Editorial

Welcome to the fourth issue of the year. Overall you will find a spinal theme to the issue, though I think there are some relevant generalisations to be drawn from the articles to all areas of practice. It is not of course purely devoted to spinal neurosurgery.

I draw your attention also to one of the review articles on hemifacial spasm.¹ Unusually – or perhaps even uniquely – it is not written by authors qualified in neurosciences, but by what might be termed lay experts. However, it has passed the peer review process and is therefore published. It may not be constructed entirely as ourselves in the profession might produce an article, but nonetheless is an education in two ways – firstly the material itself, and secondly the demonstration in the electronic age of the amount of understanding lay experts can achieve. Clearly knowledge and understanding of facts and their interpretation is not the preserve of any expert in any field.

For once, the neurosurgical environment seems quite calm, though for the United Kingdom the advent of different commissioning arrangements approaches, most notably that of commissioning of specialised services which will include most neurosurgery. I don't think anyone yet fully appreciates how these arrangements will work out. A challenge for the Society of British Neurological Surgeons is to ensure that in those areas where other specialities may challenge for influence – perhaps hegemony is too strong a term here – that it retains its voice and influence. Here, areas such as spinal surgery may become important. However much the bony or more structural elements of the spine are emphasised, there is still the central nervous system at the heart of the majority of it, and obviously intradural conditions and any other intradural surgery will remain securely within neurosciences, and specifically therefore neurosurgery. This is not to argue that multidisciplinary working is unimportant, precisely the reverse, and many of us are well used to working with other specialities – perhaps a good example is interventional radiology. Other areas that may prove to be of concern are pain services – again because there are areas which are by reason of location purely neurosurgical. After all the discussion the topic has generated, I hardly dare mention paediatrics – but in the transitional ages its easy to see two different policies arising for the same condition: one from paediatrics and one from the adult sub-speciality group. Resolving these issues will of course happen, though the process of resolution may not be completely calm.

A brief editorial – as usual, apologies to those whose articles are still online only, and I hope you enjoy the issue.

PAUL ELDRIDGE

Editor-in-Chief