David L. Skaggs, MD

And as long as we have the lower lumbar lordosis, L4 through S1 to be 35 degrees or over,

there's a pretty good chance that we're setting the patient up for long-term back health and to be free of significant back pain due to malalignment.

And this is new.

This comes from the adult world.

And if I wasn't sitting in a bunch of meetings learning from my adult colleagues, I probably wouldn't be doing as good of a job on children as we are now.

Yeah, I've learned something interesting.

I had a spine fellow last year named Vivian Chan, who's a neurosurgeon.

And when using different implants, she says, I can't get my hands around this.

And I've now designed five lines of spinal instrumentation.

I realize every time I design

a tool i put it in my hands i go yep this feels good so i have size eight hands and i realize you know i owe everyone in the world with small hands an apology because without knowing i've been designing things for people with big hands and my fellow dr chan had size 5.5 hands so she couldn't quite get her hands around things designed for size eight hands

So I think that this is going to become increasingly important as we have more women in spine surgery and we have more people with small hands in spine surgery.

So I think the enlightened companies are going to start designing spine tools for people with small hands.

So I view that as something I have to apologize and we all have to do better at.

So I think one of the most important parts about being a pediatric spine surgeon is getting enough experience.

So the truth is there just aren't that many children in the world who need spine surgery.

And there's not that many centers in the world that do enough of it to train someone.

So it's highly specialized with small numbers.

And if somebody really wants to be a pediatric spine surgeon,

They either have to go to a pediatric orthopedic fellowship with a huge amount of spine experience.