For Episode 14 of Gloryren’s high-end talk, we are very honored to invite Dr. Daniel J. Rosenthal to have a nice conversation with us. Dr. Rosenthal, who once served as the President of German Spine Society in 2013, has been the Head of the Section of Spine Surgery in Regional Hospital Bad Homburg, Germany since 1998. 

He was born and finished his medical study in Argentina. After graduation, he went to University Hospital Frankfurt am Main in Germany for further medical research and received his medical doctor degree. From 1992-1996, he was appointed as the Head of staff and vice director of the Clinic for Neurosurgery, University Hospital Frankfurt am Main in Germany. He had great achievements in thoracoscopic spine surgery.

Please check the recording of the interview below

1. As you was born and finished your medical study in Argentina, could you please share with us your early experience in your home country?

I was educated for fourteen years in an English school. And after that I started my medicine studies in my hometown, that's Rosario. At that time, it was the second biggest city in Argentina, now I think it's the third. And at the age of 24, I was fully approved as a medical doctor. So those were, forty years later, the best times I had. A lot of friends, a lot of stress with study and tests, and apart from that I was playing rugby, so I had a pretty occupied timetable.

2. After graduation, why did you choose to further your study in Germany and decide to stay there to start your career in medicine?

I was born in Argentina, but my family, it's a German from father and mother's side. And in fact my brother and I were the only ones born outside Germany in almost 700 years of history that we were able to follow back in our genealogy. The reason why I chose Germany was simply that I wanted to have a better education in my specialist career. And that's why I sent all my applications, not only to Germany, but the vast majority of them were sent to Germany. I had also the chance to be accepted in Spain or in Switzerland. But at that time, I had in Frankfurt an uncle of mine who was the oldest physician practicing medicine in the city. So he told me, “Just come over here and I will try to guide you and help you.” And he did it for almost ten years after I arrived in Germany.

In fact, I forgot to say I decided then, when I finished with my specialization, I was already pretty much involved in a clinic daily routine and I was just climbing positions, so that was the reason why I stayed here and continued my medical career.

3. Why did you decide to pursue a career in medicine and why, in particular, did you decide to specialize in the minimally invasive spine surgery?

Medicine was always, let's say natural sciences, was always an interesting topic for me, and I found it fascinating to read about the normal cycles of plants or animals. And I think when I was finishing high school, I already took the decision, that I wanted to pursue some careers related to natural sciences. Veterinarian medicine didn't attract me so much, at that time at least, because in Argentina it's a very narrow field. That's mainly to do with the agro-industry, so the majority of the time you are looking after cows and pigs who are the most important economical branch of the Argentinian agriculture economy. So I didn't have too much left over, but laboratory was not an option for me, because it was pretty boring from my point of view, so I decided to get into medicine. That was the reason why I decided to apply for a career in the medical sector.

And concerning minimally invasive surgery, I didn't decide myself to specialize in minimally invasive, it was more a lucky circumstance, because at the beginning of the nineties, I was working a lot with anterior approaches to the spine, and together with my brother we developed the thorascopic technique, that was 1991. So since then I've been mainly or formally pushed into what it is called minimally invasive surgery, in this situation, it would be less aggressive approaches to the spine.

4. How did your early youth experience shape your success?

I don't think that my youth experience had a big influence in success. I am by nature a very analytical person, I am curious, I try to find some logical explanations for things that maybe a little bit confused or complicated. And that's the reason why I started developing approaches that at that time didn't exist. I was lucky because I just had the opportunity to get into a field that was just starting to progress and to expand, that’s spine surgery, but I don't think that my youth experience had much influence in the career and the results of almost thirty years of medical practice in spine in my case.

5. Do you have other fields in which you are investing your time and know how?

Yes, I'm still binding part of it to Argentina where there is a project of agriculture running there since more or less ten years now, together with some of my friends that are also partners, that's a very interesting thing where I'm also dedicating my time and my know how as far as I can. And the other one is in spine field but linked to software. That's a German company that has the software for spinal measurement and analysis. We are pretty far advanced to develop a system that will allow the surgeons to navigate surgery without a navigation device. That's a hybrid and I think we will show it by the end of the year.

6. Who have been your greatest influences? What have they taught you and how have they inspired you?

For sure my greater influences were my parents in my young ages, followed by my teacher in neurosurgery that’s Prof. Lorenz who passed away many years ago, and the head of the orthopedic department at that time, who's Prof. Schmitt who also had a big influence in my way of interpreting spine diseases. And the rest are the influence and the feedback I get from my colleagues and from the patients. I think that the last one, the colleagues and the patients are the most important influences you have in medicine, because that's a dynamic process, it is always changing, and you never achieve the perfection in what you are doing in medicine. You may be close to it, but it will never be perfect. So the real influence you have in medicine is, if you are satisfied and if the patients are satisfied with the results of your surgery or your treatment.

7. In 2013, you were elected as the President of the German Spine Society(DWG), could you please talk about the importance of DWG to the hospitals and specialists in Germany?

The DWG is the result of long years of trying to match the interests of orthopedics and trauma surgeons together with neurosurgeons. Those are the three main specialties dealing with spine diseases in Germany at least. We had in Germany for more than fifty years a society called the Society of Investigation in Spine that was I think the oldest society related to spine worldwide. And at the end of the nineties, a second society appeared, and that was the Society of Spine Surgeons. So for a lot of years, the research societies were not competing, but trying to adapt to each other, and at the beginning of 2000, the interests of both societies were similar, and we managed to create the German Spine Society. At that time, Michael Mayer was the one who leaded that way or showed the way to follow, and since then this society hasn't stopped to grow. It's the biggest spine society in Europe and I think it’s the biggest spine society or at least as big as the North American Spine Society, although both of them have a very high level of recognition worldwide. The spine society has now got under one umbrella, all the persons that are willing to share their knowledge, but also their field of expertise in spine treatment, not only operative but also conservative.

We have even started to develop a program for nurses related to spine treatment. And in 2013 in Frankfurt we started with the first symposium where nursing was included in the scientific program of the spine society, and this has been kept for almost last ten years as well. Now the importance we have with this society is that, we are now in the position to talk with the hospitals with the German health authorities or with other groups outside Germany with one language. It is not that the neurosurgeons are explaining something about treatment on the left, and the orthopedics on the right, and they are struggling against each other as it happens in lots of countries worldwide. Here we have a strict program of education that leads you to a certificate, and that gives you at least there's no official recognition for quality, but it's important as I told you, for the patients, if you have that certificate, it means that you've reached a certain amount of knowledge capable to treat effectively and successfully spine diseases. From there, we've moved two certificates for the hospitals, so we have a structure that looks after the quality of the work you are doing at the hospital, how is the hospital equipped and that's based also the degree of structural and also medical part you are treating in the hospital. So it is not the same to have a patient treated in a very little hospital with low infrastructure where they are only treating simple cases compared with a bigger hospital where they are dealing with a lot of pathologies that are also time consuming, and also needed for the population like trauma or tumors or any kind of complex spine surgery. It has a different level of recognition. And we've graded that in Grade one, two and three, being one the clinics were the highest complexity, and three were the lowest one. So the importance of the DWG is that we have now a society that is expressing the needs of the spine surgery, but also defending their positions against whoever and whenever it's needed.

8. You have great achievements in thoracoscopic spine surgery, what insights would you like to share about performing this kind of surgery?

It's difficult to say. I think it's nothing special on the technique, except that the surgeons have to learn how to work with the longer instruments than they are used to in an open surgery. One of the biggest problems, or I don't call it a problem, but the drawbacks of the technique is that, it uses an anterior approach. That's a drawback for those who are afraid to perform anterior approaches, because anterior approaches at least in Europe are surrounded by a sort of aura that means a difficult surgery, dangerous surgery and it's exactly the opposite. It's the most direct approach to the spine and it's the less aggressive technique to treat some spinal diseases. The most important thing is to dedicate some time and use that time to gain confidence in order to get used to this kind of technique and this kind of approach, there is nothing spectacular in the technique itself. The result is that, when I developed that in 1991, a lot of people had decided that they don't have the intention to deal with stress and with all the unknown world of anterior approaches for them, so they are sending the patients to my clinic which I appreciate a lot. And that's the reason why I got such a big recognition concerning thoracoscopic approaches mainly for the degenerative disease of the thoracic spine.

9. Could you please share one case that you think is the most challenging and impressive one?

When I read the question I was trying to remember one. But I really don't have one case that is the most important one if you call it like that or the most impressive, because it may be impressive because of the size of the pathology, it may be impressive because of the results you have achieved with the surgery. But I think every single case for itself is important. It may be not so subjective to surprise, or for a lot of people be extremely complicated when you see the picture. I don't think that there are impressive cases in what we are doing. Maybe we have impressive results because we don't expect to have a bad result in a good surgery or a good result in a bad surgery. But I think every single case is for the surgeon important and impressive. I can show you tons of big discs that have been successfully operated, but I can show you also one small disc causing serious neurological deficits, and after a surgery that's technically really not demanding, the patient recovers completely, so the term impressive is a very relative one in my opinion.

10. What is your proudest career achievement to date and why?

I've also been thinking about that question as well. I believe that my proudest achievement is the group of people I have around me working with me every day. I don't call it a department, but it's a team, and to keep that team working, you need a lot of efforts, a lot of experience, and I think that’s the proudest achievement I have. That's the part of the administrative part and the rest is the recognition of the patients and my colleagues during the last forty years.

11. Gloryren adds: How many spine surgery that are performed in your department every year and how many thoracoscopic spine surgery that you have performed so far?

We are performing now about eleven to twelve hundred surgeries a year. And that amount is being done for spine surgeons. For China, these numbers are not so big, but for Germany, they're big enough. I've just made a summary until 2021, and I went above 3,000 thoracoscopic spine surgery performed by myself.

12. What advice would you give to young spine surgeons?

Be curious, be committed to what you are and what you are doing, and never accept the words “it's not possible”. I think those are the three advice that I can give them, and those are the three things I've always been doing during my career. I wouldn't have developed thoracoscopic surgery or all the other approaches I'm using if I would have just done what my chief was doing or what the others are doing, and that was the result of a curiosity. Can it be done? Is it possible to do it? And if you don't stick to your plan, you will end up doing nothing, so even if you have drawbacks, you should keep working on it and it will happen that as some sort of solution appears in the horizon and leads you to the solution of the problems you are facing.

13. What would you have been if you had not been a medical doctor?

Another good question, probably I would have been an agricultural engineer, because the more I get involved with the topic, you have the biological parts, you have the entrepreneur part and you have also the room enough to develop new things. So in fact, we are working on an idea I have in order to have crops transported in a very quick and cheap way, that's a problem in Argentina because of the long distances, and it should be a problem in China as well, but we'll talk about it when the time is mature for it, now it's just a project.

14. What are your interests and hobbies outside medicine?

That's easy, soccer, traveling and cooking.