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The evolution of minimally invasive spine surgery in the middle east and Bangladesh

The emerging field of minimally invasive spine surgery, which began in earnest about ten years ago, is just beginning to make an impact in the Middle East and Bangladesh. Some of the factors that have impeded the growth include political instability in Bangladesh and attitudes of political conservatism in the Middle East, the latter of which is rather surprising when cone considers that this region of the world was the birthplace of mathematics and science with some very progressive thinkers. However recent social turmoil has diverted funds away from the development of world-class healthcare facilities.

The stabilization and increased oil based prosperity of the region has led to a renaissance in the healthcare sector with an influx of foreign medical expertise and technology from both Germany and to a lesser extent the US. The incorporation of minimally invasive spine surgery into the treatment regimens will have a dramatic effect on the well being of the population. As has been argued before the lack of a disability system places injured workers in a precarious position should they incur an injury while working and are forced to take time off work, which naturally leads to a markedly reduced income. MISS addresses the spinal pathology without causing the collateral damage associated with open back surgery and this allows the patient to return to work in a much shorter time frame.

The population in Bangladesh is still primarily a manual one with a high incidence of premature spinal degeneration, which if treated early and effectively will mitigate the longer-term consequences of advanced spinal disease. This truncated series of events is economically beneficial to society in that it keeps the active workforce fit enough to continue generating income for the economy.

The are also cultural reasons that make this variation of surgical intervention attractive to the population of the Middle East and Bangladesh, in that the minimization of tissue damage is significantly less intimidating to patients than the trauma and pain associated with the wide incisions of old fashioned surgeries.

The purchase of equipment in Bangladesh is probably one of the largest hurdles in conjunction with the lack of training and the solutions to these two problems would be to persuade government investment and foreign investment, for it is just a short time before the market for these services will exponentially grow.

From a practical standpoint the most convenient way to commence an interventional pain/minimally invasive spine program would be to start with the introduction of just interventional procedures which would allow the development of radiological skills and then progress onto the performance of lumbar endoscopic discectomies. Once a program with a solid reputation had been created the next step would be the introduction of percutaneous lumbar inter body fusions.

Money and medicine are essential bedfellows and without question medical progress would not exist without financial investment. However with innovative techniques and speed of procedure a lot of case can be performed with a small space of time. The key is to develop a unit that is effective, economical and produces high quality results. This interestingly, if the population of patients is large enough will attract physicians from around the world wishing to gain the experience; they are unable for several reasons, to gain in their own country. The global healthcare marketplace is playing out in some rather democratic ways that have broken down the parochial protectionist barriers of the last 20th century. Healthcare is be shared amongst humanity and not hoarded among the few affluent. To create a healthier world the western medical profession must accept their obligation to disseminate their knowledge throughout the world, even though the occasional US graduate feels a sense of having been cheated since he had to actually pay large sums of money to obtain his education, which has sadly created an anti-social protectionist attitude in US graduates. This must change and it is part of our common human heritage to spread the knowledge without expecting commercial reward.

Within the spine sector there are numerous entities that interact for the business and they are a combination of large corporations and smaller businesses, which produce a variety of medical device implants and instruments. For the last ten years they have been operating predominantly in the US due to the excessive fees they have been allowed to charge to doctors and hospitals. With the introduction of Obamacare these fees have been severely curtailed and as a consequence these companies are now actively searching foreign markets, one of which is Bangladesh and India. The sheer numbers of people with an increasing middle class are producing a never before seen patient population with enough money to buy tertiary care, and so the companies that recognize these opportunities early will be the one to benefit.

Moving into foreign healthcare markets can be a daunting exercise and is best carried out with local partners, who understand the legal, business and regulatory framework that will ensure success. The complicated picture of minimally invasive spine surgery requires a high level of expertise that must be incorporated in to any program for it to be a success.

The world has become a global healthcare market and those companies that recognize the cultural barriers and develop innovative solutions will be the ones that win the golden goose.

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