[ NEWS - SPINE ] decade work exceptionally well !” stated Dr . Daniels .
“ Patients may not understand that the most modern implants may actually have higher risk of failure as they are not tried and true tested with long term safety . There have been products lauded as the latest and greatest implants which were launched and failed such as ACDF plates with failing locking mechanisms and expandable cages which collapse over time . The latest implants are not always the greatest !”
And Think Community Hospitals Don ’ t Have the Latest Technologies …
“ Furthermore , patients were not comfortable undergoing surgery in community hospitals and receiving care by physician extenders . Patients should be educated that community hospitals , especially ones with spine centers , can provide excellent care in spine surgery and may actually be better places to go for routine spinal surgery compared to major academic centers . Physician extenders are an essential part of almost all surgical teams , and often are able to spend more time with patients compared to busy surgeons .”
“ Finally , patients wishing to save money felt that they were willing to convert postoperative visits to telehealth and forgo neuromonitoring . Spinal deformity patients must get X-rays postoperatively to monitor for devastating complications which can lead to paralysis such as proximal junctional failure , and neuromonitoring is essential for patient safety in many spinal surgery types . Forgoing these essential steps places them at risk of catastrophic complications .”
“ Spine surgery patients have a poor understanding of which cost saving measures may impact their safety and surgical outcome . We need education , education , and more education . Patients must be educated regarding spine surgical risks and which components of care are essential for an optimal outcome .” — EH
Anterior Spine Surgery Debate – Is It Over ?
Want to rile up spine surgeons ? Then say something against the anterior approach .
Which the venerable and esteemed Juan Uribe , M . D ., Chief , Spinal Disorders , Sonntag Chair of Spine Research and Vice Chair , Neurosurgery at the Barrow Neurological Institute in Phoenix did in a recent LinkedIn post .
Dr . Uribe wrote : 5 things I hate about ALIF 😡 and then listed them , including a bonus point :
1 . Risk of major vascular injury 2 . Risk of retrograde ejaculation
3 . Difficulty on revision cases due to scar around the major vessels
4 . No possibility of direct neural decompression 5 . Risk of sympathetic dysfunction ( Hot / Cold legs )
Bonus : In the U . S ., routinely relying on an access surgeon to perform the approach 😩
WOW , was there ever a reaction … starting with the Chief of Spine Surgery , The Warren Alpert Medical School of Brown University , the equally esteemed and venerable Alan Daniels , M . D ., who responded saying :
• best approach for restoration or lordotic apex / physiologic lordosis
• low complication rates when done by experienced ALIF team
And Dr . Daniels added : “ All approaches have benefits and downsides . Vessel injury and retrograde ejac rate is low in high volume ALIF centers . Sympathetic issues are a definite downside , similar to thigh numbness / quad weakness in lateral fusion .”
Simon Sandler , M . D ., Ralph Mobbs , M . D . and Stephen Hochschuler , M . D . immediately chimed in — supporting ALIF .
Then the dam broke . Responses poured in from all over the globe .
Here they are , in rough chronological order . It ’ s interesting reading . ( See table on page 20 .)
Fittingly and finally , a patient chimed in . Shawn Palmer , M . D ., hip and knee surgeon at the University of Chicago Pritzker School of Medicine and a former anterior spine surgery patient , said , “ I have one of those . Fifteen years out and love it . My back is the only thing that doesn ’ t hurt in the morning .”
Thanks to all of these remarkable surgeons for their timely , thoughtful , and thought-provoking comments . — RRY
5 things I love about ALIF :
• highest fusion rate at L5 / S1 ( challenging fusion level )
• best approach for restoration of foraminal height
• best approach for big lordosis correction
Source : Andrew Huth and RRY Publications
19 - RYORTHO . COM