after surgery. It is a very powerful and humbling experience.


SSN: … and the worst?

FM: As a resident you are mostly operating and seeing patients in the short timeframe when they are in the hospital. We don’t get to develop a long-term relationship with most of our patients, but this is something I look forward to after the end of residency and fellowship.


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

FM: I have been very fortunate in my journey to meet fantastic colleagues and mentors, and the relationships I developed along the way mean a lot to me. Every step of the way has been special.


SSN: Are you planning to attend any orthopaedic events over the next year?

FM: While I was able to attend several meetings last year including the AOA, NASS, SRS, and AOSpine, this upcoming chief year is much busier, but I am hoping to attend the AAOS annual meeting in San Francisco and a few spine surgery courses.


SSN: How do you think the future looks in the field of spinal surgery and what are your predictions for 2024 and the next decade?

FM: I think spine surgery will continue to see an increased use of spinal navigation and endoscopic spine surgery. Another area with great potential for growth is predictive analytics, both in predicting patient outcomes as well as preoperative- or intraoperative- assistance in planning spinal deformity correction and goals. The future is certainly bright and there are multiple avenues for spine surgeons and researchers to pursue