Neurosurgery is very strong at Nanjing General Hospital, and doctors are well equipped to focus on specific pathologies, or subspecialty directions.
The spinal cord abroad is done by neurosurgeons, while in China it is mainly done by orthopedic surgeons. (There are more thoughts on the reason for this.) What are the reasons for this?
If you want to understand the above two points more deeply, you have to start with the history.
Looking back at the history of doctors, you can see a trend, which is that doctors can eventually do a narrower range of work. In ancient times, shamans were also doctors, and doctors were also practitioners of elixir. Later on, there were doctors and doctors, but they cured all diseases, such as Hua Tuo. more than 100 years ago, Western medicine was introduced and divided into surgery and internal medicine. more than 50 years ago, surgery was divided into general surgery, orthopedics, etc. only 30 years ago, neurosurgery started to be divided in big hospitals all over the country.
In the 1970s and 1980s, neurosurgery was still mainly operated under the direct vision of the naked eye, with high surgical risks, complications and high mortality. There were also very few neurosurgeons, usually only about 5. In the early 1980s, CT scanners appeared and were commonly used, soon followed by the introduction of magnetic resonance, which greatly increased the chances of detecting diseases in the brain. Coupled with the reform and opening up, economic activities increased at a rapid pace and there was a massive increase in patients with traumatic brain injury, neurosurgeons entered an era of expansion and busyness. The accumulation of experience in surgery under the microscope and the emergence of new techniques also brought neurosurgeons into an era of burgeoning knowledge.
Brain surgery is much more demanding than surgery in other departments, for example, an operation in the thigh area of orthopedics, post-operative rebleeding of 500ml can be done without special treatment, general surgery, intra-abdominal bleeding can reach 1000ml before resuscitation may also be fully recovered, while in neurosurgery, intracranial rebleeding of 30ml is enough to make a patient lose his life, and the time given to the doctor to deal with it may only be In neurosurgery, 30ml of intracranial hemorrhage is enough to lose a patient’s life, and the time given to the doctor to deal with it may only be a few minutes. So, it can be said that it takes a long time to train a doctor and a longer period to train a neurosurgeon.
Put another way, it can also be said this way: due to the advancement of the discipline, there are so many things to learn that neurosurgeons are under pressure to learn; due to the advancement of diagnostic methods, there are so many patients identified that neurosurgeons are under pressure to work; due to the long training cycle, there is a big demand gap for neurosurgeons.
For these reasons, over the years, neurosurgeons have been busy with traumatic brain injury, brain tumors, cerebrovascular disease, no time to take into account the spinal cord disease, except for spinal cord tumors can not be put off, or operated by neurosurgeons, like spinal cord trauma, disc herniation and other diseases because there are orthopedic surgeons can also deal with not many neurosurgeons to pay attention to and in-depth research it.
Sometimes, neurosurgeons have a sense of pride because neurosurgeons can also remove appendixes, reset fractures, and do chest drains, but general, orthopedic, and thoracic surgeons who have not worked in neurosurgery for quite some time to do the most basic craniotomy (opening the brain) work must be impossible. Pride is not original, 20 years ago, neurosurgery patient death and disability rate is high, the nature of the work is not as good as other surgical departments, medical students choose surgery is mostly thoracic surgery, urology, orthopedics, general surgery, neurosurgery, burns and plastic surgery in this order, now is different, neurosurgery may be the first choice in surgery, based on several students from Nanjing University School of Medicine to learn the best chose neurosurgery. The result is that many young medical school graduates have joined the ranks of neurosurgery over the past 10 years.
Among these doctors, there is no shortage of excellence and neurosurgery is growing even faster. There are now more than 20 neurosurgeons in each major hospital. Under these conditions, finally, you don’t have to be tired of dealing with emergencies and frequent shifts every day, and you can better improve your surgical skills and do research. But after a few years you will then also find that the surgery you think is beautiful, others also do it very well. Once you get past the accumulation period, a talented surgeon will do the surgery with a lot of confidence. With the support of modern equipment, there is no longer an off-limits area of surgery that has not been done in the cranial cavity. Now, there are several “first-rate surgeons” in every major city in China, and there are even a group of scholars who have in-depth research in certain diseases. Compared with 10 years ago, the situation has been reversed, the original work that no one did, now several people will pay attention to, several people do the same research at the same time, the collision is inevitable. More importantly, the development of neurosurgery in the cranial scope has reached a mature stage and seems to be reaching a plateau.
Neurosurgery is definitely expanding outward, and the first one is spine (spinal) surgery. Further out, there is peripheral neurosurgery.
Spinal surgery includes spinal cord lesions (such as spinal cord cavity), intradural tumors, herniated discs, and spinal cord trauma. Although there is not much attention, spinal cord lesions and spinal cord tumors can only be done by neurosurgeons. However, herniated discs and spinal trauma are now mainly handled by orthopedic surgeons.
The progress of spinal surgery in China in the past few years is mainly due to orthopedic surgeons, especially in the technique of internal fixation of the spine. Thanks to advances in fixation materials and imaging technology, the treatment of disc surgery and spinal instability has changed dramatically.
Which why do neurosurgeons still have to work on the spinal cord?
I encountered and carefully examined this question when I went to the Phoenix, Barrow Neuroscience Institute in the United States in 2008. This hospital is one of the top 10 hospitals in the United States in terms of neuroscience research, and neurosurgery is the absolute strongest department in the hospital, so you can say that the whole hospital revolves around neurosurgery. It has more than 5,000 neurosurgical procedures a year. However, about 45% of these patients are operated on for spinal cord lesions. In the United States and Europe, spinal cord surgery is mostly included in the scope of neurosurgery and is handled by neurosurgeons.
Whether spinal cord disorders are handled by orthopedic surgeons or neurosurgeons is also debated abroad.
In fact, spinal cord disease is most fundamentally due to lesions in the vertebrae or spinal cord that affect the nerve tissue, and all symptoms are produced by the affected nerves. The root of treatment is the problem of nerve protection, and the adverse consequences of the disease or serious surgical complications – paralysis – are also the result of nerve damage to the spinal cord. Therefore, advances in spinal surgery are ultimately the result of improved nerve function. And understanding of nerves is something that neurosurgeons have the deepest appreciation for within the surgical system, with a distinct intellectual advantage.
Neurosurgeons doing work on the spinal cord may also have an even more obvious technical advantage. They have experience in microsurgery for cranial surgery, are accustomed to fine manipulation, and are always aware of the protection of nerves. The prevention, treatment and rehabilitation of spinal cord damage and brain damage are basically similar and can draw on each other’s experience.
This is the main reason why American neurosurgeons do spinal surgery.
Of course, orthopedic surgeons also have the advantage of doing spinal surgery because they have a deep knowledge of the skeletal structure and function surrounding the spinal cord and are experienced in internal fixation techniques. The same good treatment outcomes can be achieved.
Imagine the results if neurosurgeons and orthopedic surgeons came together to do this work. The orthopedic surgeon takes care of the bone and the neurosurgeon takes care of the nerve, which is definitely – a pearl in the rough.