The global implications for minimally invasive spine surgery

The evolution of minimally invasive spine surgery since the early 1990s has seen some of the most profound changes in the way healthcare is delivered to patients with debilitating and deformed spines. The rapid advances in technology and understanding of the bio-mechanical processes that form the foundation for the multiple pain and disability syndromes associated with back pain have fast forwarded the specialty in to the modern era. Long gone are the days when overly aggressive ill diagnosed back condition was treated by surgeons who in all honesty were simply operating in the dark.

Thankfully since then and in large part a consequence of the vastly improved vibre-optic technology the ability to correct painful spinal conditions has moved from the aggressive wide back incision of the last two decades carried out by mostly orthopedic and neurosurgeons to the percutaneously and minimally invasive procedures competently performed by physicians from the interventional and radiology communities, with the skilled use of fluoroscopic guidance and interpretation.

These significant technological and medical advances have progresses at various rates around the world depending on the politics of the local healthcare system which is inevitably tied into the business framework associated with healthcare delivery. In systems that are predominantly funded by the government the professional turf wars have almost no commercial relevance and will not be discussed in this essay, as their contribution to the main argument is negligible. However the two systems where the majority of healthcare is paid for either privately or by self pay fall squarely into the arena of business related professional turf wars, the two most extreme examples being the US and India.

Indian has made great strides in the healthcare sector over the last decade establishing it as a world leader in the provision of world-class healthcare at vigorously competitive prices that undermine the US market. Private Indian companies have been aggressively courting inefficient healthcare systems from the world with promises of high quality cost effective healthcare as a fraction of the price it costs in the US. This concerted strategy has been very successful and Indian is now established as one of the foremost destinations for what is referred to as medical tourism. The net result of this is to attract patients away from the more expensive European and US and therefore drive down the business model of the previously once unassailable US market. This trend will undoubtedly continue as the realities of Obama care continue and US citizens realize that they are in fact paying more for their healthcare than before the implementation of the so called Affordable Health Care Act. These customers will now increasingly choose to have their elective surgery performed in India at a fraction of the cost and with the same if not greater quality.

The importance of this trend to the US is to alert it to the fact that patients will now shop the globe for the what they consider the best medical services at the best price, and whether it’s a orthopedic surgeon, neurosurgeon or minimally invasive spine surgeon their only concern will be the competency and cost of the surgeon. The majority of surgeons are now routinely publishing their outcomes and complications and this move towards transparency will further encourage the selection of these non-US doctors for the performance of elective procedures. The US healthcare system has become overly beauracratic and excessively litigious which is part of the explanations for the markedly elevated healthcare costs.

In some parts of the world where need is greater regional politics will allow the dissemination of innovative ideas that invariably push the boundaries of medicine forward. This unfortunately has been stymied in the US, which at one time used to hold this position but no more. The overburden some regulatory bodies are petrified of litigation and so would rather do nothing. There is an old English expression that is the motto for the British Special Forces-The SAS_ ‘who he dares wins’ and while I am not for one moment suggesting these military tactics be employed to the civilized world of medicine, what I do firmly advocate is the willingness to take meaningful risk, for without risk there can be no progress, and before long the US will go the same way as Britain after the second world war. The British made the NHS too rigid, which led to a mass exodus or brain drain of the brightest minds to countries that encouraged and nurtured their innovative approaches.

Within this final paragraph the US medical establishment must wake up and take note of what changes are occurring across the world especially India, where medical innovation and progress are rapidly advancing without the cumbersome beaureacracy of the US. Healthcare consumers are increasingly becoming the final say in where and to whom they will go to receive their medical attention just in the same way that every other industry sector has been forced to do so.

It therefore makes no sense to eliminate the interventional pain physicians from the field of minimally invasive spine surgery for its is these physicians that occupy the major part of this musculoskeletal sector and it is they that have the manpower and skill to effectively treat the ever increasing number of patients with painful back conditions using minimally invasive spine surgery. This strategy will more likely prevent US patients from having to seek these services in foreign countries.

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