Radek Kaiser is a Clinical Spinal Fellow at Oxford University Hospitals NHS Foundation Trust, and Associate Professor of Neurosurgery at Charles University Prague, Czech Republic. His research focus looks at the anatomical variations of peripheral nerves and alternative reconstruction techniques in the surgical treatment of peripheral nerve injuries, degenerative spine disorders and spinal oncology.
SSN: What drove you to choose a career in spinal surgery and medical research?
RK: I have wanted to be a doctor since primary school, and during medical school, I knew I wanted to pursue a surgical specialty. I chose neurosurgery after a detailed exposure during a summer internship in Vienna after my fifth year of medical school. Following my residency in Prague, I completed a clinical research fellowship at The Centre for Spinal Studies and Surgery in Nottingham, after which I joined the Military University Hospital Prague as a spine surgery specialist.
Additionally, I specialized in peripheral nerve microsurgery, which gave me the incredible opportunity to combine major spinal surgery with the most delicate neurosurgery. Early in my career, I worked on research involving neurotrophins in peripheral nerve regeneration as part of my PhD in neuroscience. My passion for science has remained a fundamental part of my practice ever since, continuing to drive my enthusiasm for medical research and advancements in spinal surgery.
In 2023, I had the opportunity to join the Spinal Unit in Oxford, where I am furthering my education in the areas of spinal deformities and oncological spinal surgery.
SSN: In a recent news article, we looked at research highlights of the role of SPECT/CT in identifying pain generators in degenerative spine disease. Could you tell us more about your research?
RK: Our research has shown the potential of SPECT/CT in identifying pain sources in degenerative spine disease. SPECT/CT has proven to be a valuable tool, particularly for patients with unclear MRI findings, aiding in more accurate diagnoses and tailored treatments. We found it to be more precise than MRI in diagnosing facet arthropathy and guiding treatment decisions.
The SPINUS I study published in Acta Neurochirurgica demonstrated significant improvements in pain and disability among patients undergoing spinal fusion for SPECT/CT-positive lumbar degenerative disc disease. We also examined the correlation between MRI findings and SPECT/CT positivity in chronic low back pain patients. The results indicated a strong correlation between SPECT/CT positivity and more severe degenerative changes. However, not all severely affected segments showed positivity on SPECT, suggesting that SPECT may only identify the “active” degeneration causing pain. This supports SPECT/CT as a valuable tool in managing degenerative spine disease by providing additional functional data, enhancing the understanding of pain mechanisms, and aiding in tailored treatment plans.
This research underscores the importance of integrating SPECT/CT into clinical practice to enhance treatment outcomes and improve the quality of life for patients with degenerative spine conditions.
SSN: What could your findings mean to help support the treatment of spinal degeneration and what will be the effect on patient experience?
RK: Our goal is to make SPECT/CT a standard part of the comprehensive evaluation for patients with chronic back pain, especially when MRI cannot clearly identify the source of pain. Future studies will determine whether this approach is also applicable to patients with chronic neck pain, where MRI only shows degenerative disc disease without associated disc herniation, spinal canal stenosis, or foraminal stenosis.
In cases where all conservative treatments have been exhausted, such patients could be treated using spinal fusion. By incorporating SPECT/CT into routine diagnostics, we aim to enhance the precision of pain source identification and improve treatment outcomes, thereby significantly enhancing the patient experience.
SSN: What is planned for the next stage of your research?
RK: We have established an informal group called the Oxford – Prague Spine and Nerve Research Group, through which we will continue our research in applied neuroanatomy, focusing particularly on the relationshi