High-quality spine research does not always equal large budgets and complex infrastructure

High quality research is essential for constant progress in medical science and in our efforts to improve patient treatment and enhance outcomes. However, high-quality research and top-tier scientific studies have become synonymous with large research budgets and complex infrastructure, making impactful research almost impossible in many developing countries.

As a result, many surgeons and practising clinicians in the developing world consider research to be out of reach. Instead, they rely on adopting solutions from research done in the developed world, which often may not meet their patients’ needs or align with their socio-economic conditions.

A team led by Prof. Dr S Rajasekaran at Ganga Hospital , Tamil Nadu, India, is blazing a trail showing that excellence in research can be achieved effectively with limited resources, provided the research question is relevant and the methodology is correct.

In 2022 they received the prestigious North American Spine Society’s (NASS) Outstanding Research Award for a record fourth year consecutively, for their clinical work on ‘Perioperative Analgesic Efficacy and Safety of Erector Spinae Plane Block in Posterior Cervical Spine Surgery – A Double-Blinded, Randomized Controlled Study’.

Their research involved a randomized clinical trial focusing on enhanced post-operative pain relief for patients undergoing cervical spine surgery, by supplementary regional block. They demonstrated significant benefits to the patient by using a technique that has been used in lower back pain surgeries.

“The key to our success is that we ask the research questions which are relevant to patient care, and use sound methodology that is available to us,” Rajasekaran said, noting that his team has a strong track record of over a decade winning awards, grants, and prizes for their research.

“This team is an excellent example of really good collaboration bench to bedside, and bedside to bench. The focus comes from what we observe in our clinical practice. If you have the right research methodology in your mind, if you identify and observe a clinical problem that is worrying you in practice and set up a trial around that, it will work well for you” Rajasekaran observed.

Community-appropriate solutions for back pain and particularly low back pain are desperately needed in developing economies. When paid sick leave and medical insurance are not the norm, pain like this can have a dramatic impact on an individual’s quality of life, beyond the immediate injury, and can severely affect their family’s economic security. That was an incentive for Rajasekaran’s team to extend their research into the basic science aspects of low back pain.

Funding research has always been a great challenge. At Ganga Hospital, research is fully integrated into the daily medical practice. At the beginning, Rajasekaran recalls, they would rely on the financial awards that come with winning these research prizes to fund further research. Since the first prize in 2004 for work looking at lumbar disc nutrition, every award fund was ploughed back into the system to fund their next research.

The consistent body of excellent work they built up then enabled them to apply for, and receive, major grant funding, including from the Indian government. Since those early days, their funding structure has diversified but the focus remains the same—community appropriate solutions.

Rajasekaran is proud to say that their clinical and basic science research efforts have transformed their unit into a high-volume publishing unit, focusing on the problems they see in day-to-day practice: spinal infections, low back pain, severe injuries, road traffic accidents and other pathologies unique to developing economies. This latest award exemplifies the benefits of a fully integrated research and treatment model, such as that in place at Ganga Hospital.