pain mgmt doing microdiscectomies

[MilesDavisTheDoctor]

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I'm an M2 and I've heard from some anesthesia pain mgmt friends that they do micro discectomies and some other simple spine procedures like spinal cord stimulators. Are these the same type of procedures that neurosurgeons and orthopedic spine surgeons perform?

 

[mmmcdowe]

I am not aware of any pain management doctor doing microdisectomies. They may be doing some sort of disc injection. In terms of spinal cord stimulators yes they often will do stage one stimulators where they percutaneously insert them for a trial and may or may not actually do the final implantation themselves. My general impression is that some of the younger fellows like it at first but after one or two complications or poorly chosen candidates to back away. The reality is fundamentally you cannot be competitive in a field where you cannot manage your own complications. That is when most neurosurgeons have backed away from doing things such as the peritoneal implant for shunts. You can do it it is not that hard until it goes wrong.

 

[longhaul3]

I would be shocked if a pain management doctor is doing a microdiscectomy. Despite being hugely common and taking less than an hour, it is not a particularly simple surgery. What do they do when they cause a huge ventral durotomy and avulse the nerve root with the drill?

Perc SCS is not that difficult. I did them mostly unsupervised as an intern but there is a fundamental difference between surgeons and non-surgeons. Having revised a number of them for infections and wound complications I know I would never refer someone to a pain mgt doctor for a full SCS/pump implantation (trials are a different story, they do fine with them and can keep them).

 

[lobelsteve]

I would be shocked if a pain management doctor is doing a microdiscectomy. Despite being hugely common and taking less than an hour, it is not a particularly simple surgery. What do they do when they cause a huge ventral durotomy and avulse the nerve root with the drill?

Perc SCS is not that difficult. I did them mostly unsupervised as an intern but there is a fundamental difference between surgeons and non-surgeons. Having revised a number of them for infections and wound complications I know I would never refer someone to a pain mgt doctor for a full SCS/pump implantation (trials are a different story, they do fine with them and can keep them).

You sound pretty ignorant of your colleagues skills/abilities. SCS is the purview of Pain, some docs are just too lazy/unskilled and not worth the time cost to implant. But then in many locations the surgeons throw in a paddle in the wrong spot because they were doing the patient a favor between their real cases. Back to original topic: no way should anyone but ortho spine and neurosurgery should be doing microdiscectomies.

 

[longhaul3]

You sound pretty ignorant of your colleagues skills/abilities. SCS is the purview of Pain, some docs are just too lazy/unskilled and not worth the time cost to implant. But then in many locations the surgeons throw in a paddle in the wrong spot because they were doing the patient a favor between their real cases. Back to original topic: no way should anyone but ortho spine and neurosurgery should be doing microdiscectomies.

Maybe I am. I am probably biased because we have one of the more well known pain/neuromodulation neurosurgeons around and probably get a disproportionate amount of disaster redo referrals because of it. I suppose I don't hear about the SCS cases done successfully by pain mgt.

Maybe I am super ignorant - are you saying anesthesia pain doctors do paddle SCS? As in lami for paddle placement? Or am I misunderstanding your point?

 

[lobelsteve]

Maybe I am. I am probably biased because we have one of the more well known pain/neuromodulation neurosurgeons around and probably get a disproportionate amount of disaster redo referrals because of it. I suppose I don't hear about the SCS cases done successfully by pain mgt.

Maybe I am super ignorant - are you saying anesthesia pain doctors do paddle SCS? As in lami for paddle placement? Or am I misunderstanding your point?

Paddles done by the real surgeons (Neurosurgery and Ortho Spine).
Perc permanent done by PMR/Anes Pain routinely. If I see a perc done by a surgeon using spaghetti wires, I know something isn't right.

 

[MilesDavisTheDoctor]

What do you guys think about this? AANS/CNS Position Statement on Arthrodesis of the Spine 8.21.21

 

[tiedyeddog]

Paddles done by the real surgeons (Neurosurgery and Ortho Spine).
Perc permanent done by PMR/Anes Pain routinely. If I see a perc done by a surgeon using spaghetti wires, I know something isn't right.

I know this thread is old but plenty of neurosurgeons place perc leads. Perc leads are much faster. The data on which is better isn’t by any means conclusive.