modern imaging and equipment

modern imaging and equipment?

The key to good surgery in all disciplines is a surgeon who is dedicated to the care of his or her patient, who takes a good history and examination and then o ff ers the best treatment that is available under the circumstances. In a high-income country this will often involve MRI scanning, dissection under microscope control and expensive titanium implants. In a resource-poor, low-income country it may involve just as much time and skill, but often a much more conservative approach. When surgery is needed the surgeon may have to do the best that he or she can with the equipment available. The case in Figure 37.11 illustrates this point well. Note the lateral cervical spine radiograph with a fracture/dislocation at C2/3 sustained by a patient living in a low-income country . The pedicles of C2 are fractured, allowing C2 to subluxate forwards on C3 and compress the spinal cord. The patient was admitted several days after a car crash, holding his head with his hands for stability . In a high-income country where there is imaging and fluoroscopic-guided pedicle screw fixation, the fracture could easily be fixed. In the low-income country , there was no cervical spine instrumentation available and the surgeon used a low-risk, low-technology technique of wiring the arch of C1 to the spine of C2 with stainless steel wire, then laying on corticocancellous bone graft. The reduction was stable, the graft incorporated and the patient was thankful. It is not appropriate to say that this was inadequate treatment compared with the best that the world has to o ff er, because the best that the world has to o ff er was not available. Debnath UK, Freeman BJ, Gregory P et al. Clinical outcome and return to sport after the surgical treatment of spondylolysis in young athletes. J Bone Joint Surg Br 2003; 85 (2): 244–9. Fairbank J, Frost H, Wilson-McDonald J et al. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 2005; 330 : 1233–8. Fritzell P , Hägg O, Wessperg P et al. V olvo Award in Clinical Science: lumbar fusion versus non-surgical treatment for chronic low back pain. A multi-centre randomised controlled trial from the Swedish Lumbar Spine Study Group. Spine 2001; 26 : 2521–34. Gardner A, Gardner E, Morley T . Cauda equina syndrome: a review of the current clinical and medico-legal position. Eur Spine J 2011; 20 (5): 690–7. Holmer H, Lantz A, Kunjuman T et al. Global distribution of surgeons, anaesthesiologists, and obstetricians. Lancet Glob Health 2015; 3 : S9–11. Janssen ME, Zigler JE, Spivak JE et al. ProDisc-C total disc replacement versus anterior cervical discectomy and fusion for single-level symptomatic cervical disc disease. Seven-year follow-up of the prospective randomized U.S. Food and Drug Administration investigational device exemption study . J Bone Joint Surg Am 2015; 97 (21): 1738–47. Meara JG, Leather AJ, Hagander L et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386 : 569–624. Patchell RA, Tibb PA, Regine WF et al . Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 2005; 366 : 643–8. Srikandarajah N, Noble A, Clark S, et al. Cauda Equina Syndrome Core Outcome Set (CESCOS): an international patient and healthcare professional consensus for research studies. PLoS ONE 2020; 15 (1): e0225907. Tokala DP , Lam KS, Freeman BJ et al. C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis. Eur Spine J 2007; 16 (9): 1471–8. Waddell G, McCulloch JA, Kummel ED et al. V olvo Award in Clinical Science: non organic physical signs in low-back pain. Spine 1979; 5 : 117–25. Wiltse LL, Newman PH, Macnab I. Classification of spondylosis and spondylolisthesis. Clin Orthop 1976; 117 : 23–9. modern imaging and equipment?

The key to good surgery in all disciplines is a surgeon who is dedicated to the care of his or her patient, who takes a good history and examination and then o ff ers the best treatment that is available under the circumstances. In a high-income country this will often involve MRI scanning, dissection under microscope control and expensive titanium implants. In a resource-poor, low-income country it may involve just as much time and skill, but often a much more conservative approach. When surgery is needed the surgeon may have to do the best that he or she can with the equipment available. The case in Figure 37.11 illustrates this point well. Note the lateral cervical spine radiograph with a fracture/dislocation at C2/3 sustained by a patient living in a low-income country . The pedicles of C2 are fractured, allowing C2 to subluxate forwards on C3 and compress the spinal cord. The patient was admitted several days after a car crash, holding his head with his hands for stability . In a high-income country where there is imaging and fluoroscopic-guided pedicle screw fixation, the fracture could easily be fixed. In the low-income country , there was no cervical spine instrumentation available and the surgeon used a low-risk, low-technology technique of wiring the arch of C1 to the spine of C2 with stainless steel wire, then laying on corticocancellous bone graft. The reduction was stable, the graft incorporated and the patient was thankful. It is not appropriate to say that this was inadequate treatment compared with the best that the world has to o ff er, because the best that the world has to o ff er was not available. Debnath UK, Freeman BJ, Gregory P et al. Clinical outcome and return to sport after the surgical treatment of spondylolysis in young athletes. J Bone Joint Surg Br 2003; 85 (2): 244–9. Fairbank J, Frost H, Wilson-McDonald J et al. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 2005; 330 : 1233–8. Fritzell P , Hägg O, Wessperg P et al. V olvo Award in Clinical Science: lumbar fusion versus non-surgical treatment for chronic low back pain. A multi-centre randomised controlled trial from the Swedish Lumbar Spine Study Group. Spine 2001; 26 : 2521–34. Gardner A, Gardner E, Morley T . Cauda equina syndrome: a review of the current clinical and medico-legal position. Eur Spine J 2011; 20 (5): 690–7. Holmer H, Lantz A, Kunjuman T et al. Global distribution of surgeons, anaesthesiologists, and obstetricians. Lancet Glob Health 2015; 3 : S9–11. Janssen ME, Zigler JE, Spivak JE et al. ProDisc-C total disc replacement versus anterior cervical discectomy and fusion for single-level symptomatic cervical disc disease. Seven-year follow-up of the prospective randomized U.S. Food and Drug Administration investigational device exemption study . J Bone Joint Surg Am 2015; 97 (21): 1738–47. Meara JG, Leather AJ, Hagander L et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386 : 569–624. Patchell RA, Tibb PA, Regine WF et al . Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 2005; 366 : 643–8. Srikandarajah N, Noble A, Clark S, et al. Cauda Equina Syndrome Core Outcome Set (CESCOS): an international patient and healthcare professional consensus for research studies. PLoS ONE 2020; 15 (1): e0225907. Tokala DP , Lam KS, Freeman BJ et al. C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis. Eur Spine J 2007; 16 (9): 1471–8. Waddell G, McCulloch JA, Kummel ED et al. V olvo Award in Clinical Science: non organic physical signs in low-back pain. Spine 1979; 5 : 117–25. Wiltse LL, Newman PH, Macnab I. Classification of spondylosis and spondylolisthesis. Clin Orthop 1976; 117 : 23–9. modern imaging and equipment?

The key to good surgery in all disciplines is a surgeon who is dedicated to the care of his or her patient, who takes a good history and examination and then o ff ers the best treatment that is available under the circumstances. In a high-income country this will often involve MRI scanning, dissection under microscope control and expensive titanium implants. In a resource-poor, low-income country it may involve just as much time and skill, but often a much more conservative approach. When surgery is needed the surgeon may have to do the best that he or she can with the equipment available. The case in Figure 37.11 illustrates this point well. Note the lateral cervical spine radiograph with a fracture/dislocation at C2/3 sustained by a patient living in a low-income country . The pedicles of C2 are fractured, allowing C2 to subluxate forwards on C3 and compress the spinal cord. The patient was admitted several days after a car crash, holding his head with his hands for stability . In a high-income country where there is imaging and fluoroscopic-guided pedicle screw fixation, the fracture could easily be fixed. In the low-income country , there was no cervical spine instrumentation available and the surgeon used a low-risk, low-technology technique of wiring the arch of C1 to the spine of C2 with stainless steel wire, then laying on corticocancellous bone graft. The reduction was stable, the graft incorporated and the patient was thankful. It is not appropriate to say that this was inadequate treatment compared with the best that the world has to o ff er, because the best that the world has to o ff er was not available. Debnath UK, Freeman BJ, Gregory P et al. Clinical outcome and return to sport after the surgical treatment of spondylolysis in young athletes. J Bone Joint Surg Br 2003; 85 (2): 244–9. Fairbank J, Frost H, Wilson-McDonald J et al. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 2005; 330 : 1233–8. Fritzell P , Hägg O, Wessperg P et al. V olvo Award in Clinical Science: lumbar fusion versus non-surgical treatment for chronic low back pain. A multi-centre randomised controlled trial from the Swedish Lumbar Spine Study Group. Spine 2001; 26 : 2521–34. Gardner A, Gardner E, Morley T . Cauda equina syndrome: a review of the current clinical and medico-legal position. Eur Spine J 2011; 20 (5): 690–7. Holmer H, Lantz A, Kunjuman T et al. Global distribution of surgeons, anaesthesiologists, and obstetricians. Lancet Glob Health 2015; 3 : S9–11. Janssen ME, Zigler JE, Spivak JE et al. ProDisc-C total disc replacement versus anterior cervical discectomy and fusion for single-level symptomatic cervical disc disease. Seven-year follow-up of the prospective randomized U.S. Food and Drug Administration investigational device exemption study . J Bone Joint Surg Am 2015; 97 (21): 1738–47. Meara JG, Leather AJ, Hagander L et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386 : 569–624. Patchell RA, Tibb PA, Regine WF et al . Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 2005; 366 : 643–8. Srikandarajah N, Noble A, Clark S, et al. Cauda Equina Syndrome Core Outcome Set (CESCOS): an international patient and healthcare professional consensus for research studies. PLoS ONE 2020; 15 (1): e0225907. Tokala DP , Lam KS, Freeman BJ et al. C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis. Eur Spine J 2007; 16 (9): 1471–8. Waddell G, McCulloch JA, Kummel ED et al. V olvo Award in Clinical Science: non organic physical signs in low-back pain. Spine 1979; 5 : 117–25. Wiltse LL, Newman PH, Macnab I. Classification of spondylosis and spondylolisthesis. Clin Orthop 1976; 117 : 23–9.