Avicenna Society

11/19/2025

Syringomyelia can range from silent to mimicking almost any spinal symptom, which makes surgical decision making tricky. I am assuming most of our orthopedic colleagues do not routinely manage syrinx, so I am curious how you prioritize intervention.

My approach is to consider progression on MRI, clear clinical deterioration [weakness, gait issues, dissociated sensory loss], associated pathology like Chiari or tethered cord, and the presence of significant cord edema or rapid cavity expansion. Asymptomatic or stable syrinx usually stays in surveillance.

What are your surgical criteria and thresholds in your practice?

11/16/2025

In our last case conference, we discussed in detail when to cancel and when not to cancel a case. Recently, a colleague asked me about a above situation. In my own practice, the key question is always the same, is there an active infection. Chronic conditions like caries, mild gingivitis, long standing skin changes, or even stable ulcers do not automatically lead to cancelling an instrumented fusion. CONSIDER THESE SITUATION SOMETIME TAKES YEARS TO RESOLVE!

I rely first on clinical signs. Labs support the decision, CRP and WBC for acute processes, ESR as a slower adjunct. If there are no clinical signs of infection and the labs are normal or consistent with the patient’s baseline, I generally proceed. A chronic ulcer without warmth, redness, or purulence is not an infected wound. I document the exam, verify labs, and move forward.

I am interested to hear how others handle chronic dental issues or skin lesions before fusion and what threshold you use for postponement.

11/10/2025

Looking forward to seeing you all in Dubai on January 1 at this fantastic venue. It’s going to be an incredible start to the year filled with innovation, collaboration, and new milestones in spine surgery.

11/06/2025

11/03/2025

We had a very productive discussion about **surgery cancellation criteria in spine cases**, especially concerning **anticoagulants** and **GLP-1 receptor agonists**.
Sharing here a few key papers that summarize current recommendations and perioperative considerations.
Special thanks to **Dr. Stainer** for providing these valuable resources.

10/23/2025

Patient underwent L3-5 OLLIF in 2023 with excellent recovery. Over the past year, developed isolated low back pain consistent with sacroiliac (SI) joint pathology. SI provocation tests positive; two diagnostic/therapeutic injections each produced >80% pain relief, currently asymptomatic.

Interestingly, recent CT/MRI demonstrate significant L3-4 adjacent segment degeneration with disc herniation, yet the patient has no claudication or radiculopathy.

Question for discussion: In a case like this—radiographically severe adjacent segment disease but clinically silent and with proven SI etiology—how aggressive should one be in addressing the L3-4 disc pathology?

10/16/2025

For those interested, here are the AP and lateral X-rays of a two-level OLLIF. These surgeries can be highly efficient, and that efficiency depends more on technique and experience

Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube.

10/16/2025

75-year-old patient, 90% axial back pain with mild bilateral foot numbness (mostly L5). Conservative treatment has failed. Imaging shows notable lateral listhesis.
Question for discussion: how significant do you consider lateral listhesis in your decision-making, and which level would you prioritize for intervention in such cases?