As an orthopedic specialist, Dr. Daniel DeRosa likes to say that nothing in the realm of neck or spine surgery is “a chip shot.”
There are simply no easy plays.
It’s the spine’s complexity and acuity — physicians speak about the intensity and high level of required care — that DeRosa grew to love during his medical training. That passion is evident when he discusses how the spine works and the techniques he uses to address the physiological problems causing pain, discomfort, and immobility for his patients as part of Cape Fear Valley Health’s growing orthopedic team.
“It runs the gamut,” DeRosa says about the kinds of symptoms his patients present. “I have 35-year-olds with advanced arthritis, and I have 90-year-olds with degenerative changes. The unique thing about my job is I can see someone one day who has one of the worst spines I’ve ever seen, but is relatively asymptomatic, and doesn’t have any nerve pain or leg pain — just some back pain. And then I have some patients with just a whiff of arthritis, but they have pretty debilitating radiculopathy, or nerve pain, in their legs.”
Some orthopedic treatments can be cut and dried — “You know,” he says. “A plus B equals C.”
Rare with the spine.
Major growth for Cape Fear Valley Health
For DeRosa, who joined Cape Fear Valley Health in July and works out of Valley Orthopedics & Sports Medicine on Walter Reed Road in Fayetteville, it’s hard to overstate the importance of the spine’s role in the body’s overall function. The spine supports structure. It keeps us standing tall, facilitating our movement. But it also houses the nervous system, enabling communication between the brain and the rest of the body. Signals originating in the brain need the spine as a delivery channel, telling muscles and organs what to do; signals from the body use the same wiring, the same spinal pathway, to the brain in reverse.
It’s the original information superhighway. Disruption, then, through injury, disease, or degeneration, can mean trouble.
DeRosa’s addition is part of a significant period of growth of Cape Fear Valley Health’s orthopedic footprint. Over the last year and a half, it has grown from two clinics to eight. Through acquisition (including Huff Orthopedics this past August and Cape Fear Orthopedics & Sports Medicine in October) and expansion, there are now 30 service providers within Cape Fear Valley Health’s ortho team in Cumberland County and in practices in Harnett, Moore, and Sampson counties. Combined, they serve an average of 550 patients per day.
What makes DeRosa unique — aside from being Cape Fear Valley Health’s sole orthopedic spine specialist — is that he’s one of the 30% of spinal surgeons who performs advanced minimally invasive anterior column surgery through the side of the body to treat spinal disorders and reduce long term back and leg pain, he said, resulting in shorter (or no) hospital stays, less blood loss, and faster recovery time. Smaller incisions also mean muscles and tissues in the surgical area suffer less stress, particularly advantageous for older patients or those with other negative health conditions.
“So there’s less demand on health care systems, better outcomes both short and long term,” he said.
An example: DeRosa can perform a single-level lumbar surgery through a patient’s side in about 20 minutes. A surgeon without his training and expertise would take a more traditional approach, going through the posterior spine with “big, open incisions that involve a lot of electrocautery and burning of the muscles,” DeRosa said.
Methodologies he employs are catching on among spinal surgeons, DeRosa said, but it’s still a niche. For him, that expertise means being able to treat more patients, and solve problems, more effectively.
Many of his patients present challenges tied to achieving simple desires, like the retired military officer he recently treated who wanted nothing more than to play with his two grandchildren, but couldn’t because of severe leg and back pain. Or the patient who loved golf and saw it as a stress reliever and respite from work, but suffered from neurogenic claudication — a compression of nerves that made walking distances or swinging a club result in leg cramping, pain, and numbness.
For the former, DeRosa applied a minimally invasive fusion technique that resulted in the grandfather playing “everything he wanted” on the floor with his grandchildren just six weeks post-op. For the latter, a lumbar spine procedure — again, minimally invasive — had the patient back on the fairways in just three months.
“With the spine, there’s a lot of nuance,” he said, “and there’s a lot of context, so there’s diagnostic testing and making sure you’re doing the right thing by the patient.”
Overlap compounds complexity. Arm pain, for example, can originate from a problem in the neck. Or degenerative changes combine with carpal tunnel syndrome or acute elbow pain — requiring nuance, investigation, and multiple levels of treatment protocols. Sometimes, DeRosa adds, it’s about “knocking out” one problem to make a patient functional again before working to heal other symptomatic issues.
“I tell patients, ‘Spine surgery is different than other musculoskeletal procedures/intervention.’ There are a lot of moving parts, so a lot of it is, ‘What are our goals? And how do we accomplish that in the most effective manner?’”
‘Time to go civilian’
DeRosa earned his DO (Doctor of Osteopathic Medicine) from the Kentucky College of Osteopathic Medicine before completing internships and residencies at Tripler Army Medical Center in Hawaii and a fellowship at Duke University. He accepted an Army health professional scholarship; a portion of his more than 13 years in the U.S. Army was spent as a Flight Surgeon in an aviation regiment in Central America and deployed to combat zones in the middle east as an Orthopaedic Surgeon with a Forward Surgical Team.
Along the way, his professional focus switched from orthopedic and related trauma surgery to the spine, and he was serving as a spine surgeon at Womack Army Medical Center when that active duty obligation came to an end. His wife, Raffaella, also a doctor — she’s a urologist at Womack — had transitioned out of active duty two years before. The couple has two children, a daughter, Giuliana, and a son, Domenic Carlo.
“It just was time,” DeRosa said. “I felt like I did all I could do in the Army, and it was time to go civilian.”
He loved North Carolina and the relationships he’d developed with surgeons in the area, and wanted to continue to be able to help treat veterans — particularly after connecting with so many Fort Liberty-based soldiers who’d suffered spine injuries related to their work and deployments. He’s still teaching at Womack, but given Cape Fear Valley Health’s orthopedic growth, moving there made sense.
“With Cape Fear being the largest medical center within an hour radius, I felt like I wanted to stay here and build something right here,” he said. “There’s a deficit of spine surgery here … and a huge need for spine care. So that opportunity to build a service line and to support the area was very appealing to me.”
About 85% of his work focuses on degenerative changes (such as arthritis and age-related conditions) as opposed to trauma (from falls or car accidents and the kinds of injuries paratroopers might experience). And as a part of an orthopedic team, he regularly engages with his Cape Fear Valley Health partners. They’ll ask him, for example, to help diagnose complex cases, which might involve the spine. All calls he’s happy to answer.
The Army helped deliver DeRosa to Cumberland County. He’s hoping his practice will keep him in Fayetteville for a long, long time.
“This is my home,” he said. “I don’t have any plans to leave. I plan to continue to build and advance spine care here, and to try to keep everything that we can in this region. My goal is for there to be no reason for anyone to need to leave Fayetteville to get the most advanced, cutting-edge, appropriate health care — especially for the spine. We should offer that here, and that’s my plan.”
Read CityView magazine’s “New Year New You” January 2025 e-edition here.
