Neurosurgeon proves necessity is mother of invention

December 20, 2017
Dr. Bruce Frankel
Dr. Bruce Frankel displays two of the patented surgical devices he invented: the Everest Fenestrated Tap and the UST-5311. Photo by Sarah Pack

Kitty Hawk had the Wright brothers. Apple had Steve Jobs.

MUSC has Bruce Frankel.

Neurosurgeon, researcher, blacksmith, speaker, inventor. A Renaissance man with a keen power of observation and a lightning quick wit that could have just as easily landed him on late-night TV, his domain is the operating room — where not only does he use his skill to serve patients, he channels his boundless mental energy into innovation.

Whether he is placing screws in a spine, forging 160 layers of steel into a Bowie knife or creating a way to see beneath a tumor, his brand of curiosity doesn’t end with simply wondering how something might work better. He, like many inventors, is compelled to fix problems by creating unique solutions.

And he has 12 patents and 10 licenses to show for it.

Since the fifth grade, Frankel has been figuring out better ways. When he runs into a problem, his mind immediately goes into high gear.

“I get the idea to try something a different way, usually because there’s an unmet need. So I’m always asking myself, ‘Why are you doing it that way?’ ‘Can this be done better?’” 

Approaching things differently started early for Frankel. As a boy of about 10, he decided to make his own skateboard. From scratch. He cut the platform out of wood, stained it, got the individual parts and put it together. “I guess it was I was in the fifth grade,” he recalled, “when I went through a major bicycle- and skateboard-making phase.

“Frankly,” he laughed, “they weren’t very good. But I liked seeing how they held up under certain conditions. If I could skate around and the board didn’t crack in half, I was like, ‘Wow, I made something robust enough that it could withstand so and so,’ and I enjoyed being able to fix it when it broke.”

Plus, he learned he could bring a project to fruition.

“There was something, and there still is, about making something myself. I’m a blacksmith now. I like making things myself and seeing how far I can push it. There’s just something very intriguing about it.”

Not surprisingly, that driving curiosity made its way into his work.

His first medical invention was a cement tap. When he was a young surgeon, he had a patient in Memphis with a fracture in a bone that was very osteoarthritic. He realized the screws he was going to insert into it weren’t going to stay put.

“’This is terrible,’ I thought to myself. ‘She’s going to get up, and the screws are going to rip out of her back.’ I would take a needle and inject the cement in the bone, but the bone was like Swiss cheese — it would squirt backward along the needle and out another hole. So I thought, ‘Why don’t I make a disposable tap that would prevent backflow of cement that could be followed by screw placement?’”

There was, in fact, a whole body of knowledge on how to cement them, but none of it worked very well, so he set out to remedy that. And he came up with an idea that allowed him and other surgeons to better cement them, giving patients a more robust and satisfying quality of life. This concept skirted other existing patents and regulatory hurdles, had a number of patents issued and is still commercially available for use today.

It’s not just how something can be done better that he grapples with but also how to improve on something that’s inferior or possibly even dangerous.

Such was the case when he devised a way to use a hand–held ultrasound-containing instrument to see within and around a tumor.

“I was doing surgery and couldn’t see blood vessels behind the tumor no matter what I used, and that posed serious risks. So I thought, ‘I have to find a better way of doing this.’”

Thinking outside the box paid off. He improved on an existing technology, taking it to a new and innovative place.

“I didn’t invent ultrasound,” he explained, “but I made a device that is an instrument that has ultrasound built into it so that I could use it as a probe, a curette or a scraper, but also so I could look at what I was doing simultaneously with that instrument and almost see into the future. I could tell where important blood vessels are before I saw them by eye.”

The device was unique enough that it is used in a number of different surgical applications. For that invention, he received two patents, with others still pending.

Not long after, he recognized there was still a need for a safer way to locate pilot holes in bone prior to performing a pedicle screw implantation — a type of bone screw that is implanted. He crafted a small ultrasound device with a probe attached to the tip that could be used to detect even the smallest bone breaches prior to the screw being inserted with the potential to greatly decrease the risk of injuring spinal nerves traveling millimeters away.

Interestingly, what is most exciting for him is not just how many other surgeons are using his invention, but how they are taking it to the next level – beyond what Frankel had originally imagined.

“The ultrasound-based instrument — it’s a very versatile thing. The pedicle screw system is only used in spine. But I also use this ultrasound tool for pituitary surgery, as do other surgeons. They use it at quite a few famous institutions around the country. Many places are seeing the value in it and making it safer for patients. Now, people are developing operations for patients with cancer to more safely resect metastases that are growing in the spine. So people are developing new operations around it and building on it. It’s nice. I’m really thrilled by the versatility of that particular device and how you use it with different instruments you attach it to.”

Building on his invention. For him, that’s important validation.

“I’m very mindful of the fact that if I come up with an idea, I understand that I may see the utility, but when you see the market accept them, and you see other surgeons accept them, there’s a pride. It’s thrilling to see that you really were onto something.”

That possibility keeps his wheels turning, always asking, “What if?” Still, he doesn’t see how that makes him particularly unique.

People have been asking that question for a very long time, he said.

“You look back in history at the surgeon-inventor type; there have always been users and inventors,” he explained, pointing to London surgeon John Bradmore, who saved the day in the early 1400s when Henry V was shot in the head with an arrow, the tip of which lodged itself six inches into his face.

Surgeons at that time would break the shaft of the arrow off wherever it was, so it didn’t show. If the person survived, the surgeon then would try to pull it out.

“Accounts of the surgeon who devised the technique to be able to get the arrow out of the skull of the future king of England shows that people have been doing this forever. It’s just part of being a human. You’re working with instruments and creating things that didn’t exist — and seeing that you’re no different than any other human being. Whether it was 500 years ago or 2,000 years ago, you’re just doing what a human does.”

And earlier this year, his did it again. Frankel received notice that the FDA had approved another device he invented, a curved titanium rod he invented for use in minimally invasive lumbar spinal fusion surgeries where degenerative spinal conditions, fractures, dislocations or tumors are present. According to Frankel, who worked with MUSC’s Zucker Institute for Applied Neurosciences to develop this device, it’s a huge improvement over the standard rod that surgeons typically use in these surgeries.

Frankel noticed during his surgical procedures, when he would tighten the construct down, the curvature of the rod would cause the top part of the tall screws he was inserting to touch or overlap. When the screws are not placed properly, it puts stress on the components. After the procedure, that could lead to loosening or other complications. But because of the device’s wave shape, several concave dips in the rod allow screws to stay put and not touch when tightened.

He has also worked with ZIAN on several other devices, like an expandable cage, which is used to reconstruct vertebral bodies in complex spinal surgery. This device has been issued two patents and is being actively licensed to industry.

While revolutionary inventions such as these might conjure up images of state–of–the–art equipment lining the walls of an engineering lab, in reality, Frankel’s process is quite a bit less intimidating. At night and on weekends, he can be found in his garage, tinkering with the supplies he’s bought at Lowe’s, designing prototypes.

Between his inventing, a busy surgical schedule and responsibilities that at any time can include teaching, grant writing and research, it might seem like he’s on the job 24/7. Colleagues wonder if it’s not actually a bit more, especially when you add in the fact that Frankel and his wife, a neurophysiologist at MUSC, are so incredibly active in the lives and activities of their five kids.

Sometimes, in fact, it takes hitting the friendly skies for Frankel to find time to take a mental break.

“Airplanes are great times for that. I’ll take whatever time is available,” he said with a laugh. “We’re always getting pinballed from one place to another with our jobs, so if there’s some downtime, it’s a wonderful thing. I find it very soothing. Also, the blacksmithing is invaluable when my mind is rushing, and I need to just focus on something else and not try to fix something. Sometimes it can be very taxing to have your mind continuously racing.”

He genuinely enjoys the artistic process of making pattern–welded steel knives, which he gives away to friends. It allows him to decompress. He welds the high–carbon and stainless steel — all 160 layers — and forges it together. From the bolster to the tip, he handcrafts every single part of the knife. And the etched artwork? His. Even the leather pocket sheath to place it in — he sews it himself.

And while he’s fortunate to have been granted so many patents, licenses and relicenses, he also said he’s had lots of failures. That just keeps him going back to the drawing board. And not for the prestige — for the people who benefit from his work.

Patents, he said, are just a necessary evil.

“The business side of this, I am lousy at it. I only have an interest in them in order to get these ideas to market. I don’t care about patents. I care about my patients. But in order to use a device on a patient or get it into the clinic, I need to interest companies in it. One of the ways to interest companies is to build value in it. You build value by having patents.”

For him, that makes all the politics and red tape worthwhile, because being in the operating room and inventing, he said, are the biggest thrills of his professional life.

“I love my patients. My greatest love is being a neurosurgeon. Using these instruments to help patients in the operating room is one of the most thrilling things that I’ve experienced. And writing about them, if I’ve used it to reduce blood loss or increase the strength of what I’m doing — that, to me, is thrilling.”

He has a couple of new things coming down the pike soon. But for now, he said, he’s in a quiet period.

Will that last?

“No,” he admitted.

“I do look back and think, ‘That was a fun ride.’ I learned this and that, which gives me perspective. But it seems like it’s the next thing that really holds that excitement for me.”