Spine Surgery in itself is a very vast subject; hence, gradually it has been able to segregate itself from Orthopedics.
--By Dr Gaurav Raj Dhakal
Most of the medical specialties have branched into super-specialties. Initially, there was only M.B.B.S, and then came the era of specialized MD and MS doctors. However, in due course of time, these degrees became insufficient and the concept of Fellowships, MCh and DM began. Now, one can avail the services of a DM Gastroenterologist, DM Nephorologist, DM Endocrinologist, MCh Plastic Surgery, or MCh Cardio-thoracic surgery.
Similar to the super specialization in General Medicine and General Surgery subjects, similar concept has started in Orthopedics. There are several branches to gain expertise inside Orthopedics, Arthroscopy and Sports Medicine, Arthroplasty (Joint Replacement), Hand Surgery, Foot and Ankle Surgery, Pediatric Orthopedics and Spine Surgery. The last five years has seen a rapid trend in Orthopedic Surgeons seeking sub specialty training. All this has created a better environment for patient care with focused management. Unfortunately, there are no sub-specialty training opportunities in Nepal and therefore there is the need to seek educational opportunities abroad.
Spine Surgery in itself is a very vast subject; hence, gradually it has been able to segregate itself from Orthopedics. The management of spine problems requires a qualified spine surgeon, who has completed a hands-on, clinical, long-term fellowship program from an accredited institute. In majority of the developed countries and our neighbours, there exists a separate spine surgery wing with dedicated spine surgeons rendering outpatient, emergency and operative services.
In Nepal, majority of the population suffer from spine related problems.80% of patients presenting to the spine clinic complain of back and neck pain. The rest 20% are affected by serious causes, which require comprehensive investigation and management. Age related degenerative problems (spondylosis),cervical and lumbar disc prolapse, spine fractures, spine tumours, spinal cord and nerve compression, deformities (scoliosis and kyphosis), spine infections including spinal tuberculosis, vertebral slippage (spondylolisthesis) are the other spine associated problems.
For the last two decades, the health sector has witnessed a plethora of changes. Much of the investment and improvement has been initiated by the private sector. We now have general hospitals and specialized hospitals to cater to the specific illness. However, all of us involved in this sector should make sure that these services reach people of all socio-economic status.
The biggest challenge in spine surgery is creating an awareness in the population that spine related problems are best managed by a spine surgeon. Second, a strategy has to be formulated to make the spine surgery cost affordable to all. Third, a dedicated centre catering to spine has to be started!
The author is a Spine Surgeon at Norvic International Hospital. He has completed a long-term clinical spine fellowship from Kolkata, India and also has been felicitated by the Association of Spine Surgeon’s of India for having secured the first position in the All India Spine Fellowship Exit Examinations 2014. He is currently at Indiana University receiving further training in Pediatric Spine.