The lack of trained spinal surgeons

The lack of trained spinal surgeons

• In the last 25 years high-income countries have seen the rapid development of spinal surgery , and the rapid development of spinal surgery as a complete career. It is now normal in such countries for spinal surgeons to practise only in the field of spinal surgery and no longer to undertake general orthopaedic or neurosurgical operations. This has inevitably led to refine - ment of skills and increasing subspecialisation. In low-income countries, where there may be a single orthopaedic surgeon for 1 million people, doing ‘just spinal surgery’ is not an option, and a much more general approach is needed. In the map shown in Figure 37.10 , each country in the world is repre - sented with an area proportional to the number of people in the population per active surgeon. This represents surgeons of all types, but it shows that, in many parts of Africa, there are more than half a million people per surgeon. The map show - ing the population covered by each spinal surgeon would be even more striking.

Population per provider <18,059 18,059 – 56,261 56,261 – 139,732 139,732 – 306,301 306,301 – 664,333

664,333 Figure 37.10 Global distribution of surgeons, anaesthetists and obstetricians. Each country in the world is represented with an area proportional to the number of the population per active surgeon. (Reproduced with permission from Holmer H, Lantz A, Kunjumen T of surgeons, anaesthesiologists, and obstetricians. Lancet Glob Health (a) Figure 37.11 (a) Lateral cervical spine radiograph with a fracture/dislocation at C2/3 sustained by a patient living in a low-income country. (b) The surgeon used a low-risk, low-technology technique, wiring the arch of C1 to the spine of C2 with a piece of stainless steel wire, then laying on corticocancellous bone graft. et al . Global distribution 2015; 3 (Suppl 2): S9–11.) (b)

The lack of trained spinal surgeons

• In the last 25 years high-income countries have seen the rapid development of spinal surgery , and the rapid development of spinal surgery as a complete career. It is now normal in such countries for spinal surgeons to practise only in the field of spinal surgery and no longer to undertake general orthopaedic or neurosurgical operations. This has inevitably led to refine - ment of skills and increasing subspecialisation. In low-income countries, where there may be a single orthopaedic surgeon for 1 million people, doing ‘just spinal surgery’ is not an option, and a much more general approach is needed. In the map shown in Figure 37.10 , each country in the world is repre - sented with an area proportional to the number of people in the population per active surgeon. This represents surgeons of all types, but it shows that, in many parts of Africa, there are more than half a million people per surgeon. The map show - ing the population covered by each spinal surgeon would be even more striking.

Population per provider <18,059 18,059 – 56,261 56,261 – 139,732 139,732 – 306,301 306,301 – 664,333

664,333 Figure 37.10 Global distribution of surgeons, anaesthetists and obstetricians. Each country in the world is represented with an area proportional to the number of the population per active surgeon. (Reproduced with permission from Holmer H, Lantz A, Kunjumen T of surgeons, anaesthesiologists, and obstetricians. Lancet Glob Health (a) Figure 37.11 (a) Lateral cervical spine radiograph with a fracture/dislocation at C2/3 sustained by a patient living in a low-income country. (b) The surgeon used a low-risk, low-technology technique, wiring the arch of C1 to the spine of C2 with a piece of stainless steel wire, then laying on corticocancellous bone graft. et al . Global distribution 2015; 3 (Suppl 2): S9–11.) (b)

The lack of trained spinal surgeons

• In the last 25 years high-income countries have seen the rapid development of spinal surgery , and the rapid development of spinal surgery as a complete career. It is now normal in such countries for spinal surgeons to practise only in the field of spinal surgery and no longer to undertake general orthopaedic or neurosurgical operations. This has inevitably led to refine - ment of skills and increasing subspecialisation. In low-income countries, where there may be a single orthopaedic surgeon for 1 million people, doing ‘just spinal surgery’ is not an option, and a much more general approach is needed. In the map shown in Figure 37.10 , each country in the world is repre - sented with an area proportional to the number of people in the population per active surgeon. This represents surgeons of all types, but it shows that, in many parts of Africa, there are more than half a million people per surgeon. The map show - ing the population covered by each spinal surgeon would be even more striking.

Population per provider <18,059 18,059 – 56,261 56,261 – 139,732 139,732 – 306,301 306,301 – 664,333

664,333 Figure 37.10 Global distribution of surgeons, anaesthetists and obstetricians. Each country in the world is represented with an area proportional to the number of the population per active surgeon. (Reproduced with permission from Holmer H, Lantz A, Kunjumen T of surgeons, anaesthesiologists, and obstetricians. Lancet Glob Health (a) Figure 37.11 (a) Lateral cervical spine radiograph with a fracture/dislocation at C2/3 sustained by a patient living in a low-income country. (b) The surgeon used a low-risk, low-technology technique, wiring the arch of C1 to the spine of C2 with a piece of stainless steel wire, then laying on corticocancellous bone graft. et al . Global distribution 2015; 3 (Suppl 2): S9–11.) (b)