At NASS 2026 in San Antonio, the Early Career Advisory Council will host a luncheon roundtable session on Navigating the Transition to Early Spine Practice: Careers, Choices, and Sustainability. At this session, early career attendees have the opportunity to engage directly with experienced faculty in small-group discussions on topics not always covered during residency or fellowship.

To offer a preview of the conversation, the early career moderators for this session have asked the faculty assigned to their topic to answer some questions. Siddiqui: For trainees and early-career individuals, what types of research projects provide the best foundation for building a long-term spine research portfolio?

Fehlings: I advise trainees to begin with research questions that arise directly from clinical practice. The most successful long-term research careers are often built around a sustained area of inquiry rather than a collection of unrelated projects. Early on, observational clinical studies, prospective registries, systematic reviews, and outcomes research provide excellent opportunities to learn study design, methodology, data analysis, and scientific writing.

At the same time, I strongly encourage trainees to explore translational research opportunities. Some of the most exciting advances in spine care have emerged from understanding disease mechanisms at a fundamental biological level and then translating those discoveries into new therapies, technologies, or clinical strategies. Projects involving biomarkers, neuroprotection, spinal cord repair, regenerative medicine, imaging, or computational modelling can provide invaluable exposure to hypothesis-driven research and foster meaningful collaborations with basic scientists and engineers.

Importantly, I encourage young investigators to seek projects that can evolve into a broader program of research. A clinical outcomes study may generate hypotheses that lead to laboratory investigations, multicenter collaborations, or eventually clinical trials. Developing expertise in a focused area while cultivating both clinical and translational research skills creates a strong foundation for a sustainable and impactful academic career.

Patwardhan: Long-term spine research portfolios are built around clinical questions that address spinal disorders with high patient-volume, supplemented by systematic reviews, prospective outcomes research, registry-based studies and strong collaborations. Aim for a sequence of projects that build on one another. The goal is to develop expertise in a focused area while progressively transitioning from descriptive studies to hypothesis-driven research. Uninterrupted research funding is essential for the survival of a long-term research portfolio.

Some Examples:

1. Adjacent segment disease research – lumbar and cervical
You can build a progression such as:
• Epidemiology - Systematic reviews and meta-analyses to
• build literature expertise
• Clarify evidence gaps
• Generate ideas for original studies
• innovative hypotheses
• Develop capabilities for experimental studies
• Biomechanical studies of fusion constructs – adjacent segment effects
• Computational modeling
• Predictive modeling
2. Clinical outcomes research
Examples include:
• Patient-reported outcomes measures (PROMs)
• Minimal clinically important difference (MCID)
• Predictors of postoperative complications
• Reoperation risk
• Return to work
• Functional recovery
• Useful for quality improvement initiatives
• A single database can support numerous publications over several years.
3. Predictive modeling and AI
• Predicting complications
• Forecasting length of stay
• Predicting revision surgery
• Automated imaging analysis

Siddiqui: What were the key milestones that helped you transition from being a collaborator on studies to becoming an independent investigator with your own research program?

Patwardhan: The hallmark of an independent investigator is the establishment of a well-funded and sustainable research program that advances the field and attracts collaborators and trainees. Across biomedical research, the transition from collaborator to independent investigator is marked by several key milestones, and my own career has followed a similar progression:

• Develop a unique research niche: focus on a specific area of spine research where you can establish yourself as an expert
• Demonstrate research leadership: serving as first author, then corresponding, and eventually senior author on publications
• Build preliminary evidence: generate high-quality pilot data that supports future grant applications
• Secure independent funding: starting with institutional or foundation funding and progressing to larger national awards
• Create a research team: mentor students, residents, fellows, research staff, and collaborators to support a sustainable research program
• Develop research infrastructure: establish resources such as databases, laboratories that enable long-term, high-impact research
• Lead collaborations: by designing studies, and leading multidisciplinary teams
• Build professional recognition: Gain visibility through invited presentations, editorial responsibilities, grant review panels, and leadership roles in professional societies
• Mentor future investigators: train students and junior researchers who contribute to and eventually expand your research program
• Maintain a cohesive long-term research agenda: Ensure that individual studies build upon one another, creating an impactful body of work.

Fehlings: Several milestones were particularly important. First, I learned the value of identifying clinically meaningful questions that addressed unmet needs in spine care. Establishing a niche area of expertise helped distinguish my work and provided a clear direction for future investigations.

Second, mentorship was critical. Working with accomplished investigators exposed me to rigorous scientific thinking, grant development, and leadership within collaborative networks. Over time, success in publishing studies as first and senior author helped establish academic credibility.

A third milestone was embracing a translational research mindset. Rather than viewing basic science and clinical research as separate endeavors, I became increasingly interested in how discoveries from the laboratory could be developed into therapies that improve patient outcomes. Building integrated programs that connected experimental models, biomarker development, and clinical studies enabled me to ask larger and more consequential questions.

Securing independent funding was also transformative. Obtaining competitive grant support not only provides resources but validates the importance and feasibility of a research program. Finally, building multidisciplinary teams—including basic scientists, engineers, statisticians, trainees, and clinical collaborators—allowed us to tackle complex scientific problems in ways that no individual investigator could achieve alone.

Siddiqui: How do you balance clinical responsibilities, surgical training, and research productivity while developing a competitive track record for grants?

Patwardhan: Balancing clinical responsibilities, surgical training, and research productivity is one of the greatest challenges for aspiring surgeon-scientists. Success typically comes from focusing on the following:

• Prioritize clinical excellence: Strong surgical training builds credibility, generates meaningful research questions, and establishes a solid foundation for a clinician/scientist career
• Develop a focused research niche: Concentrate on one or two related areas to create a coherent, impactful research portfolio with potential for improving patient care
• Protect dedicated research time: Schedule consistent, uninterrupted time for writing, data analysis, and project development
• Build a collaborative team: Work with mentors, scientists, statisticians, engineers, and trainees to increase productivity and broaden expertise
• Publish consistently: Maintain a steady record of high-quality publications that support a clear research trajectory
• Pursue funding progressively: Begin with pilot and institutional grants, then advance to foundation and federal funding as your track record grows
• Seek strong mentorship: Learn from experienced investigators while gradually establishing your own independent research identity
• Align research with clinical practice: Focus on clinically relevant questions that arise from patient care to maximize impact and sustainability
• Develop grant-writing skills early: Practice writing proposals, seek feedback, and use preliminary data to strengthen applications.

Fehlings: I agree, balance is one of the greatest challenges in academic medicine. My first recommendation is to recognize that research productivity requires intentional protection of time. Research rarely happens in the margins of an already full clinical schedule.

Early-career clinician-scientists should develop structured schedules that include dedicated blocks for research activities, manuscript preparation, and grant development. Equally important is building a strong team. Successful research programs depend on talented trainees, coordinators, collaborators, and research staff who help maintain momentum across projects.

I also encourage young investigators to view clinical practice and research as complementary rather than competing activities. Clinical observations frequently generate the most important research questions. In my own experience, caring for patients with spinal cord injury and degenerative spinal disorders has continually informed both translational and clinical research priorities.

For those interested in translational science, collaboration is particularly important. Few clinician-scientists can independently master advanced molecular biology, bioengineering, neurophysiology, data science, and clinical investigation. Building partnerships with experts in adjacent fields allows young investigators to contribute to ambitious multidisciplinary projects while maintaining a clinical career.

Siddiqui: What makes a grant application in spine research stand out, and what are the most common reasons promising proposals fail to receive funding?

Fehlings: The strongest grant applications clearly articulate an important clinical or scientific problem, present a compelling rationale, and propose a feasible approach supported by preliminary data. Reviewers want to see that the question matters, that the methodology is rigorous, and that the investigative team has the expertise and resources necessary to succeed.

Applications are particularly compelling when they connect mechanistic scientific insight with a plausible path toward improving patient care. From a translational perspective, reviewers increasingly look for proposals that bridge the gap between discovery and application. Whether the focus is biomarkers, neuroprotective strategies, regenerative therapies, imaging innovations, or artificial intelligence, investigators should demonstrate a clear understanding of how the work could ultimately influence clinical practice.

The strongest applications are innovative yet realistic. They present a bold vision while maintaining achievable objectives and clearly defined milestones. Strong multidisciplinary teams are often a major advantage because they demonstrate that all aspects of the project from laboratory science to clinical implementation can be executed successfully.

In my experience, promising proposals most commonly fail because the research question is insufficiently focused, the methodology is not adequately developed, or the proposed work is overly ambitious for the available resources and timeline. Another common challenge in translational research is failing to define a clear path from discovery to clinical impact. Reviewers must be convinced not only that the science is rigorous, but that the findings have the potential to move the field forward in a meaningful way.

Patwardhan: For someone building a long-term career in spine research, grants that combine clinical significance, methodological rigor, and a clear trajectory toward future independent funding tend to have the greatest impact.

What makes a spine research grant stand out?

• Addresses a significant unmet need: such as improving outcomes, reducing complications, lowering costs, or advancing understanding of spinal disorders
• Clear, testable hypothesis: the research question is focused, novel, and grounded in strong preliminary evidence
• Strong preliminary data: pilot data demonstrating feasibility is a strength
• Innovation with clinical relevance: clearly explains how it could change spine care and what is innovative about the approach
• Rigorous study design: appropriate controls, statistical power, validated outcome measures, and a realistic analytical plan
• Feasible scope: aims can reasonably be completed within the timeline and budget.
• Experienced team and environment: expertise of investigators and consultants, institutional support, access to necessary patient populations or laboratory resources
• Clear path to future funding and impact: reviewers value projects that will generate data for larger grants and establish an independent research program.

Why do promising proposals fail?
Even scientifically interesting ideas are commonly rejected because of:

• Lack of clearly defined hypothesis or specific aims
• Insufficient preliminary data to support feasibility
• Methods that are overly ambitious or inadequately described
• Statistical or methodological weaknesses
• Lack of innovation or how it differs from existing literature
• No discussion of potential pitfalls or alternative approaches
• Inconsistent budget or timeline that does not match the project's scope
• Do not align well with the funding agency's priorities or review criteria
• Are written unclearly, making it difficult for reviewers to identify the central message.

Siddiqui: Any closing thoughts?

Fehlings: Building a successful research career is a marathon rather than a sprint. Focus on meaningful problems, seek outstanding mentorship, cultivate multidisciplinary collaborations, and remain intellectually curious. Some of the most important advances in spine surgery have come from investigators who were willing to bridge traditional boundaries between basic science and clinical practice. The future of our field will depend on clinician-scientists who can move discoveries from the laboratory to the bedside and then bring new questions from the bedside back to the laboratory. That continuous cycle of translation is where true innovation occurs.