Spine surgery is unique in that two completely different disciplines specialize in it: neurosurgeons and orthopedic surgeons.
People sometimes figure that neurosurgeons handle the spinal nerves, and orthopedists the bones. But this isn’t always the case.
Dr. Peter Angevine, a neurosurgeon at the Spine Center at the Neurological Institute of New York, knows that operating on the spine means operating on the whole structure: nerves, bones, discs and all. He wanted the most comprehensive spine training possible. So he trained as a neurosurgeon… and then completed a prestigious fellowship in orthopedic surgery.
To understand those conditions, it helps to understand a little about the spine. The normal spine has a shape that helps it support the body with a minimum of effort. When viewed from behind it is straight, and from the side it has gentle curves that balance each other out.
But some spines develop curves where they shouldn’t, or lose curves that they need. The joints between vertebrae may also develop unusual rotations. All spinal deformities result from a combination of these two problems–curvature and rotation.
Sagittal imbalance is a condition where the spine is out of balance front-to-back. In sagittal imbalance, perhaps the gentle inward curve of the lower back has been lost, and the normal outward curve of the mid-back is exaggerated. A spine with scoliosis, meanwhile, has a side-to-side curvature.
Though he is trained as a surgeon, Dr. Angevine knows that spinal deformity does not always require surgery. Part of his job is to evaluate each situation and decide, along with his patient, on the best course of action. (For a real-world example, watch a short video about Dr. Angevine’s patient Constance on his bio page here.)
When surgery is necessary, Dr. Angevine considers the bones, joints, nerves, and the overall alignment in each plane. During surgery, he re-aligns the spine and fixes it in place with screws and rods, and he places a bone graft to fuse the vertebrae together.
His broad base of knowledge and extensive experience with such surgeries make him valuable not just as a surgeon, but also as a teacher. Experienced surgeons attend his classes as part of their Continuing Medical Education(CME). CME consists of classes and activities designed for practicing doctors. It helps them keep up to date with developments in their fields, and also helps them develop and hone new areas of expertise. Neurosurgeons are required to participate in Continuing Medical Education to keep up their board certifications.
Dr. Angevine is a strong believer in the importance of Continuing Medical Education, and in the importance of sharing his experience and knowledge with other doctors. That’s why he volunteers his time teaching CME classes, and serving on a national committee that oversees CME and maintenance of certification for experienced neurosurgeons.
His courses are also popular with neurosurgical residents–neurosurgeons-in-training who are working towards their board certification. Each year, Dr. Angevine teaches a spinal deformity course sponsored by the American Association of Neurological Surgeons (AANS) for neurosurgical residents. His lectures on topics like “Principles of Global Spinal Alignment” are very instructive for the neurosurgeons who are just starting out.
Last year, Dr. Angevine was on faculty for a three-day spine surgery course sponsored by the AANS and the Scoliosis Research Society. The course was attended by both orthopedic and neurological spine surgeons.
At this year’s AANS meeting, Dr. Angevine co-directed “Techniques for Adult Spinal Deformity Surgery: A Hands-on Course for Neurosurgeons.” Dr. Angevine and his co-director, Dr. Praveen Mummaneni of UCSF, constructed the course so that their participants would gain skills with evaluating spinal deformities; forming treatment plans; instrumentation during surgery; avoiding or managing surgical complications; and achieving bone fusion after surgery. The course lasted a full day … and judging from that list of topics, it was a very full day indeed.
Image credit, Spine: geralt / [Pixabay]
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