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)?

Yes

No

Spin

al co

rd inju

ry

Cerv

ical sp

ine inju

ry (

deco

mpre

ssio

n ...

Thora

cic

and lum

bar

spin

e inju

ry (

de...

Pedia

tric

Spin

al defo

rmit

y

Adult

spin

al defo

rmit

y

Spin

al tu

mours

(extr

adura

l)

Cerv

ical degenera

tive d

isease

s

Cerv

ical dis

c hern

iati

on

Cerv

ical st

enosi

s

Cerv

ical Spin

e a

rthro

pla

sty p

roce

dure

s

Thora

cic

dis

c hern

iati

on

Lum

bar

Spin

al st

enosi

s

Lum

bar

dis

c hern

iati

on

Lum

bar

Spin

e a

rthro

pla

sty p

roce

dure

s

Spin

al in

fect

ions

Min

imal in

vasi

ve s

pin

e s

urg

ery

0

2

4

6

8

10

12

14

In your country, which specialty treats the following spine conditions?

Neurosurgery

Orthopaedic surgery

Interdisciplinary approach

Not 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 all

Maybe in future

No idea

Yes but in 10-15 years time

Yes 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 5,59

Interspinous 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

it fo

r yo

u?

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.