In spine care, surgeons and nonsurgical pain management physicians have had some tensions over who addresses different procedures, especially as minimally invasive procedures become more widespread.
However, interspecialty collaboration is becoming a bigger priority. William Mitchell, MD, president of the North American Spine Society, said this will be a major part of spine care in 2026.
“The biggest disruptor for spinal surgery is that numerous surgical procedures are now being requested and performed by interventionalists,” Dr. Mitchell said. “NASS represents high quality comprehensive care. We advocate for our members working together for the patient’s benefit, which often means not holding on to patients, but getting them to a provider with surgical training.”
Most recently spine and interventional pain groups endorsed or affirmed guidelines for addressing sacroiliac joint complex pain. A total of 21 organizations formally endorsed the guidelines, and The American Society of Anesthesiologists; and American Academy of Physical Medicine & Rehabilitation, and the North American Spine Society affirmed them.
Brad Sorosky, MD, a physiatrist with Phoenix-based Desert Spine & Sports Physicians, also affirmed the importance of collaboration with surgeons.
“We approach surgeon collaboration with careful consideration and mutual respect,” Dr. Sorosky said. “We believe that open dialogue and evidence-based practice create the foundation for effective collaboration. Although interdisciplinary tensions can exist across different specialities, our skill sets complement rather than compete with surgical expertise.”
However, with collaboration also comes the importance of recognizing the unique strengths between a surgeon and nonsurgical physician.
“I’ve observed through teaching injection courses that surgeons sometimes underestimate the technical complexity of our procedures,” Dr. Sorosky said. “Our training involves thousands of hours developing needle guidance skills, which represents a distinct expertise. Our collaborative philosophy centers on leveraging each specialty’s unique strengths to optimize patient outcomes. We have developed exceptional expertise in needle-based procedures, and when these interventions reach their limitations, our surgical colleagues are positioned to deliver superior results.”
And endoscopic surgical techniques are an area where some physicians feel are best-suited for surgeons to perform. In 2021, several spine and orthopedic societies published a stance warning against allowing non-spine surgeons to perform spinal arthrodesis.
“Pain physicians obviously play a critical role in the care of spine patients, but I believe endoscopy is a surgical tool with a wide breadth of applications,” Xiaofei (Sophie) Zhou, MD, said. “This can range from medial beach transections all the way to fusions with interbody placements. Because it is a surgical tool, I believe that only a fully trained surgeon (ranging between six to seven years of training depending on orthopedic or neurosurgery background) should be utilizing it. Our training in open surgery gives us an understanding of the anatomy and also the ability to choose which surgery is best suitable for a patient’s particular needs. As we all know, proper patient selection is the key to any surgical success.”
