In the 1980s, doctors thought twice before referring patients for spine surgery, which could cause complications in the spinal cord. The brain and spinal cord make up the central nervous system of humans.

Spine surgery, one of the most delicate procedures that surgeons perform, can cause serious nerve damage that may lead to weakness, paralysis, excruciating pain, sexual impotence, and even loss of bowel and urinary bladder control.

In difficult and complicated cases, repeat surgeries may have to be done, such as what happened to a former president of the country. Even in the best hands, complications can’t be totally avoided.

Dr. Rafael Bundoc, a noted orthopedic surgeon and professor at the University of the Philippines College of Medicine, assures me that the art and science of spine surgery has enormously improved in the last three decades, much more so in the last 10 years.

“It is continuously emerging worldwide at an unreachable pace, and emerging surgical techniques and technologies in the field have also widened the disparity between the have and the have-not countries,” says Bundoc.

The good news for the 15,000 or more Filipino patients who need spine procedures every year due to pain, deformity or paralysis acquired from trauma, congenital deformities, infection, neoplasm and degeneration, is that there are now promising advances in the field.

The not-so-good news is that we need more local surgeons to be on par with their colleagues in developed countries. We already have some highly competent spine surgeons like Bundoc, but their number is too small to handle all the cases in the country.

Updated

It is imperative that spine specialists in the Philippines and other developing nations keep the skills and knowledge updated so they can help more people in the country.

It’s almost incredible that very delicate operations on the spine can now be performed using minimally invasive spine surgery (MISS). Small “key-hole” incisions are made instead of the long cuts traversing a good length of the spine. The procedure can be bloodless, requiring only short hospital stay. Other advantages are decreased infection rates and significantly faster recovery.

“MISS techniques are, however, very difficult to adopt due to inaccessible training, the need for specialized equipment, and a very steep learning curve,” laments Bundoc.

For the first time, the Philippines will be hosting a regional and international event on “Minimally Invasive Spine Surgery Techniques” in cooperation with the North American Spine Society.

“This is an invaluable opportunity for local surgeons, anesthesiologists, pain specialists, residents in training, medical students, nurses and paramedic practitioners to learn firsthand the latest in MISS,” says Bundoc.

Organized by the Section of Spine Surgery of the University of the Philippines-Philippine General Hospital, the congress will be held June 26-29 at the Manila Hotel, with the first two days to be held at the Anatomy Dissection Laboratory, UP College of Medicine in Manila, for hands-on demonstrations and training.

Orthopedic and neurosurgeon spine specialists from the Asean region, as well as anesthesiologists, pain specialists, and general orthopedic surgeons and neurosurgeons are expected to attend this once-in-a-blue-moon gathering.

The congress-workshop will consist of two days of hands-on experience for the participants working on soft cadavers from the UP College of Medicine, and two days of didactics that will reexamine and define the gold standard for MISS, both locally and globally.

Standard of care

Bundoc is confident that this event will provide participants an opportunity to gain exposure, confidence and knowledge in MISS, which is gaining ground internationally as the standard of care for patients with spinal disorders.

We hope that the Philippines can eventually catch up with developing countries in being experts at MISS. The congress can encourage our modern training hospitals to make it part of their curriculum, since we have a lot of potential spine surgery candidates in the country.

Bundoc explains that there are only three training centers in the country providing exposure to MISS. “Many of our specialists who want to adopt the latest MISS techniques have to go to other countries to attend symposia and seminars, to observe actual cases, or have actual hands-on experience. Their journey is difficult and expensive.”

I’m sure this congress on Asean MISS techniques can spur advancement in the country and Asean region. Our government should support initiatives like this.

It is very much in line with the old Turkish proverb: “If the mountain could not come to Muhammad, then Muhammad must go to the mountain.” Since many Asean spine specialists cannot travel outside to learn the latest in MISS, then let us bring the education closer to where they are.

I’m certain, too, that the foreign specialists who have introduced surgical innovations in this field can learn from local experts like Bundoc—a classic case of mentors learning from their students.

Perhaps because of the scarcity of resources, our local spine experts have come up with creative ways to modify some procedures to make them less costly but almost equally effective for patients. After all, necessity is the mother of invention.

Interested participants to the Asean MISS Congress, text or call 0918-9799227; visit https://5thaseanmisst.org