December 14, 2019
Advanced cervical spine surgery part 1

Advanced cervical spine surgery part 1

OSNI is in its 20th year and we’re very
specialized ortho group I’m one of the spine surgeons
And we’re gonna talk a little bit about some of these advances that have
occurred through my career. I finished in 2003 with my fellowship at RUSH in
Chicago and I’ve been here in Northwest Indiana ever since that time and there’s
a bunch of these slides to talk about the way we used to do it
there’s a lot of people that still do the way we used to do it is demonstrated
In a beautiful swallow study you That really demonstrates something with
with some of the issues with the way that spine surgery used to be done.
the big push for me when I first started was everybody would
comes into the office stating I never want a spime surgery it’s awful everybody does awful
everybody does terrible so for me when I first started it was exactly that
there an opportunity for us to go from fusions to motion preservation which is
what we’re going to talk about today and can we do these procedures and all
procedures in a more minimally invasive fashion so patients can go home on the
same day or first thing in the morning just like you see on TV and can we do
that on a routine we produce the most safe basis and so that’s basically been
the whole crux of my career is driving that and I’ve been very fortunate
able to teach that on a national and international stage and really help
drive the field forward so again when you think about spine surgery most people think long procedures high complication rate and the term I’ve
heard more and I like I came I’d clinic they took a little break so I could come
and get the talk I’ll go back to clinic I’ve heard it before I left clinic today
this morning I will hear it in the afternoon don’t let anybody operate on
your spine has anybody else for this sort of comment right okay I don’t I
don’t take offense I hope that part of the solution so the whole key to
advanced technology is that we can improve the outcome for the recovery the
recovery period and these are some of my colleagues that have also committed
their careers to doing this and so we put together this position statement
this was back in 2016 that was published in spine state basically we have broken through
this glass ceiling – all of the things that we thought would be limitations
from minimally invasive spine we’ve now blown out of the water so we’re able to
do a tremendous amount of work through these minimal incisions minimal blood
loss basically eliminating transfusions for the vast majority of all patients so again today we’re going to talk a
little bit about cervical disc replacement so the this year that
picture is called the movi see and so Moby people think about is whoever’s you
know older in the room thinks about this DJ and you know making all kinds of dis
techno electro beats and whatnot but Mobi C stands for really mobile core
so there’s a picture of this device where that the central core of the
device really flowed I need meadow metal and then that central mobile core so
this is a patient of mine she’s a nurse and she was dead set against having a
cervical fusion she wanted to maintain motion her neck she came instead look
this is exactly what I wanted this is how I want to be fixed etc everybody so
we did a two level disc replacement for the movi see with Zimmer is the only on
label two level disc release so you’re allowed to do to love them in
point of fact I the majority of the procedures I do or one level because
they feel that the majority of patients problems can really be owned down to one
level so this multi level 3 level 4 level procedures in general I think are
for the most part not indicated and really should try to be avoided at
almost all cost and even two level surgeries are much the exception than
the rule I really feel that if you really focus and listen to your patient
almost always can really isolate this to a one-level issue
so the different concepts in emotional preservation is either a metal-on-metal
replacement or metal on plastic and so there was this research I did this is
1993 I was thinking about showing a picture of why I look like 1993 so my
first name is didn’t and so when I was in college they used to state nitin hair
a lot has changed with my hair now so I’m just gonna go with it before and
after that but I did this research and looked at the plastic in the aging so
even before I was a spine surgeon when I was an engineering student in college I
had done this research in New York on this is a knee replacement on the
plastic here and what’s the best way and the best materials that could be used
for this and the study we use it the way they used to sterilize this was was with
this gamma irradiation and once they irradiated it the longer that the
plastic sat on the shelf it would start to degrade and basically I proved that
so and this was as a college student this was a very prestigious lab that I
worked in they subsequently got published in jbjs which is a very
prestigious Journal since I was a college student they left
my name off that publication because I didn’t even finished college I was still an udergrad
so they they wanted to put like MD PhD PhD MD PhD even for me they there was no
Degree yet there was nothing there was no Since I hadn’t graduated so that
was great a great experience I learned a lot but frustrating that I didn’t get my
deserved accolades at that time. I’m a huge
believer in technology so I was like one of the first guys with a Model X here at
the hospital one of the first ones in Chicago it’s something I’m very
passionate about is pushing few of the field for the iPhone the very first
iPhone that came out ahead got you know so this is where my
heart lies in engineering and really thriving technology I think that the
possibilities for spine are equally Unlimited so this is a video that I wanted
to show you that I’m glad we were able to get up here so this is what It looks with an over the top cervical plate this is sort of the common way that
people had done this historically and so there’s some research papers I wrote on
this when I was a fellow. This plating one of my mentors Dan
Riew talked about what’s called adjacent segments disease increased with the use
of this over-the-top type plating and what you can see here is the patients
Can develop these pretty severe osteophyte above this a lot of this is being felt
just by virtue of using this plate and so we’ll talk about some emerging
technologies both for the fusion standpoint and the displacements and
pointed at zero profiles so you don’t have to dissect anywhere except the disc space help decrease some of the situation
Adjacent segment disease what’s fascinating about this video and I’ll play this a couple
of times is it’s basically a swallow study I don’t know did anybody catch
that yeah so what happens is in a swallow study use it make you swallow
the die I’m gonna see if I can go slow here and what you see here is as the
diet goes forward it’s pretty thick it’s pretty thick and as it goes around this
bump you can see how narrow it is there now that’s incredible because for years
for years people have talked to me about this dysphasia after spine surgery and I was
like how could a thin plate create that much of an issue
now I am an orthopedic surgeon so I am somewhat simplistic But my
philosophy, I think it’s made as a result of soft tissue trauma the approach and so there
was different approaches but the reality is there’s a tremendous
amount of tissue that above and beyond where this
is when you operate you see that there’s almost like a ridge of soft tissue that
comes out here and that’s what’s causing this obstruction so this patient came to
see me after seeing the ENT state we need this level fix now so this guy had
a problem down here at surgery with the neurosurgeon in the area. I operated
On his lower back so he said – you fixed my lower back
please help you with this problem instead of you think so
what we’ll do is we’ll go down in here we’ll have to trim this down but then
we’ll take a 0 profile device over here so I’ll show you what we’re doing now
with this is this is a patient of mine where there was to a two-level issue
here and instead of putting this over the top plate here what we do is we
operate at the level of the disc so when I operate I make an incision here in the
front of the neck I come down I put a retractor and that shows me just this
level I’m not operating on this both head off there’s something called Caspar
Pins that surgeons use where they put a screw into this bone
then they distract that open so that they could
see the disc space so I try to avoid that the periosteum the outer covering on the
bone once you violate that the bone thinks it was fractured if you put a
screw through this so now this bone wants to heal what’s the how does the
bone heal that forms more bone right so that’s where I think part of these
issues are that people aren’t fully fully understanding with this surgery we
need so it just wants to do that I operate I literally cut the disc here at
cut the disc when you’re operating in this district so I’ve been out 16 years
now and I haven’t gone back and looked at my own but it is extraordinary for
one of my own patients to come back with a piece of adjacent disease the literature
has it adjacent segment rate up to 20 percent okay that’s I’m lucky if it’s if
mine is 1% and typically what happens to me and
they come back and have a problem about right here and then their problem is
like somewhere completely different in the moment
it’s it tends not to be that adjacent segments and it’s intuitive when you
look at this film versus that one with the plate this just looks like it’s you
know a little bit more of a natural

Leave a Reply

Your email address will not be published. Required fields are marked *