I think the spine field is nowadays evolving so quickly, that it is hard for any surgeon to keep up. In the last decade we have learnt so many new things about the biomechanics of the spine (i.e. spinal alignment and balance, etc.), new techniques have been developed and are being adopted broadly (i.e. TDR, MIS, lateral and prone-lateral approaches, robotics, endoscopy, etc.) that today’s spine surgeons, even if they are already experienced, need to be open-minded and be willing to adopt new surgical techniques.

This implies that, as surgeons, we need to stay humble, since none will be able to master all techniques. The best deformity surgeon will probably not be a master of endoscopy and the best MIS tubular surgeon will probably come short in pediatric deformity. So, there should be a will to collaborate and to interact with each other. At the same time there is still a lot that we do not know and understand about the spine. Therefore, we need to accept that sometimes doing less is probably going to get the best outcome for a patient.

As adopting new techniques, even on a senior level, is becoming more common, one of the best pieces of advice a colleague gave me about adopting a new surgical technique is: “at first, do it safe; then do it well; finally, do it fast.”

As a European graduate living and working outside of the USA, joining NASS is probably not the first thought one might have at hand. However, during my career, I have witnessed that knowledge and exchange, especially in the medical field, is and has always been global and knows no limits.

Joining NASS and regularly participating at the annual meetings has allowed me to keep up-to-date with the spine field and keep in contact with my American colleagues and friends, especially those who do not travel abroad often. The personal exchange with these colleagues and the industry, as well as getting their (sometimes alternate) point of view has always been enriching and has allowed me to be aware and keeping track of new developments in the spine field early-on.

One of the most important lessons I learned in my career as a spine surgeon was taught to me by father who had been trained in endoscopy by Dr. Tony Yeung. He explained to me that the key to solving most cases is finding the pain generator. As a physician, you need to use all the diagnostic tools in your hand (anamnesis, physical exploration, radiology, etc.) to precisely locate the most probable cause for the patient’s present symptoms. This is a completely different approach to the more holistic management of cases I witnessed during my residency. At the same time, in complex cases there may be several or confounding pain generators. Therefore, finding the pain generator whenever it is possible (and sometimes it is not), can be tedious and may require you to initially dedicate more time to the patient.