Avicenna Technical University

This presentation by Dr. Michael Wang is an eye-opening session on current developments in the field of spine surgery. In his expertly delivered speech, Dr. Wang tackled two major points of contention within our medical community.

The first point he addressed was the misconception that spine surgeries of less efficiency, which can extend up to eight hours, are inherently safer or superior for patient outcomes. This has led to a narrative that unduly characterizes more efficient surgeons as unsafe, which is an unjust and misleading portrayal of the skill set these professionals bring to the operating room.

Dr. Wang's second point of focus was the widely held belief that larger, more extensive surgeries are preferable, even in cases of scoliosis. This assumption is often unchallenged and leads to a default bias towards more invasive procedures, without necessarily benefiting the patient.

Providing a wealth of expertise and experience, Dr. Wang presented his trans-combine approach, developed over the course of four hundred cases. He succinctly summarized the method and its benefits, emphasizing the efficiency and safety of the procedure.

Parallel to Dr. Wang's approach, our own medical practice has made significant strides. We proudly reflect on over two thousand successful occurrences of similar surgeries. Our patients experience the capability to walk in the Post-Anesthesia Care Unit (PACU), just as Dr. Wang has observed in his own practice. For the past decade, these multi-level surgeries have been a part of our routine offerings at our dedicated surgery center.

Today's presentation concludes with a compelling forecast for the future of spine surgery, a future that is rapidly unfolding before us. It's a poignant reminder, particularly for the younger generation of surgeons, that they can choose to be a vanguard of this new era or remain adherents to antiquated practices. Dr. Wang's insights underscore the importance of adopting innovative and evidence-based approaches for the betterment of our patients' health and recovery.

Listening to Dr. Wang, it is clear that progress in our field is not merely about the adoption of new techniques; it's also about the willingness to challenge old paradigms and improve upon them for the sake of patient care. The surgery community should take note of these evolving perspectives as we strive to advance patient outcomes and safety.

Case for Awake MIS TLIF for L45 Spondylolisthesis Michael Wang This presentation by Dr. Michael Wang is an eye-opening session on current developments in the field of spine surgery. In his expertly delivered speech, Dr....

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Another paper that we should not fall for fashions and applying 1 to 1 juvenile deformity parameter to degenerative ones is not justified

Conclusion
Patients who achieve and maintain PI–LL < 10 2-years postop following adult spinal deformity surgery have nearly identical SRS-22r and ODI outcomes, and comparable 2-year reoperation rates as compared to patients who have PI–LL ≥ 10.

https://link.springer.com/article/10.1007/s43390-023-00766-y

I love this light-hearted presentation of why prone lateral should be the standard of care. What I have been doing for the last 12 years ( over 1600 cases and 3400 levels) is a trans-Kambin posterior to psoas prone lateral. By all standards, it is superior to lateral or posterior approaches. We do this surgery in about 35 minutes skin to skin, 96% of the patients go home in 24hrs. We need only 2 boxes in the OR (not 7, no need for any complex retractor sets) , one set for interbody and one set for screw placement. This reduces the workload in the ORand makes the operation so much more efficient.

William Taylor Prone Lateral Is the New Standard

Many expandable cages feature complex mechanical components that are susceptible to failure and reduce internal biologic volume. The ARM Arrow cage, employed in transforaminal oblique lateral lumbar interbody fusion (OLLIF), addresses this by using the cage's shape to transition from a static to an expandable form. This is achieved by inserting the cage at a lower profile and then rotating it to its final position. This process involves specific steps, but the outcome is a robust expansion of the cage size from 9 mm to up to 15 mm

X Ray view

IMG 7615 OLLIF In Situ cage rotation x ray view

Call value of what we do is training constant improvement

https://www.beckersspine.com/spine/58091-dr-hamid-abbasi-to-introduce-ollif-procedure-in-orlando.html

Some patients indeed require a 360 cervical fusion. However, it's important to note that this significantly increases the operative time, and as we are aware, posterior cervical procedures are known for their higher infection rates.

For patients whom I believe require additional instrumentation but are at a higher risk due to factors like age, diabetes, or high BMI, I have been utilizing a double plating technique over the past few years, with very positive outcomes.

While a 360 fusion remains a good standard, especially in high-risk patients, surgeries lasting longer than 3 hours come with considerably greater risks.

I am looking forward to publishing my series next year.

The discogram of 2023 is significantly different from the discogram of 1990, as it provides much more detailed information. In cases like this one, we utilize this additional information to narrow down the number of levels that need to be addressed. While the MRI suggested a three-level disease, the symptoms did not provide clarity. The discogram allowed us to focus our attention and perform a one-level fusion instead of addressing all three levels.

What fuels my relentless dedication is the profound realization that we possess the ability to help patients for whom all hope seems lost. These patients endure journeys spanning days, just for the opportunity to come to us. When they are told that nothing can be done due to high risks, they seek our expertise. Giving them hope and option is what we do.

"Nightmare Blast from the Past"

I'm old enough to remember using these side loader screws. They were a challenge to install, and I've removed many of them. I can't even begin to describe my frustration with these screws every time I take them out. They're difficult to align at the right angle, they often strip the screwdriver, and there are all those corners that need to be freed before we can extract them. It's one of those ideas that might have seemed good on an engineer's desk but turned out to be a nightmare in real-life situations.

Some less experienced surgeons may think the reason I can perform a 3 level fusion and discharge the patient home in 3 hours is solely because of the surgery. However, they couldn't be more wrong. The surgery is only the tip of the iceberg in a whole system, and it's a team effort that delivers such results. Here, only one aspect of it, perioperative pain management, has been developed over eight years with the involvement of more than a hundred providers.

Celebrating National PA Week!

Grateful for our Physician Assistants who play a vital role in spine care. Your dedication and expertise help us keep patients moving and living their best lives. 🙌💙 "

If you are interested in actual technique of trans kambin ollif and thoracic MIS DTIF

The book is published

61 year old patient no significant myelopathy but neck pins and rip radic and weakness

What is your favorite surger if for this ?

Today is the second day we are using our in-house developed artificial intelligence in our office for documentation.
Project SURI is artificial intelligence developed by my team and it’s going to save us hundreds of thousands of dollars, It listens to me and the patient and compose the medical record within minutes. The reason you don’t see thousands of buttons is because it adjust to my needs rather than the other way.

Now this is a collection what it a good candidate for trans kambin OLLIF

What Klein said to Semmelweis regarding hand washing after cadaver lab before examining Post part um women!

The field of dreams, if you build it, they will come. When you provide the right care, patients are willing to travel to you. Today, I am performing surgery in Alexandria, MN, a city with a population of 13,000. My first patient is coming from Minneapolis, a metropolitan area with a population of millions, and the other one is traveling from Bismarck, a six-hour drive away. Patients are smarter than ever; they research and understand your value and will seek you out if you provide unique care!"

What is not a good candidate for straight trans kambin procedure with anatomic decompression:

One way or another direct decompression is needed

As a side note patient has sever dysetesia in ge***al region ! Can we explain it?

For the first time in over surgery center to perform sacroiliac joint fusion with Trident system under local MAC anesthesia specially, for elderly patient. This is a very good alternative to general anesthesia and considering the surgeries were 12 and 15 minutes to recovery is very fast.

Please join us or podcast at 2:30 PM central US time online on YouTube essence of medicine podcast and talk about one of my personal heroes of medicine Ignaz Semmelweiss, a man ahead of his time who was ridiculed for suggesting, you should wash your hand after you do cadaver lab before you go and examine the patient

All you need to know about the future :-)

Interbody and posterolateral fusion, one year after the surgery with transkambin OLLIF procedure:

We usually see interbody fusion 3 to 4 months after the surgery and in facets usually 4 to 6 months after- the so call MIS facet decorticator is used to grind the surface of the face and deposit biologics

Great day in our surgery center: 4 big fusions, all done at 2:30, by 5 o’clock All patients are discharged. It was great to have Dr. Goyal from California.

This is why your surgeon must possess the skill to accurately place pedicle screws using their expertise alone.

A 5-minute must-see video for all spine surgeons:
Presented by a prominent center with experienced surgeons.
This reputable center collected and reported the data transparently.
The re-surgery rate for misplacement stands at 2.2% (6 patients), not accounting for cases corrected during the initial surgery.
Instances of dural tears and nerve injuries are also included.

https://youtu.be/c_8QK9HWjG8

I am not a big fan of medial tomlateral approach for SIJ fusion- this was done by a local pain specialist - what is surprising is that patient is reporting 80% of the pain is gone - but it comes back when he exerts

What would you offer the patient ?

Home grown direct lateral “MIS-DLIF” same instruments as Trans kambin OLLIF - no complex retractor system, no awkward posture for surgeon, a handful of instrument is all you need. We have been doing it since 2015 whe published our paper 2017. Surgery in 30 minutes and patient discharged under two hours after surgery- her leg pain was gone - I am so happy to provide this kind of care in our own surgery center.

The best part of my day is seeing real results in my patients, and spine care as a whole. This is a message left on the Facebook of one of my employees 🤗

This such a privilege and pleasure to have a visionary and multicultural, fellow colleague, and friend drSharif with us- we did three surgeries in our surgery center yesterday and all pushing for discharge within hours, and this result can be replicated .shf