Dr. Arnold Graham Smith is a pioneer in lower back pain relief.
Arnold Graham Smith studied at King’s College at the University of London to obtain his degree in Medicine. He had been encouraged to become a Doctor by his family practitioner, William T Macdonald, MB, ChB, who was a graduate of Edinborough University, but it soon became clear that a career as a Trauma Surgeon was to be his goal. After interning at his Teaching Hospital on the Orthopaedic Surgical firm, he entered general surgical training and 5 years later passed the examinations required to become a Fellow of the Royal College of Surgeons of England. During those surgical training years he spent additional time as an Emergency Room doctor and served six months in Plastic Surgery to prepare for a career in Trauma.
Dr. Graham Smith followed his general surgical experience with one more elective course, six months of Neurosurgery at the Radcliffe Infirmary, Oxford, under the supervision of Prof. Joe Pennybacker. Here, he learnt how to carry out detailed neurological examination of patients and assisted in neurological surgery, including spinal surgery. He was next appointed Orthopaedic Registrar for two years in the Oxford training program, and followed this with four years as Senior Registrar in Orthopaedic Surgery at the St. Mary’s Hospital training program in London. It was during this final four years that he spent one year as Fellow at Rancho Los Amigos Hospital in the Los Angeles area of the USA, and his plans to become a Trauma specialist changed.
Rancho is the Rehabilitation Hospital for L.A. County, and when it was discovered that Dr. Graham Smith had neurosurgical experience he was placed on the Spinal Cord Injury (SCI) service, to care for paraplegics and wheelchair people with varying degrees of paralysis. His knowledge of plastic surgery was helpful in treating the skin breakdown of pressure ulcers and bedsores but it was here that he first experienced the workings of a rehabilitation team where therapists, nurses, psychologists and surgeons all had equally important roles to play in achieving the best treatment outcome for each individual patient. That philosophy has stayed with him ever since and he still relies on the expertise of a treatment team for the best outcome.
After his final year in London was concluded, Dr. Graham Smith returned to the USA where he has lived ever since. He worked for nine years in the SCI field, first in Georgia at the Roosevelt Warm Springs Hospital, and then in Florida, in Jacksonville. During this time, the development of the CAT scan was making spinal diagnosis more reliable and his interest returned to his spinal surgery days in Oxford. He visited a lumbar spine surgery pioneer in Dallas, David K Selby MD, who became his mentor and friend, and who introduced him to surgeons in San Francisco, Dallas and Minneapolis who have all contributed to his knowledge of spinal surgery. He sadly left the field of SCI in 1986 to concentrate on lumbar surgery. The innovative Radiologist in New Orleans, Charles Aprill MD, introduced him to discography as a useful diagnostic test, and so he brought this procedure to Jacksonville, later asking the local radiologists to learn how to do it and thus making the test available to all the spine surgeons in the community. Interventional spinal diagnosis has become so important that it has its own organization, the International Spine Intervention Society (ISIS), of which Dr. Graham Smith was a founder member.
In 1987 Dr. Graham Smith performed the first pedicle screw fixation surgery of the lumbar spine in Jacksonville, since when it has become the standard of care for most lumbar fusions. The Dallas connection was responsible for other advances in Jacksonville including the Patient Controlled Analgesia (PCA) pump and the ice water cooled pads applied to incisions after orthopaedic surgery.
In 1994 a local Physical Therapist asked Dr. Graham Smith to find out what could be done to help patients with disabling Sacro-iliac Joint (SIJ) pain. Nothing had been written about this in the spinal surgery literature for nearly 70 years and this small group of patients had been overlooked. A lack of a secure diagnosis was at the heart of the problem, but the advent of the CT scan and then the MRI made it clear that their symptoms of buttock and leg pain were not due to nerve pressure from a disc herniation or spinal arthritic changes. Again Dr Aprill obliged by describing a diagnostic injection technique to temporarily anesthetise the painful SIJ. A local radiologist, Clifford H Spohr MD, learnt how to do the test and by 1995 there were six patients in Jacksonville ready with confirmed diagnosis, waiting for definitive treatment. In the ten years that have followed over 80 patients with this condition have undergone surgical treatment using three different procedures. The latest operative technique was perfected in Jacksonville in 2003 and it is now being used in other centers across the USA. Further information about the SIJ can be found among his Published Articles and Education documents.
As the practice of medicine has changed with managed care, spine surgeons have found their decisions being second-guessed by family practitioners, knee surgeons and physiatrists, to name but a few, as insurance companies require second opinions for surgical procedures. In 1998, a group of senior spine specialists founded the American College of Spine Surgeons (ACSS) and its examining arm, the American Board of Spine Surgeons (ABSS). Dr Graham Smith became a Charter Member in 1999 and in 2001 he was recertified by examination. He is a member of the Board of Directors of the ABSS, where he serves on the credentials committee and is also the chairman of the examination committee. He believes that spine surgery is now so complex that it should only be performed by surgeons with special training, and second opinions about what should be done should only be given by specialists. To that end, just as orthopaedic and neurological surgeons require Board certification, so spine surgeons can now become Board certified.
Dr. Graham Smith is an active member of the North American Spine Society and ISIS and has made several presentations at their annual conventions in recent years.