the spine serves as the backbone of the body both literally and figuratively when disorders affect this critical support system it can lead to a myriad of challenges that's when modern medicine comes into play from robotic assisted spine surgery and dis replacement surgery to 3D printed implants Innovations in spine surgery are revolutionizing how we treat spinal conditions offering patients quicker recovery times and better outcomes today we'll explore the latest advancements that are pushing the boundaries of what's possible in Spinal Care and answer your questions on this episode of ask the doc send in your questions to questions allhealth tv.com or allhealth go on Facebook or YouTube or visit the askthe do page on our website allhealth tv.com welcome to ask the dock a show where we encourage our viewers to send in their health questions I'm Dr gorgi branik a minimally invasive of spine surgeon and today we're going to be talking about recent advancements Innovations in spine surgery and how they work let's kick things off with a Facebook question from Theo Theo asks hi Dr branik my older brother Phillip just found out that he needs fusion surgery for spinal stenosis I've heard that fusing the vertebra can severely limit your Mobility is there another type of surgery he can have that's not so drastic or invasive the I'm so glad that you asked these questions thank you for reaching out so uh stenosis means narrowing of the canal patients who have stenosis will say that they have a a significant limitations in how far they can walk so they'll also say that they can sit comfortably if um your brother has a difficult time sitting then he probably has something besides stenosis such as a degenerative disk that is symptomatic and then fusion surgery may help dis replacement may help so I would talk to your doc about why does he need a fusion surgery is the stenosis so severe that there's no way to decompress the canal because in general when patients come to me and say they have stenosis and limitations and walking but no real difficulty sitting you could sneak in and do a very uh really a very elegant minimally invasive operation where you decompress the canal create just a little bit more space for the nerves and patients do amazing they get up and go walking and they say that their old symptoms are gone a lot of these patients say they have a difficult time standing up straight so that just disappears right after surgery thank you again for your question Tio our next question comes to us from Mel who reaches out to us on our very own website allhealth tv.com male asks doctor I'm a former weightlifter and I was recently diagnosed with spondi something or other I can't say it so forget about spelling it the surgeon said he's going to fuse my spine together I don't know about you but I don't want my spine fused you know this is very similar to the previous question about whether a fusion is necessary my wife said I should ask you about getting some stem cells she remembers seeing something about it on TV what do you think M first thank you for reaching out to us with your question uh and speaking of question this is a really good one before I answer let's check out this video from the good Folks at Mayo Clinic so we take a small amount of fat from the belly and those are mean kimal stem cells those cells are then expanded in a Petri dish um in a culture setting once the cells expand out to 100 million cells they are then injected into um the patient's lumbar spine and the cells then migrate to the um highest area of inflammation their area of spinal cord injury so this is a phase one study of stem cells for spinal cord injury and we need to do further studies to further expand upon this treatment to make it more effective and to reach more patients I have a difficult time uh with stem cells because um I've been involved with stem cell research for a while now and stem cells are like babies if you place them in uh if you place babies in the middle of Wall Street um there's no guarantee that they are going to become great uh Traders stem cells need direction they need humors and mediators to stimulate their development and stem cells have become really glorified I think beyond what they are able to accomplish um so I would just uh I would beware and I would really ask all the right questions uh about this particular clinic and stem cell involvement now when it going back to your question M um so a fusion for spil listesis probably that's what your brother has um uh and that's probably uh Theo and that's probably what you have as a weightlifter um spond listesis is very much amable to Fusion if it causes your pain now with spand listesis pain is with sitting pain is with bending backwards and as a weightlifter uh you may remember that when you used to stretch backwards like in a bridge you could say well that used to be my very painful position that means that the spine listesis is actually relevant you see there are a lot of changes in your spine that may be present on Imaging but aren't actually causing your pain and you're right Theo that a fuse spine is not a normal spine you don't want to lose Mobility so I'm not sure if stem cells are necessarily the answer but I also don't want you to rush into a fusion surgery first get a second opinion and make sure that your doctor tells you exactly and understands exactly where the pain is coming from and then if it's reasonable then a minimally invasive Fusion May really take away your pain because spol listesis is very much correlated with back pain I hope this helps Bianca just reached out to us uh on her on our inst page and the question for me is hi Dr b um my father might have to get surgery on his spine he was triming the hedges in our backyard and he fell off the ladder Bianca I'm so sorry um anyway I've been hearing more and more about mini invasive surgery what is it exactly Bianca I personally love this question and it just so happens that I'm a minim invasive spine surgeon so this is right up my alley but before I share my in-depth knowledge with you let's check out this video from our partners at Baptist Health [Music] the minimal invasive spine surgery is something that can be used to address all sorts of spine pathology typically uh minimal invasive techniques are used for the lumbar spine for treatment of sciatica treatment of deformities treatment of of degenerative dis disease [Music] I typically prefer minimum invasive spine surgery whenever possible because it results in less tissue injury less blood loss and in the end the patients were able to recover quicker from surgery the recovery process from a minimally invasive spine surger is fairly quick patients typically arrive to the hospital in the morning have surgery and 4 hours after surgery we have them walking around around the halls with the physical therapists and the nursing staff it's usually one night in the hospital and by 2 to 4 weeks they're back at work spine surgery can cause a lot of apprehension in uh patients mostly due to things they've heard from Friends relatives uh with any type of surgery I think one has to be Allin because right surgery slows you down it it hurts uh but I think that with minimally invasive techniques the recovery can be shortened people can be back at work pretty quickly and I think that in the end we can see a really a meaningful return in in [Music] function let's go back to Bianca's question Bianca's father fell while trimming these Hedges and the most common fracture that you see in the elderly is what's called a compression fracture where the vertebral body just sort of crushes down these are luckily uh very stable fractures and often times patients are able to avoid surgery Bianca but if your father's been suffering for a while there is a minimally invasive technique where we introduce a needle through the skin through the bone right into the front of the spinal column where the crushed bone is causing his pain and we inflate a balloon that sort of gets the bone back up to its original height and then we withdraw the balloon all through that one needle and then we inject some cement or glue it hardens fairly quickly and it keeps the bone in a stabilized position uh it's an amazing procedure called the kyphoplasty and uh if uh the fracture is indeed the cause of your father's pain then when he wakes up from the procedure what takes about 20 30 minutes he will say that his pain is gone it's it's really rewarding um I'm happy to help and I hope that it's something uh so uh uh minor as a compression fracture it could be something worse burst fracture you know obviously it's impossible for me to diagnose just with your question but make sure you get a second opinion if you have any questions about whether what you're getting is the right thing in case you missed it the first time here here is another opportunity to find out exactly where to send in your questions send in your questions to questions allhealth tv.com or allhealth go on Facebook or YouTube or visit the ask the do page on our website allhealth tv.com Luca just sent us a question from our YouTube page Luca's question is hi Dr B can you please explain the benefits of using 3D printing technology in spine surgery as well as tell me how it works well looka 3D printing uh is just as you imagine it's a cool technology it's useful tool for surgery like for surgeons like myself particularly because everyone's a little different now we have implants to replace discs replace bones and the companies that provide us these implants will bring in hundreds and hundreds of options into the operating room so that we can fit it best for the patient but what if it still doesn't fit perfectly well in that case a CAT scan performed before surgery will provide the useful information that is then used by the 3D printer to create the model of the implant that fits the patient perfectly now there are some Innovative companies in the realm of spine that are already using this technology uh it is still sort of new and uh we're still waiting to see really the long-term benefits of such uh but this is not something imaginary this is really happening in the world of spine surgery we've got another question from allhealth tv.com you should really check out this page it's chalk full of very useful information Enzo asks hey Doc I played Hoops in college I was pretty good too but during one game I went up for a rebound and I got hammered not only did I have a concussion but I screwed up my back too it's gotten worse over the years and now I've been diagnosed with sciatica so I talk to a surgeon and I guess I'm a qualified candidate for robotic surgery so I'm not too sure I'm digging the idea of a robot doing surgery it sounds a little too futuristic for me Doc what do you think and you're hilarious let's check out this video from Mayo Clinic and then we can talk about the Star Wars of spine surgery robotic spine surgery is the use of robotic guidance for the placement of spinal instrumentation when we do surgery on the spine generally there are two main reasons to do surgery one is decompression if the nerve roots or the spinal cord is compressed we decompress the nerves or the spinal cord and two is instability if there's instability of the spinal cord we may have to stabilize or perform a fusion our hope is that by bringing enabling Technologies into the operating room Technologies like robotic surgery or uh navigation guided surgery that we can make surgery safer faster and more reproducible and hopefully be able to benefit more patients with uh robotic assisted surgery uh some people have the conception that the robots doing the work and the surgeon may be off in a different location and although I don't want to predict what might happen in the future teolog is rapidly changing today robotic assisted surgery does still involve the surgeon right at the uh surgical table of the patient so if you were a patient and you were looking into a surgery where a robotic assisted spinal surgery is happening you would still see the primary surgeon at the table an assistant surgeon across the table from that primary surgeon and the robotic arm next to the primary surgeon moving into the locations that the primary surgeon has identified for it to move into that's a really great video Enzo robotic spine surgery is as the video mentions it's robotic assisted and um uh a robot needs to be connected to the patient during the surgery I remember when the robotic surgery started there were major issues as if somebody would bump the frame that connects the robot to the patient it would cause a frame shift in that the screws which is what the robot is best at at placing screws all the screws would be misaligned and uh this created some major issues in the past now since then there's been some Innovations in this field particularly in the world of augmented reality which we'll talk about in a minute and navigation so there are many ways to make surgery super precise and robotic sounds very Innovative but it is not the only way to really get it to 99.9% accuracy this next question is from YouTube and it's from Regina she asks hi Dr Bic my wife Ivon had back surgery last year and it didn't really help her that much I'm really sorry Regina so her surgeon suggested that she get something called a spinal cord stimulator is that like electr shck kind of stuff can you give us the download because I'm a little nervous about it Regina I'm happy to hear you are so involved in your wife's Health Care Let's uh she's a very very lucky woman spinal cord stimulator is to make you ins sensate to the pain it does wonders for patients that are paralyzed and have pain related to the trauma however often times I hear spinal cord stimulator being used for patients who have a real problem and I always say to patients that in order to place the spinal cord stimulator you have to have spine surgery if you're going to have spine surgery why not correct the underlying problem talk to your doctor and perhaps get a second opinion about whether your wife can correct underlying issue there are some innovative ways minimally invasive ways nowadays to correct failed spine surgery if you've got another another question we've got answers and just in case you missed it the first couple of times here's yet another chance to find out where to send in your questions send in your questions to questions at allhealth tv.com or all Health go on Facebook or YouTube or visit the ask the do page on on our website allhealth tv.com we've got a question from Jamarcus from Facebook Jamarcus asks hi Dr bavan I spoke to my orthopedic surgeon a few days ago and he told me he's going to be using augmented reality goggles for my surgery ah we just mentioned that I've warned them for some video games but how do doctors use AR in surgery as a gamer I'm more Curious than nervous Demarcus that's an excellent question let's watch this video from Mayo Clinic and then we'll talk all about it for people with severe back pain from arthritis or degeneration often the last option for Relief is spine surgery now doctors are using augmented reality to achieve less pain with fewer complications for patients Dr Miles Hudson a neurosurgery resident at Mayo Clinic explains the Innovation what it truly means is augmenting or enhancing your visual senses and your visual field and that's what the augmented reality does by combin desing patient scans and MRIs the technology allows the surgeon to see more without creating larger incisions using those scans our technologists can make the 3D models of the scan and then we can use the 3D models and pair that to our neuron navigation software and then by fusing those two together you get a navigated 3D model that we can overlay through different visual devices such as a headset or the surgical microscope itself just helps Elevate that safety to the next level by knowing where all critical structures are and being able to actually see them through all the bone and soft tissue for the Mayo Clinic News Network I'm Joel Streed J Marcus so I remember trying this technology out and essentially there's a helmet that goes into your head and as I'm looking at the patient I can see through them it's as futuristic as it gets but the reality is that it's a little bit over technologized because what we have now that's much more simple is looking at a screen and seeing exactly where where the pedicles which is a part of the bone where the screw usually goes supposed to go so argumented reality again sounds very gimmicky and it's useful but uh there are other Alternatives and the more technology you get to surgery the more risk you get of that technology malfunctioning it is an exciting World though and it's an amazing advancement now we're cooking up next is a question from Eva which comes to us from YouTube Eva asks hi Dr ban I'm 39 years old and I've been diagnosed with minimal osteoarthritis or Lumar spine what can I do to ease the pain and improve my condition however thank you for sending in this question and I'm sorry to hear that you're in pain if you have minimal osteoarthritis and you are in pain then the most important thing is that you are in pain it's hard to judge the severity of symptoms based on the severity of findings on the MRI sometimes MRI is very bad and a patient's not terrible sometimes the MRI has early changes and a patient just can't live always try conservative care like epidural steroid injections proper Physical Therapy but if that fails and a patient continues to suffer for young patients there's now dis replacement we can now maintain motion as opposed to placing screws and rods we can get the patient spine back to the original shape so talk to your doctor about dis replacement but also consider really maximizing conservative care with properly targeted epidural steroid injections I guess it's a YouTube kind of a day the next question comes to us from censia who asks doct nine years ago I had a spinal infusion on my L5 now I'm in pain again and I've been told that my L4 L3 are messed up I have spinal stenosis on my back not looking forward to surgery what do I do how do I make that better well Hortensia um this is a very common issue um um essentially when you have a problem with uh two bones that have been fused it is very possible for example in your case I'm assuming you mean l45 it's very possible that after a fusion surgery the level above l34 or the level below L5 S1 will degenerate and you see there are these nerves that exit at every level so if you correct the issue with this nerve you may start having issue with another nerve right below it so consider getting a proper injection at the level above or at the level below and make sure that that's exactly where the pain is coming from if you can ensure that that's truly the source of your pain there are very innovative ways to address what's called adjacent level disease level above and level below to this tiny incision made on the side of the patient spine here's another question from our website allhealth tv.com love it oxana's question for me is hi Dr branik what can you tell me about vertebral body tethering vbt I'm asking because my little solka Anushka has severe scoliosis and a doctor said that we need to get ahead of it they said that these techniques will allow for growth and motion as she's only 12 and still growing they're good doctors but they didn't do a great job explaining what vbt is would you mind filling in some of the gaps absolutely so um 12 years old is a little late for this procedure but I have heard of this procedure being used in a little little kiddos who uh have a tremendous amount of growth left and vbt involves placing these devices alongside the spine hooked onto the vertebra and the patient after surgery after recovery comes back to the Doctor Who then brings a special device right next to the patient's back and it literally makes theice Dev elongate or grow so vbt essentially guides a crooked spine with scoliosis into proper direction of growth but get a second opinion even though you think your doctors are good 12 years old is a little late for that procedure definitely please get a second opinion you can never have too many so people keep them coming I really appreciate all this questions speaking of questions here another one from our Instagram page and Brody is looking for an answer to this short but very topical question hi Dr banik what are the latest Innovations in spinal disc replacement hi bro this is an excellent question it's right up my alley because I do a lot of dis replacement so um with dis replacement we correct the loss of dis height which is always associated with disk degeneration the operation is really done from the front which is surprising to many patients but because it can be done a minium invasive fashion you don't really injure the abdominal wall you sneak around the abdominal contents and you are arrive at the spinal disc without really causing any significant injury you remove the disc and then implant a true mobile device that restores patients disc height but maintains motion you don't have to sacrifice motion and that's significant on many levels especially because long term it doesn't cause the same issues with the generation below or above the fused segment as you would with a fusion with a disc replacement you keep your motion and other levels don't degenerate with any expedited rate I uh I've been really blown away by this procedure because truthfully most patients wake up and their pain is gone and it's almost immediately after surgery talk to your doctor about dis replacement you will be very pleasantly surprised um uh without having to pay those long-term costs of adjacent level degeneration thank you again uh for coming to this episode of ask the dock uh we really appreciate all of your questions and uh please keep them coming uh I'm excited to talk to you more about these very intricate issues uh and uh remember uh to access our website all Health TV with a chalk full of really important information send in your questions to questions allhealth tv.com or allhealth go on Facebook or YouTube or visit the askthe do page on our website allhealth tv.com