ASIAN ORTHOPEDIC SPINE INSTITUTE

14/10/2024

Speaking as a surgeon who does biportal endoscopic spine surgery, I'd like to add that fusion really is an option that's reserved for patients whose main problem is mechanical spine instability pain. Patients with JUST radiculopathy from nerve compression - even those who have compression from clinically stable spondylolisthesis (i.e., no complaint of significant instability pain) - improve with decompression treatment ALONE, for as long as the decompression was adequate AND the decompression technique did not introduce added instability to the spine.

Even in cases of degenerative spondylolisthesis with stenosis, it's been shown that the spinal mechanical construct does not progress to clinically significant instability if the surgical approach did not sacrifice critical support structures (i.e., facet joints, midline osseous-ligamentous complex, multifidus muscles).
So if there's no PRE-operative clinically significant instability, why do a fusion, right?

And if the surgical technique can achieve adequate decompression WITHOUT creating any instability that will require fusion, then why do fusion?

CONTENT0:00 Comment question from a viewer: is spinal fusion surgery needed for spondylolisthesis with stenosis? 0:45 This is an area in which orthopedic spi...

28/09/2024

Operate... Work on book chapters... Rest... Repeat...
(Way past my initial deadline. Hopefully, the illustrations make up for the tardiness.)

09/09/2024

Late post, just wanted to share the patient's experience following spine surgery... This is 6 months after cervical decompression BTW.

(Before surgery, this gentleman was already paralyzed from the shoulders down, and was totally bedridden -- couldn't sit, couldn't stand or walk, couldn't even hold a pen or spoon & fork.)

www.facebook.com/drhenrydimaano

08/09/2024

08/09/2024

10/08/2024

https://youtu.be/jEqoYNZr6rM?si=YmZn8V6igSjHlscJ

Long before I learned how to do biportal endoscopic spine surgery, I was already doing knee & shoulder arthroscopic procedures. It's very rewarding, restoring a patient's joint functionality with just two small skin holes and some joint cavity clean-out.

That said, there's always been this debate as to whether or not arthroscopic debridement has any role in the treatment of degenerative knee joint disease (osteoarthritis). If you mean *definitive treatment*, I'd say no, arthroscopic debridement does not repair or replace worn cartilage inside the joint. At best, arthroscopic debridement of an osteoarthritic knee is an interim solution aimed at buying the patient time for preparation for eventual total knee replacement.

But arthroscopic debridement does help manage knee joint pain originating
from meniscal degenerative damage (which contributes to mechanical pain),
from free-floating osteochondral fragments (which can mechanically irritate the joint),
from inflamed synovial tissue (which is pain-sensitive),
from reactive inflammatory cells & chemicals in the joint fluid (which increase pain even more).

So here's a demonstration of how knee arthroscopy can help a relatively young patient with beginning knee osteoarthritis.
The patient is in her early 40s, is of normal body weight, has no history of knee trauma, but is presenting with right knee pain on ambulation. She can't walk without experiencing severe knee pain on the medial side of her knee. She's still too young for total knee replacement -- and even if she wasn't, she admittedly couldn't afford TKR within the immediate future anyway. Oral medications weren't working for her anymore. Hence, the potential role of arthroscopy in giving her a pain-free knee. Take note: she still has osteoarthritis of the medial compartment of her right knee, and this will still progress as years go by; but at least, for now, she's able to lead a normal life again, thanks to the arthroscopic clean-out.

Long before I learned how to do biportal endoscopic spine surgery, I was already doing knee & shoulder arthroscopic procedures. It's very rewarding, restorin...

04/08/2024

One of the unexplored advantages of UBE spine surgery is its ability to go "radiation-free" / "fluoroscopy-less". As long as the UBE procedure is simply decompression (i.e., no fusion / instrumentation involved, no pedicle screws & rods to be installed), leveling can actually be done using an ultrasound (with or without the guidance of pre-op imaging studies).

I actually incorporated the use of ultrasound imaging to my orthopedic practice back in late 2018. Prior to that, my skill set with doing nerve blocks was limited to landmark techniques and peripheral nerve stimulator techniques. Learning how to use the ultrasound for musculoskeletal imaging was a challenge, given that ultrasonography isn't taught to orthopods. Lucky for me that I discovered Dr Ki-Jinn Chin's YouTube channel, as well as the NYSORA channel which is mainly hosted by Dr Admir Hadzic. Their teachings came in handy with my ambulatory / minimally invasive ortho surgery practice, especially during the Covid19 pandemic lockdown years.

More importantly, Dr Ki-Jinn Chin's teachings on spine blocks totally revolutionized my approach to biportal endoscopic spine surgery. So you'll have to excuse me for being starstruck when I finally met him personally last month in MARA's 3rd post-grad convention-workshop.

09/06/2024

Thank you, ESFI, for inviting me to share my ideas & skills as part of your faculty. (Hard to believe that half a decade ago, I was the one doing UBE cadaver work.)

And thank you, Mactronic, for offering to let me bring back your UBE instrument set, UBE RF plasma & UBE burr drill kits back to the Philippines. It's nice to finally find good hardware for such a small fraction of the price of more well-known brands.

05/03/2024

Glad to see AO Spine is finally realizing how powerful UBE spine surgery is as a surgical technique -- and as a paradigm.

https://www.aofoundation.org/spine/about-aospine/blog/2024_02-blog-ube-miss

(So the question that's worth asking is: when are YOU going to acknowledge & accept the paradigm shift?)

BY DR ASHWINKUMAR VASANT KHANDGE

25/12/2023

Bilateral Decompression & Fusion for Pott's Disease of L4-L5 ...

This 51 year old patient presented with clinically significant mechanical lumbar pain and moderate radiculopathy (L>R) due to unstable collapse of L4 on L5 secondary to tuberculitic spondylitis.

Anti-TB meds were started 3 months prior to surgical treatment. Surgical goals were prompt mechanical stabilization & neurologic decompression of the collapsing L4-L5 segment.

Treatment done was UBE-ULBD of L4-L5 with percutaneous L4-S1 fusion. Total en bloc flavectomy was done using mainly the "no K-punch" technique.

Not surprisingly, there was so much adhesion & inflammation in the epidural space brought about by the TB infection, thus making the flavectomy more challenging than in the usual degenerative stenosis setting.

23/11/2023

Presenting the first ever UBE-TLIF in Pampanga...

I originally brought UBE spine surgery technology to Region3 in 2022, after having established this service in Fe Del Mundo Med (QC) in 2020-2021...

At its core, the role of UBEss thus far had mainly been to save patients with stable spines from unnecessary destabilizing surgical technique (which in turn warranted the more expensive fusion surgery techniques like PLIF or TLIF) -- i.e., treat patients with motion-preserving spine decompression without having to add motion-obliterating screws/rods/cages in the mix.

On rare occasions though, we find patients whose main complaint is instability pain brought about by arthropathic facet joints and degenerated discs -- i.e., pathologies that actually do need fusion technique in order for the patient's symptoms to resolve. So how can we do properly indicated fusion surgery along with decompression without having to strip open the bulk of the spine muscles?.. The answer is: do the fusion using biportal endoscopic approach. Patients will have lesser post-operative pain, faster post-operative recovery, lower risks of operative morbidities (e.g., bleeding, infection, subsidence, fusion failure, etc...)

01/07/2023

Time to represent...

http://www.wubes2023.org/?fbclid=IwAR3Hm-1M_cWc4UKDdihyfjFdn-zR6jG6ZV3J8b1P-gmgjywcrgzYIaOxFdI

WUBES2023,wubes2023,wubes,The World UBE Society