It’s 7:15 a.m. at the North Meridian Surgical Center in Carmel, Indiana, on a cold January morning. Dr. Rick Sasso ’82 has already completed one spine surgery and is preparing for a second—a minimally invasive microdiscectomy surgery on a woman in her mid-40s with debilitating leg pain.
Using devices and procedures he has developed and patented, Sasso is focused as he begins to carefully remove pieces from a herniated disk and other tissue pressing on a bundle of nerves. “This is going to be an incredible result for her,” he says after he leaves the operating room to meet with the woman’s family.
Two hours later, at 9:28 a.m. in the pre-op/post-op area of the surgical center, just steps from the operating room, “SASSO” is hand-written on signs on two rooms for his patients from the early morning surgeries. The beds are empty. A charge nurse says, “Oh, they were out of here lickety-split. They’re both on the way home and doing great!”
Sasso, who leads the Indiana Spine Group medical practice, North Meridian Surgery Center, and the Indiana Spine Hospital, smiles and says, “We do one thing and one thing only, and we do it remarkably well.”
It all started in the late 1990s with the three founders of Indiana Spine Group— Sasso, an orthopedic surgeon who specializes in spine surgery; Ken Renkens, a neurosurgeon who specializes in spine surgery; and Kevin Macadaeg, an anesthesiologist who performs spinal diagnostic and pain management procedures. In 2010, the group expanded and built a professional office building in Carmel, which includes the North Meridian Surgical Center.
Sasso and his partners began to imagine a spine hospital on the same footprint as the other facilities to provide a turn-key, highly specialized approach to care for patients with a wide range of spine issues. Six years ago, the 20-bed Indiana Spine Hospital opened. It has become a model for patient care and efficiency.
It is there where spine doctors can meet and diagnose patients, get instant MRI and CT scans, and in cases that call for outpatient surgery, they simply go down the hall. Even though about 90% of the patients they see don’t require surgery, when they do, everything is under one roof—a one-stop shop entirely focused on the spine.
“I didn’t set out to build a hospital; I really didn’t set out to build a medical office building,” Sasso says. “It’s all about what’s best for our patients. And we discovered that when the physicians have control, we are way better at taking care of our patients.”
The hospital boasts oversized rooms with Murphy beds in the walls so parents can stay with their children recovering from scoliosis surgery. Sasso is proud of the design, architecture, and even the food service: “People literally come here to have lunch because the food is super good!”
Wabash Magazine last profiled Sasso 15 years ago when the devices he had created—a complex set of screws, plates, and rods used in spinal fusion and stabilization— were revolutionary. But in the hands of capable surgeons who had done the right amount of diagnostic work before surgery, the actual procedures were, even then, pretty routine in most cases.
“If we’ve done the right work ahead of time, through conversations with patients and reviewing the scans, the surgery is not that difficult,” Sasso says.
While the screws, rods, and cages used in spinal fusion and other surgeries have evolved somewhat since then, the real leaps have come in the areas of guided navigation and interoperative CT scanning.
Years ago, Sasso’s patients would get X-rays or scans in another part of the hospital, and the images from that fixed point in time and different physical position were of little use. Today’s navigation system is not unlike the GPS found in most cars— constantly adjusting with every movement and turn. The system involves a camera mounted in the operating room above the table, a reference frame with a series of sensors on top, a portable three-dimensional O-arm scanning device, a computer, and a half-dozen screens, which display precise three-dimensional images and data in real time all around the operating room.
“The engineers who first developed this idea 20 years ago had the frame in the wrong place and we couldn’t work around it,” Sasso explains. “The idea was good and there was potential to really help patients, so I came up with a different system. I used a pin that we use in trauma cases, and I ‘MacGyver-ed it’ to put it into the iliac crest, which made a lot more sense to me. It’s a more stable place, it was out of our way, and allowed us to get images before we started the operation. That’s how truly minimally invasive surgery is done.”
With the equipment and facilities in the surgical center and spine hospital, it’s obvious why the Indiana Spine Group has doubled in size in the past two years alone. It attracts some of the top talent in the country, including Dr. Michael McCarthy, who trained in his fellowship at the Hospital for Special Surgery in New York City and was named a top-20 surgeon under 40 nationally.
“If you look across the country, you won’t find the amount of technology that is in this building; you won’t find this in many level-one, large academic centers,” McCarthy says. “We’re in a unique situation here. The capabilities that we have here in Carmel, Indiana, will blow a lot of billion-dollar institutions out of the water.”
Even with all the technology, Sasso’s favorite spot in the building is the Medical Academic Center (MAC) on the third floor. The sprawling MAC is a teaching facility that has 10 operating stations, a 90-seat high-tech auditorium, kitchen, cafeteria, and cold storage area. The entire focus is education and training.
“When we were designing this place, our accountants and all the smart people said to only build a two-story building,” Sasso says. “And I said, ‘You don’t understand. The third floor is what gets me excited; the MAC is what I’m most passionate about.’ They said, ‘We can’t account for it; we can’t make it work financially.’ And I said, ‘I don’t care. This is what we’re going to do.’”
At the center of the MAC Bioskills Lab are two fully equipped operating tables with cameras, in addition to eight other operating stations, high-speed drills, general instrumentation, an O-arm, and robot.
Trained surgeons like Sasso can demonstrate surgery in the center of the room using a cadaver, while medical students, residents, and fellows can watch the monitors as they practice the technique on their own cadavers. Or live video feeds from the hospital’s operating rooms can be sent to the MAC so doctors can replicate while watching an actual surgery in real time. Other surgeons can moderate a discussion from the operating room for a truly interactive teaching and learning experience.
The MAC is doing far more than training future spine surgeons; it also hosts groups of high school and EMT students for gross anatomy labs. In the year before the pandemic, nearly 1,300 high school students experienced one of these hands-on, faculty physician-led gross anatomy labs. The level of excitement from them encouraged MAC Director Sandra Haugo to start a medical-training boot camp program for high school students interested in a healthcare career.
“Students attending the camp have the chance to dissect a cadaver from head to toe, and in the last two days of the program they perform real procedures,” says Haugo while standing in the room full of freezers where human tissue is stored. “The students are guided through a knee replacement surgery; a resident shows them the procedure, then they go to the cadaver and do it themselves. They also have the chance to experience spinal navigation and robotics, suturing, casting, a craniotomy, and plate a broken bone. They learn so much in a single week with us.”
Sasso adds with pride, “Most medical students won’t get that experience in their first two years. We have better spine equipment up here in our cadaver lab than most hospitals in the city.”
after an energetic and fast-paced tour of the facility, Sasso slows down momentarily to reflect on his career. He has helped develop devices that are in use all over the world, but for him it’s not about the technology. His legacy is the hundreds of residents, fellows, and spine surgeons he’s taught, encouraged, trained, and nurtured.
“Alan McGee is an unbelievably good spine surgeon in Fort Wayne,” Sasso says. “He called me one day and asked, ‘Would you train my son and let him come back to Fort Wayne to practice with me?’
“That’s just a huge honor for a really top spine surgeon to ask me to train his son.” He pauses, getting emotional. “Fellowships are about sharing your skill set.”
Hardy Sikand, CEO of Sasso’s medical conglomerate, sees it simply.
“What I like to tell people when they ask me why guys like Dr. McCarthy leave prestigious places like the Hospital for Special Surgery in New York to come here is, ‘Why do you think Nick Saban gets the best recruiting class every single year?’ It’s because people want to be with the best,” he says. “That’s the environment we have here.
“Talent attracts talent.”