12th ArgoSpine Symposium: No Consensus over the Best Approach to Treatment
BY ARMELLE WIART, FEBRUARY 11, 2008
In Paris in late January, steps away from the Seine and under the watchful eye of the Eiffel Tower, over 200 neurosurgeons from around the globe assembled for the 12th Argospine Symposium: Recent History of Spine Surgery: Complications and History. Both themes were discussed extensively over two days of lectures and interactive case discussions.
The first theme, history, was present in lectures on the origin of the spinal cord, current knowledge surrounding cord vascularization, spine tumor removal, fusion and non-fusion techniques, cerebro-spinal fluids and cervical and lumbar disc replacement. It was also present in a tribute to Professor Raymond Roy-Camille, a French pioneer in spine surgery, given by current Argospine president Professor Christian Mazel. It transpired in lectures discussing new procedures once thought impossible, and its meaning fully resonated in insistence on the importance of teaching younger surgeons.
The theme of complications reared its head in every case discussed. The symposium was characterized by a desire not to shy away from cases that “went wrong” but, on the contrary, to explain them in detail, risking the criticism of peers, in an effort to understand why they went wrong and what can be learned from them.
The symposium was uniquely scientific and pedagogic in nature. Surgeons present took notes and pictures of the slides projected, asked many questions to the presenters and never hesitated to engage in frank exchanges with one another. The two days of lectures were peppered with interactive cases which consisted of a surgeon presenting a case during which complications arose and asking the assembly which course of action they would have taken. The presenting surgeon detailed the patient’s history and symptoms and offered the assembly different choices of treatment and types of intervention. The attendees chose one (or more) options using a “clicker” that calculated the response rate for each choice. Rarely was there a wrong or right answer. The division in the results clearly illustrated the lack of knowledge that still surrounds the origin of pain, as well as a lack of consensus over the most appropriate course of treatment.
Surgeons also remained deeply divided over the benefits of fusion versus total disc replacement, with a sixty-forty split between those who had used a cervical prosthesis in the past, and those who hadn’t, and a sixty-forty split between those who would be willing to have a prosthesis implanted on them and those who would favor fusion.
Consensus, however, did exist over the observation that the best method of correction for complications is prevention. The most important and recurrent items on the list of prevention techniques were making sure that all efforts had been made in ascertaining a correct diagnosis, holding a conversation with the patient to discuss their options rather than leaving it in the hands of a resident or medical student, the presence of different surgeons in the operating room
See you next year for the 13th Argospine Symposium on Medical Imaging and Spine Surgery: Advances and Controversies.
