Welcome to an exciting new feature for SSN. Each issue we will meet and interview a surgeon specialising in spinal surgery, taking a look at their career history and the highs and lows of life in theatre. This issue, we welcome one of our consultant editors Iona Collins, consultant orthopaedic spinal surgeon at Morriston Hospital, Swansea
OPN: As a specialist in spine surgery, could you tell us more about your experience and training background in this field?
IC: I originally trained as an orthopaedic surgeon, which I feel gave me a good biomechanical foundation on which to build my understanding of spinal problems. I’ve learned that many degenerative spinal problems can be helped by understanding the biomechanics of spinal degeneration and applying these concepts to rehabilitation exercises. This means that people who suffer with spinal pain can be helped to understand the fundamental importance of good posture, which empowers them to help themselves.
OPN: What drove you to choose surgery as a career – and spinal surgery in particular?
IC: I like the tangible nature of surgery – it’s literally a hands-on approach to helping people. Most of the time, the improvements are immediately experienced by the patient and this is gratifying to witness. It’s a big responsibility to take care of people’s spines and help them to improve their quality of lives, while avoiding risk of harm. I especially enjoy watching people recover from the effects of spinal cord compression, which can be quite a dramatic functional improvement, especially when the cord compression is from advanced cancer.
My ambition to be a spinal surgeon was sparked when the wonderful Dennis Calthorpe in Derby expertly removed a sequestrated disc from my lumbar spine – I quickly recovered with no pain following the surgery; it was an amazing experience. I’ve learned the importance of spinal posture and flexibility as a patient.
OPN: What’s the best part of your job?
IC: When patients get better. It’s a humbling experience and I am grateful to the surgeons who put their efforts into training me over the years.
OPN: … and the worst?
IC: Well, the opposite! Unfortunately, surgery is not entirely risk-free and for most spinal degenerative issues, surgery really should be the last pain-management option since it is also the riskiest. In reality, surgery does not “go wrong” so much as it doesn’t always meet our expectations. This can be frustrating, especially when postoperative scans show structural improvements. I can’t over-emphasise the importance of a thoroughly informed patient-consenting process when negotiating spinal surgery for this reason.
OPN: What has been the highlight of your career so far?
IC: I am part of an initiative funded by Welsh Government to develop MRI software that calculates fracture risk in spinal metastases. The project is a collaboration between a start-up company called Osteotronix, Swansea University and ABMU Health Board. Our initial data looks promising. I hope that in the next ten years people with advanced cancer will have their spines assessed and their fracture risk per vertebra should help guide low-risk, low-cost and pain-free prophylactic treatment.
OPN: If you weren’t a spine surgeon what would you be?
IC: A frustrated spine surgeon.
OPN: What would you tell your 21-year-old self?
IC: Stay the course, it all ends well.
OPN: If you were Health Minister for the day what changes would you implement?
IC: 1. Number one, without question, would be to speed up the communication networks, starting with internet connections.
- I would make sure that all A&E departments are co-located with 24-hour GP services. This would mean that when people book into A&E with issues that should be dealt with by a GP, their further management can be adopted by a GP straight away, thus reducing the volume of people flowing through A&E. The remaining people who need A&E treatment should then receive treatment more quickly.
- Patients would keep their own medical records.
- The cost of medications should be known, so that when two different medications offer the same improvements, then the least expensive one should be chosen if possible.
- I would encourage trusts and health boards to adopt more flexible working times for hospital staff, especially theatre staff, who tend not to earn overtime or claim time back when operating lists over-run. The result is that operations are sometimes cancelled in order to avoid the risk of keeping theatre staff in work beyond their inflexible working shift.
- Sufficient parking spaces for patients and staff in hospitals.
- A more pro-active approach to disease prevention rather than treatment of disease. Anti-smoking campaigns, pro-exercise campaigns, increased tax on alcohol and a ban on routine use of antibiotics in livestock feed.
- Implement a fixed penalty notice for non-attendance at appointments without prior notification.
- Increase student places for medical and nursing qualifications to expand the workforce.
- Improve child health education in schools to encourage a healthier new generation.
OPN: Away from the clinic and operating theatre – what do you do to relax?
IC: Relax? I have no idea what this word means! Life is pretty full-on, with work and family life.
OPN: How do you think the future looks in the field of spine surgery?
IC: Ultimately, I wish that people would have no need of surgery, for example by earlier management of cancer so that it is less likely to spread to the spine. I would love to see children being more active at school and spending less time hunched over books with poor spinal posture. I’ve heard of some schools purchasing standing desks, which sounds like progress. For problems that require spinal surgery, such as spinal trauma causing spinal instability, I can see personalised computer-aided planning and execution of the surgery becoming the future routine. As we improve our data capture for treatment outcomes, we should be able to give more accurate information about the best treatments available.
A graduate of St Bartholomew’s Hospital Medical School, Iona is a consultant orthopaedic spinal surgeon and founding member of the NHS spinal unit at Morriston Hospital, Swansea, with research links to Swansea University. Three spinal fellowships from 2006-2008 helped train Iona in the full repertoire of spinal surgery. Iona’s current interests include developing new MRI software to calculate fracture risk in spinal cancer and developing a new website called www.fixmyspine.co.uk, which collects evidence-based information from as diverse a background as possible, in order to find evidence-based common themes that are crucial for spinal health.