At Eurospine 2010, 15–17 September, Vienna, Austria, an international panel from Eurospine including Hans-Joachim Wilke, Germany, then president of the society, Ciaran Bolger, Ireland, then upcoming president of Eurospine, Max Aebi, Switzerland, president Eurospine Foundation, Haluk Berk, Turkey, general secretary of the Eurospine Society and local hosts Michael Ogon and Josef Grohs spoke to the press on the latest trends in spinal medicine.
Max Aebi, Bern, Switzerland, a former president of Eurospine and also editor-in-chief of the European Spine Journal (ESJ), spoke on the need to put resources and education to confront the problem of ageing. Aebi said, “I think ageing is basically related to wear, to degeneration. The more the body machine functions, the more it will be worn out. Ageing is a fundamental issue of every industrialised society In Europe, in 1995, there were 8.9 million women who were 80 years old or over, but by the year 2050 it is predicted that there will be 27 million women in this age group— an increase of 300%. On the male side, the increase will be 400%.This is a very important challenge that medicine needs to tackle in the next 20 years because 80% of healthcare costs accrue in the last two years of a person’s life.” Talking on the issue of investment in research, Aebi highlighted that in the last 20 years there had been billions of Euros invested in cancer research which had resulted in an increase in survival by eight months. Yet, he said, “ there is very little money which goes in the research of the musculoskeletal system, including the spine, even though this has a direct impact on the quality of life for elderly people. I think this is really something our society has to increase awareness about —this is something we cannot ignore or neglect.”
Are 80% of all spine surgeries unnecessary?
Grohs – “80% of young people have an episode of back pain, but in 90% of this group it will go away within six or twelve weeks. They do not need surgery. In older patients, back pain will recur and increase, some of them will need surgery due to neural compression, structure deterioration. While you should treat even these cases conservatively with pain killers, physical therapy etc, but if a patient cannot get rid of pain for over half a year, then you should consider surgery.”
Ogon, said that he believed that spine surgeons did not perform unnecessary surgeries. “We do stay on the conservative side in acute problems, but the older the patients are, and in cases of spinal stenoses, then it is important to consider surgery.”
Bolger said it is important to note that any principles are based on science and not on anybody’s opinion. This is really the purpose of Eurospine, the Spine Tango registry— to find out what the truth is. We need to determine what the truth is, educate people and act on the basis of real data, scientific principle and provide evidence–based treatment,” he said.
The question of complications
To the question “Are complications in spine surgery underreported?”, Bolger said, “There are several reasons for this and it has not all got to do with the “dishonesty” of the surgeons. There is a certain bias in publishing journals, like in newspapers, towards good news and the latest developments. ESJ has been very definite in promoting papers which talk about problems, because problems need to be discussed.
“The reporting of complications also needs to be seen in the context of society. It is also a societal and political issue, in that we need to generate and create an atmosphere in our hospitals and in our institutions of “non-blame” reporting. It is very difficult for an individual surgeon to put up his/her hands and talk about complications when the reaction to that is to blame the doctor and say, “look you are not going to be operating anymore.
“Our management structure in our hospitals throughout Europe, particularly where there is an issue of funding, tends to promote a “good” picture. And a doctor who stands up and says “there is a problem” is often shut down or frightened to say anything because there is a tendency to shut them down because it is a blame culture. We need to foster a non-blame attitude to complications and a non-blame attitude to reporting problems.
Berk added that it was important to remember in the blame culture there was a fine line between reporting complications and getting malpractice suits. “This is why people are reluctant to talk about complications, even if there is no fault on the treating side,” he said.
Aebi added that the medical field had much to learn from the aviation industry which talked about “adverse events” rather than complications and malpractice. “We have to learn to stop blaming doctors. There is no 100% guarantee in medicine. We should analyse the reasons for something going wrong, and do something to correct it, rather than blaming people,” he said.
Call for Europewide standardised education in spine
Hans-Joachim Wilke spoke on the important steps made regarding spine education by the society.
He said Eurospine had two main objectives:
- To deliver a consistent educational programme to future spine specialists
- To deliver continuing education to current spine specialists
“In terms of quantitative measurements, this would be a standard European spine diploma throughout Europe and a consistent Accreditation delivered by the EACCME,” said Wilke.
In the press conference, he said “We have presented to the presidents of most national societies of almost all European countries, on the idea of a standardised education programme. This also pertains to all the different disciplines dealing with treatment for the spine—neurosurgery, orthopaedic surgery or trauma. It will be an absolutely standardised basis of knowledge and is a complex issue because there is a lot of politics in the different countries that needs to be considered. It is important to remember that whether they are in Ireland, Switzerland, Turkey, Spain or anywhere else in Europe, that they have the same basis of education.