In 2021, several spine and orthopedic societies published a stance warning against allowing non-spine surgeons to perform spinal arthrodesis.
Years after that statement was published, many spine surgeons still agree that while pain medicine physicians are important to spine care, surgeons should remain the ones at the helm of endoscopic cases.
Note: Responses were lightly edited for clarity.
Question: Should pain management physicians perform endoscopic spine cases?
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: I really rely on my relationships with my pain doctors, and I’m glad they provide the services they provide, but I feel like endoscopic surgeries and modifications of tissue and their risks and complications should be left to qualified surgeons. We’ve had surgical supervision over a period of years, rather than just a weekend course. Not to diminish any of their abilities, but the technical skill, the discernment, the ability to see and identify problems before they occur and to fix potential complications should be left to surgeons and people who have had years and months of supervised experiences.
Lali Sekhon, MD, PhD. Spine Surgeon at Reno (Nev.) Orthopedic Center: Anyone can do anything, but it’s about complication management and offering the gamut of procedures so the patient gets the correct procedure. I think the understanding of surgical anatomy and handling of tissues by spine surgeons, with immediate bailout techniques available puts spine surgeons in the drivers seat for these procedures.
Xiaofei (Sophie) Zhou, MD. University Hospitals (Cleveland): I feel pretty strongly that pain management physicians should not be performing endoscopic spine surgery. Pain physicians obviously play a critical role in the care of spine patients, but I believe endoscopy is a surgical tool with a wide breadth of applications. This can range from medial beach transections all the way to fusions with interbody placements. Because it is a surgical tool, I believe that only a fully trained surgeon (ranging between six to seven years of training depending on orthopedic or neurosurgery background) should be utilizing it. Our training in open surgery gives us an understanding of the anatomy and also the ability to choose which surgery is best suitable for a patient’s particular needs. As we all know, proper patient selection is the key to any surgical success. By allowing pain practitioners without adequate surgical training to start performing surgery would be a mistake.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): With all due respect and bearing, not in the smallest degree, aside from the most obvious of training biases and skill level, and the fact that many of these ‘decompressive procedures’ are neither radiologically conspicuous nor clinically favorable, these physicians are incapable of managing their causative complications and failed outcomes. In this community and witnessed experience, the benefit to cost comparison is antithetical and patient naivete is imposed upon regularly for exorbitant fees charged outside of specialty. Surgical specialties are learned and protracted for reasons of safety and nonindulgence. These procedures harken back to the kyphoplasty craze of auld.