A consultant neurosurgeon and the current president of EUROSPINE, Tim Pigott talks to Spinal News International about his career so far. Outside of his daily practice and society engagements, he is also involved in research into how we can use registry data to help improve patient selection for surgery. He has noticed “exponential growth” in the number of patients coming for treatment over the last 10 years, and remarks that one of the main challenges to spinal care is economics, positing that physicians must work with policy makers to ensure the needs of patients with spinal pain are heard. He advises young physicians to listen carefully to what their patients tell them, and to seek advice and support from colleagues when needed. An avid football fan, Pigott also discusses his interests and hobbies outside of the spinal world.
Why did you decide to pursue a career in medicine?
I was inspired by two friends of my parents who were doctors. They demonstrated the ability to apply science to patient management but with a great understanding of the individual’s needs and concerns. It is getting this balance right that can be the great challenge for medical practice.
What drew you to neurosurgery, and in particular spinal surgery?
As a very junior doctor I spent six months working for Professor Ted Hitchcock. He was an inspirational teacher, who always had time for the most junior member of the team. My interest in spinal surgery evolved from my interest in microsurgery and the management of intradural spinal problems, which has remained one of my main fields of work.
Have you had important mentors throughout your career? What have they taught you?
My first mentor was Jonathan Punt (paediatric neurosurgeon in Nottingham, UK). He was a hard task master but instilled in all the trainees the importance of listening to patients and attention to detail, something I have never forgotten. My mentor in spinal surgery has to be Gerry Towns (spinal neurosurgeon in Leeds, UK) who is a master of surgical technique. His emphasis on careful tissue handling, haemostasis and use of the microscope were all very important in my future career.
What is the main focus of your current research?
My current focus is registry data. Liverpool are a big user of Spine Tango with a database of over 11,000 cases, with excellent follow up data. We are currently looking at ways to use this data for prognostic modelling to help improve patient selection for surgery. The challenge is to ensure accurate data and proper evaluation of that data to produce meaningful information. What this has meant in practice is a much better understanding of complications that matter to patients, the ability to look at our outcomes and benchmark these with other centres around Europe.
What is the most interesting piece of research you have read recently?
Rather than a piece of research I would recommend Being Mortal by Atul Gawande, it is a must read for all doctors. He explores the issue of age-related frailty and the importance of life still having purpose even in patients nearing death.
How have your research activities influenced your clinical practice, and vice versa?
I think academic rigour is really important in medical practice, especially evidence-based medicine. This allows for a clear discussion with a patient about the potential options (including the non-surgical ones). Specifically, the registry data has allowed us to give patients a much clearer idea about the outcome of surgery and the complications as expressed by previous patients.
How has the field of spinal surgery changed since you started your career?
There has been an exponential growth in the number of patients coming for treatment, we have seen growth of almost 10% each year for the last 10 years. This is mainly due to the ageing population but also the change it what can be achieved and the more educated consumer. There has been an explosion of knowledge around deformity and sagittal balance. We now have much better instrumentation than when I started out in my career, especially for the cranio-cervical junction.
In your opinion, what are the most exciting developments in spinal surgery that we can expect in the next five to 10 years?
At the EUROSPINE 2017 meeting in Dublin, UK, we had an inspiring talk from Mark Pollock about the use of exoskeletons in paraplegics to enable walking. It is this and functional restoration with regeneration that will be the big developments in the next five to ten years. Spinal surgeons will need to keep abreast of these changes so that they are able to be involved in the management of these patients.
What do you think are the main challenges in the field at the moment?
Economics! Everyone knows that we have an ageing population with greater requirements for spinal interventions. Health resources are not infinite and it will require great effort to ensure that the group of patients with spinal pain have a voice. Margareta Nordin (former EUROSPINE President) and colleagues have demonstrated that this is a leading cause of disability worldwide and that we have to improve access to spinal services for all. Increasingly, governments and health insurers will demand evidence of efficacy and cost benefit for us to be able to undertake treatments. This makes a very strong case for the use of registry data to demonstrate the outcome of any spinal intervention.
What are the potential solutions?
Organisations such as ours need to engage with policy makers to make sure that the needs of patients with spinal pain are heard. We must demonstrate that our treatments are effective with proper outcome data, and also that what we do is cost effective. This does not just apply to surgery but to all aspects of spinal care.
You have been an active member of EUROSPINE for some time. What have you achieved over the past year as president?
EUROSPINE is a team effort and everything that has been achieved is by the excellent group of people around me. Besides the tremendous growth of our membership base and the ongoing success of our meeting activities, we have established the EuSSAB advisory board as a platform to bring all European national spine societies together to discuss core issues of common interest to the benefit of all members of any spine society in Europe. Regarding our core activities we have had our first (and very successful) non-surgical diploma in Geneva (EDISC), which I attended and greatly enjoyed. We are furthermore in the process of launching our new e-learning platform and our first blended education session will take place in November. We have moved our Spine Tango service provider to Northgate who are well known for running the British Joint Registry. Our certification project for centres of Spinal Excellence has now fully launched. We have had a successful meeting last year in Barcelona, Spain, and an exciting Spring Speciality Meeting earlier this year in Frankfurt, Germany.
What advice would you give to someone wishing to start their career in spinal surgery?
The most difficult thing to teach is when not to operate but it is the most important part of decision making. Always apply your knowledge to your decision making and never forget to listen carefully to what the patient tells you. It is easy to become disheartened if your interventions do not turn out as you hope, this is when it is especially important to seek advice and support from colleagues.
What are your interests and hobbies outside of spine?
Anyone who knows me will appreciate my support of Liverpool Football Club, it was a fantastic season for them and they won the Champions League which is the premier club tournament in Europe! I also enjoy hiking, classical music, playing the piano (badly) and gardening.