Back Pain Gimmicks VS Real Innovations

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Health Channel host Kathy Buccio talks to Dr. Georgiy Brusovanki, a spine surgeon for Baptist Health South Florida about back pain, getting second opinions and so much more!

Transcript
Laser spine surgery robotic surgery stem cell injections these all sound super modern and really cool but do they actually work here’s what spine expert dr ghoshabru savonik has to say as we’re talking about these new innovations that are coming on the market how do we know the difference dr responding it’s hard to know it’s hard especially because the field is uh very narrow now and there’s a lot of information on very specific topics right um I love the second opinion i think that if you’re ever in doubt it’s always worth it to get a second opinion you will feel better even going with the first opinion after you’ve talked to someone else and you’re verified that that’s the right way to go um and i like the patience i like the patient connection as well i think that’s important I agree patients should be able to talk to other patients I don’t know how many practices allow um that same thing that we do in my in my in my practice where patients have to talk to somebody who’s already had an operation but I think it’s reasonable to ask for that right uh look online there’s great forums yelp is a great tool i agree but just beware of looking at publicly sort of voiced information not educated information information from other patients from other doctors you know you really have to be critical and detail-oriented you know a tillif fusion is not the same thing as an a-lift fusion but on facebook someone may say well I had a fusion and you won’t necessarily know which one one has a three percent failure rate whereas the other one has a 36 percent failure rate okay so as always by beware so if you want to try a new treatment what do you do should you get involved in clinical trials no no why well look because clinical trials imply that you’re going to take the risk of an unproven procedure the only way that that high risk can be tolerated is if there is no solution for your problem or if the problem has a mortal risk right that’s why trials are so common for cancer patients especially with metastatic disease because these patients are looking for something in a field where we have nothing good right that’s not the case with spine surgery anymore so i don’t think you should try experimental things I think that you know i’m a conservative doc i’m a late adopter you know I wait for studies to show me that if I commit a patient to a procedure i’m not going to take them somewhere where they’re going to get in trouble right you want to make sure that it works right okay so let’s talk about some examples of real improvements that we’re seeing right now and one example that you’re very passionate about is the minimally invasive surgeries so I want to talk about how you’re how this is done sure so um it sounds like a gimmick but the reality is that minimally invasive uh implies a frame change from what was done in the past so because the human spines in the middle of the body to get to it was always associated with a lot of morbidity and when you only had a single incision in the back to get to the front of the spine which is in front of the spinal cord you’re talking about major morbidity major risk to a patient it just looks like I have a little incision in my back but what’s deep inside is very important to sort of understand so when you avoid cutting muscles when your incisions are smaller when there’s no dead space when you use tubes with great lighting you have better visualization yet there’s less mobility there’s no big open wound remember classic surgery you open up the patient wide enough that a light at the ceiling can provide you light inside the wound so that means that it has to be a pretty big wound now with the minimum invasive technique we minimize that and we keep going smaller and more precise so now the best part about it is all the benefits you get from it not just the small incisions of course and the fact that you don’t have to cut muscle of course I mean there’s a dramatic difference and studies really do go along with this multiple multiple studies talk about how mean invasive surgery patients go back to work sooner they have less pain they get back to their normal activities sooner they’re less infections because of small incisions there’s no dead space they don’t need blood transfusions as much so it’s a it’s a it’s an it’s a change in an entire perception on how to operate and by the way there’s minimally invasive options in other surgical fields general surgery obstetrics etc i know that something else you discussed in previous shows is something called disk replacement and our caller actually asked a question about that as well so what is this replacement is this new or is it just something that’s been improved upon so look 15 years ago when I started doing research on disk replacement in animals and cadavers it was a gimmick it was not accepted and very few doctors did them so the american academy of orthopedic surgeons which is kind of like our governing body has become very clear over the past few years that this is now the standard of care for the cervical spine you minimize the chance of adjacent level disease for young people it it would be it would be a bad idea to do a fusion when there’s minimal arthritis and it’s just a disc problem do a disc replacement so now we’ve gone from a gimmick to something that has undergone 20 years of research with thousands and thousands of patients so it is not a gimmick I believe that this is now the new standard and you do this a lot in your practice I do because I always try to avoid a fusion unless a patient has deformity or instability now another big innovation in the medical industry is robotic surgery sure so talk to us a little about robotic surgery and what it is so again sounds like a gimmick right a robot yeah of course I want a robot but the reality is that this is no longer a gimmick again 15 20 years ago this was sort of crude now uh with uh here you’re seeing so just to be clear the robot is not doing the surgery the surgeon right absolutely okay the robot is just a tool the surgeon controls it with the help of his assistants and what it allows you to do is to be much more precise with less morbidity you know I don’t need to put my hand into a wound anymore i have specialized tools the robot is the next level of specialized tools so for example to put a screw into the spine has about a five percent error rate now when you use x-rays and a minimally invasive technique it goes down to about maybe two to three percent with a robot it goes down to less than one percent wow now that sounds like splitting hairs but when you’re talking about thousands and thousands of surgical patients one percent is a huge number of complications so a robot is the way to go if you’re doing anything more than a two level fusion because not only is it more precise it will also make the operation faster less blood loss and uh it has really made a big difference there’s a few so no so that’s what we have the standard of care now but are they improving upon robotic surgery or we’re going to see more absolutely absolutely so in my world spine surgery robotic surgery is really just still sort of an aiming arm it’s an assist right with like gall bladders appendectomies hernias the robot is now probably 50 of the action and in the future you will see the robot doing the entire procedure my old professors at duke were working on ways to do brain surgery where using robotic surgery exactly because remember you can’t just take things away getting to the middle of the brain tumors commonly are inoperable because of how much mobility the patient would take in the approach now a robot can sneak around corners tight spaces where no human can do in a safe way and then perform the same operation so this is going to happen within 5-10 years of our life that’s fascinating how mind-blowing is that just think of what health care and surgery will look like in just a few short years wow
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