Spinal fusion, cement augmentation and spine surgery in 2023 : a multidisciplinary approach

The latest medical evolutions have learned us that obtaining optimal results and improving patient safety more and more requires a multidisciplinary approach when treating spinal disorders, whether traumatic or degenerative.

The last decades have therefore seen the birth of multiple efforts of collaboration between spine surgeons, neurosurgeons and orthopedic surgeons, and non-surgical physicians, such as emergencies specialists, pain physicians, radiologists and anesthesiologists.

A multidisciplinary medical pathway

With the growing interest of patients for minimally invasive techniques, we have observed that an increasing number of non-surgeon physicians are involved in first line procedures such as epidural and foraminal injections, cervical or lumbar, facet radiofrequency or thermal desensitization, but also even in percutaneous techniques, such as arthrodesis of the sacroiliac or facet joints, stabilization of a lumbar segment with interspinous process clamps, vertebroplasty or kyphoplasty, performed in hospital outpatient clinics, ambulatory surgical centers and even — in some instances — physician offices.

At IM2S Monaco, we are encouraging a multidisciplinary approach for spinal disorders, and work that way on a daily basis. The management of our patients is centralized by spine surgeons, who will guide them towards the most adapted treatment, usually with a first line of non-surgical therapies involving several non-surgical specialties. The patients are then reviewed and evaluated to see if additional non-surgical management is needed or if the evolution justifies a more surgical solution.

Surgeon driven minimally invasive procedures

When surgery is required, even minimally invasive surgery should always be considered as real surgery. We therefore have decided to guarantee our patients that any procedure that could potentially induce a change in spinal biomechanics, such as fusion, vertebral augmentation or kyphoplasty will always be exclusively performed by trained spinal orthopedic surgeons and neurosurgeons.

These surgical interventions, sometimes wrongly presented as benign or without risks, do induce permanent changes in the shape and balance of the spine, by blocking vertebrae together, inducing or correcting deformities, inserting metal implants, or increasing the rigidity of vertebrae by the injection of cement in the bone.

To evaluate who is a rightful surgical candidate, to perfectly master the operative technique, and treat the potential immediate or delayed complications, a proper training is required, the like of which can only be found in orthopedics and neurosurgery programs.

« Arthrodesis or any other intervention that alters the biomechanics of the spine should not be performed by practitioners in other fields outside of specialty-trained neurosurgery or orthopedic spinal surgeons. »

Optimal patient care and patient safety are therefore best served when surgical diseases affecting the spine are managed by neurosurgeons and orthopedic spinal surgeons trained in the full spectrum of spinal biomechanics, including instrumentation and fusion techniques. Arthrodesis or any other intervention that alters the biomechanics of the spine should not be performed by practitioners in other fields outside of specialty-trained neurosurgery or orthopedic spinal surgeons.

IM2S and its spine team hereby endorse recent official recommendations by renowned scientific associations including the American Academy of Orthopedic Surgeons, the American Association of Orthopedic Surgeons, the American Association of Neurological Surgeons and many others