Training A New Generation of Spine Surgeons In Minimally Invasive Surgeries (MIS)

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Technological advancements have made it possible for spine surgeons to perform even complex surgical procedures using minimally invasive techniques. Considering the complexities inherent in any kind of spinal procedure, this is great news all around as it means lesser complications, reduced hospital stay and lower overall expenses. 

Acknowledging the many benefits and the resultant preference for minimally invasive surgeries, many teaching institutions are looking to hire MIS-experienced surgeons as faculty to train a new generation of spine surgeons. Others are sending their current faculty for training in these new techniques.

Students on ward rounds at the Regional Hospital Incorporating MIS into the curriculum

While incorporating the newer techniques into the curriculum is crucial for young spine surgeons, experts say it is equally important to ensure that it is not done at the cost of learning traditional open techniques that are instrumental to treating various pathologies.  As a result, surgery residencies and fellowships are developing innovative new ways of instruction to ensure the next generation of spine surgeons still receives adequate training in open techniques while also acquiring proficiency in minimally invasive techniques.

This is proving to be challenging for students as well as teachers. Scheduling extensive training in minimally invasive techniques into an already packed residency and fellowship program can make the curriculum even more demanding. In addition to their general spine training, residents also receive training in how to perform lateral fusions and MIS decompressions and also how to place percutaneous screws.

For teachers the challenge lies in continuing to adapt and expand their skill set so that their training remains unbiased and their residents receive a balanced view of traditional spine technology and minimally invasive techniques. The ultimate aim is for students to receive diverse and comprehensive training in the benefits of both methodologies so they can decide which ones work best for them in different situations.

To meet this end, students are exposed to minimally invasive techniques as well as open procedures early in their training. Many medical schools are making it possible for residents in their program to assist in surgery with different faculty members so they get exposure to and become familiar with different techniques and instrumentation styles.

Future of training 

According to the experts, working with smaller exposures, MIS tubes and retractors and depending on fluoroscopy and other image guided navigation platforms are the future of spinal surgery and primary skills for training surgeons will eventually revolve around these techniques instead of direct visualization. 

Because of the limited clinical time and the strict regulations in place, another likely development in the near future is the increase in cadaveric workshops that aim to provide additional opportunities for students to complement their training outside of the clinical curriculum. Cadaveric workshops allow trainees to practice new techniques in the cadaver lab before employing them on patients.  

In time, spine training is expected to progress to a more structured and coordinated effort at the residency and fellowship level.

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