AO Spine North America recently started a new online consultancy—as a service for surgeons. If you have a spine case coming up and wish you had access to expert input in the planning, or if you recently completed a case that you would like to receive feedback on from the experts, or if you are interested in observing and learning from others’ experiences, these sessions are for you.
The AO Spine North American Case Consult series is held on the first and the third Monday of each month at 9:00 PM EST. The private, confidential forum allows surgeons to present cases, receive input on their treatment plans, and get feedback on completed cases in a secure environment. The series is moderated by Dr. John France and panelists rotate.
The Case Consult platform is aimed primarily at attending orthopedic spine and neurosurgeons, recent spine fellow graduates, and current spine fellows. The discussions are relevant to orthopedic spine and neurosurgical practices, and will help diagnose, treat, and manage spinal disorders and deformities. Expert advice will help address barriers and challenges to obtain optimal patient outcomes related to the cases presented, and be valuable for building collaboration skills with peers and experts when determining best surgical approaches, be it for surgical or non-surgical treatment options.
"The discussions will help diagnose, treat, and manage spinal disorders and deformities."
France wants to keep the concept as easy going and simple as possible and to let the concept evolve. He encourages participants to share documents, images, pictures, slides, and to bring along as many cases as possible, to develop the sessions into an online mentoring events.
Ali Baaj and Shari Cui were invited as panelists for the first Case Consult on October 19, 2020. Both find the concept highly educational. Baaj highlights the value from the direct focus on the proposed diagnostic and management questions of your actual cases. "It's a confidential yet educational platform in which fellows and surgeons can share management questions and ideas of real clinical cases seen in their practice. It is a great platform to share knowledge and to answer questions in a confidential and collegial fashion."
Cui believes the initiative will evolve into a great resource for both established surgeons and for those early in practice. "Especially those who are the only spine-trained surgeons in a group practice, can benefit a lot. There is so much gray zone in spine surgery that having a second, third, or fourth pair of eyes on a difficult case can be beneficial to surgical decision making and patient counseling," Cui says.
"Having a second, third, or fourth pair of eyes on a difficult case can be beneficial to surgical decision making and patient counseling."
"This is a fantastic way of getting those perspectives from a diversely trained group of spine surgeons, and to hear their experiences with that particular pathology," Cui concludes.
In the inaugural session, the panel kicked off with a debate on a "bread and butter" case of myeloradiculopathy from Cui. Not an unusual case, but one which can present a therapeutic dilemma, and where patient expectations may greatly vary to what the surgeon finds important to address.
"You've got to talk to the patient, not to end up with a very unhappy patient," Baaj stressed, after which France pinned the participants down how to deal with the case. The differing approaches were eventually voted on which goes to show, how treatment decision may be not clear cut at all.
A second case was presented by Michael Galgano, who says the feedback was exactly what he was looking for in his ongoing scoliosis case. "Traditional neurosurgery residency programs and spine fellowships tend to lack formal education on pediatric spinal deformity, because this subset of patients has traditionally been managed by orthopedic surgeons," Galgano explains. "However, there are some dedicated neuro-spine surgeons, such as myself, who have a growing interest in pediatric deformity."
"The most challenging part of pediatric spinal deformity is not necessarily the technical execution of the surgeries."
For Galgano it makes sense that, if you are taking on complex adult deformity surgeries, you should be able to apply your skillset also to the pediatric population. "The most challenging part of pediatric spinal deformity I have come across in my own practice is not necessarily the technical execution of the surgeries, but the complex decision-making and concepts unique to this sub-field," Galgano continues. "In an effort to deliver high quality spine care to my pediatric patients, I feel obligated to seek out every educational opportunity that arises."
The AO Spine North America Case Consult series gives younger surgeons an opportunity to put their thought processes and decision-making on display for critical feedback from more senior surgeons. Galgano sees these kinds of experiences necessary for continued growth as a surgeon and welcomes any opportunity to discuss a recently completed case, or upcoming surgery with a surgeon more experienced and find it of great value. "Although we may be comfortable in our current practice, the constructive feedback is what allows us to grow in the way we approach a case. It allows us to keep ourselves in check."
Galgano expects a good mix of retrospective review of completed cases as well as prospective discussions about upcoming surgeries to be the way forward with the Case Consult sessions. "There are times when I am seeking input on a very complex surgery that I have yet to take on. Other times, I am looking for constructive feedback about a complex surgery I have completed and would like to discuss what I could have done differently. This would bring the most value."
Find out more about the upcoming Case Consult sessions and sign up here.
