Operate less frequently, says expert
Dr Edward C Benzel, MD, is the Chairman of the Department of Neurosurgery at Cleveland Clinic in Ohio, US. He also holds a faculty appointment, Professor of Surgery, at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (CCLCM of CWRU). Dr Benzel’s major clinical interests are neurosurgery and spinal disorders, including cervical spondylosis and syringomyelia, complex spine instrumentation and spine tumours. In an exclusive interview with Future Medicine, Dr Benzel says that research in all domains of neurosurgery is flourishing at Cleveland Clinic. By Sreekant Ravindran
You have said that all spinal disorders primarily come under the non-surgical domain. Does this signify the role of traditional medicines such as Ayurveda in curing spinal disorders?
I said: “The treatment of back pain comes primarily under the non-operative domain. Surgery for such a malady should be a relative exception.” I recommend core strengthening exercises, flexibility exercises and other symptomatic treatments. I have little experience with traditional treatments, other than acupuncture. Acupuncture, in my experience, is associated with mixed results – and henceforth is not a mainstream treatment.
Can DNA sequencing technology revolutionise treatments related to spinal disorders, especially spinal deformities?
I am sceptical here. I do not feel that such strategies will have benefit – at least in the next two decades. It is difficult for me to believe that we can make an old disc young, or an unstable joint stable, with such therapy.
What are the milestones achieved by Cleveland Clinic under your chairmanship?
We have developed a multidisciplinary spine programme in which neurosurgeons, orthopaedic surgeons, rheumatologists, physical medicine (rehabilitation doctors), psychologists and psychiatrists work as a team. Our Neurosurgery residency has grown in size to 21 residents, as has our spine fellowship (six fellows per year). Fellowships in all other domains of neurosurgery are also offered. Research in all domains of neurosurgery is flourishing. Resident education is at its all-time high, with residents receiving multiple awards. The training programme has received many accolades as well.
Spinal treatments are very expensive, especially in emerging countries like India. How can we make it more cost-effective without compromising on the quality of treatment?
Chose implants based on value (quality/ cost). Less expensive implants are most often just as good as their more expensive counterparts. Finally, we should operate less frequently. We spine surgeons perform too many spine operations, particularly for degenerative disease. Hence, conservative decision making is warranted. For example, gabapentin has been shown to be very effective for lumbar stenosis symptoms. This can obviate the need for de-compressive surgery in the majority of cases.
Could you explain the special “Fusion Surgeries” that you have been recently performing? What makes this surgery unique?
I perform a lumbar insitu (no instrumentation) lumbar facet fusion. This eliminates the need for ‘mutilating lateral transverse process dissection, as well as the complications and cost associated with instrumented fusion.
Please tell us about Mazor Robotics guidance system, if you are familiar with it?
It provides image guidance which can be achieved with other strategies. One must take care to secure fixation of the robot, lest movement results in obligatory inaccuracies.
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