You Don t Understand This Stuff???

Transcription

1 SPINE SURGERY

2 You Don t Understand This Stuff??? Welcome to the club Most PCP s don t understand what we do Half of other orthopods don t get it Sometimes we can t even explain it to each other Why would we expect you to understand this? I have absolutely no idea what this means

3 It s Not Rocket Science and (Thankfully it s NOT Brain Surgery) We REALLY do only a handful of things So, Why is this so hard? Different Patient Population Different Anatomy Different Philosophy Different Language Different Challenges

4 Different Patient Population Spine Patients are Different Need a separate degree in psychiatry Often lots of chronic pain/narcotics Sometimes secondary gain Already had a failed spine surgery Nobody can actually find the pain generator

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10 Obvious Pain Generators

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12 Not So Obvious Pain Generators

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16 Different Anatomy This is 3 dimensional anatomy that takes years to understand and perfect

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21 Different Philosophy Fusions - As opposed to one big joint that we are trying to make work better by replacing the whole thing, often times we are trying to fuse many smaller joints together so they never move again. In this way it resembles fracture surgery. Nerve Decompression Like one big ass carpal tunnel full of lots of nerves

22 Instead of molding the anatomy to fit the selection of implant sizes and choices we re much more likely to change the kind of implants and how they are being implanted than the other way around.

23 Have to remember what the goal of the surgery is. It s easy to get caught up in the thought of fixing the MRI. There s a lot of abnormal stuff out there that isn t painful or causing a problem. Fix what is broken, nothing more, nothing less. Understand you can t fix everything and that you might be back here someday.

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25 Different Language I WTF? had this patient today with spondylosis, spondylolysis, spondylolisthesis, degenerative scoliosis, central and foraminal stenosis with neurogenic claudication, and radicular symptoms. Thank God they didn t have cauda equina syndrome.

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27 Sometimes we might as well be speaking Greek. (its actually probably Latin) So what does all this mean Spondylosis Inflamatory Degerative Disease Spondylolysis a defect in the posterior elements that can cause a slip Spondylolisthesis a slippage of one bone on another

28 Stenosis Narrowing especially of the central canal or neural foramina Neurogenic Claudication Lower extremity pain brought on by activity or position change usually due to irritation on the nerves Radicular symptoms Pain radiating down an arm or leg in a particular nerve root distribution.

29 Cauda Equina Syndrome Constellation of symptoms including some or all of the following: pain, saddle anesthesia, bowel and/or bladder dysfunction due to pressure on a very specific part of the spinal cord/nerve roots.

30 Disc Herniation

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33 Stenosis

34 Spondylolisthesis

35 Degenerative Disc Disease

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37 Surgery We do A LOT of fusions. Why? How we were trained What we see We do A LOT of revisions. Why? No one else will What we see

38 What s Up With LIF s? How many are there? What s the difference? Are we just trying to make you crazy? So let s see there s the DLIF, XLIF, OLIF, TLIF, PLIF, and ALIF

39 The Difference The good news is that 2 are the same (XLIF which is a brand name and DLIF) These are a Direct Lateral Interbody Fusion Which basically means that we approach the disc space from the side The OLIF is a variation on the theme Approaching the disc space obliquely, usually slightly in front of the pelvis but still behind the gut contents

40 The PLIF and TLIF are so similar that the difference isn t even worth talking about This stands for Posterior or Transforaminal Lumbar Interbody Fusion This basically means that we approach the disc space from posteriorly

41 And lastly, ALIF is Anterior Lumbar Interbody Fusion Hopefullly it is obvious that we approach the disc space from anterior and this usually requires the services of a general surgeon for access.

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43 Interbody Cages Shape really depends on how (what direction) its being put in. Variety of materials Most common is made of PEEK (poly ethyl ether ketone) Also, carbon fiber, titanium mesh, metal, other plastics, or hybrid

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45 TLIF

46 PLIF

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51 DLIF or XLIF

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60 ALIF

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66 OLIF

67 Instrumentation Interbody cages Pedicle screws Medial cortical screws Anterior or lateral plates or stand alone devices Disc Replacements Corpectomy devices

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70 Medial Cortical Screws

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74 Interspinous Device

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76 Anterior Lumbar Plate

77 Some Kind of an Ectomy Laminectomy Discectomy Corpectomy Facetectomy Foraminotomy???

78 Laminectomy

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81 Facetectomy

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83 Microdiscectomy

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86 Corpectomy

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91 How About Kyphoplasty? There has been a great deal of discussion about this one recently. First how is it different from a vertebroplasty? Kyphoplasty is actually a brand name but the procedure has spawned other cavity creating cementing products Verbebroplasy is no longer paid for in most cases

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97 Why Are There So Many Codes These procedures are mostly independent with only a few that truly rely on another to make sense. They re like musical notes in that each one has it s own sound but when played together in the right combination make one beautiful chord. It s essentially A La Carte Surgery at it s finest. Custom ordered to suit the needs of each very unique situation.

98 A little bit of this, a little bit of that. Not everyone needs the same things and there is so much variability that things change quickly. John likes to say that it s the same way everytime unless it s different.

99 I like to think of it as a remodel. Sometimes the foundation is just fine but the electrical and plumbing are just plain shot. Sometimes it s the other way round.

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105 So Why On God s Green Earth Every day is different You couldn t make up some of this stuff Somebody has to do it The satisfaction of knowing you did something to make a difference for people.

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