Avicenna Society

09/22/2025

09/11/2025

Case of Dr Basit

What would you have done

64 yrs male patient came to us with complaints of weakness B/L lower limbs not able to walk and pain radiation to B/L lower limbs Rt>>lt.
Patient gives also history of bladder and bowel involement since 1 week.
History of weakness in both lower limbs since 15 days.
Patient says he has back pain with radiation to lower limbs since last 5 yrs but it has agrevated since last 3 months.
O/E patient has grade 3 power in hips and knees and grade 2 power in ankle and feet. Ankle and knee reflex exaggerated and ill sustained clonus on right side. Pain score for leg 8.pt on wheelchair.
MRI shows
Compression at the D11/12 level with severe canal stenosis and severe stenosis at L4/5 level.
Did endoscopic extraforamenal approach for D11/12 and decompressed the cord at this level , and did ULBD at L4/5 level.
1st post op day pain score 0
Patient felt better was mobilised on walker.
No change in power grade at ankle and feet on 1st POD, but patient feels better and says his legs feel lighter.

09/10/2025

Avicenna Society is expanding its educational curriculum with a dedicated YouTube channel for **basic spine management and education**.

We carefully review thousands of presentations and select the most valuable content for learners at every stage:

* **Medical students** (end of training)
* **Residents** (early residency)
* **Family practitioners & non-surgeons** seeking insight into back pain management

This channel provides structured, accessible education on how spine specialists approach diagnosis and treatment of back pain.

Stay tuned and subscribe to this and other Avicenna Society channels for ongoing updates and resources:
👉 [https://youtu.be/eDomQHDZ2ho](https://youtu.be/eDomQHDZ2ho)

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09/03/2025

I think these two slides capture the core question of fusion surgery, namely what is the best kind of fusion.
The upper slide, courtesy of Dr. Mayur Kardile, illustrates that the choice of surgery is never dictated solely by pathology or the theoretical “best” procedure. Instead, the decision always reflects a combination of surgeon skill, patient needs, and the availability of resources.
The lower slide reflects our policy at Avicenna Technical University, which is to prioritize fusion techniques based on which goals they achieve most effectively. While more elaborate algorithms exist, I believe the simplicity of these two visualizations makes them universally applicable and practical

09/01/2025

The Value of Ambulatory Surgery Centers (ASCs) in Spine Surgery
Presentation Summary
This perspective, presented by Dr. Frank Phillips in Chicago, highlights the growing role of ASCs in spine surgery. Hospitals remain essential for rare, complex disease, but they are inefficient venues for high-volume, elective spine procedures.
Why ASCs Matter
Safety & Outcomes: Data consistently show that spine surgery in ASCs is as safe as in hospitals when patients are appropriately selected.
Efficiency & Patient Experience: ASCs offer predictable schedules, shorter stays, and consumer-friendly environments compared with hospital systems.
Surgeon Control: Surgeons manage anesthesia teams, implants, and workflow, ensuring quality and consistency.
Economic Value: Shifting even 50% of eligible Medicare procedures to ASCs could save the U.S. healthcare system $2.4 billion annually.
Beyond the Basics
While Dr. Phillips reports performing most one-level lumbar fusions safely in ASCs, our 12-year experience extends to two- and three-level complex fusions in high-BMI patients with excellent outcomes. Technique and surgeon expertise are critical—shorter anesthesia and operative times are major determinants of safety and success.
The Takeaway
The writing is on the wall: ASCs are the future of elective spine surgery. They provide safety, efficiency, cost savings, and greater surgeon autonomy. For practicing spine surgeons, the choice is clear—adapt to this model or remain dependent on hospital systems.

08/30/2025

"Defining Normal Spinal Alignment: Advances in Sagittal Plane Understanding and Planning" by Dr. Michael Kelly, University of California, San Diego, CA.

Over-reliance on rigid deformity parameters such as PI–LL mismatch, pelvic tilt, and SVA has led us away from the true biomechanics of human alignment. This talk strongly argues that these static categories oversimplify a dynamic system and fail to reflect the “cone of economy”—the natural balance of cervical, thoracic, lumbar curves, pelvic incidence, and lower limb alignment.

Key points:
PI–LL, PT, and SVA are “dead” parameters—too imprecise and misleading for precision medicine.
Lumbar lordosis is not a single L1–S1 number; distribution (upper vs lower arcs) is crucial.
Pelvic incidence drives changes in the upper lumbar arc, which balance with lower thoracic kyphosis.
Categorizing continuous curves creates artificial cutoffs and misleads treatment.
Vertebral pelvic angles (VPA) provide a continuous, individualized measure of spinal alignment relative to the hips, better guiding surgical targets.
“Perfect biomechanical construct” ≠ “right surgery”—patient goals, comorbidities, and surgeon judgment must guide decisions.
The speaker challenges dogma: precision surgery requires moving past oversimplified spinal parameters and returning to a holistic, biomechanical understanding of human alignment within the cone of economy.

"Defining Normal Spinal Alignment: Advances in Sagittal Plane Understanding and Planning" by Dr. Michael Kelly, University of California, San Diego, CA.Over-...