Magazine

Question Everything

Angela Allsup remembers exactly how she felt before becoming one of the first patients to receive a lumbar disc replacement from Dr. Rick Sasso.

"I really needed something—I was in excruciating pain," the Butler University pharmacy student recalls. A basketball injury her senior year at West Vigo High School in Terre Haute, Indiana, had left her left leg numb, with tingling and pain on her left side. Surgery that year to remove part of the lumbar disc failed.

"They took out too much," Allsup says. "It was bone on bone after that.

"I pretty much couldn’t do anything. I couldn’t go out with my friends because I always had to be in bed. I had to miss a lot of class. So it pretty much affected everything in my life."

Then Allsup and her mother saw a report on the TV news about Dr. Rick Sasso and his Indiana Spine Group’s groundbreaking artificial disc replacement procedure. At the end of her sophomore year in college, she underwent surgery.

She remembers waking up in the recovery room.

"Right away I noticed the feeling back in my leg, which was awesome," she says. "About a month later I noticed my pain was completely gone."

Three years later, Allsup’s life is transformed.

"I have the pain once in a great while, but it’s nothing to complain about," Allsup says. "The surgery changed my life completely. I can do everything I did before."

And she stills see Sasso for yearly checkups.

"He’s a pretty great guy. He really changed my life."

Given his birthplace in Warsaw, Indiana —the "orthopedic capital of the world"—Rick Sasso seems almost predestined to become an orthopedist and one of the world’s leading—and most innovative—spine surgeons.

But Sasso wanted to be a veterinarian.

"I was accepted and had my housing set up at Purdue University before I ended up applying and getting accepted to Wabash College," Sasso says from his fourth-floor office, where a dozen signed pictures from grateful former patients grace the walls. "My dad was actually the one who said, ‘You can have animals as a hobby—why don’t you think of actually going into human medicine?’"

With Warsaw home to some of the orthopedic trade’s largest manufacturers, Sasso had been around the industry since he was a child. He also learned about the subject from his dad, who performed orthopedic surgeries in his vet practice. Sasso worked summers in a county hospital in Warsaw during his Wabash tenure. He was an orderly, and found he really enjoyed it. He looked forward to becoming a surgeon and had a tough time deciding between cardiac surgery and orthopedics.

"The problem with heart surgery is you have to go through general surgery first for five years, which is a lot of bowel and belly stuff. I don’t enjoy that so much," Sasso says. "In retrospect, it was a great decision."

Another great decision was attending Wabash. The inventor and surgeon received his medical education from Indiana University and The University of Texas and has research experience at some of the nation’s top orthopedic centers, but he credits Wabash with giving him the key to his success in spinal surgery innovation—"question everything."

"Thinking outside normal constraints is a significant part of the liberal arts education; looking at things a little differently, not always accepting the conventional wisdom," says Sasso, the 2005 winner of the Indianapolis Business Journal’s Health Care Hero Award. "It is questioning everything and trying to come up with a better way to do things. My four years at Wabash College really helped me to do a lot of that. I learned that ‘Well, that’s the way it has always been done’ isn’t a good enough answer."

His refusal to accept the status quo and determination to find a better way have led Sasso to invent devices revolutionizing spinal care. Sasso and his inventions have restored function and alleviated pain for hundreds of patients. Now president ofthe Indiana Spine Group, with offices at St. Vincent Hospital in Indianapolis, he’s become a groundbreaking surgeon, inventor of market-leading medical devices, and an internationally renowned speaker and author with a busy travel schedule.

But it all began with "question everything."

Sasso put that mantra to good use during a fellowship he earned at Chicago’s Northwestern University in the early 1990s to treat cervical spinal trauma. Doctors had a difficult time taking care of certain fractures where the cervical spine meets the thoracic spine. Primitive methods like using wire and rods, as well as big hooks that went in the spinal canal, were still standard practice.

"Nothing made sense," Sasso recalls. "Nothing worked. I’m training with these world experts, and they say, ‘Oh yeah, this is the way we do things.’ I think, This is the most ridiculous way."

At the time he knew there were anchors and screws that could safely be put in certain areas, but there was no way to hook all those anchors together. They never lined up well because of each patient’s different anatomy.

So Sasso tried working with engineers to create a system in which anchors would be placed where needed, then a rod that hooked into the anchors would be attached for stability.

"It was clear we weren’t speaking the same language," Sasso says of that failed endeavor. "They came up with a mechanism that was bigger than a breadbox. I said, ‘I don’t think you understand; that will not fit in the back of the cervical spine. It’s completely over engineered.’ I wasn’t sophisticated enough at that time to really drive at what I thought needed to happen."

The experience so frustrated Sasso that he gave up the notion of inventing something better and entered private practice. But he couldn’t stop thinking about it; he couldn’t stop asking questions.

"It’s always in the back of your brain—that sense of ‘there’s gotta be a better way,’" Sasso says.

After gaining more experience as a surgeon, he found an engineer in Florida who had worked in orthopedics and had the capability of drawing three-dimensional designs. Sasso began pouring his resources into the partnership and resurrected his vision. This time it was successful.

"One thing led to another, and the gosh-darn thing worked," Sasso says. "Since then I’ve made every mistake known to man about protecting your intellectual property. It’s been a great learning experience. It’s not necessarily that I want to make an enormous amount [of money]. But you don’t want someone else to make an enormous amount off of what you have done."

That first invention, able to handle problems from the base of the skull to the thoracic spine, remains that market’s leading device worldwide, with about a 60-percent market share. Now every spine company sells a similar product.

Medtronic, the world’s largest spine manufacturing facility in Warsaw, makes six of Sasso’s patented products. About four of them are top sellers in their field. Others are more niche contraptions.

"Once you get the reputation of being able to work through problems, you may be invited to work on different projects," Sasso says. That often leads to other patents.

Sasso’s inventions have been the catalyst for the pioneering surgeries he has performed, including the first artificial cervical disc replacement in the United States and the first lumbar disc replacement using the Flexicore-brand.

"It’s nice to be asked to be involved in cutting-edge technology," he says. "Obviously, they don’t want goofballs to be the first to do such a thing. So it’s an honor to be on that team."

But helping patients who are suffering from debilitating pain brings the greater rewards for Sasso.           

"It’s why we continue to do this," he says. "There’s nothing better than being able to help somebody who has been incapacitated for an extremely long period of time, to watch them get back to doing their normal things. Most of the time these low-back problems occur in people who are in the prime of their lives. If it wasn’t for their back problems, they’d be fully functioning members of society."

One of Sasso’s most common operations relieves pressure on a nerve in the neck or lower back that can cause some of the most excruciating pain in the arm or leg—such incapacitating pain that patients are practically immobilized.

"What’s really neat about those operations is that they’re outpatient operations— takes me 30 minutes to do—and the pain’s gone," Sasso says. "It’s really neatto see patients as they’re walking out of the hospital, a couple hours after their operation and pain free. There’s nothing better than that—seeing someone completely change."

Read more about Sasso’s work at www.indianaspinegroup.com

For a photo album of Sasso in surgery, click here.