Early in life, I took a notion to make medicine a career as I watched my father journey through medical school, radiology residency, and private radiology practice, first in New Orleans, then Metairie, La., and finally Jupiter, Fla. Throughout his professional career, he believed enthusiastically that pioneering new procedures and publishing results was the icing on the cake of practice that kept work from descending into dull routine. He believed that research made a valuable contribution to the medical community and to public health.
He published original peer-reviewed studies on basket retrieval of retained common duct stones through T-tubes after cholecystectomy and on alcohol injection of renal and hepatic cysts, among other topics. Research in practice was a way of life, whether in a National Institutes of Health-funded research lab or in a community hospital’s radiology suite.
Neurosurgical practice is no different, and in fact cries out more than ever for neurosurgeons in all modes of practice to contribute to the scientific knowledge base and to use valid research data to justify and improve decisions and procedures in everyday practice. Research is the rain that nourishes the seeds of discovery and renews and revitalizes neurosurgical practice. We must strive continuously to prove the value of what we do, as well as how to do it differently, and better.
Clinical research, or more specifically, how we as neurosurgeons incorporate research into our everyday practices, is the topic selected for this issue. The purpose is to examine how we find, use and add to neurosurgery’s research knowledge repository. The development and dissemination of neurosurgical tools has never been faster, but that growth comes at a price. The price is organized criticism and analysis of our assumptions, our practice, and the ideas and recommendations of our colleagues. We have to overcome the inertia of habit and seek better ideas, with the question perpetually before us, Am I perhaps mistaken; is there not a better way?
For example, endovascular treatment of carotid stenosis is an alternative treatment to carotid endarterectomy. We must seek proof as to whether endovascular treatment offers true advantages over surgical treatment, and learn when it should be used. And we must train to use the method that is proven better.
Internal stabilization can relieve the pain of lumbar instability. We must learn what procedure works better, demonstrate when it is needed, and prove the belief with valid clinical data. The absence of valid outcome studies leaves us vulnerable, not only to criticism for performing unnecessary surgery, but also to denial of care when it is needed, based on invalid but unrefuted data. The Spinal Patient Outcomes Research Trial (SPORT) discussed in this issue illustrates the need for routine prospective studies validating routine clinical care in all areas and subspecialty interests, rather than reacting to other studies of debatable design and questionable conclusions that threaten clinical practice.
Proof is a fundamental justification that we all too commonly neglect. We rely on our experience, on word of mouth, on imitation, and on authoritative pronouncement. It is the easy and fast way. But today’s technological complexity and pace of change requires more. We must seek, whenever possible, unbiased clinical data, and when it is lacking, design and create it ourselves.
In this issue of the Bulletin, we catch a glimpse of research in many of its permutations and how it reaches and affects neurosurgeons in practice. Here we examine the role the American Association of Neurological Surgeons (AANS) plays in promoting research, both basic and clinical, in encouraging translation of bench research to bedside care, and in bringing practical applications and techniques to practicing neurosurgeons.
Research is not just an academic exercise or a scholar’s responsibility. It is our glimpse into the future, our guide to the present and our legacy from the past. With this issue, we hope to tell not just the story of research in practice, but to rekindle interest and enthusiasm for participating in clinical research in every neurosurgeon’s professional life.
James R. Bean, MD, is associate editor of the Bulletin and chair of the AANS/CNS Washington Committee. He is in private practice in Lexington, Ky.