Masterclass Endoscopy Talk
With International Spine Surgeons
I was invited to speak at the Spine Endoscopy Masterclass, Fundamentals for International Surgeons, here in San Diego, on a topic they gave me called Global Consensus Endoscopy as the New Standard. Endoscopic spine surgery is not new, the evidence behind it goes back almost thirty years, and at this point the question of whether it works is settled. What’s surprising is that despite all that evidence, only a small number of surgeons actually perform it at a high level. I talked about why that gap exists and what separates a good outcome from a bad one.
I also shared how my own thinking has changed over the years. I challenged the room with a real case, my own mother’s, from six years ago when she was 84 (now 90yo!). At the time, she needed a decision made about fusing her spine or not, and I asked the surgeons in the room what they would do today. My answer is different today than it was 6 years ago.
There’s also Q&A from surgeons in attendance at the end, so you can get a sense of what’s on their minds as well. Watch the full video to hear it all!!
Blood or Nerves?
The Real Cause of Pain Behind Neurogenic Claudication
For most patients, this comes down to blood flow, not just nerve compression. Every nerve needs a constant supply of energy, and that energy comes from blood. Look at all the blood vessels surrounding the spine (see video). When the spinal canal narrows, it doesn’t necessarily compress the nerves themselves, it squeezes those blood vessels instead.
That’s fine while you’re resting, but the moment the nerves start firing and generating electrical signals, they need more blood coming in, and it’s the veins that get clogged up from the stenosis. Neurogenic claudication is really an interruption in blood flow more than mechanical compression of the nerves. Now you know.
THE EXCEL SPINE Family
What a night. We got the Excel Spine family together for a Summer Bash to watch San Diego FC beat the Colorado Rapids. But this was about much more than just a soccer game.
Nights like this remind me of the community we’ve built together after all these years. I’m blessed and so lucky to be surrounded by such awesome people doing such awesome things!!
UCSD OR came out, along with their pre op nurses and PACU team, the Surgical Center of San Diego, our surgery reps, back brace reps, and bone growth simulator reps. Dr. Irwin Goldstein and Dr. Brandon Goldstein were there, and I caught up with Dr. Danny Song, Dr. Mary Ombach, and Dr. Darrington to name only a few!
I really want to thank everybody who was able to make it, because if they weren’t there, it would have been pretty boring. Thank you, Adrienne, for the idea and coordinating. This is why friends don’t let friends get bored!
A retired police officer who now works at a gun range came in to see me after years of worsening back and leg pain. It had already taken him off the golf course and off his bike. The pain radiated into both buttocks, with numbness, tingling, and weakness that had become constant down his left leg. He’d been recommended a fusion by another surgeon but does not want a fusion, so we decided on the LESS procedure after considering all non-operative options, going in to decompress two levels of his lower spine while preserving his facet joints and avoiding the muscle disruption of an open approach.
The problem was driven by spinal stenosis, facet arthropathy, ligamentum flavum hypertrophy, and a non-isthmic spondylolisthesis, along with a calcified facet cyst that had hardened into a bone spur pressing directly on the nerve root. Watch what it took to get him back to the activities he’d been missing.