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When Does Intervention End and Surgery Begin? The Role of Interventional Pain Management in the Treatment of Spine Pathology

  • Anesthetic Techniques in Pain Management (D Wang, Section Editor)
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Abstract

Purpose of Review

Recent advances in the field of interventional pain management (IPM) involve minimally invasive procedures such as percutaneous lumbar decompression, interspinous spacer placement, interspinous-interlaminar fusion and sacroiliac joint fusion. These developments have received pushback from surgical professional societies, who state spinal instrumentation and arthrodesis should only be performed by spine surgeons. The purpose of this review is to evaluate the validity of this claim. A literature search was conducted on Google Scholar and PubMed databases. Articles were included which examined IPM in the following contexts: credentialing and procedural privileging guidelines, fellowship training and education, and procedural outcomes compared to those of surgical specialties. Our primary research question is: “Should interventionalists be performing decompression and fusion procedures?”.

Findings

Advanced percutaneous spine procedures are not universally incorporated into pain fellowship curriculums. Trainees attempt to compensate for these deficiencies through industry-led training, which has been criticized for lacking central regulation. There is also a paucity of studies comparing procedural outcomes between surgeons and interventionalists for complex spine procedures, including decompression and fusion.

Summary

Pain fellowship curriculums have not kept pace with some of procedural advancements within the field. Interventionalists are also not trained to manage potential complications of spinal instrumentation and arthrodesis, which has been recognized as an essential requirement for procedural privileging. Decompression and fusion may therefore be outside the scope of an interventionalist’s practice.

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Data Availability

All cited data are available within the article or its supplementary materials. Please contact the corresponding author for further clarification on statistics cited here.

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  1. Department of Neurological Surgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA, 19107, USA

    Advith Sarikonda, Adam Leibold & Ahilan Sivaganesan

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Sarikonda, A., Leibold, A. & Sivaganesan, A. When Does Intervention End and Surgery Begin? The Role of Interventional Pain Management in the Treatment of Spine Pathology. Curr Pain Headache Rep 27, 707–717 (2023). https://doi.org/10.1007/s11916-023-01165-8

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