Lessons Learned from 27 Years’ Experience and Focus Operating on Symptomatic Conditions of the Spine under Local Anesthesia:The Role and Future of Endoscopic Spine Surgery as a “Disruptive Technique” for Evidenced Based Medicine.

Abstract

The Practice of Medicine will always be an art based on science. The human body is more complex and not like a mathematical formula. History has shown that concepts in medicine, judged by “key opinion” leaders, currently depend on scientific publications that affect medical treatment through the medical literature. Strict adherence to Cochrane criteria and old “evidence based” concepts are used for scientific dissemination and publication, but also used for insurance reimbursement in the United States. Health care is becoming more and more supported by government subsidy and payment is dependent on guidelines established by each payer. The ability of innovative and valuable level five expert EBM opinions to get published for dissemination to the scientific community can be difficult for researchers because institutional support or NIH funding is the usual pathway. If there is no institutional support, researchers must pay fees to get their work published in open access Journals. It may be the time to consider “innovative disruption” as a form of evidence based medicine to mitigate the unsustainable increasing cost of health care for spine treatment. Endoscopic spine surgery fits consideration as an innovative disruptive procedure. Patients seeking advice from their chosen physician or health care provider for their physical complaints are for conditions that are based on the Physiology and Patho-anatomy causing their symptoms. In spinal conditions, while most patients are not taken seriously until they complain of “debilitating” pain, symptomatic conditions that can be resolved with tincture of time and/or supportive modalities are supported by allopathic as well as homeopathic and naturopathic physicians. Surgical or invasive procedures are usually reserved for more specific allopathic conditions. These conditions may cause not just pain, but numbness, a change in sensation, weakness, or only intermittent debilitation. The symptoms may also reflect separate and concomitant symptoms that can be confusing when the physician focuses on a single source of the symptom. Extensive experience and perseverance with techniques that work for the clinician is valuable when there is a database large enough to be studied and mined, to demonstrate statistical significance. Such is the case with procedures that can be validated by endoscopic imaging to evaluate, and validate the complaint by the ultimate result: symptom resolution. Traditional radiologic Imaging by itself, however, is inadequate to explain complaints of symptoms that may or may not be debilitating in the physician’s judgment, and the patient may be simply dismissed or prescribed a drug to mitigate the complaint. This has, in many ways, contributed to the myriad of pharma solutions to every symptom complaint in allopathic medicine. A myriad of Naturo-pathic remedies are also marketed and sold over the counter, supported by millions of symptom sufferers who do not expect insurance reimbursement. There are also allopathic means to diagnose and treat symptomatic conditions in the spine, especially in the lumbar spine that currently garners third party reimbursement. The role and future of endoscopic spine surgery is supported here as an innovative disruption to our current means for scientific validation. Performed expertly and properly, a “warrantee” can be provided.