With the advent of new techniques for treating spine disease, the discipline of spine surgery has grown rapidly. No longer can the general orthopedic or general neurosurgeon handle the complete array of spine-related problems presented. Spine surgery techniques have become so rapidly evolving and complex that a new discipline “spine surgery” has been born in the medical community.
A physician trained specifically in spine surgery may be better adapted to adhere to certain principles than his counterpart who have either trained as a general neuro or orthopedic surgeon. Careful handling of nerve tissue which will ultimately reduce postoperative scarring and reduce the chances of intraoperative tissue damage are more likely for the individual who is well versed in the use of micro-instruments techniques and visualization with illumination. Most spine surgeons now agree that the use of high powered magnification either through a microscope or special magnifying glasses is essential for handling tissue around the spine. The well trained spine surgeon will also have at his disposal a complete array of techniques which can be individualized to patients. A surgeon which utilizes a narrow range of techniques applied to all spine pathology should be viewed with suspicion. Every patient presenting with a spine problem necessitating surgery will have some unique quality which will require adaptation of all known surgical techniques.
Traditional outcome after spine reconstruction surgery may be measured based on symptomatic relief and the presence of a solid bony fusion. Contrary to intuitive thinking though, the presence of a solid fusion does not necessarily correlate completely with the resolution of symptoms. Such factors as the correct primary diagnosis as well as technical considerations about the surgery may improve the overall results over the short term.
Short term resolution of symptoms though should not be the complete criteria by which spinal reconstruction surgery is judged. Also, symptoms may be relieved for a short period of time by adequate fusion surgery and results may degrade over time if the reconstruction is not performed in a way which either recreates or corrects sagittal plane imbalance.
A key factor which will identify a surgeon qualified to do high quality spine surgery will be a record of producing spinal balance if spinal reconstruction is necessary. Little skill is necessary to produce a spinal fusion. Significant skill is necessary to recreate spinal balance (see balance).