biospine webinar

There’s no time for hesitating when you’re in pain. If you’ve been waiting for a sign to pursue spine surgery, this is it.

Spend time with BioSpine’s board-certified neurosurgeon, Reginald Davis, M.D., as he guides you through an informative presentation about the spine and spine surgery.

Dr. Davis offers insight on his philosophy of the mechanics of the spine. You’ll learn just how important the minimally invasive technique is to recovery and wellness, as well as how to choose the right spine surgeon. You can determine which option best suits your situation as he counsels you on surgical and non-surgical options. There’s no mystery to minimally invasive spine surgery when you have a veteran professional by your side.

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Welcome, and thank you for joining us. My name is Michael Moore, and I'm part of the operational team here at the BioSpine Institute. The data shows us that 30% of all Americans have an active neck or back problem and that 80% of Americans will suffer from back pain sometime in their life. It's the second most common reason that an individual would visit an ER. Back pain is what brought you here today, and probably what you all have in common. Whether your discomfort is mild or severe, you're looking for answers. And the answer isn't always surgery. Scheduling a consultation with BioSpine is a commitment to understanding your pain, not to surgery. In fact, 70% of BioSpine patients are treated non-surgically. After meeting with the surgeon, the power is in your hands to decide the next step. BioSpine is a 16-year-old orthopedic medical practice that specializes in neck and back injuries only. Our five-surgeon practice, comprised of a combination of MDs and DOs, orthopedic and neurosurgeons, each with over a decade of experience, focuses solely on minimally invasive approach. That means should you choose surgery, no matter what it is, it will be performed through an opening the size of a penny. Patient recovery is a fraction of traditional back surgery rehabilitation. In fact, many of our patients are back to work in just three days. You shouldn't have to suffer any more than you already are. We're happy that you're doing your research and that you're letting the BioSpine Institute help. I would also like to reiterate that all of our surgical procedures performed at the BioSpine Institute are recognized by the American Medical Association, thus being covered by health insurance plans. We understand the importance of using your health insurance and minimizing your out-of-pocket expense. As you know, there are literally hundreds of different insurance plans, so during our scheduling process, we confirm exactly how your insurance works with our practice. And we can also determine co-pays, deductibles, and any associated costs if any if surgery is recommended. And now, the moment you've been waiting for. It's time to introduce today's speaker neurosurgeon, Dr. Reginald Davis.

Well, Mike, thank you for that introduction and thank you all for joining us this evening. What we'll cover is our treatment philosophy, the spine and different causes of pain, common spine problems, nonsurgical options, the minimally invasive approach, and benefits, and then we'll follow up with questions and answers. But before we delve into that, I'd like to introduce myself formally. I'm Dr. Reginald Davis, and I'm a neurosurgeon at BioSpine Institute. I did the entirety of my training at Johns Hopkins University and Hospitals, this in Baltimore, where I really started my professional life as primarily a brain surgeon. I did a lot of craniotomy with brain tumors and all sorts of things, but as a neurosurgeon, I also treated the spine. And I found that my spine patients were challenging, interesting, and perhaps more in need of my particular skill sets. And more and more I found myself drawn to the rapidly advancing new technologies, and the ability to do more and more with the patient and to alleviate their pain with less and less invasiveness. And that really began to form the core of my philosophy, where I would use the most advanced technology, the least invasive, to help my patients through their trials and tribulations, their pain, with as little offense to the spine as possible. And so the philosophy that I developed at that would be I wanted to make my patient better-- the patient was already center-- but I wanted to do as much as I possibly could with the least amount of invasiveness necessary. I soon found myself leaving the Hopkins arena and my private practice in Baltimore. And once in Florida, I spent some time in an ambulatory outpatient center where, again, I could practice this philosophy, minimally invasive spine surgery, outpatient spine surgery, really addressing significant problems but with the least amount of invasiveness as possible. And finally, I find myself with kindred spirits here at BioSpine Institute where our treatment philosophy is entirely meshed. And I think that we all feel exactly the same. After thousands and thousands of patients and multiple attempts with different technologies, we've all come to the same conclusions. We like to treat the patient as an individual. First and foremost, a patient is complicated, that you have many problems, and you have a life, and you're not just a back pain that we can treat generically, you're not just a bad-looking X-ray, you're not just a diagnosis with a cookie-cutter solution, or an MRI where multiple, multiple problems can be uncovered, each one of which requires a major surgery. You are a complex individual with a specific need and a specific request, and so we look at you as the individual, and that's how we approach it, and that's a basic tenet of our philosophy. First and foremost, we take a history. We listen to you carefully. We really glean and discern what it is that bothers you, how it's affecting your life, what you'd like to have addressed. And then with a very detailed and sophisticated physical examination, we can correlate what you say to the physical findings, that give us significant clues as to where and how you might be hurting and what we might be able to do about it. Finally, we add on the layer of sophisticated testing with X-rays and MRIs, and ultimately, we come up with the source of your pain. Usually, it's concordant. Usually, there is an MRI finding. Usually, it's one of many findings, but we pick the one that bothers you, and then with that, we can address that very, very specifically. So our philosophy easily summed up, we will use the latest technology, the most compassion, and the greatest amount of skill, and that we utilize as much as necessary, as little as possible intervention to get you back to being you.

To best understand what we do and how we do it, perhaps you should understand the spine itself. The spine is divided into three different segments of the cervical spine, which is the neck, the thoracic spine, which is really that part of the spine that bears the ribs, so that's the mid-back, and then the lumbar spine, and that's the lumbosacral spine, which is the lower back and including the pelvis and the sacroiliac joint. Each one of these serves a specific purpose, but overall, the spine is a uniquely designed and engineered structure that affords flexibility and strength, at the same time as protecting the delicate structures therein. Each one of the elements moves in a very specific pattern, and any alteration of that pattern of movement or inflammation of the joints that move, or pinching, or crushing, or disruption of the delicate nerve fibers, can lead to pain. And each and every one of these has a very specific way of presenting itself in the history, and examination, and studies, and has also a very, very specific manner in which it's treated. And we can go over some of those common ailments that results from disorders of the spine and their treatments in the following section.

So let's look at some potential causes of pain. And basically, as I said, the spine is a living structure, very complex. And some of the most common causes of pain is loss of strength and flexibility, just a sedentary lifestyle, or the opposite, where you've got a very stressful lifestyle with working habits, and finding yourself in poor posture situations all the time, faulty body mechanics, overall poor posture, improper lifting. And then there can be congenital deformities, such as scoliosis, or the abnormality in the curvature of the spine. Excessive weight is also a source of pain. But there is a natural process called degeneration. Some may refer that as to aging, some as to wear and tear of an overused spine. But overall, it creates change in the spine, which can result in inflammation, excessive growth of calcium deposits, and bone spurs, and ligaments thickening, and overall, be a very significant source of pain. And of course, there are other traumatic sources of pain. Whether it's a ligament or tendon sprain, muscle strain and pain, broken bones, ruptured disks, ruptured tendons, a sprain, and broken facet, all these things can be potential causes of pain. They all present differently. They all impact your life differently. They all have a myriad of different solutions and treatment options, and we'll go over those as well. There are several ways of categorizing the types of pain. Some can be done on a time frame, whether it's acute, happening very quickly, or whether it's chronic, happening for a very long period of time or greater than six months. The pain can be localized right to the spine and the neck or the lower back. The pain can also radiate into the arm or into the leg, and that radicular type pain is usually indicative of nerve injury. The pain can be on the basis of inflammation. And inflamed joints, or inflamed disks, or inflamed capsules can cause localized back pain, or they can secondarily inflame the nerve. And so the types of pain can get to be complicated. This is sorted out in many ways by that detailed history, but it's very important that we understand the type of pain so that we can best treat you. Diagnosis of your pain ailments, as our philosophy has indicated, is very, very important. Without the proper diagnosis or proper analysis, we can't really treat you properly. And so our diagnostic regimen starts with that detailed history. We want to know why you're hurt, where you hurt, how it impacts your life, under what conditions is it better, what makes it worse. Those are clues that we use then to try and solve the riddle where the pain is coming from, and what we can do about it doing as little as possible but as much as necessary. So following the history, we do a diagnostic physical examination. That examination allows us to examine or analyze the functioning of the spine and the nervous system. So how do you move? How does your spine move? Where is there strength? Where is there weakness? Is there lack of sensation? What brings on the pain? Those are all clues as to where the pain is located. And under what circumstances the pain manifests itself, gives us a clue as to the overall function of the spine. And even with that, we've already started developing some ideas or hypotheses of where your pain may be coming from and what the ultimate diagnosis is. That is further analyzed with X-rays, and these look at the bone and the structure of the spine, and with flexion-extension, we always get some indication of the movement of the spine. But many structures are still invisible in the X-ray. And so ultimately, we go to the very sophisticated MRI or the CAT scan, where we can see in three-dimensional representation, not only the bones but the soft tissues, including the muscles, the tendons, the ligaments. And most importantly, we can see the nerves, the nerve roots, and the spinal cord, as well as the disks, and what may be causing the pain. And usually putting these things together, we can come up with a composite of where your pain is, why it hurts, what the mechanism of pain would be, the ultimate diagnosis, and perhaps more importantly, what we can do about your pain. With that, we can develop an entire spectrum of treatment options, some as little as an injection, others as much as major surgery, but ultimately, tailored for you, designed for you, your wishes, and how we can make you better, once again, doing as little as possible, but as much as necessary.

So why don't we go over just a few of the common spinal conditions many you've probably heard and think you understand, and perhaps you'll learn something, or perhaps you'll be able to teach me something with your questions and answers later. But one of the most common conditions that we treat is spinal stenosis, and spinal, of course, refers to the spine, and that can be the lumbar spine, the thoracic spine, or even the cervical spine. All these areas are subject to stenosis, which technically means a narrowing. And if you can imagine that the spine is a tube or a canal, that canal has a space that's usually ideal that allows the nerves and spinal cord to flow freely without being impinged or impacted. If that space is compromised by whatever means, whether you had a disk herniation, or a ligament hypertrophy, or thickened ligaments, or something in the middle, the function is compromised, usually causing pain, numbness, tingling, and weakness, and that's the hallmark of spinal stenosis. There is degenerative disk disease. The disk or the pads between the spines, and those pads are usually inflated. They're pressurized, or moist, and very resilient, and very flexible, and elastic. And with injury, or with wear and tear, that elasticity goes away, and the disk collapses. It starts to be less elastic and less protective, and that degenerative disease process can cause pain, usually indicative of mechanical back pain. It can even lead to radicular pain if the nerves are being pinched. There is a herniated disk, and so the disk can rupture and its gelatinous center can extrude. That can cause pressure on the nerves, and that also is a source of pain. And then there's osteoporosis. That's weakening, a loss of bone calcium, and as such, microfractures can occur, or even catastrophic compression fractures can occur, requiring a treatment. And finally, there is the spondylolisthesis. Now, that's a mouthful, but that means slippage of the spine itself. And that's where the structure that's holding the spine, even the bony structures fail and allows the spine to completely malalign. And oftentimes, that's a source of major pain, and that too are things that we can treat in a very minimally invasive fashion.

As I stated, we offer a full spectrum of treatment options for all the ailments that you've heard, and some that I probably have failed to mention. And even though we're surgeons, we pride ourselves on, again, doing as little as possible but as much as necessary. And sometimes, it's only necessary to go with nonsurgical treatments. These include behavior modification. We have the ability to prescribe anti-inflammatory medications. There's also physical therapy and chiropractic care. All these things are things that we do in attempt to rid you of your pain, in this case, without surgery whatsoever. Pain medications and even get into some epidural steroid injections, which technically is not surgery although it does require a needle injection, these are all attempts, again, to get you feeling better, and in this case, without surgical intervention.

Of course, as surgeons, we pride ourselves on our minimally invasive surgery. And minimally invasive means a lot of things to a lot of people. Some people think that it's just a small incision, and, yes, it is indicative or indicated by a small incision. But truly, the minimally invasive surgery embraces the entirety of our philosophy, and that is we get accomplished exactly what is done with a big surgery, larger incisions, wide open surgeries, the hours and hours of operating sometimes. And we do this, though achieving the same goal, accomplishing the same outcomes through a very small incision, with much less trauma to the spine. So once again, as much as necessary, but as little as possible to get the job at hand done. So why minimally invasive spine surgery? Well, there are many, many benefits. And as I said, the small incision is only one thing, and that's sort of like the superficial aspect. But for the most part, that small incision means that we've preserved tissue. We've preserved the muscle tissues. We've preserved back tissue. We don't separate the tendons and ligaments. So all those structures are still there, meaning that your spine is as strong as it was when we started. That small incision also is indicative of minimal blood loss. So there's less scarring, less blood loss, less trauma to surrounding tissues, which means there's a more rapid healing time. We can do it on an outpatient basis because there's less healing, less trauma, less pain, and less need for recovery. Infection risk is very small, less than 1%. And then there is the less post-operative pain we reflected by minimal opioid use, rapid return to function, and rapid return to work. And so these are all the advantages inherent in that small incision of that minimally invasive spine surgery. And so a big question, why minimally invasive spine surgery? And perhaps to answer why, maybe it is best to understand what. Exactly what is minimally invasive spine surgery? Many would say that I do the operation with a small incision, therefore, it is a minimal spine surgery. Minimally invasive spine surgery actually encompasses a philosophy, philosophy that you've heard, as much as necessary, but as little as possible. And so if the goal is to relieve the pressure on the nerve, you can do that with a big incision, cutting the muscles, removing bone, in an open fashion in a hospital setting with an overnight stay, or you can accomplish that same goal through a less than 1-inch incision under the microscope, using microscopic tools in a minimally invasive fashion, sparing the muscles, sparing the tendons and ligaments, opening a window in the bone instead of total removal, but decompressing the nerve. And so that philosophy of minimally invasive spine surgery really encompasses getting the proposed surgery accomplished, achieving the same goal, but doing so with much less collateral damage to surrounding structures including the bones, including the muscles, the ligaments, and soft tissue, with tremendous benefits. And that's what minimally invasive spine surgery encompasses as a philosophy. Now, the why is because in doing so, there are tremendous benefits to you, the patient. First of all, preserving of those tissues, preserve stability, there's no cutting of valuable muscles that you need for function, there as a result of less blood loss, the blood loss is often minimal or practically nonexistent resulting in less scarring, and then so there's less of a chance that there'd be complications of the healing process from the spine surgery itself. It's done on an outpatient basis. And so in an ambulatory spine center, it's more boutique here. You're more like a guest in a home where you are treated. The entire center's for you. And very quickly, you can retreat back to the safety of your own home for your recovery process. The recovery process, by the way, is much shorter. It's much less onerous. It's much less painful. Opioid use is down. The infection risk is almost nonexistent with the less than 1% infection. And overall, there's less post-operative pain, and just overall, less post-operative hassle. And so that is the advantage of the minimally invasive procedure, which is why we bother to go through the extensive additional training, honing of techniques that are a little bit more tedious, a lot more difficult to achieve than the traditional open procedure. We do so because it's worth it. These are some of the procedures we perform. Now, please bear in mind, as I've stated, the minimally invasive spine surgery means that we are doing the exact same procedure, only with less invasiveness to the overall body, less invasiveness to the muscles, and to the spine itself. And so these procedures that others may perform in the hospital in an open fashion with cutting of muscles, removing a bone, hours of a procedure with blood loss and risk, we perform the following surgical procedures through a very minimally invasive technique utilizing a tube about the size of a penny. And so the surgeries include laminectomy and laminotomy, both cervical and lumbar. And we even have the ability to do so in a thoracic spine under certain circumstances. These oftentimes, are performed in a hospital in an open fashion through a much larger incision. We can do this through about a coin-sized incision utilizing the tubes on an outpatient basis under an hour, and then you're on your way. The same is true for cervical disk replacement. This is a technique whereby the bad disk in the spine can be removed-- and this is being in the neck-- that can be removed and replaced with an artificial disk, the latest technology, which allows us to preserve the motion. Treating the spine in that manner is far superior, and we, again, do so in a minimally invasive outpatient basis and where you can go home. Cervical fusion, going in through the front of the neck, and in this case, taking out the disk and all the bone spurs and things, but creating a situation where those bones grow together. A fusion is another way of stabilizing the spine. This oftentimes is done in a hospital in an open basis, but we do it in a minimally invasive, ambulatory, spine surgery outpatient basis. Lumbar fusion, that includes removing the disk, putting in the spacer, restoring the sagittal alignment or restoring the normal alignment of the spine, and then securing that structure with rods and screws to stabilize the spine, probably one of the more invasive surgeries that anyone does in the spine, we do this, again, through small incisions less than an inch and on an outpatient basis ambulatory spine surgery. SI joint fusions, that sacroiliac, the sacroiliitis, or the SI joint, that oftentimes goes bad, we can perform a minimally invasive fusion there, small incision. Same job as the outpatient or the inpatient hospital procedure, but done so with much less trauma, and much more rapid recovery. And even the latest noninvasive or minimally invasive motion-preserving stabilization of lumbar spine, now the Coflex Interlaminar Stabilization. That we do on an outpatient basis, minimally invasive, small incision. So all these things, the exact same job that is done in a bigger operation, we do so with a much less invasiveness. We have pain management techniques, which also kind of skirt the definition of surgery. But kyphoplasty, balloon inflation, installation of cement into that compressed vertebral segment, allows us to restore the strength of a crushed bone, or an osteoporosis, or brittle bone fracture, again, on an outpatient basis. In this case, it can even be done in the office, but the job is still accomplished. Radiofrequency ablation is a pain-relieving procedure whereby an electronic needle is used to ablate those painful nerve endings again, restoring health and harmony without pain, but without surgical intervention. And even the epidural steroid injections, these are things that we perform on a regular basis, depending on what the needs of the patient, what you would need to get you better. And here is a sample surgical case. But true to our philosophy, this is a real person. This is a patient who had issues and had some pain that was compromising her life, and we were able to help her. She was a triathlete before, very active, and very passionate about what she did. However, she began experiencing significant pain, which really compromise her ability to run, compromise her ability to compete, and eventually really compromise her overall life, and disrupted her harmony. And so that is the patient that we wanted to restore back to normalcy. It was quite obvious that her pain was mechanical back pain with bending, twisting. That's when she experienced pain that was so incapacitating that she couldn't run, she couldn't lift, she couldn't do the things that she loved, and that was evident on the physical examination. So we evaluated further, and the X-rays did show what is called a spondylolisthesis and a spondylosis. The spine, instead of lining up, was shifted out of alignment. And that deformity of the spine was causing severe tearing and pressure on the disk, on the facet joint, and even starting to impinge on the nerve. So it was creating a lot of havoc because the spine was unstable, no longer able to do its job to protect the contents of spinal cord and the nerves. And these images show that the spine doesn't align, and the disk at the bottom looks badly damaged compared to all the normal disks. And so there are things that we could do. She could learn to live with this. This isn't life-threatening, so one option would be to do nothing. The other option would be to try and mask the pain with medications and injections, make her feel better, and as long as she didn't do anything exorbitant or very aggressive, she could probably lead a sedentary life without surgery, but that's not what she wanted. What she wanted was to enjoy her life with as little pain possible, and as such, the best solution was to restabilize the spine, and that's the spinal fusion. And so in order to perform this lumbar fusion our way compared to an open hospital procedure where there would be a larger incision, there would be stripping of the muscles and removal of muscles, there would be removal of a fair amount of bone, and then placement of the rods and screws in an open fashion, with potential for substantial blood loss, increased risk of infection, and hospital stay. The way we perform this as a procedure would be under general anesthesia, she's asleep. We use two incisions on either side of the spine, each about a coin size in length or an inch or so, or maybe less. And then through these incisions, able to remove just enough bone to get access to the disk, the disk is removed in a microscopic minimally invasive fashion. Once that disk is removed, a spacer is placed in between the bones, which by stretching these things out, puts the bone back into its proper orientation. And that restores the stability and also restores the alignment and the proper balance of the spine. And then once that's been accomplished, the entire job, so to speak, is held together with screws, which are, again, placed percutaneously, so there is no cutting or tearing of tissues even to place the screws and locking it in with rods. And as you can see here, the final solution is basically, reconstructing the defective bony part of her spine utilizing titanium. But that bridge of titanium, enables her to resume her normal life, as you can see. Flexibility, not a problem, and able to get back to doing what she did. And that was all done in less than an hour, and she went home within a couple of hours of the procedure. And that's what we do.
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We're sorry to interrupt, but we know a fear of surgery can hold some people back. 70% of the patients who come to BioSpine are sucessfully treated without surgery. The first step is understanding what is casuing your pain - take that step and schedule a consultation. It's that easy.
We're sorry to interrupt, but we know a fear of surgery can hold some people back. 70% of the patients who come to BioSpine are sucessfully treated without surgery. The first step is understanding what is casuing your pain - take that step and schedule a consultation. It's that easy.
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