Close international collaboration will result in a “better understanding of complex spine care”

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Artem Guscha and Sergey Kolesov

The Eurasian Orthopedic Forum will take place from 29–30 June in Moscow, Russia. Two faculty members speak with Spinal News International about the state of spinal surgery in Russia.

As well as heading the departments of Neurosurgery and Neurosurgery Research at the Russian Academy of Medical Sciences’ Center of Neurology (Moscow, Russia), Artem Guscha is a recent president of the Russian Association of Spine Surgeons. Particularly interested in  minimally invasive and endoscopic spinal neurosurgery, as well as degenerative deformity, he speaks to Spinal News International about his upcoming work with EOF.

You are giving three talks and chairing a number of vertebrology sessions at this year’s EOF. What are you most looking forward to about the Forum?

At the current period of development spinal surgery, the main focus for us is “building bridges”. Being a multidisciplinary orthopaedic, traumatology and neurosurgery specialty, spine care can unify specialists from different countries, professions and beliefs. At the Forum, we aim to create a new vision in spinal care; provide the most reliable education to increase the quality of treatment for our patients.

One of the topics you are covering centres on the assessment of treatment outcomes. Why do you think this is an important area to speak about, and which outcomes methods will you be discussing at the meeting?

There is only one way for us to understand each other—to speak the same language. The main criteria for success in medicine are patient treatment results. Therefore, we have to agree on common assessment criteria and scales; reliable and representative methods for outcome created for each subspecialty in spine surgery. Using the principles of evidence based-medicine is the only way to improve the quality of spinal care

You will teach delegates about the potential benefits of epidural stimulation of the spinal cord for the treatment of chronic pain syndrome. Do you anticipate spinal cord stimulation to become a standard treatment option for spinal surgeons?

The number of spinal surgeries all over the world has grown dramatically over recent decades and still grows every year. With this increase, the number of complications also grows. One of the most frequently-observed complications of spinal surgery is chronic neuropathic pain, which cannot be successfully treated by revision surgery. Spinal cord stimulation (SCS), however, is very effective, less-invasive and supported by evidence-based research for such cases.

SCS is usually performed by pain management specialists, who are not always familiar with classical spine surgery. I think that the mastering of SCS technology by spinal surgeons will improve understanding of its indications, as well as patient selection. Overall, this will increase the effectiveness of treatment. Our patients are generally much more compliant if all of their surgery is performed by the “same hands”.

What can Russia offer spinal surgeons internationally?

I believe that Russia is a country with great opportunities for clinical trials of spinal surgeries and technologies. At my centre, we have a number of patients with different spinal pathologies, which need collaborative approach. In addition, we have experience performing modern spinal operations in our spine surgery department. I am sure that close collaboration between Russian and western spine surgeons will lead to better understanding of complex problems in spinal care.

Sergey Kolesov, currently heading the spinal pathology department at the NN Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russia, is one of the chairs of the Eurasian Orthopedic Forum’s vertebrology section. A spinal surgeon for over 25 years, his main professional interests currently include spinal deformity, spinal tumours, spinal trauma and degenerative disc disease. Kolesev is also a vice president of RASS (Russian Association of Spinal Surgeons) and a member of SRS (Scoliosis Research Society). He talks to Spinal News International about the upcoming Forum.

You are one of the chairs of the “Contradictions and Controversial Issues in Modern Spinal Surgery” section at EOF this year. What do you think delegates will gain from attending these sessions?

Modern spinal surgery includes numerous surgical techniques, and most spinal surgeons are very interested in reliability and effectiveness of these various techniques and technologies from a scientific and evidence-based perspective. At the spinal section of the upcoming congress they will have an opportunity to listen to talks and take part in discussions that will cover various controversies and problems in spinal surgery from the standpoint of evidence-based medicine.

Furthermore, spinal experts from various regions of the Russian Federation, USA, Middle Asia, Japan, China, Hong Kong, Thailand and other regions of the Eurasian continent, will take part in discussions to offer their points of view. It is expected that the spinal section will be of great interest to anyone involved in spinal surgery.

Are there any talks in particular that you are looking forward to?

We are really looking forward to hearing several amazing talks that include the use of nitinol rods in degenerative spine and spinal deformity, as well as several talks on cell therapy and biologics, which will definitely garner interest.

There will be an in-depth analysis of minimally invasive surgery and how it compares to traditional approaches in various cases. A substantial amount of time will also be devoted to degenerative deformities in adult patients and technological approaches to treatment of early-onset scoliosis.

You will be speaking about dynamic vs. rigid fixation of the spine during the meeting. Which of these methods do you think offers better results for patients, and in which contexts?

Over the last several years, the use of nitinol has been attracting more and more attention. The unique characteristics of nitinol—that include super-elasticity and high resistance to dynamic loads—allow this material to be used in various applications pertaining to spinal surgery. The use of dynamic fixation allows the reduction of the loads on the adjacent segments and lower the number of revision surgeries.

As well as dynamic and rigid fixation, the spinal sessions will feature a special focus on the use of prosthetic disc implants through the anterior approach and results of a multicentre study will be presented. Traditional rigid fixation often leads to overload of adjacent segments, which can lead to an increased number of revision surgeries.

 We are also looking to hold in-depth discussion of neuromuscular deformities in patients with cerebral palsy and spinal muscular atrophy, discussion of spinal cord injury in children and state-of-the-art technologies of spinal cord injury treatment.

Modern navigation and robotics will be another point of interest, as well as the analysis of causes of unfavourable outcomes and complications in surgical treatment of degenerative disc disease in the lumbar spine region.

 

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