The Argonaut interview: Drs. Robert Watkins Sr. and Jr.

By Gary Walker

Medicine is the family business for the father-son spinal surgeon team of Drs. Robert Watkins Sr. and Jr.

The board-certified surgeons, who have practiced medicine together for eight years, are co-directors of the Marina Spine Center in Marina del Rey and together with their partner Dr. David Chang, they treat patients from all walks of life. While it makes up a small portion of their practice, they have also built up an impressive list of clients that includes some of the top professional athletes in the world.

The doctors performed the neck surgery that Denver Broncos quarterback Peyton Manning had done earlier this year. Former Los Angeles Dodger Rafael Furcal was also a patient while he was with the Dodgers last year, and the Watkins recently performed back surgery on Orlando Magic center Dwight Howard.

Their office walls are adorned with photos and jerseys of professional and collegiate athletes who are former patients.

Watkins Sr. is a member of the National Football League’s Head, Neck and Spine Committee and is a founding member of the North American Spine Society, the largest such organization in the United States. He is considered a renowned expert in orthopaedic injuries to the back and neck and his practice includes the successful treatment of professional athletes from all over the nation.

His son has authored papers on spinal surgery defects and spine injuries in athletes, and his areas of specialty include minimally invasive spine surgery, computer guided spine surgery, artificial disc replacement, and spinal deformity.

In a recent interview with The Argonaut, the doctors talked about their treatment of high profile athletes, their views on how spinal surgery has evolved over the years and the level of concussions in professional and amateur sports, and working together as father and son.

Q: Do you feel that the emergence of image guidance has revolutionalized spinal surgery?

Watkins Sr.: It’s near the top of the most important things that have happened with spinal surgery.

Q: This procedure offers a three-dimensional view of a patient’s area of injury, correct?

Watkins Sr.: A three – dimensional, real-time view of things. Technology is expanding and is getting better and better at looking at things. What we hope to do is to be able to look at soft-tissue and bone trajectories in a better way.

There are also some new interoperative devices that we want to bring to Marina del Rey that we think will improve what we’re doing and the plans are to do that.

Q: What types of instruments or devices are they?

Watkins Sr.: Similar types of things. Interoperational visualization, imaging and the image-guiding component.

Watkins Jr.: The improvements are really in the quality of the imaging, the ability to see the bone versus soft tissue and it’s getting better all the time.

The instrumentation that is put in under navigation is improving where it can be done with less trauma to the muscles. And because the imaging is better, it can make the surgery safer and we can see more clearly what we need to see.

Sr.: This is the true meaning of minimally invasive surgery, a term that is overused a lot.

Jr.: It’s less invasive, and it doesn’t compromise safety and your ability to do the surgery properly, because of the imaging. You don’t have to expose the spine and move the muscles out of the way.

Q: Does this also lead to shorter recuperation time?

Jr.: Shorter recuperation time and overall better recovery because there’s less overall trauma to the muscles so there’s better functioning of the muscles on a long-term basis as well.

Q: Do you find yourself integrating these new operational techniques with, for lack of a better term, “old-school” techniques?

Jr.: That’s a good way to put it. I actually do a lot of teaching on minimally invasive techniques and computer-guided surgery, but I don’t necessarily consider myself a “New Age” minimally invasive surgeon. I consider myself more of a conservative, old-school type surgeon whose No. 1 goal is to do the surgery that I think is best going to treat the patient.

And if we can do it less invasive, that’s great and that’s always a goal. As compared to the priority of just doing a minimally invasive surgery but you may not necessarily help the person, our goal is “let’s do what’s going to help the person” and be least invasive as possible.

I think that’s obviously a lot of the foundation that I inherited from my father. If you’re going to treat somebody, treat them in a way that’s going to best help them. And that’s why our surgeries run the full spectrum.

Q: Are professional athletes and their injuries examined and treated in a more detailed fashion?

Sr.: It’s a comprehensive approach to the patient that I think has made a big difference for us. From the minute they walk in, that’s our patient and we’re responsible for a full return to function. It’s what we do with every patient. But it’s particularly important with a professional athlete, because it’s not just about feeling better after the surgery; they’re interested in returning to performance.

For professional athletes, it requires the understanding that you’re in it for the long haul, that you’re going to be there for the whole rehabilitation process. One of the comments we use is, “don’t do the surgery if you can’t do the rehab.”

The other thing is we enjoy that process. It’s a labor of love because we enjoy working with the guys and women and returning them to function and that’s a big part of what we do.

Q: When operating on an athlete, do you ever think about what the success of the surgery could mean to their sport as well as to their team?

Sr.: We take care of the medical care and that’s what we focus on here. Believe me, some guy who has worked hard at his business for 50 years is as concerned about his recreational sports as some of these younger guys.

Q: It must be very rewarding to be called upon to treat some of the most gifted athletes in the world.

Jr.: Ninety-five percent of our practice is made up of people who have regular jobs. Most of our time spent is with them. But taking care of athletes and the local area Los Angeles sports teams is the cherry on top. It makes our practice a lot of fun and keeps things interesting and exciting around the office.

Q: Regarding concussions, we talked in the past about the frequency of concussions in high school and collegiate sports, as well is in the NFL. There seems to be more detailed medical findings on concussions almost yearly.

Sr.: At (the Head Neck and Spine Committee)’s last meeting in New York, I felt like everyone in the room had the goals and objectives of improving the health care of the players. I think everyone’s trying to get it right and to find out what the long-term implications are for the athletes.

Q: Were you surprised at the number of recent suicides by former NFL players, most notably former San Diego Chargers linebacker Junior Seau? Many retired players who have been injured often complain that after their playing days they are left with lingering pain.

Jr.: We see 50 to 100 patients a day in our office and they’re all in pain and suffering. I don’t know that the incidents of pain and suffering are any higher in professional athletes after they retire. A lot of them have better physical bodies than the general population, so a majority don’t suffer after retirement.

Q: It must be very difficult to have patients with injuries who are living with constant pain and may never fully be without discomfort.

Jr.: That’s probably the most challenging part of our job – emotionally dealing with people who are in chronic pain and empathizing with them and seeing how much it’s impacting their life.

Q: In a prior interview, you mentioned some of your mentors. Do you ever find yourself mentoring your son?

Sr.: We’ve have a good working relationship, and I think that comes out of always letting my children make their own decisions to a certain degree. Luckily, (Robert’s) an excellent surgeon. I don’t know what I’d do if he wasn’t (laughs).

Jr.: I think it’s been a great benefit to me to be able to work with my father. Decision-making is the key part of our job, like when to operate on somebody, what kind of surgery to do, and if there’s ever a complication, how do you handle it, in the middle of surgery or after? That’s really what makes or breaks the success in our job.

Learning that from my dad and working with him has probably been the most beneficial thing, and having a grounded foundation to be able to make decisions is probably the most important thing.

That’s something that you don’t learn in a textbook.