Dr Antony Thomas - Neurosurgeon

24/01/2026

Endotracheal intubation is routinely achieved either by direct laryngoscopy or by video laryngoscopy. The incidence of difficult intubation ranges from 1% to 6%, and if not managed on time, may lead to lethal complications.

Vie scope is a novel device in the world of airway management. It is completely different from conventional direct laryngoscopes and video laryngoscopes. It is an affordable alternative to video laryngoscopes that provides a highly illuminated view of the patient's airway, but without a camera. Vie scope does not have the traditional open-style blade; instead, it has a self-enclosed cylindrical clear tube with a flare-trumpet design at the end. The clear tube allows light to be transmitted from the ring of light-emitting diodes (LEDs) positioned at the handle end, which illuminates the entire tube (360°) and the airway with impressive clarity when looking down the tube [Figures 1 and 2]. When using the traditional laryngoscopy blade, the blade is inserted into the mouth and the tongue is then swept to the left. One of the innovations of the Vie scope is that the enclosed circular tube displaces tissue such as the tongue or debris from trauma out of the way, so that the provider has a straight line of sight to view the patient's vocal cords. Another advantage of Vie scope is that having more than one light source at the end of the handle avoids obstruction of the light source from blood and secretions, giving the user the best chance of intubation success.Once the visualisation is made of the vocal cords, a bougie is then passed down the tube using the coloured bands to determine the proper depth. This makes it simple and inexpensive in comparison to video laryngoscopes. The Vie scope design makes it ideal for the use in difficult airway patients, especially confined space rescue as intubation can be done by either hand. The Vie scope may be an excellent intervention during cardiopulmonary resuscitation without interruptions.

The Vie scope can ensure the intubation success rates.[3] Our initial experience with Vie scope showed great flexibility in use as its LED lighting helps in visualising the vocal cords easily, and it can be used with either hand.

To conclude, Vie scope is the tool that every anaesthesiologist needs in their airway kit for future airway management.

Airway https://share.google/ckTDghSxMS3VlYASb

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Luche +27792937439

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For the viescope, bebe scope and bougie
Med aid approved

15/01/2026

Osteoporotic Fractures (Benign)
Cause: Weakened bones from osteoporosis (age, gender, low calcium/Vit D) due to low-energy trauma or even spontaneously.
Symptoms: Acute back pain, often relieved by rest; pain worse with movement, coughing, sneezing; can be asymptomatic.
Imaging (MRI): Shows bone marrow edema (bright signal) in the vertebral body, usually spares pedicles in acute cases, but can show limited edema in posterior elements.
Prognosis: Generally good, with healing within weeks/months, though deformity may persist.
Treatment: Pain management, bracing, osteoporosis treatment; kyphoplasty for severe pain.

Malignant Fractures (Pathologic)
Cause: Cancer spreading to the spine (metastasis from lung, breast, prostate, etc., or primary blood cancers like myeloma).
Symptoms: Pain that may be persistent and progressive, potentially worsening neurological symptoms (weakness, numbness).
Imaging (MRI): Shows abnormal signal in the entire vertebral body, often involves pedicles and posterior elements early, convex posterior border, epidural/paraspinal mass.
Prognosis: Malignant, due to risk of spinal destruction, neurological damage, and cancer progression.
Treatment: Varies by cancer type; aims to control tumor, stabilize spine (surgery/cement), relieve pain, and manage cancer.

Key Differentiating Factors (MRI)
Pedicle Involvement: Malignant fractures often involve pedicles early; osteoporotic fractures less so, though some acute benign fractures show posterior element edema.
Posterior Border: A convex posterior vertebral body suggests malignancy.
Masses: Presence of epidural or paraspinal masses indicates malignancy.
Diffusion MRI: Can help differentiate; malignant tumors restrict water movement (restricted diffusion), while edema in benign fractures increases it.

When to Suspect Malignancy
Elderly patients with new back pain, especially with a history of cancer.
Fractures with rapid onset of neurological symptoms or severe, unrelenting pain.
Imaging findings suggesting tumor (e.g., pedicle involvement, posterior mass).
If there's any doubt, especially in older adults, a biopsy might be needed to confirm the diagnosis, as treatment and prognosis are vastly different.

25/12/2025

Merry Christmas

25/12/2025

Disc degeneration is graded by imaging (like MRI) using systems like Pfirrmann, which scores from Grade 1 (normal) to Grade 5 (severely degenerated), based on changes in disc height, nucleus hydration (brightness on MRI), and the boundary between the nucleus and annulus, reflecting progressive dehydration, structural breakdown, and potential instability leading to pain and nerve issues.

This widely used system uses MRI to assess discs on a 1-5 scale, with higher numbers indicating worse degeneration.
Grade I (Normal): Bright, homogeneous disc, clear nucleus/annulus, normal height.
Grade II (Mild): Inhomogeneous but still bright, some blurring, normal height.
Grade III (Moderate): Grayish, unclear nucleus/annulus border, possibly less height.
Grade IV (Severe): Dark gray/black, no distinction, loss of height.
Grade V (Most Severe): Black, collapsed disc space, significant height loss.
Stages of Degenerative Disc Disease (DDD)
While grading systems quantify degeneration, DDD often progresses through stages.
Stage 1 (Degeneration): Minor tears, dehydration, mild symptoms.
Stage 2 (Prolapse/Bulging): Disc bulges outward, increased pain.
Stage 3 (Herniation/Rupture): Severe pain, disc material pushes out.
Stage 4 (Severe Degeneration): Height loss, bone spurs, chronic pain.
Stage 5 (Collapse): Severe height loss, nerve compression, potential fusion.

Key Indicators of Degeneration
Loss of disc height: Discs shrink, reducing space between vertebrae.
Dehydration: Discs dry out, losing water content (appears darker on MRI).
Annulus disruption: Tears in the outer ring, allowing nucleus to push out.
Bone spur (osteophyte) formation: Body tries to stabilize the spine.
Nerve compression/stenosis: Degeneration narrows spinal canal, causing neuropathy (tingling, numbness).

06/12/2025

19/11/2025

https://m.facebook.com/story.php?story_fbid=795856813271692&id=100085421422400

14/10/2025

Cancer pain is one of the hardest challenges we face in practice.

Opioids remain the backbone of treatment, but they are not always effective. For patients with abdominal malignancies, pain can be severe, unrelenting, and resistant to escalating doses. Side effects compound the burden.

A study in Cureus (Paul & Borkar, 2022) reviewed the role of fluoroscopy-guided splanchnic nerve blocks for cancer-associated abdominal pain. This approach is particularly valuable when tumours distort celiac plexus anatomy, making traditional celiac plexus blocks less effective.

Key takeaways:

• Splanchnic nerve blocks can provide meaningful pain relief in patients with refractory cancer pain

Neurolysis or radiofrequency ablation reduces opioid dependence and associated side effects

Improved functional status and quality of life were consistently observed

• These blocks can be technically easier than celiac plexus blocks in patients with altered anatomy

we view these interventions as critical components of advanced cancer pain management. They are not curative, but they can restore dignity, comfort, and daily function where systemic therapies fall short.

Reference: Paul A, Borkar A. Fluoroscopy-Guided Splanchnic Nerve Block for Cancer-Associated Pain. Cureus. 2022.

In your experience, are advanced blocks like splanchnic neurolysis underutilised in cancer pain management? What barriers do you see to broader adoption?

we partner with you

https://pubmed.ncbi.nlm.nih.gov/40988238/

20/09/2025

Awake Transforaminal Endoscopic Lumbar Discectomy (TELD) – L5–S1 Disc Prolapse

Open microdiscectomy has long been the gold standard for treating radiculopathy caused by lumbar disc herniation. Today, however, Transforaminal Endoscopic Lumbar Discectomy (TELD) offers a highly effective, minimally invasive alternative.
With ongoing technical refinements, TELD now delivers clinical outcomes comparable to traditional open surgery while allowing faster recovery and less postoperative discomfort.

Our recent case highlights these benefits:

Pre- and post-operative MRI confirmed successful removal of the L5–S1 disc herniation.

The procedure was performed under awake endoscopic guidance, avoiding general anesthesia.

The patient is already symptom-free and doing very well.

Minimally invasive spine surgery continues to expand the possibilities for safe and reliable care.

🔗 Learn more about TELD: International Journal of Spine Surgery

https://www.ijssurgery.com/content/15/suppl_3/s38

29/08/2025

29/08/2025

Stryker Navigation

Used for First time in South Africa

For posterior thoracic spine instrumentation and fusion
Correction of Kyphosis for acute spine fracture patients in Lenmed Private Hospitals Kimberley.

1st case.
Severe kyphosis, with anterior wedge deformities of T6/7 vertebral bodies, Impression of T6 comminuted vertebral body fracture, and left upifacet dislocation.

2nd case.
T4 and T5 compression, left T3-T8 and
right T4-T5 transverse process and bilateral T4 and right T5 lamina fractures. Hyperintense signal changes of T4 and T5 present on STIR and T2W. In keeping with acute fracture/injury. Excessive thoracic kyphosis. Hyperintense signal demonstrated within the central aspect of the cord, affect segment involved T4-T5.

It was a learning Curve for everyone and was a team effort.

19/08/2025

Recurrent lumbar disc herniation (RLDH) remains one of the most frustrating challenges in spine surgery. Despite a technically successful primary discectomy, up to 18% of patients experience symptomatic recurrence. When they do, we're left with a decision that has sparked decades of debate: Should we repeat the discectomy, or should we fuse?

Let's take a look at what the data says: Meta-analyses and large database studies offer mixed insights.

Fusion may reduce recurrence and segmental instability... Lei et al. (World Neurosurg, 2023): In a meta-analysis of 11 studies, fusion reduced neurological deficit, segmental instability, and re-recurrence vs repeat discectomy, although fusion was associated with longer operative time, greater blood loss, and longer hospital stay.

Mucuoglu et al. (Neurosurg Rev, 2025): In a retrospective review of 276 patients, patients undergoing discectomy with fusion (PLF or PLIF) had significantly better postoperative pain scores and recovery rates compared to repeat discectomy alone (77% vs 71.8%).

But repeat discectomy remains effective and far less invasive. Guan et al. (J Neurosurg Spine, 2017): Using N2QOD data, both fusion and repeat discectomy achieved similar

outcomes at 3 and 12 months. However, fusion patients had 3x longer operative times, greater costs, and longer lengths of stay - with no improvement in QALYs.

Tanavalee et al. (J Clin Neurosci, 2019): Their meta-analysis showed no statistically significant difference in reoperation rates between fusion and discectomy. Discectomy had shorter OR time and hospital stay.

Clinical takeaways:

Fusion may be better for patients with significant back pain, segmental instability, or recurrence after multiple discectomies.

Repeat discectomy is ideal for younger patients with minimal back pain, lower surgical risk tolerance, or concerns about adjacent segment disease.

No consensus exists, and even meta-analyses draw different conclusions based on definitions of recurrence and radiographic instability.

17/08/2025