Forum The Importance of Being a Spinal Neurosurgeon: Evaluation of Spinal Surgery in Belgium between 2000 and 2005 and the Creation of the Belgian Neurosurgical Spine Society Patrick Fransen 1 , Bart Depreitere 2 , Alphonse Lubansu 3 , Erik Put 4 , Victor Scordidis 5 , Patrick Van Schaeybroeck 6  BACKGROUND: As the scope of neurosurgical spinal operations has broadened widely, spinal neurosurgery is certainly the one of the fields of neurosurgery where the most changes are observed. Increasing health costs and an aging population will make this issue even more crucial in the future.  METHODS: We reviewed the number of spinal proce- dures performed by neurosurgeons in Belgium between 2000 and 2005. During this period, the number of lumbar spinal operations for degenerative spinal diseases has increased by 20%, reaching more than 23,000 operations per year, among which 77% were decompressive surger- ies, 43% posterior fusions, and 50% anterior fusions, all done by neurosurgeons. The neurosurgical prevalence is even more striking in cervical or intradural procedures.  CONCLUSION: As a result we created a neurosurgical spine society to represent neurosurgeons who were otherwise almost absent from the political decision- making processes. These observations, not unique to Belgium, should encourage colleagues to play a pivotal role in all spine-related discussions with healthcare providers, state or private, to get involved in teaching spinal surgery, and to participate in clinical and labora- tory research leading to the publications that are essen- tial to put forward the contribution of neurosurgeons in spinal surgery. Peer-Review Article. INTRODUCTION There is no doubt that spinal neurosurgery is an important part of our activity. Neurosurgeons have contributed greatly to major ad- vances in spinal surgery with cornerstone publications. To illustrate that the interest of neurosurgeons for spinal matters is not new, it is worth mentioning that neurosurgeons like Cloward (3), closely fol- lowed by Dereymaeker (4), who pioneered in the late 1950s the anterior approach to the cervical spine, leading the way to the com- monly used anterior discectomy and fusion surgeries, and now to cervical disc replacement. At present, the scope of neurosurgical spinal operations has broad- ened widely, to encompass the whole range of operations from occipi- tocervical fusion to transoral dens removal and from artificial lumbar disc to pedicular fixation or surgeries for complex neuropathic pain. Percutaneous techniques, such as kyphoplasty, vertebroplasty, and per- cutaneous placement of pedicular-based instrumentation are also com- monly used by most neurosurgeons nowadays. James Ausman (1) wrote in one of his editorials that neurosurgery in the twenty-first century would be a revolution compared with neurosurgery as we know it. Spine is certainly the field of neurosurgery where these changes are the most obvious. The challenges of an aging population will also make spine surgery a major healthcare issue with a bigger economic impact on society than brain surgery. Curiously, in Belgium, and despite a well-established knowledge by the public that neurosurgeons performed spinal surgery, neuro- surgeons were often left out of decision-making groups at the Min- istry of Health or at the Social Security institutes, most of them composed of orthopedic surgeons, rehabilitation specialists, rheu- matologists, or other spine specialists. Although all neurosurgeons were convinced that we actually per- formed many procedures, we had no way to prove it and there- Key words  Belgian Neurosurgical Spine Society  Spinal Neurosurgery Abbreviations and Acronyms BNSS: Belgian Neurosurgical Spine Society 1 From the Department of Neurosurgery, Clinique du Parc Léopold, Brussels; 2 Department of Neurosurgery, Universitair Ziekenhuis Gasthuisberg, Leuven; 3 Department of Neurosurgery, Hopital Erasme, Brussels; 4 Department of Neurosurgery, Virga Jesse Ziekenhuis, Hasselt; 5 Department of Neurosurgery, Clinique Notre Dame de Grâce, Gosselies; and 6 Department of Neurosurgery, Imelda Ziekenhuis, Bonheiden, Belgium. To whom correspondence should be addressed: Patrick Fransen, M.D. [E-mail: p.fransen@neurobrussels.be] Citation: World Neurosurg. (2010) 74, 4/5:422-424. DOI: 10.1016/j.wneu.2010.03.023 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter © 2010 Elsevier Inc. All rights reserved. 422 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, DOI:10.1016/j.wneu.2010.03.023