Sarikonda Advith, Leibold Adam, Sivaganesan Ahilan
Department of Neurological Surgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA, 19107, USA.
Curr Pain Headache Rep. 2023 Nov;27(11):707-717. doi: 10.1007/s11916-023-01165-8. Epub 2023 Sep 15.
Recent advances in the field of interventional pain management (IPM) involve minimally invasive procedures such as percutaneous lumbar decompression, interspinous spacer placement, interspinous-interlaminar fusion and sacroiliac joint fusion. These developments have received pushback from surgical professional societies, who state spinal instrumentation and arthrodesis should only be performed by spine surgeons. The purpose of this review is to evaluate the validity of this claim. A literature search was conducted on Google Scholar and PubMed databases. Articles were included which examined IPM in the following contexts: credentialing and procedural privileging guidelines, fellowship training and education, and procedural outcomes compared to those of surgical specialties. Our primary research question is: "Should interventionalists be performing decompression and fusion procedures?".
Advanced percutaneous spine procedures are not universally incorporated into pain fellowship curriculums. Trainees attempt to compensate for these deficiencies through industry-led training, which has been criticized for lacking central regulation. There is also a paucity of studies comparing procedural outcomes between surgeons and interventionalists for complex spine procedures, including decompression and fusion. Pain fellowship curriculums have not kept pace with some of procedural advancements within the field. Interventionalists are also not trained to manage potential complications of spinal instrumentation and arthrodesis, which has been recognized as an essential requirement for procedural privileging. Decompression and fusion may therefore be outside the scope of an interventionalist's practice.
介入性疼痛管理（IPM）领域的最新进展包括经皮腰椎减压、棘突间间隔置入、棘突间-椎板间融合和骶髂关节融合等微创手术。这些进展遭到了外科专业协会的反对，他们表示脊柱内固定和融合术仅应由脊柱外科医生进行。本综述的目的是评估这一说法的合理性。在谷歌学术和PubMed数据库上进行了文献检索。纳入了在以下背景下研究IPM的文章：资质认证和手术权限指南、专科培训与教育，以及与外科专科手术结果相比较的手术效果。我们的主要研究问题是：“介入科医生是否应该进行减压和融合手术？”
先进的经皮脊柱手术并未普遍纳入疼痛专科培训课程。学员试图通过行业主导的培训来弥补这些不足，但这种培训因缺乏中央监管而受到批评。对于包括减压和融合在内的复杂脊柱手术，比较外科医生和介入科医生手术效果的研究也很少。疼痛专科培训课程未能跟上该领域的一些手术进展。介入科医生也未接受管理脊柱内固定和融合潜在并发症的培训，而这已被认为是授予手术权限的一项基本要求。因此，减压和融合手术可能超出了介入科医生的执业范围。
