Percutaneous spine surgery

Pioneering medical innovation is not welcome with the more established sectors of the medical community, that usually don’t understand the technology, or are unwilling to expend the effort to educate themselves. The more convenient option is sadly criticism and professional harassment.

Percutaneous Spine Surgery is here to stay and has become an extremely effective tool in the treatment for patients with back, leg and arm pain. The ability to perform these procedures in the outpatient setting has revolutionized the field of spine surgery, and will continue to advance the boundaries of percutaneous spine surgery.

The decade long journey has been ferociously fought between the neurosurgeons and the interventional pain specialists(IP) with victory on the horizon for the latter group. The central part of their persuasive argument was the critical role of the use of fluoroscopic guidance and interpretation, without which these surgeries would be impossibly dangerous. The skills acquired during an interventional pain fellowship more readily equip the IP community with the expertise to competently perform percutaneous spine surgery. The Spine Turf Wars were the eventual culmination of a decade long battle that was eventually decided by technology. This was clearly demonstrated in the 1990s with the interventional cardiologists practically annihilated the cardiac surgeons with the introduction of the cardiac stents inserted through the femoral artery.

Percutaneous spine surgery has been definitively shown in numerous studies to result in superior outcomes for most degenerative spinal diseases, and it is almost certain that this will now become the standard of care globally. The associated reduction in blood loss, the quicker recovery and return to normal function were observations made by the pioneers almost a decade ago, when the majority of surgeons in the US were still aggressively dissecting patient backs as they attempted to locate the painful disc. The percutaneous management of back, leg and arm pain in conjunction with the use of interventional pain techniques, has dramatically altered the public perception of spine surgery, which can be seen in the increased number of patients undergoing percutaneous spine surgery. The evolution from general surgery to the specialty of spine surgery began around the early 1980s, and the most impressive advances have been witnessed within the last decade, as the techniques of percutaneous spine surgery have become further refined.

The ability to send the patient home the same day was unheard of 15 years ago, when all back surgeries required at least a 5-day hospital stay, during which the risk of nosocomial infection was very high. This elevated infection rate was part of the explanation for the exceptionally high incidence of hardware infection. The percutaneous spine surgical approach almost completely deleted this risk from the picture, as the patient is discharged the same day due to the reduced pain and blood loss, the two main factors that accounted for prolonged the hospital stay.

The professional battles, otherwise known as The Spine Turf Wars, have been extensively documented elsewhere on the internet, but basically describe the differences in opinion between the neurosurgeons and the interventional pain community as to who was most appropriately qualified to perform these procedures. The IP community state categorically that because of their superior skills with fluoroscopic guidance and interpretation(FGI), which accounts for 90% of the procedure, that they are more qualified to perform percutaneous spine surgery. The neurosurgeons however predictably disagree and flimsily use the archaic fact that just because they operated on spines with wide aggressive exposures that they are bewilderingly more qualified to competently use the recent skills of percutaneous spine surgery. The visualization of the human spine for the purposes of operating in a percutaneous manner require that the practitioner have an intimate understanding of the correlation between the changing fluoroscopic image and the actual anatomical structures of the spine. Unfortunately these temporo-spatial skills were never part of either the neurosurgical or orthopedic programs and graduating residents were left to their own devices, which invariably involved attending multiple hands on cadaver training course in exactly the same way the IP physicians were obligated to do so.

A brave new world is upon us in the field of medicine with a large number of moving parts, complicated political agendas and large profits. The fact that nurses in some states of the US are now legally allowed to perform interventional spine procedures is a sign of things to come, and will with time make us, as a brotherhood of physicians, wonder why we spent so much energy fighting each other, when the real enemy was gathering at the gate. I suppose the answer lies fundamentally in the fearful and envious egos of doctors, who are unable to see that the carpet has been yanked from under their feet The medical profession (if that is what one still wants to call it) has been progressively neutered and within the next ten tears technology will have further subjugated the role of humans in medicine.

Nothing ever stays the same and medicine is no exception. The pathetic downward spiral of a once noble profession is, in my opinion, the result of weak political leadership. Most doctors are scared to strike and will generally not confront the multiple injustices imposed on their profession. Within a short period of time the profession will join the ranks of teachers(no disrespect intended), and smart kids will head to the world of nanotechnology.

#percutaneousspinesurgery #richardkaul #minimallyinvasivespinesurgery