Spine Surgeon Dr. Vincent DePalma moved to Kentucky to provide a needed service
LONDON Before he began planning to move to London, Kentucky, in 2020, it’s probably safe to say that Vincent DePalma, DO, had given little thought to the Bluegrass state. After all, he grew up in New Jersey, attended college, and completed his medical training in Philadelphia, New York, and Baltimore.
In those large metropolitan areas, however, he not only learned his craft as a spine surgeon, but he also learned that there was not a great deal of need for another spine surgeon.
“In New Jersey, there are 100 spine surgeons in a two-block radius, and they’re all doing small surgeries,” says DePalma. “My training included a lot of trauma in residency. In fellowship, I was doing complex surgeries. I wanted to go to an area where there was a huge need, where there was pathology ranging from scoliosis and severe deformity in 80-year-olds to younger people.”
DePalma researched rural areas in the southeast, including Kentucky, Tennessee, and South Carolina. He finally found the right place in London, Kentucky. Close but not quite close enough to Lexington and Knoxville, London’s proximity to rural southeastern Kentucky was an ideal choice.
“The biggest thing for me was being able to build a medical practice where there’s a big need,” says DePalma, whose patients come from communities such as London, Corbin, Berea, Richmond, Winchester, Mount Sterling, Hazard, Harlan, Hyden, Bowling Green, Pineville, northern Tennessee and even from Lexington. DePalma has patients travel from as far as West Virginia to receive his specialized care.
To say life in London is different from that of the Jersey Shore where DePalma grew up is an understatement. The youngest of four children, he grew up in a medical family. His father was a nephrologist in New Jersey. His siblings — two brothers and a sister — are also physicians.
DePalma initially chose a different route. He planned to go to law school and studied political science and international relations before his plans changed abruptly.
“One of the biggest catalysts in deciding to become a doctor was my dad passed away out of nowhere from a cardiac arrhythmia,” says DePalma. “I was in my last year of college and I saw all the people he affected and helped throughout his 30-year career — thousands of people showed up at his funeral. I decided to go back and do medicine at that time.”
DePalma attended medical school at the Philadelphia College of Osteopathic Medicine, graduating in 2014. He then completed an orthopedic residency at Hofstra Northwell Health (2014–2019) and a spine surgery and reconstruction fellowship at Johns Hopkins University in Baltimore (2019–2020). He is a board-certified orthopedic surgeon specializing in spine surgery. He joined the CHI Saint Joseph Medical Group in London, Kentucky, in 2020.
Much like his decision to come to Kentucky, DePalma had a sound reason as to why he wanted to become an orthopedic surgeon.
“I am a very goal-oriented person and outcome-driven,” he says. “I need to have a project and fix it as quickly as possible. With orthopedics, you can identify a problem quickly, then you can fix it and complete that task.”
“I went into spine surgery because of the complexity of spine surgery and the breadth and vast difference between different procedures and the workup,” he adds. “There’s a lot of thought process that goes into it as opposed to just fixing something. You work up a plan and execute that plan.”
Learning the Craft of Spine Surgery
Throughout his medical training, DePalma’s plan was to learn from the best, to take on the toughest challenges, to push himself to do more. He has a natural competitive drive, developed at least partially through his experiences playing football and baseball. Those lessons were put to the test during his residency at Northwell Health.
“My residency was a rough one. We did 52-hour shifts at times,” says DePalma, who met his wife during his residency. “I fixed nearly 400 hips as an intern and did thousands of surgeries and cases at seven different hospitals across Long Island, New York. We worked like crazy as residents and I was appreciative of that.”
That intense schedule prepared him for Johns Hopkins, where he learned from the best spinal surgeons in the world, observing techniques and developing skills that would open doors almost anywhere. Yes, even in rural Kentucky.
“We are treating Johns Hopkins-level patients here in a community hospital,” says DePalma with understandable pride. He operates three or four days a week and averages 280 spine surgeries a year. Unfortunately, the smalltown region offers a large patient population.
“I was surprised by the vast amount of spinal pathology in this region — things that have gone on so long, and they have never had treatment or never been diagnosed,” he says. “The amount of patients we see is extraordinary compared to the other areas where I was in the past. People have not had treatment for decades or forever until I came here.”
His patient population is equally divided between men and women, from teens to 90-year-olds. The most common surgery he performs is to correct severe spinal stenosis — pinching of the nerves, which results in leg or arm weakness and pain.
“Those surgeries do extremely well,” says DePalma. “It’s the only surgery where they are immediately out of leg or arm pain after the surgery. Some patients go home the same day or the next day.”
Surgery Is a Good Day
DePalma enjoys surgery because it offers the opportunity for him to fix things by doing what he’s best at. He has the knowledge to identify the problem and the skill to fix it.
“Surgery is the easiest, best part of the day,” he says. “It doesn’t cause me stress. Neither does post-op care. The tiring days are the ones where I see 50+ patients in clinic and deal with insurance companies to get surgeries and imaging approved. It’s all the work to do the work that is exhausting.”
Despite his love for surgery, DePalma only performs surgery on about 10 percent of his patients. The joy he receives from surgeries is fixing the problem.
“There is a misconception that spinal fusion doesn’t work,” he says. “Ninety-five percent of my practice is doing spinal fusion and my success rates are over 95 percent. You have to do the right surgery on the right pathology. You can’t take the easy way out. If you treat someone for spinal stenosis, your success rate is 100 percent if you do good patient selection, do the correct surgery, and do a good job at it.”
Surgery to just treat back pain is far less likely to have a successful outcome, says DePalma.
“If someone comes in with back pain, unless there is a fracture or instability there, I am not doing surgery. I am not going to do surgery and fuse your back for a degenerative disc. The outcomes are not going to be successful because the patient does not have much that is wrong with them. A lot of times, the back pain is just related to muscles and ligaments.”
A New Approach
A unique surgical technique that DePalma is now offering to his patients is a Prone Transpsoas Lateral Interbody Fusion (PTP LIF). The traditional version of the surgery requires putting the patient on their side in the lateral position rather than an anatomical position. The PTP LIF surgery allows the patient to remain in the prone position. The outcomes are the same for either surgery, but the benefits to the patient are significantly different.
“The surgical time is cut down by an hour to an hour and a half, so the patients have less time under anesthetic, less surgical time, and less blood loss,” DePalma says. “Plus, the correction of the sagittal alignment is better.”
DePalma takes great pleasure from a successful surgery. He tells the story of one patient who came to him in a wheelchair, unable to walk. He had been misdiagnosed with arthritis. DePalma correctly diagnosed spinal stenosis and corrected the issue via surgery, enabling the patient to walk once again pain free.
“I’m trained at doing something that allows me to help people who haven’t been treated for years,” says DePalma. “I tell them I can help them. I perform the surgery. I see them a few months after surgery and ask how they’re doing. They say great, nothing wrong, you fixed me. It’s pretty rewarding.”
Though other opportunities are no doubt available, he has no plans to leave London. He feels a sense of purpose to serve what has long been an underserved patient population. His goal is to establish a Spine Center of Excellence in eastern Kentucky. There’s no better way to show his patients that he has their back.