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SQI: Simpson Querry Institute

Meet the Faculty: Wellington Hsu, MD

Wellington Hsu is an SQI faculty member and the Clifford C. Raisbeck, MD, Professor of Orthopaedic Surgery and Professor of Neurological Surgery at Northwestern. He also runs a research lab with his wife, Erin Hsu, the assistant director of SQI. In this interview, Hsu describes his interest in sports medicine and how he uses his clinical expertise to contribute to SQI’s efforts to develop better materials for spine fusion procedures.

Did you always intend to get into sports medicine or did that interest develop later once you began considering orthopaedic surgery?

I was interested in sports medicine initially and that’s what brought me to the orthopaedic surgery world. When I trained as a resident, I discovered that spine was much more appropriate for my career, and I was attracted to the life impact that one can have as a spine surgeon. The injuries can be quite severe for a spine surgeon to treat, which can also lead to a dramatic impact on a patient’s life from proper treatment.

Once I began my career as a spine surgeon, it was obvious to me that the world of sports-related spine injuries had very little data. I discovered that many individuals were getting treatment based upon anecdotal evidence and expert opinion. Treating physicians had very little data to show treatment efficacy and were unable to predict outcomes. Shortly after I came to Northwestern, I started an initiative to collect data on sports-related spine injuries. As our basic lab was being developed, so was my clinical research team to help with this type of work.Wellington Hsu

What is the name for that initiative and how is that project coming along?

The group is now referred to as the Sports Professional Orthopaedic Research Tool (SPORT) and I’ve given a number of different talks in various forums summarizing the data from this group. We have over 25 publications and 75 international presentations, and the group is composed of my fellow partners, medical students, residents, fellows and undergraduate students who collect data to help shape treatment decisions for this patient population.

This data now has expanded beyond spine surgery. Even though most of my clinical work is in spine, the group has published on ACL injuries, foot and ankle injuries, and concussions, to name a few. All of the data that we have collected is focused on elite athletes who have some type of injury. 

I’ve seen you quoted in the New York Times and other national media outlets commenting on Tiger Woods’ back injury, and it’s beginning to make a lot more sense that you’re a go-to expert in this area.

In today’s world, athletes and patients want data to support the decisions they make for their medical care. The fact that we have the largest and best collection of data to make these kinds of decisions makes our group a sought-after opinion. 

Can you explain the limitations of current spinal fusion technologies and why finding better materials for these procedures is such a big focus of the Hsu group?

I have patients that I see every single day that need my services, and sometimes I’m not able to offer them surgical treatment because they’re not good candidates and there’s a high chance of failure due to their comorbidities.

If we have technologies that would allow me to perform surgery on individuals who otherwise wouldn’t have been candidates, that would open up this type of treatment to so many different people who need it. These aren’t just elderly patients; they could be young patients who are trying to do something that’s never been done before, or professional athletes who want to continue their careers for an additional five or 10 years.

The existing technologies oftentimes just don’t offer that opportunity, and if we have a number of bone graft substitutes that are available to surgeons depending on their potency, I think that would allow us to offer surgical treatment to more patients.

In what ways do you think your clinical experiences contribute to Hsu Lab projects, and vice versa? Is there anything you take from the lab back into the clinic with you?

Absolutely. It’s a rare setting where a surgeon can be performing a procedure and then a question can come into mind as to how to improve that procedure or the outcome and then you are able to test it right away in the lab. On a number of occasions, whether they are just small steps in the procedure or grand improvements on bone graft substitutes, I have that ability and that unique opportunity to test something right away.

A small example would be when I do a minimally invasive procedure, there are some challenges with using bone morphogenic protein (BMP) in a disc space. This protein is important because it can help facilitate bone regeneration, but it is also associated with potentially harmful side effects.

I came to Erin about seven or eight years ago and we developed a study to test another substance to see if it could block some of the protein from coming out into a space that could ultimately hurt the patient. We knew that was an issue, so we completed a study within three months and the data was quite compelling. The materials that could block the migration of BMP were commercially available and I knew exactly what we needed to do in order to protect the protein from leaching. I still use this technique when performing minimally invasive surgery and other surgeons have adopted this approach. That wouldn’t have been possible if not for the resources in the Hsu Lab.

From a broader perspective, we have studies in the lab and collaborations with biomaterial researchers and nanoscientists that have novel materials, methods and technologies — and we can test them. Initial bench testing can then be followed by animal testing and, ultimately, studies for the FDA. And that’s really what we’re all doing this for, developing a new product that will help patients in the right situation.

I know you are also exploring some applications for 3D printing. Can you explain those approaches and how far along they are?

I’ve been using a 3D-printed titanium cage that I helped construct with Stryker that has been on the market for four years now, and I use it routinely in patients who need a fusion (as documented in the ABC7 Chicago video below). One of the advantages of a 3D-printed cage technique is that the surface can be modified so that it’s more compatible with patient bone healing.

If you put a plastic cage in the disc space, which was most commonly done five years ago, the body doesn’t really respond to the plastic very well because it’s an inert surface. But if you have a 3D-printed metal surface which the body likes much more and can integrate bone into that surface with a higher success rate, your fusion rates increase and patients just generally do better.

This segues into the work that we’ve done in the Hsu Lab with Dimension Inx (a startup previously hosted at SQI) and other collaborations with the lab of Samuel Stupp that have explored 3D-printing technology for bone graft substitutes.

These efforts have evolved to include the Stupp lab in further modifying and homing in on the best method to 3D-print human DBM (demineralized bone matrix) and synthetic materials, and we’re working on that right now. The goal is to produce something superior to any bone graft substitute that we already have. We don’t come up with these solutions overnight, so that journey is just as enjoyable as finding the actual product that we’ll settle on.

Is there anything else you would like to highlight regarding your SQI work?

My clinical involvement with patients really enhances SQI’s ability to deliver in the short-term and the long-term, and to help make research more efficient, which is something that I’ve found to be very helpful since joining SQI — and Erin has, too. 

My experiences in the clinic continue to change and evolve, but having the ability to alter the course of research with such an important institute like SQI is very rewarding. I think this will lead to dramatic change in how we treat patients and how we deliver medicine.