The importance of being a spinal neurosurgeon: evaluation of spinal surgery in Belgium between 2000 and 2005 and the creation of the Belgian Neurosurgical Spine Society.

BACKGROUND: As the scope of neurosurgical spinal operations has broadened widely, spinal neurosurgery is certainly the one of the fields of neurosurgery where the most changes are observed. Increasing health costs and an aging population will make this issue even more crucial in the future. METHODS: We reviewed the number of spinal procedures performed by neurosurgeons in Belgium between 2000 and 2005. During this period, the number of lumbar spinal operations for degenerative spinal diseases has increased by 20%, reaching more than 23,000 operations per year, among which 77% were decompressive surgeries, 43% posterior fusions, and 50% anterior fusions, all done by neurosurgeons. The neurosurgical prevalence is even more striking in cervical or intradural procedures. CONCLUSION: As a result we created a neurosurgical spine society to represent neurosurgeons who were otherwise almost absent from the political decision-making processes. These observations, not unique to Belgium, should encourage colleagues to play a pivotal role in all spine-related discussions with healthcare providers, state or private, to get involved in teaching spinal surgery, and to participate in clinical and laboratory research leading to the publications that are essential to put forward the contribution of neurosurgeons in spinal surgery.

Uncommon magnetic resonance imaging observation of lumbar subdural hematoma with cranial origin.

A patient with a history of pain, paresthesias, and weakness in both legs is reported. Magnetic resonance imaging (MRI) of the lumbar spine demonstrated subacute subdural hematoma. Brain MRI obtained 1 day later because of progressive headache showed hemorrhagic cortical metastasis and extensive subdural hematoma. It is hypothesized that the lumbar hematoma originated from the intracranial bleeding, which was substantiated by the observation of a thin hemorrhagic collection connecting cranial and lumbar hematomas on MRI. Cranial origin should be included in the differential diagnosis of spontaneous spinal subdural hematomas.