Orthopaedic surgeons Competent to perform Spine Surgery- Doctors now look forward to NMC Gazette

New Delhi: After the recent clarification issued by the Ethics and Medical Registration Board (EMRB) of the National Medical Commission (NMC) specifying that both Orthopedic surgeons and Neurosurgeons are competent to perform Spine Surgery, the doctors are looking forward to a Gazette issued by the Commission in this regard.

Medical Dialogues had earlier reported that recently writing to Dr H.S.Chhabra, the Director of the Department of Spine & Rehabilitation Centre of Sri Balaji Action Medical Institute, NMC Ethics Board clarified "that both the Orthopedic Surgeons and Neurosurgeons are competent to perform spine surgeries. In addition, spine Surgeons can also do the spine surgeries."

This comes in the wake of a lack of clear guidelines on who can perform spine surgeries, creating confusion among the concerned surgeons. 

Confusion Regarding Competency of Orthopaedic Surgeons to Perform Spine Surgeries: 

Explaining that this confusion has been going on for more than a decade, Dr H.S.Chhabra pointed out that in February 2013, some of the members of the Association of Spine Surgeons of India had brought to notice a decision by the State of Karnataka against the eligibility of Orthopaedic Surgeons to perform Spine Surgeries.

Under the Vajpayee Arogyashree Scheme, while rejecting the authorization of the treatment of the patient at Bhagwan Mahavir Jain Hospital, the letter dated 26.02.13 mentioned the reason, "As per VAS norms, doctors with MCH (Neurosurgery) / DNB (Neurosurgery) are only entitled to perform the Spinal surgeries. Doctors with MS (Orthopedics) are not entitled to perform the spinal surgeries at present".

"Spine surgeries have long been done proficiently by Orthopedicians as well as Neurosurgeons. They are equally qualified & competent to perform spine surgery. The curriculum for training in Orthopedics and Neurosurgery incorporates medical & surgical management of all spinal ailments. Dedicated Spine Surgery has emerged but has a long way to go before it spreads to all parts of the country. The public in general and some government agencies in particular, are not clear about this factual position. This had resulted in some confusion and even adverse decisions against orthopedic surgeons, merely for doing the spine surgery," Dr. Chhabra told Medical Dialogues.

To dispel any confusion in the minds of the patients, doctors, and the regulatory authorities, the association sought clarification from the erstwhile Medical Council of India (MCI) now NMC in 2013, on the "eligibility of orthopaedic surgeons vis-à-vis neurosurgeons to perform spine surgery".

Accordingly, the MCI Board of Governors in its meeting held in 2013 had some detailed discussions on the issue and decided that Orthopaedicians may also provide spinal care including surgery to the patients.

Suspension of Orthopedic Surgeon by Andhra Pradesh Medical Council: 

However, despite this clarification from the erstwhile MCI, this confusion continued. Andhra Pradesh Medical Council previously suspended an Orthopaedic Surgeon following alleged complications in a case of spine surgery conducted by him. The incident was also covered by the media.

The incident goes back to March 2014 when the concerned doctor performed the surgery on a patient, who suffered all limbs paralysis after the operation. APMC suspended the concerned doctor's license to practice medicine for one year with effect from June 25, 2016. Further, the hospital, where the surgery was conducted, was asked to pay a penalty of Rs 3,30,000.

"With this, an erroneous message was sent out that Orthopedic surgeons were not qualified to perform spine surgery," said Dr. Chhabra.

Request to NMC to Issue Clarification: 

Consequently, the National Medical Commission (NMC) replaced the erstwhile MCI and became the Apex Medical Body in India. Following this, the doctors urged the Commission to clarify regarding the competency of doctors to perform spine surgeries.

"Since NMC had replaced MCI we had written to them to clear this ambiguity and declare that both Orthopedic surgeons and Neurosurgeons are equally qualified and have the equivalence in terms of competence and skills to perform Spine Surgeries," Dr. Chhabra told Medical Dialogues.

As per the recent clarification issued by NMC on 15.07.2024, discussions regarding the competency of doctors performing spine surgeries were held last year on 24.11.2023 at a meeting held by the Post Graduate Medical Education Board (PGMEB) of NMC.

"The Board examined the representation of the Association of spine surgeons of India. In this regard the internal meeting was held by PGMEB on 24/11/2023 and it has been stated by the Postgraduate Medical Education Board that both the Orthopedic Surgeons and Neurosurgeons are competent to perform spine surgeries. In addition, spine Surgeons can also do the spine surgeries," NMC mentioned in the letter dated 15.07.2024 directed to Dr. H.S.Chhabra.

When asked about his reaction to the clarification issued by NMC stating that both Orthopedic surgeons and Neurosurgeons are competent to perform spine surgeries, Dr Chhabra informed that they will now request the Commission to issue a Gazette notification. 

"We now intend to request the NMC for issuing a Gazette Notification in this regard," he informed Medical Dialogues.

Also Read: Who can perform spine surgeries? NMC specifies eligibility