Carl Maronich (Host): Welcome to Health Talk, presented by the Valley Health System. I'm Carl Maronich. And joining me is Dr. Kevin Sharif from the Valley Health System. And today, we'll be talking about endoscopic and robotic spine surgeries. We'll discuss how these innovative techniques are revolutionizing spine care by reducing recovery times, and enhancing patient outcomes. Dr. Sharif, welcome to the podcast.

Kevin R. Sharif, MD: Thank you.

Host: Maybe we could start by talking and explaining just what is endoscopic spine surgery and how does it differ from traditional spine surgery.

Kevin R. Sharif, MD: Sure. You've probably heard, and people hear about minimally invasive spine surgery, so making smaller incisions and doing a surgery that can get someone better with a quicker recovery. But endoscopic spine surgery is different. Endoscopic spine surgery is ultra-minimally invasive surgery. I can make an eight-millimeter incision. We're talking about an incision that's smaller than a dime. And then, using a tube the size of a straw, I can place a camera down into the spine. I can localize bone spurs or discs that may be pinching a nerve causing sciatica, and I can remove them without removing bone, without cutting any major muscle and just leaving the anatomy intact. So, it's like sneaking in, sneaking out, taking care of the problem. When I talk about these surgeries to my patients, I kind of explain it as like a Navy Seal sneaking in to where the bad guys are, taking out the target, no collateral damage.

It's interesting, you know, when it comes to spine surgery, traditionally, patients think they're going to have this big surgery with a lot of recovery. But for problems that can be handled with the endoscope, that's just not the case. Here's a good analogy for you. Imagine you locked your keys in your car. Traditional open surgery is like taking a brick, smashing the window to get the keys out. The job gets done, but then you broke the window. You got to fix the window. You got a big mess. Endoscopic spine surgery is like a locksmith. Sneak in, pick the lock, get the keys out, take the pressure off the nerve, sneak out, door's intact, window is perfect, no mess.

Host: Very stealthy.

Kevin R. Sharif, MD: Yes.

Host: So, that has to have a huge impact on recovery and ability following the procedures in terms of what patients are able to do.

Kevin R. Sharif, MD: Absolutely. Absolutely. And that's where it really shines. I mean, the reason I started doing this surgery is because I had heard about it. This takes additional training. This is not something that you pick up during your fellowship training, at residency. Spine surgeons that do this, and there's not many of us across the nation that are doing it, but the ones that have seek additional training.

And I happened to run into someone, that he's a world-renowned surgeon, ran to him at a conference. He was talking about this. He was so enthusiastic about this type of approach to spine surgery. I started talking to him afterwards about it. He's in California. He invited me to come watch him do this surgery essentially. I was a little skeptical at first. But then, being there and seeing how he was able to take care of these problems and very stealth-like, as you said, just getting in and getting down and getting the job done, I thought to myself, if I have a spine problem and it can be fixed with a endoscope, that's the kind of surgery that I want for myself. So, I decided to do some extra training. I worked with him. I went to a bunch of labs. I learned how to do these techniques. Now, I've brought them back to the valley and I'm just glad I could be able to offer this type of high quality spine care to my patients.

Host: Yeah. Wonderful. And, Doctor, let's talk a little bit about endoscopic surgery and robotic surgery and how and where those two things meet.

Kevin R. Sharif, MD: So, I'm actually the surgeon that really was a proponent of getting the robot here at Henderson Hospital. This was about five years ago. And one thing that I saw—I've been in practice almost 10 years. I actually was one of the first spine surgeons to work at Henderson Hospital when it opened up 10 years ago. And one thing I saw in the valley, just in general, was a lack of the most cutting-edge spine technology. And I kind of made a priority in mind to work with the CEO that we could bring some of this high-tech spine technology to the valley to better care for our patients. So, about three or four years after I started, we started talking about it. And we were talking about spine navigation and things like that. But then, when I got privy to the robot, I thought the robot would be the best step for the hospital to take.

So about five years ago, we were able to acquire the Medtronic Mazor X Stealth Edition. One of the best robots in the market—the best, in my opinion, in the market. And this robot doesn't actually do the surgery. You have to think about the robot as more like an assistant in the surgery. It makes the surgeon like Robocop, if you will. So, it helps us place the implants with precision and accuracy. It's just about consistency and just better patient safety. And that's what it really helps and it benefits. And also, it helps with minimally invasive spine surgery using the robot. Because the robot shows us where the anatomy is on a computer screen. It's almost like using your GPS in your car, your navigation, so we can make smaller incisions and put these implants exactly where they need to be without exposing all the anatomy.

Host: So, post-surgery, via these instruments endoscopic, the robotic, the mobility a patient will have and the activity they're able to participate in following the surgery. Is that impacted by this technology?

Kevin R. Sharif, MD: That's what it's all about. It's about the outcomes. It's about how the patient does after surgery. And with endoscopic spine surgery, I'll talk about that. First, let me get into endoscopic. These patients leave the hospital the same day. My first case that I did endoscopically, I called the patient the next day. I'm very into each and every outcome for my patient. So, I happened to call this gentleman the next day. I want to know how he did. It's my first one that I had done. I trained to do it. I knew I could do it. But he was my first patient, and I told him that before the surgery. And I called him the next day. And the first thing he said to me was, "This is weird. I really didn't expect this." And I'm thinking like, "Okay, what's wrong?" And he says, "Guess what? I don't have any pain. Is that normal? I mean, my leg pain's gone, but I don't really even feel like I have had any back surgery. My back feels a little tighter, but there's no pain." Especially with endoscopic spine surgery, most patients do not have much pain after surgery at all. They don't take opioids, so they're not taking Percocet or hydrocodone and all those things that you would think a spine patient may take after surgery. Sometimes they take a little Tylenol, and that's really all they need, and most of them are back at work the following week.

Host: Amazing. Are all patients candidates for these kinds of surgeries or are they better suited to some patients over others?

Kevin R. Sharif, MD: Yeah, it's all dictated by the problem. Some problems respond very well to endoscopic spine surgery. Other problems may respond better to other types of surgery. For me, I am a minimally invasive surgeon. So, I offer minimally invasive options to my patients. Sometimes that's endoscopic spine surgery, sometimes that's robotic surgery where we do fusions and use implants to help the patient get better.

But even with robotics, what I've seen is patients get better faster. We're using smaller incisions, less impact on the patient and greater precision. So, a lot of patients with a traditional fusion that's not done minimally invasive, they'll be in the hospital for three or four days while the majority of my patients are discharged within 23 hours.

Host: Wow, amazing. Motion preservation, that's something that, as you said a little bit earlier, it's all about the outcomes. You addressed pain. But in terms of motion following surgery, getting back to activities people enjoy, talk a little bit about that.

Kevin R. Sharif, MD: Yeah. So, that is something else that endoscopic spine surgery allows us to do. There are certain problems that actually need a fusion. The spine needs to be stabilized, it needs that type of support. But there's other problems where the spine doesn't actually need to be fused. But the reason we have to fuse it is because we have to remove so much bone and just change the anatomy so much that it would destabilize a spine and cause a further problem down the road. But with some problems and some pathology, what we call it, we can do an endoscopic surgery instead of doing a fusion. So, a patient that may have required a fusion, which would've decreased their range of motion and could lead to other problems down the road, we can do an endoscopic spine surgery and preserve their motion. And they don't need a fusion anymore.

Host: Talk a little bit about the pathway that patients may go through to end up with you. I mean, if I have some back pain, my first thought isn't to go to a surgeon probably; maybe my primary care provider. But talk a little bit about those who are suffering from back pain or some issues, what the pathway is to getting cured.

Kevin R. Sharif, MD: Most of my patients are referred by a primary care doctor or a pain management doctor. So typically, a patient will have a problem, they'll see their primary care doctor, they'll probably be sent to physical therapy. It depends, just based on the problem, and maybe sometimes the x-rays or MRIs. After physical therapy, if that doesn't work, they may be sent to pain management or they could be sent to me.

Most of my patients see me before pain management physicians sees them and try some injections, but some get injections before they come and see me. And then, when I evaluate them, my goal is to help each and every patient avoid surgery if they can. I'm a surgeon. But if you can get better without surgery, that's definitely the way to go. So, we try non-surgical things. Sometimes that's anti-inflammatory medicines. Sometimes it's physical therapy. Other times, it may be injections. And then, if nothing's working and the problem is correctable with surgery, then surgery is offered.

Host: Are there different conditions that may impact the spine that would require surgical or some other intervention as opposed to trauma? Are there other conditions that could cause a patient to need some spine care?

Kevin R. Sharif, MD: Sure. those conditions are typically degenerative in nature. They could be congenital, or it could be deformity like scoliosis. So, those are all conditions that I treat. I really treat all aspects of spine care. My training is a little bit different than most spine surgeons.

So, there's two schools of spine surgery, you could think of it that way, two teams. You have the neurosurgeons. And then, you have the orthopedic spine surgeons. I'm an orthopedic spine surgeon. However, my training was not just with orthopedic spine surgeons, it's with neurosurgeons as well. I trained at the Leatherman Spine Institute. It's one of the oldest spine fellowships in the country. And during that fellowship, you not only work with orthopedic spine surgeons, you work with neurosurgeons as well. It's about 50/50. So, I really feel like, in my training, I was able to get the best of both worlds. And this dual training allows me to see the full picture for my patients, understanding the biomechanics of the spine, and also the neurology and how the nerves affect pain.

Host: We talked about the faster recovery times and all the benefits, but are there risks associated with these surgical methods that patients should be aware of?

Kevin R. Sharif, MD: Oh, absolutely. I think that anything you do in life, there's always risks and there's definitely risk for surgery. And we do not take those risks lightly. However, with robotics, with AI planning that we are able to do, we can develop a blueprint for surgery. We go into surgery like building a custom home. We're trying to get the patient right. But we have a plan going in, because we can use AI planning in the robot. So, you wouldn't just start building a home by just hammering without a blueprint, right? So, the AI technology that we use with the robot allows us to plan the entire surgery on the computer before I even enter the operating room. So, I know exactly where the implant's going to be. But not only that, the AI has a predictive quality as well, where we can predict how much we can correct the deformity, correct the alignment, decompress the nerves to really try to give patients a predictable outcome. So, I think spine surgery is actually getting safer. Spine surgery in 2026 is safer than it's ever been before.

Host: Prior to a procedure, what kind of education does a patient go through to make sure their expectations are set and they know what's going to be happening?

Kevin R. Sharif, MD: So, I see patients multiple times before surgery, unless it's some kind of emergency condition, right? If they broke their back and they're in the trauma hospital, things are a little bit different. But typically, especially with degenerative conditions, I see them in my office several times and that first appointment is kind of getting to know them. I want to know what's going on. I want to know how this is affecting your life. I go over the MRI with them. I tell them exactly what's going on. I point out the findings on the MRI and walk them through it.

And then, if surgery is the direction that we're headed in, I explain that surgery in detail, the risks, the benefits, possible complications, and then their prognosis. "Will there be any effects down the road because I have this surgery?" That's really important to me as well. And then, we have to send them for testing. We want to make sure that our patients are healthy enough for surgery. So, we send them for testing with their primary care doctor or any specialist they may see.

And then, what's very important to me, and I have every patient come back and see me about two weeks before surgery. I want to know if their symptoms have changed. I want to be able to answer any questions that they have to make sure we're on the same page going into surgery.

Host: Doctor, you mentioned, in 2026, spine surgery's safer than it's ever been. What do you see in the future for spine surgery?

Kevin R. Sharif, MD: It's a great question. I'm really excited about the direction spine surgery is headed. We're using robotics. We're using AI. I think that's going to continue to grow. I think we're going to see some big breakthroughs in the next five to 10 years. Augmented reality is something that's being used now. And I think we'll be using it more. It's kind of like a fighter pilot with a heads-up display in their helmet. And these AR glasses can help you look directly into the patient and see a digital overlay of their spine and nerves so you can see where everything is. It's like giving the surgeon x-ray vision.

Then, there's patient-specific implants. So right now, we use implants and there's several sizes of different implants that we can use, but the concept is that we can use 3D printing to make our implants tailor made so they're not just off the shelf. So instead of buying a suit off the rack, you got one that's tailor made for you based on your anatomy and maybe even based on the quality of your bone. So, the implant matches the bone better for a better outcome. And I think the AI's going to help us as well.

Host: You mentioned earlier that the robot doesn't do the surgery—you do, but you're aided by that and all the things you just mentioned. I think probably fall in that same category they're not going to be doing these things, but there are tools that you're going to be able to use to make all this better for the patient.

Kevin R. Sharif, MD: Sure. Absolutely. Absolutely. One more thing that I'm really excited about in spine surgery outside of actual doing surgery on patients, I really feel that biologics and regenerative medicine is really going to explode. Over the next 10 years, we're learning so much about stem cells and biologics that we can use to maybe heal a disc or maybe regrow healthy tissue. So maybe at some points for some of these conditions, we don't have to operate at all, and that's the future we're really striving for.

Host: That's exciting stuff. Dr. Kevin Sharif, orthopedic spine surgeon, a lot of great information today about spine surgery. We really appreciate your time.

Kevin R. Sharif, MD: Thank you so much.

Host: For more information, visit valleyhealthsystemlv.com. If you enjoyed this podcast, please share it on your social channels and check out our entire podcast library for topics of interest. I'm Carl Maronich. And this is Health Talk, presented by the Valley Health System. Thanks for listening.

uhsv020_Carl_Disclaimer: Physicians are independent practitioners who are not employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks with any surgical procedure. Talk with your doctor about these risks to find out if minimally invasive or robotic surgery is right for you.