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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.