Philip Sell, consultant orthopaedic and spinal surgeon, University Hospitals of Leicester and Queens Medical Centre Nottingham (UK), is the 2013–14 president of EuroSpine. He spoke to Spinal News International about his career highlights and the key themes of this year’s EuroSpine meeting (2–4 October, Liverpool, UK).
Why did you decide to specialise in spinal surgery?
The decision to do medicine crystallised during my teenage years in the early seventies. Hendrix, Pink Floyd, Captain Beefheart and the Grateful Dead, coupled with the influence of hazy experiences in the strawberry fields of that time, tempted me towards psychiatry. At medical school, I realised that surgeons were far and away a much more “fun bunch” to be with as colleagues. Basic surgical training was very broad and general at that time. Orthopaedics, vascular, paediatrics, urology, and a lot of general surgery were the foundation that led me to spinal surgery. The anterior approaches were a logical progression of those skills. At a small mission hospital in Nqutu, Kwazulu, South Africa in 1983, I had a formative exposure to the consequences of tuberculosis of the spine in an environment of extremely limited resources. It reinforced my naïve socialist values that I might be able to do some good somewhere.
Who have been your mentors during your career and what influence did they have on you?
We all stand on the shoulders of giants. Professor Peter Bell, a vascular surgeon and president of the Royal College of Surgeons, probably still has no idea of the impact he had on me as a role model when I was a junior doctor training with him. Nostalgia is not what it used to be…we did 120 hours a week then, which only left 48 hours a week for partying!
Regarding spinal surgery, John Dove—a spinal surgeon and linguist—introduced me to the world of spinal surgery in Europe while I completed my MSc in bioengineering. Finally there was my fellowship in Hong Kong. I was tutored by Professor John Leong, but embraced by the whole team at “DK” (Duchess of Kent Children’s Hospital) and that resulted in lasting friendships worldwide. Working in Leicester and the Nottingham spinal unit at Queens Medical Centre I have had great support from masters of the universe of spine.
During your career, what has been the most important development in spinal surgery?
Pedicle screws have probably been the most important technical development, but the “bio-psycho-social model” has shaped my thinking as well. I am just starting to fully understand the concept and practical aspects, namely “bio” relates to the disease, “psycho” relates to the illness (symptoms and behaviours), and “social” relates to sickness (a role granted by families/communities/society). We have to treat the disease, manage the illness, and negotiate the sickness.
Of the research you have been involved with, which piece of research are you most proud of and why?
The randomised controlled trials that I have been involved with have all taught me that perfection is the enemy of good. Established beliefs are sometimes “fixed” and difficult to challenge. The simple study of steroid and local anaesthetic versus local anaesthetic alone confirmed my belief that steroids have no treatment effect. While it has not yet changed practice, it might, if others add to the volume of studies and similar results produce guidelines and systematic analysis. This allows us to approach the truth.
I am particularly pleased that all my studies have been entirely without industry funding or support, my conflict of interest statements are simply “none” in all domains. Most of my work has had modest-to-minimal impact, but I take reward in the fact that it is relevant for day-to-day practice and far from esoteric.
What are you current research interests?
My enthusiasm for research is continually dampened by the bureaucratic process that accompanies it. For example, there are ethics submissions, Medicines and Healthcare Products Regulatory Agency (MHRA) submissions, and hospitals administrative costs for research in the absence of grants. At present, we are doing a simple randomised controlled trial comparing lumbar epidural with steroid versus nerve root block with just local anaesthetic. Recruitment has been a slow process, but the numbers are building.
Outside of your own work, what has been the most interesting piece of research published in the past year?
So many papers and so many different reasons for choosing them! However, the Annals of Internal Medicine review articles (as reported in Spinal News International; issue 28) of recombinant human bone morphogenetic protein-2 (rhBMP-2) were for me probably the most important. They were ground breaking in many ways and a triumph for open medicine.
You are the 2013–14 president of EuroSpine. What are your goals for the society?
My goals are the same as the goals of the EuroSpine executive committee. We are a close team with the same vision and mission. We have a clear strategy to invest in, and engage with, our members and our stakeholders. We are a society on the move. There will be some “perception change”’ events over the next few months.
The “brand” EuroSpine has high quality and integrity attached to it. The appeal of elite scientific meetings at beautiful unique capital cities around Europe is just one fun aspect for those that wish to combine travel and networking. We have a planned development of short subspecialty “Hot Topic” Spring meetings to complement the broader larger annual meeting. The first is in Prague (8–9 May 2014).
What are the key themes of this year’s EuroSpine annual meeting?
There are two key themes. The first is high value scientific content that represents the best of research worldwide. The meeting covers all anatomic areas and all pathologies. Podium abstracts are selected by a blinded peer review process, and only about 12% of submissions are accepted. The “Best of show” session consists of the highest scoring abstracts in each category, so that super specialists can pick up on developments outside their specific interest. The presidential address will accompany a thought-provoking lecture by a prestigious world face of the (UK) BBC news service. The second theme will be updating members and non-members regarding the “Society on the move”. The future of our society is the next generation of leading surgeons, we have engaged with them, and wish to encourage more to contribute. The year 2010 was the end of the first decade of a new millennium. We are moving on, but we are standing on the shoulders of the giants of the last generation.
In this era where cost is a key issue, why do you believe international conferences such as EuroSpine are important?
Sharing knowledge and best practice is simple and cost-effective. We all have choices in life. Resources are finite. It is beyond my comprehension that caring and compassionate doctors would treat insured patients differently to non-insured, but that occurs in many healthcare environments.
Life consists of choices, we already have rationing of healthcare, and it is false to pretend otherwise.
Evidence based approaches—if the evidence is trustworthy, is the best way at present of managing health resources. It is a tragedy that the economics of recovering development costs for new medical technology has in the past resulted in the issue of harm being opaque or concealed. That has to change and fortunately is changing. The threshold for acceptable levels of harm from new technology is poorly measured and poorly understood; we need to improve our reporting and understanding.
The meeting is holding several debates about unresolved issues in spinal surgery (eg. the need for spinal cord monitoring). What do you think is the most important unresolved issue in spinal surgery?
There are several unresolved issues, including:
When to bone graft after tumour reconstruction when survival looks good and adjuvant therapy is planned
Why new procedures are introduced by trial and error rather than by trial design
Why there is such a lack of consensus on common conditions that we treat.
With regard to cord monitoring, it is very useful in scoliosis. However, we need to think when, why and what difference it makes. Patients are more like trees than lampposts…so maybe cord monitoring in whole body neuromuscular scoliosis is redundant. Also, should you remove the metalwork if there was a problem? Just because you have it in your toolbox does not mean you have to use it every time.
What advice would you give to someone who is just starting their career as a spinal surgeon?
Listen to everyone, patients, staff and colleagues. Get linked. Join EuroSpine, the spinal society of Europe and network in good locations with like-minded colleagues. Gain from the cultural diversity of Europe. Come to the EuroSpine Live educational events. Questions and challenge all that you believe. Half of what you were taught at medical school was wrong, but the problem is that you just do not know which half!
What has been your most memorable case and why?
A 49 year–old-male presented to me in February 2000. Eleven operations on, with ever larger constructs, there is still no bone fusion—despite every strategy for ostegenesis /osteoinduction that I know. He has been stable, well and enjoying life. In 2005, I published his case report on Gorham’s disease in Spine.
Outside of medicine, what are your hobbies and interests?
Glenmorangie (malt whisky), wine with bubbles, science fiction and Heston Blumenthal [a UK chef known for his experimental cooking style] are just a few of my interests. Golf is my major frustration shared with three of my colleagues early most Sunday mornings come rain, snow, plagues of locusts, or even sunshine. Scuba diving is something that I have discovered later on in life, starting age 50, but I have made up for lost time, with over a hundred dives now.
Present -Consultant orthopaedic and spinal surgeon (combined appointment)-University Hospitals of Leicester (1993 appointed) and Queens Medical Centre Nottingham (2001 appointed), UK
1991 -Spinal Fellow, Duchess of Kent Children’s Hospital, Hong Kong
2007 Backcare award; Best Scientific Paper Society for Back Pain Research Meeting Helsinki
1992-Russell S Hibbs Award; Best clinical presentation at the Scoliosis Research Society meeting
2013–14 President, EuroSpine
2012–2013 Vice president, EuroSpine
2009-2011 Executive committee, British Scoliosis Society
2006–2008 President, British Association of Spine Surgeons
2005–2007 Executive committee for Back Pain Research
- Soh RC, Sell PJ. A simple and cost-effective method in delivery of bone graft in lumbar spine posterolateral fusion. Ann R Coll Surg Engl 2013;95: 297
- Patel MS, Braybrooke J, Newey M, Sell P. A comparative study of the outcomes of primary and revision lumbar discectomy surgery. BoneJoint J 2013; 95-B: 90–94
- Patel MS, Sell P. Dose response and structural injury in the disability of spinal injury.-Eur Spine J 2012
- Venkatesan M, Fong A, Sell PJ. CT scanning reduces the risk of missing a fracture of the thoracolumbar spine. J Bone Joint Surg Br 2012; 94: 1097–100
- -Rushton PR, Grevitt MP, Sell PJ. Anterior or Posterior Surgery for Right Thoracic Adolescent Idiopathic Scoliosis (AIS)? A Prospective Cohorts Comparison Using Radiologic and Functional Outcomes. J Spinal Disord Tech 2012
- -Boszczyk B, Sell P. Bridging the channel: the first British Isles supplement of the European Spine Journal. Eur Spine J 2012; 21 Suppl 2: S149-50 –