Spine surgeon societies versus Pain surgeons

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clubdeac said:
I'm in the same boat. What's the point of getting an MRI if you don't want an epidural or surgery and have no neuro deficits. I need to look into this kvetching thing
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Find a hot reiki chick to futz around with your energy a few hours a week.
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ateria radicularis magna said:
Find a hot reiki chick to futz around with your energy a few hours a week.
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1642740841613.jpeg
 
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Members don't see this ad :)
If endoscopic "surgery" is inferior to an actual microdisk why would anyone entertain the idea of doing that?

...because it's "less invasive?"

What kind of answer is that?

What's the reimbursement like on that procedure?
 
MitchLevi said:
If endoscopic "surgery" is inferior to an actual microdisk why would anyone entertain the idea of doing that?

...because it's "less invasive?"

What kind of answer is that?

What's the reimbursement like on that procedure?
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For the same reason a dog licks it’s balls….
 
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Centeno is so annoying. Are his fellows really brainwashed into believing there's no role for anything other than PRP and BMAC?
 
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drusso said:
regenexx.com

The Fusion War - Regenexx

Regenexx offers non-surgical, regenerative orthopedic treatment options for pain related to osteoarthritis, joint injuries, overuse conditions, spine pain, and common sports injuries.
regenexx.com regenexx.com
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Arguments like those in this article are getting old. Cardiologists and radiologists are doing peripheral revascularization, IP is doing EBUS and in some places they’re even doing mediastinoscopies, and the list goes on and on.

Arguing it’s inappropriate for a pain doc to do a fusion because it’s “unsafe” is dumb when the procedure is Minuteman or Linq. They should publish the complication rates of those procedures as compared those of their own procedures.
 
Agast said:
If you’re getting spine surgery, wouldn’t it be good to have a spine surgeon?

I’m a little disappointed y’all let a neurosurgeon beat you to writing about turf wars on a far right conservative blog
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"surgeons spend years studying scrubbing"
"ancillary income streams like ... physician offices"
"Just as a complex spine cancer pain (patient) would not want a surgeon to manage his lifelong complex opioid pathway"

Wow. Great article. Maybe Dr. Menger should have hired another PA to write this article for him.
 
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There are some very high profile spine surgeons getting in on this fight. This is going to get really ugly and with the thirtysomething year old KOLs representing “pain surgeons” I envision this is a Pee Wee Herman v Mike Tyson main event.
 
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NJPAIN said:
There are some very high profile spine surgeons getting in on this fight. This is going to get really ugly and with the thirtysomething year old KOLs representing “pain surgeons” I envision this is a Pee Wee Herman be Mike Tyson main event.
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More like David vs Goliath

Spine surgeons are fighting the inevitable
 
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NJPAIN said:
There are some very high profile spine surgeons getting in on this fight. This is going to get really ugly and with the thirtysomething year old KOLs representing “pain surgeons” I envision this is a Pee Wee Herman v Mike Tyson main event.
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👍🏻 Good.

But does this mean I’ll see less cool xrays on linked in with multiple devices like ornaments on a Christmas tree?…… a vertiflex, adjacent level minutemen, posterior SI fusion, dorsal column and drg leads…
 
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And I can post pics of terribly placed pedicle screws. So what?
 
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lets all post poorly placed pedicle screws and tag him and say, this is why pain surgeons are needed, to fix these issues :lol:
 
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You all sound like a bunch of NPs. You know they’re saying the same thing about pain providers being the only ones able to do epidurals, stim, RFA and kyphos. It’s no different.
 
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pain provider?
 
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I don't think your avg pain physician has 1/10th the surgical skills of a good NS or spine surgeon, and a ton of these shiny new toys pain doctors are trying to roll out are BS.

Half the time you're listening to a KOL, you're listening to someone with financial interests in whatever device you're being convinced to bring into your practice, and after you've done 15-20 cases with BS results you've discarded that treatment anyways. This leads to pain doctors flubbing around with new devices they're not skilled enough with to be good at, and those pts following up with a surgeon to remove it.

You're not learning a lot these skills in fellowship; you're learning it in real time on real pts who follow up with other doctors when your toy doesn't work.

I do think there are a lot of neat amd effective tricks up our sleeves, but we are not spine surgeons.
 
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MitchLevi said:
I don't think your avg pain physician has 1/10th the surgical skills of a good NS or spine surgeon, and a ton of these shiny new toys pain doctors are trying to roll out are BS.

Half the time you're listening to a KOL, you're listening to someone with financial interests in whatever device you're being convinced to bring into your practice, and after you've done 15-20 cases with BS results you've discarded that treatment anyways. This leads to pain doctors flubbing around with new devices they're not skilled enough with to be good at, and those pts following up with a surgeon to remove it.

You're not learning a lot these skills in fellowship; you're learning it in real time on real pts who follow up with other doctors when your toy doesn't work.

I do think there are a lot of neat amd effective tricks up our sleeves, but we are not spine surgeons.
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You are way off. It is more like 99% of the time they are financially vested.
 
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MitchLevi said:
I don't think your avg pain physician has 1/10th the surgical skills of a good NS or spine surgeon, and a ton of these shiny new toys pain doctors are trying to roll out are BS.

Half the time you're listening to a KOL, you're listening to someone with financial interests in whatever device you're being convinced to bring into your practice, and after you've done 15-20 cases with BS results you've discarded that treatment anyways. This leads to pain doctors flubbing around with new devices they're not skilled enough with to be good at, and those pts following up with a surgeon to remove it.

You're not learning a lot these skills in fellowship; you're learning it in real time on real pts who follow up with other doctors when your toy doesn't work.

I do think there are a lot of neat amd effective tricks up our sleeves, but we are not spine surgeons.
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Totally agree that we aren’t spine surgeons - but what makes the distinction between a “shiny new toy” and “neat and effective tricks up our sleeves” ?

All neat and effective tricks started off as shiny new toys at one point, no?
 
I have a confession. I am more bothered by the invention of Interventional Orthopedics as a "specialty" than I am by pain doctors calling themselves pain surgeons.
 
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gaspasser786 said:
Totally agree that we aren’t spine surgeons - but what makes the distinction between a “shiny new toy” and “neat and effective tricks up our sleeves” ?

All neat and effective tricks started off as shiny new toys at one point, no?
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I’d say it starts and ends with anything involving arthrodesis and direct decompression of the nerves/cord.
 
gaspasser786 said:
Totally agree that we aren’t spine surgeons - but what makes the distinction between a “shiny new toy” and “neat and effective tricks up our sleeves” ?

All neat and effective tricks started off as shiny new toys at one point, no?
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If the toy is really, really shiny...Like, see your reflection level shiny - That's one.
 
Agast said:
I have a confession. I am more bothered by the invention of Interventional Orthopedics as a "specialty" than I am by pain doctors calling themselves pain surgeons.
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I call it the Franks Red Hot of Musculoskeletal care. “I put that $hit on everything”.
 
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Taus said:
So that’s why they wear those shoes when they pose on LinkedIn?
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Well, you have to realize your avg KOL is a complete and total douchebag with a confusing personality disorder combining elements of narcissism, histrionic behavior and dependance on industry.

They'll broadly distort the truth for financial gain, and they'll do it knowing the majority of the audience knows they're distorting the truth.

I had a very well known KOL lie to me in a private conversation about a device he was teaching. Both of us knew he was lying. It was fairly obvious, especially now that I have a little bit of experience with said device.
 
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MitchLevi said:
Well, you have to realize your avg KOL is a complete and total douchebag with a confusing personality disorder combining elements of narcissism, histrionic behavior and dependance on industry.

They'll broadly distort the truth for financial gain, and they'll do it knowing the majority of the audience knows they're distorting the truth.

I had a very well known KOL lie to me in a private conversation about a device he was teaching. Both of us knew he was lying. It was fairly obvious, especially now that I have a little bit of experience with said device.
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I gotta hear this. What was the lie ?
 
gaspasser786 said:
Totally agree that we aren’t spine surgeons - but what makes the distinction between a “shiny new toy” and “neat and effective tricks up our sleeves” ?

All neat and effective tricks started off as shiny new toys at one point, no?
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okay, ill bite

please tell me which procedures are neat and effective tricks?

SCS? been around since the 60s (and maybe Roman times). DRG and HF10 are only variations of the standard SCS. not new.
PRP? been around for decades too, at least by drusso's definition...
MILD? Intracept? any of these new fusions? not enough data to say that they are really effective.
 
I think many are way underestimating the power of the orthopedic and neurosurgical societies to “expose” pain surgeons as non-surgeons and convince the public that pain surgeons are not qualified to perform MISS. This is not the same as the CRNA vs anesthesiologist battle. Unfortunately many patients don’t even know that anesthesiologists are physicians.
 
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On the flip side, patients are willing to let their pain physician do these surgical procedures because the spine surgeon spent 2 minutes with them, didn’t touch them and said there was nothing they could do to help.
 
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Agast said:
On the flip side, patients are willing to let their pain physician do these surgical procedures because the spine surgeon spent 2 minutes with them, didn’t touch them and said there was nothing they could do to help.
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Sometimes that may be true. However, we are already seeing that these surgically focused pain practices operate similarly. You know, the KOL promoted medical arm and surgical arm of the practice.
 
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Agast said:
On the flip side, patients are willing to let their pain physician do these surgical procedures because the spine surgeon spent 2 minutes with them, didn’t touch them and said there was nothing they could do to help.
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If there was something legit going on, that had real surgical indications, they would have been offered surgery even with a limited exam and history. Radiating or Claudicatory limb symptoms with nerve compression on imaging or instability. If none of that is present, there is no surgical indication, Mis or not
 
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Ironic because most of the patients I've seen with failed SIJ fusions were done by surgeons who did a poor job diagnostically.
 
RoloTomassi said:
Ironic because most of the patients I've seen with failed SIJ fusions were done by surgeons who did a poor job diagnostically.
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The lack of physical exam is killer. A patient was sent to me to discuss spinal cord stimulation and I found severe osteoarthritis in his hip. Drained 20cc of fluid and injected it, 80% improved for 2 weeks. Now much happier with a hip replacement.
 
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