Washington University orthopedic surgeon Munish Gupta, MD, is the co-director of the pediatric and adult spinal deformity service. His areas of interest include complex spinal reconstructive surgery for all spinal deformities, spinal revision surgery and spinal tumors.
Dr. Gupta sees patients at:
The Center for Advanced Medicine, Orthopedic Surgery Center, 4921 Parkview Place, 6th floor, Suite B. 314-514-3500
St. Louis Children’s Hospital, 1 Children’s Place, 1st floor, Suite B. 314-514-3500
Shriner’s Hospital for Children, 4400 Clayton Road. 314-432-3600
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What happened in the course of schooling to influence you to choose your specialty?
During high school, I observed an orthopedic surgeon, who was a family friend, surgically repair a broken hip – and that left quite an impression. Before I chose my specialty in medical school, I was influenced by another orthopedic surgeon who eventually became my mentor. I enjoyed spending time with him in his office and observing in the operating room.
After I chose orthopedics as my specialty, my first rotation was the spine – which started me thinking about orthopedic surgery. The field of spine surgery is very diverse – from the occiput to the sacrum, from total disc replacement to micro surgery – and that really appealed to me.
As a medical resident, I was exposed to spinal trauma, scoliosis (curvature of the spine) and spinal deformity during my rotation at Children’s Hospital in Chicago. When it came time to choose my fellowship, I was attracted to spinal deformity because it is challenging and very satisfying to correct someone’s deformed spine.
I’ve seen children with spinal deformities transform from extremely introverted and self-conscious before surgery to outgoing and self-confident after surgery. It is life-changing for the patient.
What brought you to Washington University?
Dr. Keith Bridwell, who is the co-director of the pediatric/adult spinal deformity service here, suggested I look at this job opportunity. I’ve known him a long time and respect him a great deal. He is the one who convinced me that it was okay to leave California and return to the Midwest – I grew up in Chicago.
Keith has built a fantastic spine program here. As one of the top spinal deformity programs in the country, my goal is to continue to build on its quality and reputation.
Which aspect of your practice is most interesting?
My niche is complex spinal deformities surgery, and my patients have usually had multiple surgeries or a severe complex deformity that previous surgery was unable to correct.
It is a challenge I enjoy, and I find it very fulfilling to be able to help these patients.
What is the age range of your patients?
My goal as a surgeon has always been to take care of spinal deformities and conditions in patients from birth to adulthood. With different ages, come different problems – from a child with a spinal deformity to a teenager with scoliosis to an older person with osteoporotic fractures. Because each type of patient is unique, it gives me a unique perspective on what happens to the spine as someone grows older.
What new developments in your field are you excited about?
There has been a great deal of advancement in techniques and tools that make it possible to repair spinal deformities that we could not have repaired before. Improvements in segmental instrumentation give us a better control by using screws in spinal segments.
We also are able to use real time monitoring of the spinal cord during surgery. This allows us to safely complete the surgery without waking the patient to make sure there is no damage to the spinal cord. Before spinal cord monitoring, we had to wake the patient during surgery and ask him or her to move his or her legs. These developments are very exciting.
Is nonsurgical intervention effective for correcting scoliosis?
Nonsurgical intervention (bracing the back) has been proven to be very successful for correcting scoliosis. People had doubts about bracing, but we know that it is dose-related -- the more the brace is worn, the better it works.
A national study found that a properly-fitted brace, worn 18 hours a day can be 70% effective. An adolescent with a 30-degree spinal curve may never need a spine fusion -- if he or she wears a brace that keeps the curvature from progressing further and reaches skeletal maturity.
There are also non-operative measures that have improved the care of low back pain and spinal stenosis. These include steroid injections to relieve some of the inflammation around the nerves.
Non-operative care should always be the first option tried – unless the problem is very severe.
You mentioned earlier you are originally from Chicago. Is your family happy to be back in the Midwest?
Our children are all grown and live on the East coast, my family is from Chicago and my wife’s family is in Washington, DC. So moving to St. Louis from California brings us much closer to the rest of our family. I’m actually looking forward to my first Midwest snowfall in 23 years!
I’m sure there are many, but is there a particular award or achievement that is most gratifying to you?
What has been most gratifying for me has been the time I’ve spent volunteering in foreign countries and taking care of people who would otherwise not get the medical care they need. Spinal deformities are especially hard on girls – because they usually would not be able to get married.
It is very rewarding to see these young women, when they come back to the clinic a few years later to thank me with their husband and their kids. That’s worth more than anything else.
In what countries have you volunteered your medical services?
I’ve volunteered in Africa from 1998 until 2014. I’ve also gone to many countries including India and China. I recently returned from Turkey where I was chair of a hands-on course for 40 surgeons from 21 countries including Pakistan, Indonesia, Nigeria, Brazil, Argentina, and Russia.
Teaching new techniques to other surgeons is a very important part of what I do. One physician can do only so many surgeries a year, but if you train 100 surgeons, it is a multiplying effect that can be far-reaching.
What is the best advice you’ve received?
A friend recently told me there are three things he always keeps in mind when he is in surgery. I think these are good pieces of advice for any surgeon:
1) Don’t lose your temper.
2) Take your time and do not rush.
3) Make sure you have a relaxed atmosphere in the operating room.
If you weren’t a doctor, what would you like to be doing?
I went to a technical high school and was very good at drafting, so I considered being a design engineer for NASA. Orthopedics is a nice mix between the two, because it is very mechanical.