Interview with Prof. Stefano Boriani

I Could you give our readers a rapid overview of your career?, What are the main landmarks in your education and professional path and who were your mentors?

- I started my residency in the same department I am now directing, which was at that time located in an old building in the centre of Bologna. My first mentor was a general orthopaedic surgeon, Giuseppe Catanzariti. His name is unknown abroad but his wisdom was very important for my early training. I later attended the Rizzoli Institute and graduated at the School of Medicine from the University of Bologna. I completed my thesis under the supervision of Professor Mario Campanacci: "Hemangioendothelioma of Bone" with which I graduated in 1976. This work was also published in Cancer. Ten years later I was appointed to organize the management of trauma patients in the Department of the Rizzoli Institute directed by Prof. Campanacci and mostly dedicated to the surgical treatment of bone turnouts. Traditionally, each staff member had to investigate a specific field to evaluate the outcomes and promote improving techniques. Under Prof. Campanacci, I studied spine tumours, which at that time were

treated without specific commitments to oncologic criteria. I began to study this topic and met all the pioneers of this surgery: Bertil Stener, Rene Louis, Raymond Roy-Camille. In the late eighties, I met a young collaborator of Prof. Roy- Camille, starting with him a very a close relationship to learn the techniques of en bloc resection in the spine. The name of this friend is Christian Mazel. I used to hop on a plane early in the morning, to arrive in Paris, and then at La Piti6-Salp6triere Hospital; there, I attended the vertebrectomy with Christian, and was back to Bologna late at night... Finally we succeeded to perform the first vertebrectomy at the Rizzoli Institute in October 1991. In the following years I had the opportunity to meet James Weinstein with whom a project was launched to set up a system improving staging and surgical indications for primary bone tumours; it was designed to help make wise choices and perform the appropriate surgery:

no t too aggressive, no t too t imid.

This orientation was confirmed by what Prof. Campanacci taught us: all the decisions must be patient-centred, decisions and treatment must be a team work knowledge must be shared through close international relationships. I served at the Rizzoli Institute

till 1995, then for one year, I was the head of a spine department in Pietra Ligure, near the French border, on the coast of Liguria, and finally was appointed director of the department of orthopaedics at Ospedale Maggiore in Bologna, where I am still serving.

This is the hub of the trauma system and I was appointed the role to establish the treatment of spinal and pelvic fractures. Many polytrauma patients arrive from the highways around Bologna and the helicopter is working day and night! In the last ten years we have treated about one thousand spinal fractures, while the activity on bone tumours is still going on [with an average of 70 to 90 new cases each year) and this remains my preferred activity. I had the great chance to gather a number of excellent young collaborators, who have now reached the same level of surgical skills as mine, a team of dedicated nurses who have a passion for their work and a multidisciplinary group of specialists whose collaboration is essential to perform this kind of surgery. The neuroradiologist, Luigi Simonetti, is definitely the most important one for a safer and better surgery. Therefore our current working method demonstrates that in order to get good results a team approach is mandatory.

I Do you think that spine surgery should become a non-speciality (or independent speciality)?

8 Arc )oC.p lne N e v v s & J o u r n a l N~ January 2008

Spine surgery requires multidisciplinary knowledge. I think that it must be considered an independent speciality and spine surgeons should specifically have completed combined orthopaedic and neurosurgical training.

I How close is the collaboration between orthopaedics and neurosurgeons in Italy?

- I have excellent human and professional relationships with many neurosurgeons. Neurosurgeons represent the majority of the attendees at the meetings I organize. It is difficult to generalize, but I feel that among the present generation there are quite less prejudices between neurosurgeons and orthopaedic surgeons. We must remark that less and less orthopaedic surgeons work on the Spine: it seems that joint replacements and arthroscopies are considered more attractive and less risky.

I The early detection and consequent management of postoperative/surgical complications is essential to avoid deleterious outcomes: how are junior

doctors prepared and trained in your department to deal with complications? - Every morning all the staff meets in our department at 7:30 and all new cases are discussed together with post-operative reports and problems. An open discussion allows to improve the knowledge of possible evolutions and solutions. Younger doctors can express their doubts, and different views are being debated. Each senior surgeon has the responsibility to train younger doctors in specific fields. On that subject, I think that the words of Francesco Delitala, director of the Rizzoli Institute 60 years ago, are still valid:

~{~-Scientific, honest, quiet criticism is needed to prevent further mistakes ~,~

Mistakes are the product of a series of factors, which sometimes remain unnoticed with a superficial examination of the clinical adverse event: if we do not succeed in understanding exactly the cascade of events, it can happen again. 1.1

INTERVIEW BY NATHALIE RICHARD AND DENIS KAECH

A r Q o S p l n e N e w - , & J o u r n e l N~ January 2008 C~