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Focus on K. Daniel Riew, MD

K. Daniel Riew, MD, the Mildred B. Simon Professor of Orthopedic Surgery, is a professor of neurological surgery, the Chief of the Surgical Spine Center and Director of the Cervical Spine Institute.

Dr Riew sees patients at The Cervical Spine Institute and Center for Shoulder and Elbow Surgery, The Center for Advanced Medicine, 4921 Parview Place, Suite 12 A


What happened in the course of schooling to make you choose your specialty?

When I was in medical school, I decided to become an orthopedic surgeon because I enjoyed working with my hands and surgery seemed to be a fun and interesting specialty. But then in my fourth year, I did a rotation in cardiology, which I enjoyed so much that I decided to become a cardiologist instead. I trained in Internal Medicine and was about to do a cardiology fellowship when I realized I really missed orthopedic surgery. So I changed my mind yet again and went back into training to become an orthopedic surgeon. One benefit of all this extra training is that I am double boarded in Internal Medicine and Orthopedic Surgery, and my medicine background helps me in taking care of my surgical patients.

What brought you to Washington University?

I came to Washington University as a result of knowing Dr. Ken Yamaguchi, currently the chief of the Shoulder and Elbow service in our department. Ken and I have been close friends ever since we did our residency together in Washington D.C. When he was interviewing for this job, Dr. Richard Gelberman, the chairman of the department, mentioned that the department would also like to hire someone who had trained with the renowned Dr. Henry Bohlman, to start the cervical spine service. Ken knew that I was training with Dr. Bohlman at the time, and recommended me for the job. Having a good friend as one of my partners in the department made it a lot easier and more desirable to accept a job in a new city.

Dr. Riew and family on the Big Island of Hawaii

At the time, were you still in Washington DC?

No. At that time I was in Cleveland at University Hospitals of Cleveland, doing my spine fellowship.

How many patients do you see in a year?

I see over 2000 patients in office visits in a year, of which 500 are new patients.

What aspect of your practice is most interesting?

The most challenging cases are those patients who have had multiple operations or those who have very bad deformities of the cervical spine. Often these people have had deformities for many years, or have had multiple operations and have been told that there is nothing more that can be done for them. They often travel long distances to get to St. Louis and are very grateful when we are able to fix their problem.

Are a lot of your patients' deformities from birth?

Although some are, most are from other conditions such as ankylosing spondylitis, or previous unsuccessful operations. Their chin may be on their chest and they can’t look up, can’t drive or walk, or have a very crooked neck, resulting in marked disability.

Do patients from around the world come for a consultation?

We have treated patients from Europe, South America, the Middle East, Far East, and India. I’ve also traveled to other countries to see patients, as well as to do operations. We also see patients from many different parts of the US.

What developments in your field are you most excited about?

There are two things. One is a substance called BMP which stands for Bone Morphogenetic Protein. BMP is a substance which the body naturally makes to heal bone. Commercial laboratories have purified and have mass produced BMP so now we can use it to markedly improve bone healing rates. In the past, we would have used a portion of bone from a patient's pelvis to heal the spine. Now we can use BMP, so they do not need a second operation to harvest bone. This results in a lot less pain and disability, and allows patients to return to normal faster. This advance has been around for about five years, and has really revolutionized the way we do some complex operations.

The second thing I’m excited about is the artificial cervical disc replacement. This will allow us to treat some patients with a motion-preserving procedure, instead of a fusion of the neck.

For the artificial disc, is it only for the neck or is it being approved for the whole spine?

Artificial discs for the lumbar spine have been approved for a few years, but it is not in wide use because the number of true surgical candidates is actually very limited. The indication for the artificial disc in the lumbar spine is for back pain, but in the cervical spine, it is not for neck pain, but rather for patients who have pinched nerves or compression of the spinal cord. We decompress the nerves and put this in place instead of doing a fusion operation that would eliminate motion. This procedure preserves motion, and consequentially, many people believe that it is an improvement over fusion. It is new technology, however, and we don’t know what the very long term results are yet.

When can we expect the FDA to approve the artificial cervical disc?

It is anticipated that the first artificial cervical disc will be out sometime this summer. Unfortunately, in many patients, we can only implant this at one level. Another device is expected to be approved early 2008, which we can implant at multiple levels. There are numerous other discs that are expected to be approved over the next 2-3 years.

Which particular award or achievement is most gratifying to you?

Professional awards and achievements are nice, but undoubtedly, the thing I am most proud of is my family. None of my successes would be worth much without them. My wife, Mary, and I have three children, who have been the greatest source of joy for both of us.

During the first several years of my career here at Washington University, I worked most of my waking hours, but over the last several years I’ve learned how to manage my time better, and am now spending more and more time with my wife and children. All three kids are loving and truly enjoy being together. They are ages twelve, ten and eight.

Any additional professional accomplishments that I will achieve will not mean anything, if my wife and I do a poor job as parents. That’s why being the best parents that we can be is of paramount importance to us.

Where are you from originally?

I was born in Seoul, South Korea, and moved to the United States when I was seven. My family lived in Detroit for one year, and then I grew up in Akron, Ohio. I have two older sisters. One lives in Michigan and the other in Ohio.

What is the best advice you have ever received?

One of my mentors once said to me that if he had to do it all over again, he would have spent more time with his wife and family, instead of spending all his time at work. I think it’s important to achieve a good balance between your professional and private life.

What do you do when you are not working?

Spend time with my wife and kids. Weekends are reserved for family time: taking long walks, riding our bicycles, and watching family movies. We like to travel and do so several times each year, including several ski trips. Next year the kids will be old enough to accompany us on international trips.

What lifestyle change could most benefit our health?

Exercise! The vast majority of patients I see do not exercise on a regular basis. Only about 30% of Americans exercise regularly. Regular aerobic exercise is critical to help keep the body younger, leaner and free of trouble. Our bodies were designed to exercise. If you don’t, it breaks down. Just like a fine car with a great engine that is never used. If you keep it in a garage, it starts to rust and it doesn’t work well. The body must be used for it to stay healthy. Thirty minutes of aerobic activity 3-4 times per week will help to decrease all kinds of health problems, including neck pain. Whether one uses an elliptical, treadmill, stationary bike or swims, it is important to exercise.

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