A Commentary on “Establishing a Standardized Fellowship Curriculum for Advanced Minimally Invasive Spine Interventions: A Multidisciplinary Approach to Training and Competency”
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The paper by Oh et al. [1] proposing a standardized fellowship curriculum for advanced minimally invasive spine interventions (MISI) brings timely attention to a rapidly evolving field that transcends traditional specialty boundaries. As a practicing surgeon in South Korea, I find the vision compelling, particularly in light of how spine care is shaped differently across national and professional contexts.
In Korea, there is already considerable procedural overlap among general practitioners, anesthesiologists, physiatrists, neurologists, orthopedic surgeons, and neurosurgeons. A wide range of interventional procedures—including spinal injections, radiofrequency treatments, epidural adhesiolysis, endoscopic rhizotomy, vertebroplasty, kyphoplasty, spinal cord stimulation—are commonly performed across various medical specialties. Notably, Korean surgeons, traditionally associated with operative treatment, are showing increasing interest in nonoperative and interventional techniques. Conversely, a minority of pain physicians are venturing into more invasive territory, including endoscopic discectomy. However, compared to the United States, where some pain physicians are actively pursuing operative privileges such as sacroiliac joint fusion and interspinous spacer insertion, the Korean environment remains more compartmentalized in terms of institutional and cultural expectations.
This contrast underscores an important point: the way pain and spine interventions evolve is not solely a matter of scientific advancement or technological readiness—it is deeply contextual. Educational pathways, professional identity, medicolegal boundaries, and patient expectations all shape the scope of practice. The proposed MISI fellowship program recognizes this complexity and offers a potential solution: a standardized, multidisciplinary training framework grounded in anatomy, physiology, biomechanics, risk management, and psychiatry, applicable to both surgical and nonsurgical practitioners.
But standardization alone will not suffice. As emphasized in the paper, meaningful collaboration demands a shared scientific foundation and open communication. This is particularly vital in fields where treatment goals converge—ultimately, we all aim to relieve patient suffering and restore function. To achieve this, mutual respect and understanding must be fostered not only through joint clinical practice but also through shared education. Interdisciplinary fellowships, cadaver labs, and rotations across departments are more than checkboxes— they are cultural bridges [2,3].
From a global perspective, the diversity in training pathways should not be seen as a barrier but as a source of innovation [4]. Differences between countries—whether in reimbursement policies, procedural privileges, or academic emphasis—can inform the refinement of a truly adaptable curriculum. It is precisely because spine care is so interdisciplinary and variably defined that we need unifying frameworks like the one proposed [5].
Ultimately, the MISI fellowship curriculum is not just a blueprint for technical training—it is a call for convergence. A call to move beyond silos, to learn from one another, and to recognize that the best care emerges not from any one specialty, but from collaboration grounded in shared knowledge and mutual purpose.
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Conflict of Interest
The author has nothing to disclose.