Neurosurgery Case Review

We are looking for speakers for following topics for October Kambin Society Meeting Oct 16, 9:30 -11 PM central US standard time

1. History of TransKambin Approach and Anatomy

2. Spine spinal fusion and economy

3. TransKambin Endoscopy

4. TransKambin Fusion - OLLIF

5. TransKambin Fusion for Spondylolisthesis and Deformity

6. Barrier to Adoption and Objection to TransKambin Fusion, (Subsidization, Lordosis, Fusion and the Adequacy of Discectomy)

7. Intraoperative Neuromonitoring for TransKambin Approach

8. Percutaneous Facet Fusion and Percutaneous Screw Placement

9. OLLIF Perioperative Pain Management

10. Artificial Intelligence in Spine Practice

Please signup and submit on KambinSociety.org

*Quote of the Day: "Please do a bowel protocol."** (for cause a equina)

This quote comes from an insurance provider who suggests a bowel protocol for a patient with cauda equina syndrome. Additionally, the same person stated that there is no way a safe surgery can be done for someone over 50. More importantly, look at this picture today. The same insurance provider, and I do believe there is a reason they work for insurance instead of in a hospital, suggested spinal injections for a patient with grade two spondylolisthesis, which is mobile. What is your experience in this area?

Not every case is suited for Minimally Invasive Surgery (MIS), and it's crucial for spine surgeons to have expertise in both traditional and MIS techniques. Kudos to Dr. Sunny Kim for an outstanding job and correction for this patient, where MIS was not an option. Excellent work

TikTok · Hamid R Abbasi Check out Hamid R Abbasi’s video.

We all have seen it 😊

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What is trans Kambin ollif?

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🇺🇸 This is one of the best speeches any politician has ever given, rivaling even the Gettysburg Address. It perfectly crystallizes where we draw our strength as a nation. Our greatness isn't by default; it's a decision. We chose to be a home for anyone in need. That's why we should be proud to be American. Unlike other countries, anyone can become an American and contribute to our strength.

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If you frequently perform minimally invasive percutaneous screw placements, this new paper is a must-read for you. 📄

It delves into the nuances of energy dissipation and how it affects neuromonitoring thresholds during percutaneous screw placements. The research highlights the differences between these minimally invasive techniques and traditional open screw placements, providing valuable insights into the corresponding

Screw Stimulation Thresholds for Neuromonitoring in Minimally Invasive Oblique Lateral Lumbar Interbody Fusion (OLLIF): A Correlational Study Introduction: This study presents findings from an investigation into the correlation of neuromonitoring techniques in minimally invasive lumbar fusions and their open counterparts regarding acceptable thresholds for screw stimulation. The threshold for acceptable stimulation value for open surgery....

Over engineering is a problem in medicine

TikTok · Hamid R Abbasi Check out Hamid R Abbasi’s video.

The so-called review process is abused, overused manipulated, and just turned to another tool in a hand of devious people

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Courtesy of Dr Parsa - trans Kambin approach can be used in very smart and inventive ways

Great job

50 year old diabetic with severe discitis and osteomyelitis. Abscess extending into ALL. Nothing posteriorly into canal. Patient was in severe axial back pain with bilateral L5 radiculopathy and not responding to IV antibiotics (progressive worsening on imaging and clinically).

Opted for Transkamnin approach to drain abscess and place antibiotic impregnated beads with continued IV antibiotics for 4-6 weeks. Symptoms of radiculopathy mostly improved. Brought back and from same approach, placed the hardware to restore height, stabilize and relieve pressure on exiting nerve roots. Just like all other OLLIF approaches, patient was up and moving same day. Discharged within 23 hours. He is now 5 months post op. One of the happiest patients I’ve had.

🔍 Advancing Medical Training with Innovative Approaches 🔍

The future of any technology depends on the proper education and training of the young generation. This is especially true for the TransKambin OLLIF approach, which requires structured and comprehensive training. It’s not something that can be mastered in a weekend course.

The training process involves cadaver labs, which can be quite costly. Therefore, I'm excited to share my recent talk with colleagues in India about using a porcine model for OLLIF training. The porcine model is not only significantly more affordable but also provides the necessary haptic feedback for performing this surgery effectively.


Watch the full presentation and learn more about this innovative training approach!

Abbasi Presentation Porcine model for OLLIF training Stavya Spine workshop 2024 07 13 23 04 06 🔍 Advancing Medical Training with Innovative Approaches 🔍The future of any technology depends on the proper education and training of the young generation....

I am asked why universities are not performing and teaching and training the residents for trans Kambin OLLIF

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Galileo's discoveries were groundbreaking. He observed that Jupiter has its own moons orbiting around it, and that Venus, like our Moon, has phases. These observations provided strong support for Copernicus' revolutionary idea that Earth is not the center of the solar system or the universe.

However, Galileo's findings challenged the prevailing geocentric view and faced fierce opposition. His opponents accused him of heresy, making his life a living hell. Despite this, his contributions laid the foundation for modern astronomy and changed our understanding of the cosmos forever.

**Patient Safety: A Critical Discussion - When chat GPT is smarter than the "DUDE" in the hospital.**

Have you ever heard someone in a hospital justify their actions by claiming it was for patient safety? It's a term often cited in the U.S. healthcare system, but how frequently is it used to disguise less noble deeds? This prompted me to delve into what truly constitutes a patient safety issue.

It's not enough for someone to declare an action, surgeon, or procedure safe or unsafe. Upon closer examination, the flaws in their reasoning often become apparent. So, what defines patient safety, and how do we measure it?

In my quest for clarity, I turned to CHAT-GPT. Despite any reservations I might have about this tool, its ability to sift through vast amounts of data and provide a concise summary is undeniable. It confirmed that the patient safety metrics it provided are indeed reliable.

Let's discuss these metrics and understand what makes a healthcare action genuinely safe. Join the conversation and share your thoughts on patient safety standards. So if anybody says the word patient safety but cannot back it up by the following, you know they are being disingenuine.



Safety metrics in surgery are measurable indicators used to evaluate the safety, quality, and effectiveness of surgical procedures. These metrics help in identifying areas for improvement and ensuring patient safety. Key safety metrics in surgery include:

1. **Surgical Site Infection (SSI) Rate:**
- The percentage of patients who develop infections at the surgical site within a specified time frame post-surgery.

2. **Mortality Rate:**
- The percentage of patients who die as a result of surgical procedures or related complications within a certain period.

3. **Readmission Rate:**
- The percentage of patients who are readmitted to the hospital within a specific period after surgery due to complications or issues related to the initial procedure.

4. **Reoperation Rate:**
- The percentage of patients who require a second surgery due to complications or issues arising from the initial procedure.

5. **Adverse Event Rate:**
- The percentage of patients experiencing adverse events such as blood clots, pulmonary embolism, or cardiac events during or after surgery.

6. **Length of Stay (LOS):**
- The average duration of hospital stay for patients undergoing specific surgical procedures. Shorter stays often indicate fewer complications and faster recovery.

7. **Patient Satisfaction:**
- Surveys and feedback from patients regarding their experience, including pain management, communication, and overall care quality.

8. **Return to Operating Room (ROR):**
- The percentage of patients who need to return to the operating room for unplanned procedures related to complications from the initial surgery.

9. **Blood Transfusion Rate:**
- The percentage of patients requiring blood transfusions during or after surgery, indicating blood loss management.

10. **Postoperative Complications Rate:**
- The percentage of patients experiencing complications such as infections, deep vein thrombosis (DVT), or respiratory issues within a specified period after surgery.

11. **Compliance with Surgical Safety Checklists:**
- The percentage of surgical procedures that adhere to standardized safety checklists, such as the WHO Surgical Safety Checklist.

12. **Neurological Complication Rate:**
- The percentage of patients experiencing neurological complications, such as nerve damage or stroke, during or after surgery.

13. **Vascular Injury Rate:**
- The percentage of patients experiencing vascular injuries during surgery, including major blood vessel damage.

14. **Anesthesia-Related Complications:**
- The percentage of patients experiencing complications related to anesthesia administration, such as allergic reactions or respiratory issues.

15. **Wound Dehiscence Rate:**
- The percentage of patients experiencing wound dehiscence, where the surgical incision reopens after closure.

16. **Patient Falls:**
- The incidence of patient falls during the hospital stay, which can be indicative of issues with postoperative care and mobility management.

These safety metrics help healthcare providers monitor and improve surgical practices, ensuring better patient outcomes and reducing the risk of complications.

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Physiologic/ anatomic decompression

Admitting it or not, every surgeon who performs ACDF must have benefited from so-called indirect decompression. Yet, in my belief, there is nothing indirect about restoring a patient’s anatomy and physiologically decompressing the neural structure by restoring the patient’s anatomy to a time when they did not have clinical symptoms. Often, complete restoration is not even necessary, and as they say, the enemy of good is better—sometimes trying to make the picture look perfect backfires.

This anatomic restoration, as demonstrated in this picture, often provides the most advantageous risk versus benefit for the patient. These patients often are discharged the same day. The pictures are courtesy of Dr. Gasco, and I’m also providing a link to the paper we published a few years ago.

JAIME GASCO MD FAANS FEBNS

Sometimes, when you’re in the grind of healthcare and you feel like giving up, the universe throws you a bone and reminds you that what you do has meaning. A patient recently sent me a video expressing his gratitude. When I told him that he made my day, he responded by saying I made his week, his month, his year, and that I gave him his life back.

He can feel again, and that is the best present a surgeon can receive. Despite all the hardships and challenges we face, what we do is worth doing.

TikTok · Hamid R Abbasi Check out Hamid R Abbasi’s video.

I recently had the opportunity to perform a Transkambin OLLIF procedure on an elderly patient last Friday. The patient was discharged in under 23 hours in excellent condition. This isn't my first Transkambin OLLIF case, and I'm pleased to see many in our group, including Dr. Gasco, achieving similar success with this procedure.

What's noteworthy about this particular surgery is that the patient lost less than 60 cc of blood, and the entire procedure took barely 50 minutes. The profile and recovery of this surgery are significantly different from anterior-posterior surgeries. The key to mastering this technique lies in performing 40 to 60 cases from L1 to L5 to become familiar with the procedure.

**Upcoming Webinar and Hands-On Conference**

Dear friends,

I am excited to announce an upcoming webinar and hands-on conference. If you have the time, please join us. I will be giving a talk on using a porcine model for minimally invasive spine hands-on training and lab, as well as providing an update on the operative results of the TransCambin OLLIF approach for spinal fusion.

**Conference Details:**
- **Location:** Ahmedabad, India
- **Date & Time:** My talk is scheduled for 9:20 to 9:35 IST (10:50 PM to 11:05 PM Central Time, U.S.)

We will update you with details on how to join and participate in the conference.

Looking forward to your presence and a fruitful discussion!

Join Us for the Inspired Spine Case Conference

Dear friends,

Every first Saturday of the month, from 10 to 11 a.m. Central Time, U.S., we host the Inspired Spine Case Conference where we discuss complex cases. Tomorrow, we will be discussing the risk of neuritis following the TransCambin approach.

Please join us by following the link to our Zoom meeting.

UPDATE - this months meeting is moved though to 13th of July ( second Saturday because of 4th of July holiday weekend )

Looking forward to a productive and insightful session!

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**Clarifying Nomenclature in Spinal Surgery Techniques**

To clarify the nomenclature, I prefer using anatomical descriptions for procedures rather than attaching our names to procedures. In this regard, I advocate for the terms **Oblique Lateral Posterior Lumbar Interbody Fusion (OLLIF)** for Transkambin posterior fusion in the prone position, and **OLIF-ATP (Oblique Lateral Lumbar Interbody Fusion Anterior to Psoas)** for the anterior oblique approach in the lateral position.

Using these descriptive methodologies, OLIF-ATP and OLLIF, provides clearer, more precise communication within our field and enhances understanding of the techniques involved.

Vikings were originally from Persia? I did not see that coming.

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Today was a special day for our team, not just because we performed our version of prone lateral - MIS-DLIF on a grade 3 L5-S1 spondylolisthesis on an 80 y/o patient under one hour but because we accomplished so much more.

✅ Three trans Kambin fusion completed before noon.
✅ Patients traveled from other states to our small hospital in Minnesota for their surgeries.
✅ We provided a critical service that cannot be done in any other way

Our 80-year-old patient had no other surgical options available, making our work all the more meaningful. It's days like today that remind us why we do what we do. 💪