Transcription:
Robot-Assisted Spine Surgery

Bill Klaproth (host): If you're listening to this, you probably have an aching back. I hear you because I sometimes go through that same back pain and it is. Miserable, no question about that. However, there's good news advances in robotics and GPS technology have sparked a revolution in modern surgery. Surgeons can now perform complex procedures. Many of them minimally invasive again, which is great news so let's get to this good news and learn more about robot assisted spine surgery and how it benefits you with Dr. Sohrah Pahlavan, chief of orthopedic surgery at Community Memorial Hospital.

This is Wise and Well presented by Community Memorial Hospital. I'm Bill Klaproth Dr. Pahlavan. Thank you so much for your time before we get to hearing about advances in robot assisted spine surgery. Could you give us some brief background on yourself?

Dr. Sohrab Pahlavan: Sure. Thanks for having me, excited to be here. I was born in Iran, but I grew up in And Scandinavia and I lived there till I was 16. We moved to the US at that point middle of high school. Great timing. So I, went to high school in bay area, went to university of California in San Diego for undergrad, for med school as well. I did my residency at UC Irvine, and then I did the combined, neurosurgical and orthopedic spinal surgery fellowship at the university of Miami. And then finally ended up in a beautiful south coast in Ventura, California, where I have been practicing for the past five years.

Bill Klaproth (host): Wow. I don't think many people have that path. Iran, Sweden. It sounds like a Florida. You said Miami. And then over to the bay area.

Dr. Sohrab Pahlavan: Yeah. You know, I used to think that too, but I've met a few, Swedish Iranians here in the US, surprisingly.

Bill Klaproth (host): My goodness. Wow. Well, we're happy to have you here and Thank you for sharing a little bit of your background with us. So let's talk about the XLC is GPS. This is really exciting. First off. Can you tell us how does it work and how does this provide a better surgical experience for the patient?

Dr. Sohrab Pahlavan: Basically with the advances in, spinal instrumentation, which means, you know, roughly speaking, putting screws and rods to stabilize the spine and to correct deformities, we have had a stepwise development. And evolution in how we do these, it started off with doing it wide open exposures and feeling our path, by hand where the screws needed to go. And then we introduced interoperative imaging with a low energy x-ray. And it has advanced now to the point where we have three dimensional imaging where we merge CT scans with interoperative images to obtain a reference point in space.

And using various, localizers and sensors, we can now know using a little probe where we are at all times. And as in the further evolution of that, now we have these rigid, robotic arms that we preplan, we control where they gonna point, but we plan the paths for our instruments and our screws. And the rigid arm then maintains that path solidly giving us a high fidelity placement of the implant. And that's where we're at now. It gives us basically a very accurate and efficient way of placing screws and other implants into the spine.

Bill Klaproth (host): So you're basically navigating, pinpointing the exact spot where you need to go with this. Is that correct?

Dr. Sohrab Pahlavan: That's exactly correct. So, and it's actually the next step. further evolve from navigation, where in addition to navigating, it also allows a straight and consistent path for the tools that we pass through. So when we create the path for the screw, when we tap, when we do the various things we need to do to place the screw rigid arm maintain that trajectory and avoid any kind of Skyping or going off, until the screw is in, so it kind of helps further create another kind of step of confidence and accuracy.

Bill Klaproth (host): You've mentioned the rigid arm. I could see again, where that would really help the pinpoint accuracy of this?

Dr. Sohrab Pahlavan: Right. I I will say, the vast majority of skilled and well-trained spinal surgeons will have no doing this, the issue is that when you're doing spinal surgery, you have to hit a home run every time. You have to walk into your OR, you have to hit a home run every time. And in this really ups your batting percentage quite a bit. And the reason is you really cut out those outlying issues where occasionally a screw is going to be misplaced or there's going to be a breach or something's going to happen that compromises the outcome of the surgery. And this really helps minimize that.

And it also helps with the surgeons mental and physical fatigue. Cause it, kinda takes certain parts of the surgery out of your hands gives it to the robotic system where you don't have to focus. So, your mental and physical capabilities as much on that particular issue and can folks at elsewhere at other critical portions of the surgery.

Bill Klaproth (host): Right. So this really provides a more efficient, successful surgery. And does it help in recovery as well?

Dr. Sohrab Pahlavan: The way that it helps in recovery is that you can really quite reliably and with high confidence, do the procedures through much smaller incisions. So in that regard, as long as you're utilizing that, minimally invasive spinal surgery. technique. Yes, then you are helping the patient recover faster. you radically cut down on blood loss, infection rates. So that is definitely one of the upsides as well.

Bill Klaproth (host): Someone listening to this is probably thinking, oh man, this is great, but is this for everyone? You know, what type of spinal injuries can be corrected using the Excelsius GPS, robotic navigation surgery?

Dr. Sohrab Pahlavan: The vast majority spinal pathology don't require surgery. That's important to point out, but there's so much spinal pathology out there, so much back and neck issues out there that it does add up. So in general, this is very broadly speaking, the issues that would benefit potentially from a platform like this are usually degenerative issues. So things like spinal arthritis that lead to compression of nerves or where there is. Some sort of instability between one or two segments, or more, in the spine where it's shifting back and forth, as you stand and walk.

Conditions for instance, such as Spondiloisis, which is where the vertebra slip on each other. Those are the majority of cases where we are, using the screws to help stabilize and decompress the nerves. The other broad category would be spinal deformities, such as scoliosis, either the adolescent kind that we see as a young adult or even the adult kind, which comes as a result of arthritic issues. That is also a big indication for using this platform.

Bill Klaproth (host): And then on the same lines, who would be a good candidate for robotic surgery? How would someone know if they are a good candidate?

Dr. Sohrab Pahlavan: Unfortunately, they probably wouldn't, I think the main issue is first of all just delineating where the problem is coming from, what the nature of it is. if you do have, issues like chronic back pain that is not responding to a good conservative program, such as a core strengthening physical therapy, occasional use of anti-inflammatory medicines. And if on imaging, then you're demonstrated to have one of these conditions that we briefly touched on.

And then, especially, especially if you have pain going down into the gluteal area down your legs, hindering you from standing, walking. Those are usually things that are most effectively treated surgically, once conservative options have failed. It is broadly speaking, it's hard to know as a patient, whether specifically that is what you have. Cause it's not as homogenous of a group of pathology, such as if you have a knee arthritis or hip arthritis, but, generally speaking, that's the symptoms you'll be experiencing. Significant back pain. And also usually some component of pain going down into the lower extremities.

Bill Klaproth (host): Okay. Well, that's a very informative, so thank you for sharing that cause I'm sure that's a big question. People always ask. And is there less risk associated with spine surgery If the robot is used?

Dr. Sohrab Pahlavan: Yes. That is one thing that we can unequivocally say that there is a lower risk of screw mal placement. ie. a Low risk of the screws being placed in the wrong place. Now as with any sort of technology, it's only as good as its operator. So you have to of course use good judgment. You have to be judicious. You have to know when things maybe look a little bit off, so the surgeon Has a lot of confidence in the platform, but it doesn't remove the surgeon out of the equation, but it does make for a safer and more efficient surgery.

Bill Klaproth (host): And having this technology close to home is important as well, why is it important for someone that we have this surgery so close to home?

Dr. Sohrab Pahlavan: That's a great question. We live in a relatively small community out here, and we are close to a major metropolitan area, but it's not terribly close. It is not easy to have to drive the two hours into the city go to a tertiary referral center with more resources. And so what this technology does, it enables us to broaden our capabilities as a medical providers. It allows us to take on more complex cases. It allows the patients to stay close to home. They can do all their follow-ups where their doctor locally.

They don't need to drive to the city and quite frankly, they will get the close attention and care that I think they've come to expect living in a place like this, where the community is smaller. And there's also a lot more personal interaction with your physician. More tight-knit and I think people seek that and they want that. And I think this helps enable the and broadened indications further.

Bill Klaproth (host): Absolutely for anyone with back problems like me. You know how problematic long car rides can be. So this is really great news that it's so close to home. So what are some questions Dr. Pahlavan that someone should ask you before orthopedic surgery?

Dr. Sohrab Pahlavan: So in terms of everything, if once you've been deemed, a candidate and the subject of surgery has been broached, I think it's very important to ask, first of all, it's important that you feel comfortable with the surgeon that's going to do to surgery. You should ask them about their training, and for spinal surgery, it's, generally done by either an orthopedic spine surgeon or a neurosurgeons do the spine surgery. People always ask what the differences is? There really is no big difference any longer.

Traditionally, there were some differences decades ago, but now the training has really molted together. What's most important is that the surgeon doing your surgery, whether they are an orthopedic or a neurosurgeon is that they really need to have their practice focused on spinal surgery. They should not be doing other things. You should not be doing hip replacements or. Brain tumors on this side. This should really be the focus of your practice. And the reason for that Spinal surgery is esoteric enough that it requires your full attention and training, and you need to be dedicated to that in your practice to be a good spine surgeon.

I think that is the most important thing by far the same applies to other orthopedic things. You know, if you're getting your hip replaced or a knee replaced. I mean, there's orthopedic surgeons there that that's all they do. They literally only do hip and knee replacements. And maybe it sounds ridiculous, but that is how you get the best results. This person does, eight to 10 of these a week. That's the guy or girl that you want. That's it, there's just no two ways about it. So that's one thing. The other thing I would say, that's important to ask is. What your expectations should be from the surgery?

I think that's extremely important. unfortunately when you have a spine procedure or any surgery, really, it's not always going to be a hundred percent perfect and pain-free afterwards, it's very important to realize what the limitations of the treatment are and how much better you can get. That is obviously different for different cases, but I think it's a very good question to ask your provider, your surgeon and really get an answer that you feel comfortable with. If you feel like it's not going to be worth the recovery time and whatever potential. risks from surgery, then it's important for you to know that ahead of time.

Bill Klaproth (host): So another question on training, as you were talking about that, I'm just curious, what type of training then does a surgeon undergo in order to become proficient at robotic spine surgery? What's the training involved with that?

Dr. Sohrab Pahlavan: Training as is mandated by the FDA is that you do a training course, on the platform you're going to use, And that's required. Everybody has to do that. Now, in terms of the training that you have, as a practitioner, that's going to obviously be variable, but I will say that usually there is a learning curve of about 30 cases. So usually after 30 cases, most surgeons will be quite proficient and fast out with the platform. That's the rough guide. And I think for me, for instance, now we're at almost a hundred cases, so. I'm past that learning curve, but we're always learning. We're always trying to do things better. We're always trying to perfect the procedures that we're doing.

Bill Klaproth (host): Absolutely. And Dr. Pahlavan, thank you for your time. We appreciate it. Last question, anything else you want to add when it comes to robot assisted spine surgery?

Dr. Sohrab Pahlavan: I just want everyone out there in the community to be aware that we have this platform. We have great surgeons, very well-trained surgeons. Surgeons that you will feel comfortable with, confident in that will respond to your needs. I certainly take great pride in trying to do what's always best for my patients. I am happy to go over options for them. I'm always happy to. I give them other options that may be viable. Not everything is always going to be surgical. I also want to really emphasize that there's a big misconception out there that spine surgery just doesn't work.

I will challenge that greatly and that while I am a surgeon, I'm biased, I would say I have hundreds of patients every year that are more than happy that they had their surgery that did exceptionally well. So the worst thing you could do is just come in, talk to us See, what options are out there for you.

Bill Klaproth (host): Absolutely. Great advice, Dr. Pahlavan. Thank you so much for your time. This has really been informative. Thank you again.

Dr. Sohrab Pahlavan: Thank you for having me. Thank you so much.

Bill Klaproth (host): And once again, that's Dr. Sohrab Pahlavan, and for more information, please visit CMHShealth.org. CMHShealth.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Wise and Well presented by Community Memorial Healthcare. Thanks for listening.