Traditional neurosurgical spine surgery allowed for decompression of compressed neural elements via laminectomies and discectomies. Rigorous training in these procedures, combined with respect for the fragility of the neural elements, led neurosurgeons to be the leaders in the field of spine surgery.

Traditional orthopaedic spine surgery allowed for fusions and instrumentation procedures for the correction of spinal deformity. As time progressed, a “turf” battle began to develop between neurological and orthopaedic surgeons. Orthopaedic surgeons began to perform decompressive procedures and neurosurgeons began to perform instrumented fusions.

As a result, neurosurgeons were faced with two alternatives: 1) learn how to perform fusions with or without instrumentation, or 2) work in conjunction with an orthopaedic surgeon who would perform these procedures, when necessary. The decision by organized neurosurgery to expand the domain of neurosurgical spine surgery has served the neurosurgical community well.

We are now faced with a new problem— “comprehensive” spine centers surfacing throughout the United States. These spine centers treat both operative and non-operative disorders of the spine. Many neurosurgeons have chosen to delegate the care of these nonoperative conditions to physiatrists, anesthesia pain specialists and orthopaedic surgeons.

New Frontiers

On March 19, 1998, Oratec Interventions, Inc. received 510(k) clearance from the Food and Drug Administration (FDA) to market a new device known as IDETTM or Intradiscal ElectroThermal Therapy. A 510(k) clearance means that this procedure is essentially similar to other procedures performed prior to 1976; it does not address the clinical efficacy of the procedure.