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Lessons Learned from 27 Years Experience and Focus Operating on Symptomatic Conditions of the Spine under Local Anesthesia: The Role and Future of Endoscopic Spine Surgery as a “Disruptive Technique” for Evidenced Based Medicine

The Practice of Medicine will always be an Art, based on science, but rigid concepts in medicine, judged by key opinion leaders with emphasis on scientific publications, are affecting the medical literature through strict adherence to Cochrane criteria and “evidence based” concepts in order to be accepted for publication and reimbursement. Payers of Insurance re-imbursement does not recognize expert opinion but requires methods proven with level I or 2 evidence based studies [1]. Even if the result is warranted, insurance reimbursement to honor contracts that does not meet the arbitrary criteria of the insurance carrier needs reform. The ability of level five expert EBM opinions to get information to the scientific audience can also be difficult for most researchers because they either need institutional or NIH funding, or must pay publishing fees to get their work published by open access Journals. The best level I studies are sometimes ignored when the business of spine adversely determines the procedure’s ultimate fate. Chymopapain is one such example