Mr. Deb Pal
Consultant Neurosurgeon
MBBS FRCS (Edin) FRCS (SN)

My Approach to Spinal Surgery

In the UK fully trained Spinal Surgeons may either be of Orthopaedic or Neurosurgical background with comprehensive training in all aspects of spinal surgery. A spinal fellowship programme at the end of one’s specialist registrar training is mandatory. With a growing elderly population, more and more patients with spinal conditions are being referred and it is important that they and others select the surgeon who is fully trained in all aspects of spinal surgery.

For me spinal surgery became of interest during my neurosurgical training as well as during my spine fellowship at Nottingham when I trained under some excellent surgeons to gather this interest. As a consultant spinal surgeon in Leeds since 2009, I have established my practice with special interest in certain areas of spinal surgery including minimally invasive procedures for cervical and lumbar degenerative spine, revision lumbar surgery, lateral access surgery as well as surgery for thoracic disc herniation. The latter is one the most challenging procedures in spinal surgery that is undertaken by selective few surgeons in spinal units. Leeds teaching hospital is one of the very few spinal units in the country where this procedure is performed without removing the rib through the chest. Myself and a colleague have been performing this for the last decade with very satisfactory outcomes.

In general spinal surgery is something the patient chooses to have and it is not always essential. Pain is a very disabling symptom and different people react to it differently. What is important is to be aware is that the vast majority of patients improve with conservative measures and that surgery is NOT necessary. Surgery is always the last resort in my practice and I would always try to screen the patients who will not require surgery. As a surgeon, patient selection is vital for the best outcome. When conservative measures have failed, surgery is offered to those patients whose clinical symptoms and radiological findings correlate.

One of the few conditions where early surgical intervention is mandatory and can reverse symptoms is spinal cord compression in the neck. This is an area of interest for me and I have been involved in a lot of quality improvement projects aiming to improve patient awareness and develop a defined pathway for patients in the NHS.

As a result of advancements in spinal surgery over the last few decades, we have the benefit of some advanced minimally invasive techniques that includes lateral access surgery (which is one of my key interest), minimally invasive spinal fusion and certain procedures in the neck. Options need to be discussed with the patients regarding the pros and cons of various procedures and it is important that they understand in detail and ask questions relating to all aspects of their care.

I see a lot of patients in their 80’s or even 90’s who are symptomatic with their spinal conditions and I firmly believe that provided one is reasonably fit, age should not be the only criteria for offering life changing procedures to patients. I have operated on several patients in this age group with life changing outcomes. However, one needs to screen the patients appropriately and choose the simplest and shortest procedures that can offer a life changing outcome.

Clinical research is a key aspect of my practice. I have published more than 40 manuscripts in peer reviewed spinal journals. One of my key interest is FOOT DROP from lumbar degenerative condition. I have published extensively on this including our departmental case series, the 1st meta analysis as well as a national survey from surgeons across the country.

Safety remains the primary concern in my practice. I am proud to say that my practice is comprehensive and evidence based. Where necessary, I perform surgery jointly with colleagues to shorten surgical times and improve overall outcomes for my patients. I work with some experienced anaesthetists, excellent physiotherapists and my patients are cared for by specially trained spinal nurses.

Special clinical interests

Cervical and lumbar disc herniation and nerve compression, symptomatic thoracic disc herniation, complex spinal surgery including Degenerative adult scoliosis, Instrumented fusions, Minimally invasive spinal surgery, lateral access surgery ( XLIF) as well as revision lumbar surgery and spinal surgery in elderly.