gms | German Medical Science

Objective: The call for certified spine centers in Germany is unmistakable. Certification, however, can only be obtained by a hospital, not by a single department. Interdisciplinary teamwork of trauma/orthopedic surgeons (TOS) and neurosurgeons (NS) in the treatment of complex spine pathologies might not only be beneficial to pass the certification process but also result in better patient care.

Methods: We retrospectively analyzed the data of 74 patients undergoing an interdisciplinary operation by a NS and a TOS between 2013 and 2017 in a 700-beds-hospital certified as level 1 trauma center. Particular attention was paid to the patient distribution among the departments as well as to different pathologies, DRG points obtained, and the necessity to transfer patients to other hospitals. A major change in collaboration started with a new specialized senior TOS in April 2015.

Results: The number of interdisciplinary operations increased significantly from 2 in 2013 and 2014 to 7 in 2015, 28 in 2016 and 35 in 2017 so far. 37 patients were treated on a neurosurgical, 34 on a trauma surgery and 2 successively on both wards. Two remained in oncologic care. While in 2013 and 2014 all 4 patients were trauma cases, those constitute only 31% of all 74 cases. 37.8% of the patients had degenerative disorders, 18.9% tumors, and 12% spondylitis. Stabilized segments could be extended from only thoracolumbar to C0-S1. The average of DRG points obtained was 4.37, and with 5.68 for the trauma/orthopedic and 3.44 for the neurosurgical patients significantly higher than the departmental averages (1.275/ 1.715). In 9 cases, the operation was performed as emergency procedure. While 3 of the 4 patients treated in 2013/14 had to be transferred to other hospitals for additional procedures, in the years 2015 to 17 only 1 patient needed to be moved to a workers compensation hospital while 8 had secondary surgery to obtain 360 degree fusion in our own hospital.

Conclusion: Interdisciplinary collaboration of TOS and NS not only resulted in a higher number of treated patients but also in a wider spectrum of operations performed, improving the chances for single surgeons of both specialties to qualify as a spine surgeon and therefore enable the hospital to pass the certification process as a spine center. More importantly, however, much more complex procedures could be offered to our patients, avoiding loss of time in emergency cases as well as a stressful transfer to distant hospitals.