Choosing To Be A Neurosurgeon

Terence Verla, MD, MPH specializes in minimally invasive approaches for complex deformities of the spine. In his interview with Carl Erickson, regional director for Stand-Up MRI of Florida he discusses a variety of issues neurosurgeons face that can be assisted with the modern benefits of multi-position mri scanning.

An Inside Look at Neurosurgery: A Conversation with Dr. Verla

In a thought-provoking interview hosted with Carl Erickson of Stand-Up MRI of Florida, Dr. Verla, a distinguished neurosurgeon with Orlando Health, sheds light on the high-stakes world of neurosurgery, patient care, and the evolving role of advanced imaging technologies.

The Path to Neurosurgery

Dr. Verla opens up about the origins of his passion for neurosurgery, a journey marked by a natural curiosity for unexplored territories. Initially intrigued by space and aeronautics, his aspirations evolved after witnessing the urgent need for solutions closer to home.

"I saw more people suffering here who needed help," he shared, recalling how he transitioned into medicine. Neurology and neurosurgery captivated him because of their profound, irreversible consequences—a realm where every decision has life-altering effects.

Neurosurgery demands precision and accountability. Unlike many organs, the brain and spinal cord are irreplaceable. "You make a mistake—someone dies; you delay treatment—the outcome is irreversible," he emphasized.

Life on the Frontlines of Neurosurgery

Dr. Verla discusses the intense, fast-paced nature of his field, especially during trauma care. In one case, a patient arrived with severe brain hemorrhaging caused by a tumor. Time was critical: without intervention, the patient would have succumbed within a day. "The patient was declining in front of me… within hours, surgery was completed, and by evening, the patient was awake and speaking." The success of such cases, Dr. Verla shared, fuels his sense of purpose and keeps him grounded.

He highlights disparities in healthcare globally, particularly in developing countries where diagnostic tools and skilled specialists are often unavailable. A condition treated promptly in the U.S. could end tragically in resource-limited settings. This insight inspires him to pursue broader health initiatives to improve access worldwide and even within underserved areas in the U.S.

Spinal Surgery and Minimally Invasive Advances

With a specialization in spine surgery—both complex reconstructions and minimally invasive techniques—Dr. Verla describes the razor-thin margins of error in his work. Procedures often occur within millimeters of the spinal cord, where even minor missteps could cause paralysis.

His meticulous surgical strategy relies heavily on imaging tools like X-rays, CT scans, and MRIs. Yet, these tools, while crucial, have limitations: they capture static images, missing the dynamic nature of pain and movement. Dr. Verla acknowledges that dynamic MRI imaging, such as upright imaging, provides crucial insights into the spine’s condition under the stress of movement or weight-bearing. He recalled a case where standard imaging failed to reflect a patient’s real condition until more advanced techniques were considered.

The Importance of Clinical-Radiographic Matching

A major part of Dr. Verla’s diagnostic process involves correlating clinical symptoms with radiographic findings—a discipline often overlooked in early stages of patient care.

"If the images don’t match the pain pattern, you can end up doing unnecessary surgeries," he warns. The ability to pinpoint the source of a patient’s symptoms through accurate correlation ensures tailored, effective treatment plans. Patient education plays a significant role: Dr. Verla frequently walks patients through imaging results to explain the origin of their pain and manage expectations for surgical outcomes.

Failed Back Syndrome and Post-Surgical Care

Failed Back Syndrome—persistent pain after spinal surgery—is another topic Dr. Verla explores. This condition, he explains, arises from multiple factors, including pre-existing degenerative changes, lack of physiologic spinal alignment, or even incomplete diagnosis. Importantly, post-surgical outcomes also depend on patient engagement in rehabilitation efforts like physical therapy to strengthen core stability.

"Patients play a key role. Surgery may fix the mechanics, but proper pre- and post-care is essential for success," Dr. Verla emphasizes. He adds that emerging treatments like neuromodulation—rerouting pain signals to reduce perception—hold promise for patients unresponsive to traditional interventions.

Technology’s Role: Dynamic Imaging and Beyond

Advanced technology remains central to Dr. Verla’s practice. He highlights innovations like functional MRIs for brain mapping, intraoperative imaging tools, and dynamic spinal imaging, which give surgeons clearer, real-time insights during procedures. These tools are especially valuable when removing brain tumors located near critical areas or when spinal structures shift during surgery.

Staying Calm Under Pressure

Surgeries lasting over 12 hours are not uncommon, requiring immense focus and mental fortitude. Dr. Verla credits his ability to remain calm under stress to his consistent demeanor, both inside and outside the operating room. Neurosurgeons, he believes, must embody a steady presence, ensuring precision even in high-pressure scenarios.

"If you're not calm outside of the OR, it’s going to be hard to stay calm inside," he shared.

A Personal Reflection: Humility and Learning

Despite his experience and expertise, Dr. Verla remains humble. He emphasizes the importance of seeking help and learning from colleagues when encountering unfamiliar cases. In a dynamic field like neurosurgery, collaboration ensures the best outcomes for patients.

Final Thoughts

Dr. Verla’s journey—from growing up in Cameroon to specializing in one of the most demanding fields of medicine—is a story of perseverance, humility, and passion. His reflections not only highlight the complexities of neurosurgery but also underscore the role of advanced imaging and patient-centered care in achieving the best possible outcomes.

For Dr. Verla, neurosurgery is more than a profession—it’s a calling to improve lives one patient at a time while striving for broader impacts on healthcare systems.