spine surgery in europe: status quo?

Spine Surgery in Europe:Status Quo?

Haluk Berk M.D.

UEMS-MJC on Spine

• 16 th of September 2011, Brussels• Participants– Robert Gunzburg– Wilco Peul EANS– Haluk Berk EBOT– Tamas İlles (apologies)– Max Aebi– Finn Christensen– Representative from (Interventional) Neuroradiology– Bernard Maillet

• Robert Gunzburg Chair• Wilco Peul Secretary

• Next meeting– 6th of January, 2012 13:00 Brussels.–

Methods

• Spine Society Presidents– 14/25

• E-mails to members of SSE and other spine societies– 203/845 responded

National spine societies• Austria• Belgium• Czech Republic• Denmark• France• Italy• The Netherlands• Rep of Ireland• Spain• Sweden• Turkey• UK

•n members 20-750•Total 2850

•1 Ortho spine•1 Neuro spine•12 Mixed society

Is there an established spine fellowship in your country?

Yes No

4

10

Is cross fellowship possible (i.e. Or-thopaedic surgeon to Neurosurgery fellowship program and vice versa)?

YesNo

Spin

al co

rd in

jury

Cerv

ical s

pine

inju

ry (d

ecom

pres

sion

...

Thor

acic

and

lum

bar s

pine

inju

ry (d

e...

Pedi

atric

Spi

nal d

efor

mity

Adul

t spi

nal d

efor

mity

Spin

al tu

mou

rs (e

xtra

dura

l)

Cerv

ical d

egen

erat

ive

dise

ases

Cerv

ical d

isc h

erni

atio

n

Cerv

ical s

teno

sis

Cerv

ical S

pine

arth

ropl

asty

pro

cedu

res

Thor

acic

disc

her

niat

ion

Lum

bar S

pina

l ste

nosis

Lum

bar d

isc h

erni

atio

n

Lum

bar S

pine

arth

ropl

asty

pro

cedu

res

Spin

al in

fect

ions

Mini

mal

inva

sive

spin

e su

rger

y

0

2

4

6

8

10

12

14In your country, which specialty treats the following spine

conditions?

NeurosurgeryOrthopaedic surgeryInterdisciplinary approachNot treated

2-Cervical spine injury

4-Pediatric Spinal deformity 6-Spinal tumours (extradural)

8-Cervical disc herniation 10-Cervical Spine arthroplasty procedures

12-Lumbar Spinal stenosis

2 4 6 8 10 12

A-Do you think a subspecialty period of one year should be considered in order to provide a certification of competence in a given subspecialty?B-Do you think a combined spine fellowship should be offered?C-Do you think the EFORT should develop a spine subspecialty-training program and fellowships?D-Do you think the Eurospine-SSE should develop a spine subspecialty-training program and fellowships?E-Do you think the EANS should develop a spine subspecialty-training program and fellowships?F-Do you think there is a need for spine subspecialty training in neurosurgery/orthopaedic surgery?

A B C D E F0

2

4

6

8

10

12

12345678910

Do you think that there will be a need for separate spine speciality?

No not at allMaybe in futureNo ideaYes but in 10-15 years timeYes definitely as soon as possible

1

4

1

8

Survey 2

• Female 7• Male 187

• Neurosurgeon56

• Orthopaedic surgeon97

• Spine surgeon41

• Age– <30 1– 30-40 44– 41-50 75– 51-60 53– >60 21

Who does, what?

Who does, what?

Who does, what?

Who does, what?

Who does, what?

Who does, what?

Who does, what?

Who does, what?

Who does, what?

Who does, what?

Cervical disc herniation (ACDF) 7,61 6,14

Cervical spinal stenosis 7,55 6,09

Anterior cervical stabilization techniques? 7,85 6,47

Cervical disc herniation minimally invasive/endoscopic techniques? 4,28 3,60

Lumbar disc herniation 8,71 7,89

Lumbar disc herniation minimally invasive/endoscopic techniques? 6,37 5,43

Lumbar spinal stenosis 9,00 8,31

Extradural tumour surgery? 7,38 6,08

Intradural tumour surgery? 4,44 3,64

Spinal deformity techniques (kyphosis, scoliosis)? 7,08 6,44

Emergency management of cervical spinal trauma? 7,47 5,81

Posterior cervical stabilization techniques? 7,56 6,28

Craniocervical stabilization techniques? 6,89 5,36

Emergency management of thoracic and lumbar spinal trauma? 8,28 6,95

Posterior thoracic and lumbar stabilization techniques? 9,08 8,58

Anterior thoracic and lumbar stabilization techniques? 7,75 6,61

Anterior thoracic and lumbar stabilization minimally invasive/endoscopic techniques? 5,02 4,27

Spinal Injections 7,04 5,59Interspinous devices 6,48 3,81

Dynamic stabilization techniques 6,64 4,33

IDET, Nucleotomy procedures 4,18 2,41

How

com

peta

tnt a

re y

ou in

?

How

impo

rtan

t is i

t for

you

?

Av SD

Do you think a subspecialty period of one year (after completion of the current 5–6 year national neurosurgeryWho does, what?/orthopaedics training programs) should be considered in order to provide a certification of competence in a given subspecialty?

6,98 3,13

Would you personally be interested in a subspecialty spine fellowship-training program (minimum 1 year)?

5,38 3,78

Do you think a combined (neurosurgery and orthopaedic) spine fellowship should be offered?

8,50 2,28

Do you think the Eurospine-The Spine Society of Europe should develop a spine subspecialty-training program and fellowships?

8,39 2,29

Do you think EANS-European Association of Neurosurgical societies should develop a spine subspecialty-training program and fellowships?

6,04 3,39

Do you think EFORT-European Federation of Orthopaedics and Traumatology should develop a spine subspecialty-training program and fellowships?

5,74 3,49

Do you think there is a need for spine subspecialty training in neurosurgery/orthopaedic surgery?

9,06 1,80

Conclusion

• ???• There is a tendency towards spine sub-

speciality.