Non - traumatic atlantoaxial rotatory subluxation

Figure 2: 3D-computed tomography (CT) scan showing right rotatory atlanto-axial subluxation without any increase in the atlanto-dental distance confirming the diagnosis of Fielding’s type-I atlantoaxial rotatory subluxation. smaller centers. This leads to undue concentration of neurosurgeons in a few centers, where facilities are available, leading to less and less of neurosurgical work for individual neurosurgeons and frustration among the younger neurosurgeons. This has to be tackled in two ways: i) The National body like the Neurological Society of India (NSI) must take charge in identifying the likely vacancies in a year in the Neurosurgery Posts in various Hospitals, both Teaching and non-teaching and suggest to various teaching Hospitals on the intake of candidates in a particular year based on the likely vacancies. The number may be based on likely vacancies in existing institutions and new opportunities likely to arise in new institutions with Neurosurgical facilities. This may sound utopian, but can be implemented with some effort. ii) The Teaching Hospitals must provide for a mandatory period of after-qualification training for all Neurosurgical Postgraduates trained by them. This may mitigate the unemployment and under-employment to some extent and also allow young Neurosurgeons gain more experience and confidence. As for the second point, the NSI and the Medical Council of India must coordinate and see that the minimum standards are kept up in the Teaching Hospitals approved for Neurosurgical Training. They must do periodic surprise inspections in such Institutions and withdraw recognition of the Institutions if there is a shortcoming. The training must include opportunities to familiarize with operating microscope, endoscope, stereotaxy and training in one or more subspecialities. The minimum standards must be based on the standards available at the Central Institutes like AIIMS, PGI, etc. Private institutions offering Neurosurgical training (for DNB program), must be supervised by NSI and NBE and minimum standards must be same as Teaching Hospitals as mentioned. For this NSI must have a subcommittee to coordinate with MCI and NBE. Regarding the third point, it is a real truth that the majority of Neurosurgical trainees in non-teaching Private Hospitals approved by the NBE do not get adequate practical experience because of the natural limitations of Private Medical Care environment. The trainees in such Institutions must be rotated through Teaching Hospitals preferably in the same city for a good period of their training. It must also be insisted by NBE that the candidates perform minimum number of independent operations under each category of Neurosurgery during their training. Finally NSI, in concurrence with the various Universities Neurosurgery Examinations throughout the country. I think we must act before it is too late. Otherwise the future may not forgive us.