Avicenna Society

01/06/2026

A quick follow up and an important clinical lesson.

This patient had imaging that would tempt most spine surgeons to jump straight to L5-S1 fusion. We did not.

Careful history, asking the patient to stand and point to the pain, and systematic sacroiliac joint provocation tests localized symptoms to the SI joint. Multiple protocol-driven SI joint injections produced near-complete pain relief each time, confirming the diagnosis.

Treatment was bilateral sacroiliac joint fusion, not L5-S1 fusion. One year later, the patient is completely pain-free.

Key points:
• Imaging alone is not diagnosis
• SI joint must be part of the differential, even with obvious lumbar pathology
• About 25 percent of first-time low back pain originates from the sacroiliac joint
• About 75 percent is spinal, do not ignore the spine, but do not ignore the SI joint either
• Skipping proper differential diagnosis risks taking the wrong surgical path

Due diligence protects patients. Shortcuts cost them.

01/05/2026

Make a post
What is your favorite mode of treatment for this 80-year-old male for L5-S1? Would you as well treat L4-5?

01/01/2026

01/01/2026

ASML is the only company on earth that can build extreme ultraviolet lithography machines.

13.5 nanometers atomic precision. Near x ray optics. Every advanced chip in the 2020s and beyond depends on this.
This exists because a few physicists refused to accept that it was impossible.
They were laughed off stages. Funding was denied. The US walked away.

ASML did not.
Medicine is no different.

When gatekeepers reject ideas like turning a 4 to 5 hour spine surgery into 35 minutes, with better outcomes, 1/20 infection risk, and four times faster recovery, they are protecting inertia, and exporting our innovation.
Innovation never dies. It just moves elsewhere, thrives, and then gets reimported, like electric vehicles and endoscopy.
Max Planck said it best: Progress is driven by a few INSPIRED individuals, often working quietly in overlooked corners.

Hence, INSPIRED SPINE.
STAY INSPIRED MY FRIENDS

12/11/2025

It is a privilege and an honor to be in Dubai and present the OLLIF talk in a plenary session to colleagues from around the world, December 3, 2025.

Full talk: https://youtu.be/2NMHiAy_d3w

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

12/11/2025

There is always a learning curve. TransKambin OLLIF is no different. Early on, our full setup took 30 to 40 minutes before we could even start the case. By protocolizing every step and eliminating inefficient actions, our setup time is now consistently under 3 to 5 minutes.

This video pair demonstrates the common C arm setup and the full draping process for the field.
Draping sequence: https://youtu.be/ViS7c3X9VQQ

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

12/11/2025

There is always a learning curve. TransKambin OLLIF is no different. Early on, our full setup took 30 to 40 minutes before we could even start the case. By protocolizing every step and eliminating inefficient actions, our setup time is now consistently under 3 to 5 minutes.

This video pair demonstrates the common C arm setup and the full draping process for the field.

C arm setup: https://youtu.be/W_WJohsA0B4

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

12/09/2025

For complex TransKambin OLLIF cases, we use the Alexandria setup. The lateral machine has five degrees of freedom and is positioned at a 25 degree angle to the patient, which lets us correct scoliosis and torsional deformities to obtain a true lateral view at every lumbar segment. This configuration allows us to handle difficult anatomy and maintain precise orientation throughout the case. Below is how the x-ray unit is arranged in the OR.

12/03/2025

Dear society,
A quick update for everyone at the WFNS Dubai conference. I will give a talk about OLLIF today between 8:00 and 8:10 AM in Hall 5.

Later today we will cover sacroiliac joint fusion. That session is scheduled for 14:20 and 14:30 in Breakaway 17 in Sheikh Makhtum D.

Please join us for the presentation and the follow up discussion.

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?