MEMBERS
Dr. Puno at the Kosair Surgical Services Department Wing Dedication in his honor.
Freshly accepted into engineering school.
Dr. Puno reclining on a self-designed wooden
toilet for rural areas.
Dr. Puno as a boy.
had many patents in joints and trauma, as well as his own mechan-
ics laboratory. He graciously allowed me to work there, and I was
able to learn more to adapt surgery techniques to mechanics,” Dr.
Puno recalled.
This exposure quickly paid dividends with the creation of the
Puno-Winter-Byrd (PWB) spinal instrumentation. This invention
placed adaptive screws and support bars along the length of the spine
in a design that provides mechanical stability of spinal segments
while bone fusion takes place. It was a game changer, in part because
of a pivotal piece included in its design: the poly-axial pedicle screw.
The poly-axial pedicle screw is a screw with a head enclosed in
a housing device. This allows a range of motion which accommo-
dates spinal curvature. The simple design was transformative for the
specialty and would become Dr. Puno’s first patent. He still speaks
of it with great reverence. “I was 31 at the time, and no one here
would make the prototypes, so I sent my design to the Philippines
and then fine-tuned it in Dr. Gustilo’s lab. With that device, the
surgeon can do new fixations to align the spine through a much
safer procedure.”
Although he had initially planned to return to the Philippines,
unrest in the country encouraged Dr. Puno to stay in America. He
now had a wife, Dr. Maria Regina, as well as two children, Risa and
A toy wooden boat powered by a
rubber band that Dr. Puno designed
at age 11.
Ronnie, to consider.
“My wife is an anesthesiologist. She received an opportunity
to work for the University of Louisville in 1985, so we moved here
instead. But, I couldn’t take my boards in orthopedics because I
trained in another country. I had to repeat my entire five-year res-
idency, even though I was already fully trained,” he said.
During his second residency, Dr. Puno and his colleagues began
clinical trials of the PWB spinal instrumentation. He worked as the
principle investigator of a 16-center clinical trial while technically
only a second-year orthopedic resident at UofL.
“A world-famous spine surgeon came from Cleveland so I could
teach him the instrumentation. We went to a different hospital and I
couldn’t find my locker. He said, ‘What kind of dump is this that you
don’t get your own locker?’ I said, ‘Yes doctor, orthopedic residents
don’t get their own locker.’ He looked at me and was blown away
that a resident was teaching him this procedure,” Dr. Puno laughed.
Upon completion of his residency, Dr. Puno joined the Leath-
erman Spine Center in 1991. In the 27 years since, he has treated
patients of all ages from around the world, some coming from as
far away as California, Madrid and Guam. He was recently honored
(continued on page 40)
NOVEMBER 2018
39