Abstract
Introduction
Spine surgery is a growing and challenging subspecialty in most health systems in Latin America and Peru, where the extent of its possibilities must attend an overflowing spine pathologies demand, such as traumatic and degenerative; considering that budgetary resources with almost immediate availability and trained medical specialists are imperative needed. Continuing medical education and subspecialization with competency-based curricula responds to the rapid expansion of technology and knowledge in this field, a fact which promotes better patient care, a greater sense of responsibility and dedication, a trend of critical analysis and research, and certainly the possibility to get more attractive job opportunities. This study examines the gaps in knowledge of the author who developed a 3 months' Postdoctoral Training AOSpine Fellowship Program, focused on traumatic and degenerative spine pathology, at the Department of Spine Diseases of the Instituto de Ortopedia e Traumatologia (IOT) FMUSP, Sao Paulo, Brazil.
Material and Methods
AOSpine Fellow Neurosurgeon activities in the scope of spine diseases were evaluated over a first period of 6 months before training (n = 12 patients) and a second period of 6 months after training (n = 18 patients) at the Neurosurgical Unit, Department of Surgical Specialties of the Hospital Antonio Lorena del Cusco, Peru; with emphasis in the fields of clinical and surgical practice (clinical, radiographic, and operative records from the whole 30 consecutive operative patients group with traumatic and degenerative diseases), academic performance, and research tasks. Multivariable linear regression was used to evaluate the relationship between experience level of the surgeon and surgical performance; as well as mentioning differences in the other two practice fields.
Results
Real differences between two periods were identified with the greatest difference in better performance seen on completing the fellowship (vs. nonfellowship): cervical trauma (80 vs. 62%), cervical stabilization (71 vs. 54%), thoracolumbar trauma (92 vs. 59%). and degenerative spine diseases (65 vs. 47%) and its complications (36 vs. 31%). In the second period, surgical correction and level of complications were significantly better; meanwhile, operative time and length of patients stay were significantly longer. No group differences were founded with respect to estimated blood loose (EBL), transfusion rates, and postoperative infections. Other advantages of the posttraining period were review log cases, surgical technique discussion, analysis of biomechanics, classification system, surgical approach and planning, number of screws placed, and stronger constructs. Finally, two spinal research projects were developed in the posttraining surgery.
Conclusion
To provide an efficient and safe service covering the broad spectrum of spinal pathology, a formal AOSpine fellowship, ideally with a formal curriculum, should be considered and recommended. Advantages include optimization of the diagnostic process, therapeutic classification, biomechanical analysis, neuroimaging study, selection of material, and user satisfaction. Research activities and academic industry support must be enhanced.