Arthur L Jenkins III, MD, is the founder of Jenkins NeuroSpine and is one of the nation’s most recognized and highly respected spine surgeons. In addition to his academic appointment at Mount Sinai Hospital in New York City, Dr. Jenkins serves as a clinical expert and author of clinical research trials, patented inventor, advisor to biotech companies, and an official neurosurgeon for the New York Police Department and the NFL.
SSN: Since we last spoke to you in 2024, you have recently published a study highlighting a less-invasive surgical technique for metastatic spine cancer that reduces complications, shortens hospital stays, and allows patients to begin radiation therapy sooner — with a potential survival benefit. Can you tell us more about this new technique?
AJ: We published my work on developing a minimally invasive way of removing cancer that had spread to the spine, had eroded the bone, and caused compression on the neural elements or collapse of the vertebral bone. These types of problems often cause severe neurologic dysfunction, pain, weakness, and sometimes paralysis. Because the spine and spinal canal and cord are deep in the middle of the body, making getting to them challenging, and often requiring extensive surgery to expose the area, and even bigger procedures to stabilize the spine after removal of all the structures between the surface of the spine and the tumour.
We realized that most of the time, these cause problems only in one particular location, and they can often be removed through a minimally invasive approach. What we did that was novel was that we combined this with a minimally invasive reconstruction under direct vision, putting cement into the vertebral body, and making sure that none of it was spilling out and compressing or touching any of the nerves. We would get an intraoperative CAT scan to prove we had filled the gap adequately with cement so that the bone would not collapse further.
By doing it this way, we were able to avoid removing normal structures to get to the abnormal structures, we do not destabilize the spine in a significant way. And by leaving most of the patient’s anatomy intact, we’re able to get in, get out, and let them get on with their life much more quickly, much more safely, and even with better outcomes than the standard open quote old school close quote approach. We were even able to operate safely and effectively on patients who were sicker, and more quickly because it was a shorter procedure with less blood loss than standard surgery, and these both combined to give surprising survival benefit, with almost none of the life threatening complications that make open spinal tumour surgery so risky, like infections, sepsis, pneumonia, blood clots, or wound problems.
Hospitals and insurance companies should like it because it led to shorter length of stay, shorter operations, less costly procedures, and improved neurological function which means less long-term care after surgery for someone who comes in paralyzed from their tumour.
SSN: What could this research mean for patient outcomes and the future of spinal surgery and spine cancer patients?
AJ: This research hopefully will lead other surgeons to recognize that the need for spinal instrumentation in spine tumour patients is often led more by the approach than by the tumour itself, and that these minimally invasive treatments are not just adequate but in some cases superior to the classic teaching. And therefore, if you’re reducing length of stay, if you’re reducing the duration of weakness and even improving neurologic function through a less invasive approach, these techniques need to be acquired by any “spine cancer surgeon” who is concerned for their patient’s outcome. We expect that this will help a lot of patients by offering a much shorter, and more efficacious surgery.
SSN: Are you currently involved in any other research projects? If so, could you tell us more about their focus and potential outcomes?
AJ: YES! I am currently involved in MANY different research projects, including:
- Developing new treatment paradigms for treating hypermobile Ehlers-Danlos Syndrome (hEDS) induced cranio-cervical instability (CCI) and dysautonomia. That is a mouthful of really big words that most people don’t understand. However, this has become popularized by many influencers and other celebrities, including Billie Eilish, Selma Blair, Jameela Jamil, Sia, Lena Dunham, Halsey, as well as the author, Rebecca Yarros, who’s written an entire book series about her main character who has hEDS and turns it into a superpower. These are people who have managed to become successful in spite of the often debilitating neurologic side effects, but this is the tip of the iceberg, and many patients suffer from the severe autonomic dysfunction, including low blood pressure, a condition called postural orthostatic tachycardia syndrome (POTS), swallowing problems, digestive problems, problems and even air hunger on top of neck pain, brain fog, and other auditory, visual, and other neurologic problems. This condition is often progressive. It seems to be worsened with autoimmune components and often is paired with other inflammatory and digestive and vascular anomalies.
- After listening to my patients describe these conditions, we dug deeper and found that there has been some research done on spinal instrumentation and fusion for the CCI, which we have seen excellent, if imperfect, results from, and we are continuing to work to improve, devise new treatments and technologies, and especially increase awareness of this debilitating problem that affects women more than men and young people more than older people. The sooner we can get these people back on with their lives, the better society will be.
- Another research project is on another underappreciated condition, Bertolotti’s Syndrome (BSy). This is a condition that was first described in 1917 and has been described in the literature over many years until the 1980s as being a common cause of back pain and leg pain. However, in 1984, a well-intentioned junior orthopaedic spine surgeon published what he considered a new classification that was apparently designed simply to predict who had disk herniations at the level of a congenital anomaly, to avoid doing painful and complicated myelograms on these patients, because we did not have MRIs then. By the time his article was published, MRIs were actually being widely used and nobody needed to do myelography routinely. So the purpose of the article became moot, but his classification system was widely misinterpreted as saying these congenital anomalies can’t cause pain because they don’t get disc herniations (the one has nothing to do with the other but it’s been widely misquoted and misapplied) and now a generation of people have been told: there’s nothing wrong with them, that their congenital anomaly (that IS causing their pain) “can’t cause their pain”, and they’ve been gaslit and otherwise treated as social pariahs for “making up” their problems. This condition actually responds very well to one of two surgical procedures, which we developed minimally invasive techniques for performing. We are working on improving awareness of this widespread but poorly understood condition. We’ve published many articles, and you can certainly look those up in PubMed, that describe our experience in treating it. We present widely at regional, national, and international conferences to try to increase the awareness of this condition, and that it IS treatable. Just the fact that it’s treatable helps these people to seek additional help. So, this is an area where we are giving people their lives back and when in some cases they are bed bound from this condition that they’ve been told there was no treatment for.
- We have multiple other research projects, in many cases collaborating with experts in different specialties and different institutions, and in some cases even different countries, including thoracic outlet syndrome (TOS), thoracic disc herniations, coccygectomies through minimally invasive approaches, and repair of spinal fluid leaks through novel techniques and technologies, repair of intradural tethering, and spinal cord injury related complications.
- In addition to that, I’ve started two separate private startup companies to develop novel technologies ranging from novel instrumentation techniques and new types of spinal implants to make things safer and less invasively placed, and a novel suture design for closing dura and vascular tissue.
- Most importantly, I invented a novel form of reactive dynamic armor that would protect wearers (like athletes, military personnel, and kids learning to ride bikes) from injury, to try to keep athletes from BECOMING patients in the first place with spinal cord injuries and other traumatic injuries.
SSN: How does the future look in improving spinal care treatment?
AJ: I think the future looks good for improving spinal care treatments, but there are several headwinds that the world is facing right now.
- First of all, the insurance companies continuing to deny care through byzantine, and in some cases contradictory manners, without a thoughtful review of their denial guidelines, is keeping access to newer treatments away from patients who could benefit. These insurance companies (it seems to me, in my humble opinion) to be solely concerned with quarterly profits and not concerned with getting patients back into the workplace, by restricting approval for surgical procedures that patients cannot afford on their own.
- In addition, there is a general inertia in the medical community to adopting new technologies, even when validated with good clinical studies. It has been said that it takes an average of 17 years for new wisdom and insight to become general medical knowledge. It’s that inertia, even in today’s instant satisfaction, social media oriented environment that is precluding widespread adoption of validated techniques and insights, like many of the things that I’m doing research on.
- So, on the one hand, we have lots of new opportunities and businesses and technologies that are becoming available, but on the other hand, between a generalized medical inertia and insurance companies prioritization of executive pay and quarterly distribution of profits over patient satisfaction and patient outcomes, that we as physicians and patient advocates are fighting for the adoption of these very techniques and technologies that we’re developing.
SSN: Will you be attending or speaking at any medical conferences or events this year?
AJ: I will be attending many medical conferences and events this year.
- I will be at the Winter Clinics sponsored by the Mayfield Clinic in Snowmass, Colorado later this month in February. I’m an invited speaker at that.
- I’m an invited speaker at the Minimally Invasive Neurosurgery Society’s annual meeting in Costa Rica in March.
- I will be participating as a delegate in the Council of State Neurosurgical Societies as a representative of the state of New York for the New York State Neurosurgery Society, as well as the American Association of Neurologic Surgeons annual meeting. Both of these meetings are in San Antonio at the end of April, beginning of May.
- In addition, I have several other meetings, including some international meetings that we have submitted our research to for presentation.
- I am also on the executive board of the New York State Neurosurgery Society, and so I will be attending our annual meeting in New York City in May.
- I will also be attending as Vice President of the American College of Surgeons New York State Chapter the annual meeting in May at the Sagamore Resort in upstate New York.
- In all cases we are promoting at these meetings the adoption of newer techniques and technologies, education of residents and surgeons better ways of treating patients, and ultimately trying to improve the quality of life for patients, and for practicing physicians: around the country, in New York State and Connecticut, and in New York City as well.
SSN: How do you think the future looks in the field of neurosurgery and spinal surgery and what are your predictions for 2026 and the next decade?
AJ: I think the future of neurosurgery and spinal surgery is certainly ripe for change.
- Obviously, the brain computer interface is a huge disrupting factor on the way we will be interfacing with the world. The way social media has in some cases been seen to be beneficial and detrimental to society has not played out fully and I don’t feel we have adequate guardrails on how artificial intelligence agents will interact with people who have brain computer interfaces. The unintended consequences of the confluence of these two areas, I think, require much more extensive discussion and potentially regulation to keep them more separated. I don’t want to have a brain implant, That then can be hacked or surreptitiously overridden by even the most well-intentioned multi-billion dollar company that has a social media platform that wants to present me with subtle or explicit ads, suggestions, or even interferences. I certainly don’t want state actors to be able to hack into my brain without there being adequate safeguards. That I think is a big concern.
- Obviously, robotics is a huge challenge for spine surgeons. On the one hand, robotics make medium to less experienced surgeons able to place instrumentation at the same level that highly experienced surgeons do, shortening what seems to be a learning curve. But at the same time, these companies are taking all the experience that surgeons have with both stereotactic and robotically placed screws, and they’re using these as training data to train robots to replace surgeons as the placer of surgical hardware and potentially even the performance of all surgical procedures in the future. Well, I think that radiology, pathology, dermatology, and possibly the practice of general medicine is more immediately going to be impacted by artificial intelligence. Artificial intelligence plus robotics will likely be replacing the vast majority of spinal surgeons in the next 20 years or so. And we are in the process of training our replacements. So, I do have great concerns about the direction this is going. And while I may sound like Cassandra saying that the sky is falling, I am not unaware that these are actually being studied in research labs and that taking short-term benefits may have a negative impact upon the field as a whole. On the other hand, if we can truly prove that these robots do it better than humans do with fewer mistakes, maybe the issue is we are the dinosaurs. But if that’s the case and they can do that with just about everything we do, we may actually go the way of the dinosaurs.
- As far as 2026 goes though, I see more issues from a financial point of view with the insurance companies’ regulations and hopefully the government potentially breaking up insurance companies because of the monopolistic impact that they have upon the practice of medicine. Given that insurance companies now own the insurance provider, the dispute arbitrator (like Optum) and in some cases the independent dispute resolution arbitration agents (like Maximus) and then medical practices and individual hospitals! So that if a patient comes into a hospital, they’re only going to get the care that an administrator in the insurance company has decided they are entitled to, with no appeal to an outside agent, because the hospitals may have blocked independent doctors from even practicing medicine there. So, if you go to a hospital, you’re going to get only one way of doing something instead of getting potential additional opinions. And that’s not fair to patients. And that is happening now in some hospitals. I’m hoping that by the end of 2026, the Justice Department will recognize that this has gone too far.
Image and text submitted by the author
