Neurosurgery versus orthopedic surgery: Who has better access to minimally invasive spinal technology?

INTRODUCTION

For Latin America, we evaluated the main obstacles spinal neurosurgeons and orthopedists have to performing minimally invasive spine surgeries (MISS). Variables studied included high MISS implant costs, and limited access to navigation technology, percutaneous screws, and to operating microscopes.[4]

MATERIALS AND METHODS

Survey data

In the survey, respondents were asked about their personal practice [Table 1]. All questions had five possible responses regarding the performance of MISS: always, frequently, sometimes, infrequently, and never.

Table 1:: Demographic data of the respondents in terms of: experience, place of work, number of surgeries performed per year, and the types of pathology (indications), for which surgery was performed.

RESULTS

We received 306 responses (25.6% response rate) from spinal surgeons; 177 were orthopedists (58%) and 129 were neurosurgeons (42%). Notably, 42.4% of all spinal surgeons reported more than 10 years of surgical experience, and performed fewer than 50 MISS procedures per year [Table 1].

Obstacles to MISS technology

Both neurosurgeons and orthopedic spine surgeons reported limited access to intraoperative CT, bone morphogenetic protein, neuronavigation technology, interbody cages, tubular retractors, intraoperative X-rays, and percutaneous screws [Figures 1-3]. Further, 84% of neurosurgeons reported always having access to a microscope versus 39% of orthopedists (P < 0.01).

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Figure 1:: Comparing neurosurgeons’ and orthopedic spine surgeons’ perceived access to protheses to perform ALIF, LLIF or TLIF, tubular retractors, percutaneous screw fixation and intraoperative X-rays.

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Figure 2:: Comparing neurosurgeons’ and orthopedic spine surgeons’ perceived access to intraoperative CT, microscopes, bone morphogenetic protein, and navigation devices.

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Figure 3:: Perceived causes of limited access to minimally invasive spine surgeries-required technologies.

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DISCUSSION

Latin American spinal surgeons have limited access to perform MISS spine surgery due to the; high cost, lack of availability of implants/hardware, and the high cost of neuronavigation. Further, we found that neurosurgeons have more access (84%) to operating microscopes versus orthopedists (39%).[4]

Of interest, Avellanal et al. determined that neurosurgeons may have greater need for utilizing operating microscope, as they perform 2-times more neural decompressions while orthopedists performed 2.5 times more fusions (instrumented and non-instrumented).[1]

Further, Pejrona et al. found that neurosurgeons felt more competent dealing with certain cervical pathologies (e.g., spinal tumors) warranting an operating microscope versus orthopedists spinal surgeons who were more frequently treating spinal deformities/pelvic trauma.[5]

MISS

MISS have inherently greater risks to neural/vertebral structures, as they typically provide more limited/insufficient exposures, restrictive maneuverability, and restrictive operative corridors.[3] Further, limited visibility is often associated with greater neurological deficits resulting in inadvertent lumbar plexus injuries, major vascular injuries, and bowel perforations.[2,6]

CONCLUSION

Although both neurosurgeons and orthopedic spine surgeons in Latin America have limited accessing to the technologies for performing MISS, neurosurgeons are better able to utilize operating microscopes versus their orthopedic spinal surgeons’ counterparts.