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Cervical Spine Surgery - Spine Center of Texas
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Cervical Spine Surgery

Post operative lateral view of the cervical artificial disc replacement of X-ray.

 

Cervical Spine Surgery Presentation - Video Transcription

 

Dr. Sahni: 00:09 Okay guys, just getting set up here, getting ready to be well, we are alive. See if we can get a couple people to join, get myself miked up, get myself prepared. Alright, well hello. We’ll let a couple more people hop in here and let me get a little bit more organized. The kids were off today. I had forgotten about that and so I had to go pick my kids up, put me behind a little bit, but that’s okay. No big deal. So what we’re going to talk today about is the cervical spine and a treatment of the cervical spine. A couple of new things that we haven’t had in the past. I’m actually going to have a patient who’s going to come and talk to us who had spine surgery recently. It’s actually prerecorded, but that’s just because of scheduling conflicts, but it’s just a few hours old.

Dr. Sahni: 01:03 We prerecorded a short discussion and put that up. I’ve also got some live surgery to show you and we’ll even discuss interesting cases today, but of course I want to show you guys the anatomy of the spine as we did last time and so I’m going to use my visual aids. I could last time. So here’s my first a visual aid and let’s make sure you can see here. This might be hard to look at it and I won’t spend much time on it. I think when we did the lumbar talk, it ended up lasting like an hour and a half and so I’m certainly not going to. I’m going to try to maybe be a little quicker about this time. I think that’s a little, probably a little bit too much, but this is. I’m looking at the spinal cord and so I think the biggest difference here to really point out is that when we’re in the um, neck, we’re actually dealing with the spinal cord and this is a subtle point that may have gotten past you easily does when I talked about the lumbar spine.

Dr. Sahni: 02:00 That’s the below l one l two. In other words, most lumbar surgeries well below one l, l one l two, does not involve the actual spinal cord and have also been called the Carter Corner, which means Horse’s tail in Latin, but up in the neck or anywhere above at one. Oh, two, of course. Surgery occurs commonly in the neck was coming up in a less commonly land that thoracic spine and actually less commonly as high as l one L two. Although of course it happened scoliosis and in many other types of surgery. Do you require getting up higher with a spinal cord lips, it’s a much more dangerous surgery. If I were to press even just slightly on the spinal cord during surgery, the patient could have a deficit even just a millimeter or two for just a second. Uh, whereas you can actually tug the nerves in the low back and, um, and, and not have to worry about those types of issues. But I’m here. What we’re looking at is if you’re looking from back to front and we’ve cut off those poster elements again, you would have had to have been part of my last talk. So let me show you so I don’t expect everyone to remember.

Dr. Sahni: 03:00 And here’s a spot here. This is the last time we showed a lumbar spine and this time I’ve got a model of a cervical spine. So what you’re seeing here is the brainstem. We’re going to talk much about that. This is the skull here and then below that we’ve got the cervical vertebra. Good. This is one and two that are up at the top aren’t real common, isn’t real common to operate a high. Certainly in some cases, but most of the time we’re operating down here. This is three, four, five, six and seven. And these are the bones called the vertebra and exiting out here. This is looking from the front. This is. This is actually what I see when I’m operating. Okay. Is I’m actually looking at your bones in your disks and put retractors, your esophagus and your trachea. I go from the left.

Dr. Sahni: 03:47 So there’s a study showing that is kind of a, you know, something that’s been thought to be the case for a long time. That the recurrent laryngeal nerve, one of the nerves. It’s important for you to be able to talk is very predictable on the left side, there’s less predictable in the right side, but of course if someone’s left to right here, the is, they may go to the right people, go to the right side all the time and typically do fine. There’s a little bit higher theoretical chance of injuring that nerve, but on the left side, I moved your esophagus and trachea this way in your carotid artery, which isn’t represented here and your a hysterical audit master this way. What’s your muscles of the neck and then divide actually the Muslim club that homo high, like if I’m working in an area that requires that and then I get down and put some retractors and actually expose this area so I can see these desks.

Dr. Sahni: 04:30 And so what happens in, you know, another thing that makes the cervical anatomy very different, and we won’t get terribly into this, but it is important, is that your vertebral artery actually passes up very close to the area where we’re working. When we do surgery in that particular order is key to the circulation of the brain. So anything that particular artery, which thank goodness I’ve never done is a very serious issue, something that you have to be very cautious about because in particular he feeds up into something called the circle of Willis, does get some redundant blood flow to the brand, but you certainly don’t want to injure someone’s perturb for two blogger. It’s very much when you’re doing what’s going to post cervical surgery, which there’s so much to cover that I probably won’t talk much about that today. We’ll talk about the much more common than anterior cervical surgery, but it’s more common when you’re putting screws and these tiny little bows called lateral masses in the vertebral arteries just millimeters away from where you working.

Dr. Sahni: 05:18 And so when we make sure that I’m staying in the view there, I think I am sorry if I’m up here with this. Great. So here’s where your nerves are that are exiting easier lateral masses that we instrument and these your lambda, and just like in the low back, we have the laminate and the laminate can get removed when we have to remove pressure. The big difference being that I have more options in the lumbar spine, I have more options in the lumbar spine because again, I can retract those nerves and not cause a significant neurological injury. In the cervical spine, you have to generally go where the problem is. So if the spine being compressed from the front, you need to do your surgery from the front because you can’t move the spinal cord out of the way. You can’t push her out the way like you came.

Dr. Sahni: 06:03 The nerve roots flow l one L two. If the problem is the back is in the back, then when you approach the spine from the back, and of course again obviating the need to have to put pressure or retract on the spinal cord itself. So again, let’s just go back real quick to this model. This is the front, these are the sides, this is the back. And the very. And the surgeon that I’m going to talk about today is called the anterior cervical decompression and fusion. Why would somebody need that? This is of course, again, is after, um, having all conservative dream. This guys, once you know I, I always preached that you haven’t heard me talk about surgery. We’re going to start doing that now. Um, but we always try physical therapy, activity modification, a medical pain management. I’m a epidural steroid injections and of course you can also do medial branch blocks and we’re in radiofrequency ablation of the neck the same way you can do it in the lumbar spine because the media branches again, branches off these ridiculous nerves just like we have in the lumbar spine, come back and innovate these little lateral masses, the same ones we instrument when we have to do, if you put screws in the back with very, very high risk and difficult surgery, um, but I’ve done many of them and that little branch comes in interface these lateral masses and you can actually numb those to try to get rid of neck pain that is caused by pain.

Dr. Sahni: 07:22 And then ultimately ablate them doing radio frequency ablation, burning the nerve, if you will, to eliminate the pain. But that’s not really the focus of what we’re talking about today. But my point is that we would try injections. We can branch blocks or things, all of these different treatments before choosing to do surgery. Why would we do surgery on someone spinal cord? Well, on someone’s neck and ultimately on the spinal cord. It can be for two basic reasons. One would be for pain and the other pain in the neck and, and even headaches and includes lots of pain, occipital pain, headache, pain, neck pain. Um, again, just like the lumbar spine, we talked about this. I tried very hard to avoid fusing someone solely for pain. These are the people who in my opinion generally don’t do as well, so when just has back pain.

Dr. Sahni: 08:13 Where I find my patients doing extremely well is when they have both leg pain and back pain. I’m not saying I never refuse anyone for neck pain and I have, but I’m very selective. I want to make sure the pain is severe. I want to make sure that I’m that so bad that chances are there’ll be better not worse. People who fuse people’s necks or backs just on some changes in their MRI and don’t really focus on other studies like nerve injury, nerve tests, instability would be a good one. That bones are shifting and the back is unstable. That’s obviously a pretty big deal. Not very common, but a lot of people are using unfortunately, just because your disc changes color a little bit. Well guess what, if you live long enough, everyone’s disc is going to change color. And uh, I myself have some pretty bad looking disks in my lower back and when I lost weight I started eating more of a plant based diet and routine exercise programs, stretching.

Dr. Sahni: 09:05 All those wellness issues had zero pain. And so anyone who offers me surgery, um, just because my MRI looks bad. Um, well that would be crazy. I mean, why would I do that? I could, I could exercise, I can lift weights, I can do like I can rake board, I can serve, you know, why would I have surgery? Just because my MRI looks bad, but unfortunately we see that a lot. Let’s see. It’s uh, it’s unfortunate. So, um, but I think most surgeons are going to go with people who have a weakness in their arm and numbness in their arms. So let’s switch views here and let’s switch views here. And what happens is we’re, again, we’re looking from the back. The disks are in front of the spinal cord here, okay? And so you’re not seeing that real well. See if I can find a better view here.

Dr. Sahni: 09:46 These are the nerve routes that exit out between those bones. And so these are these nerves here that we’re seeing are the same nerves that we’re seeing here except what they’ve done in this image. He’s a cutaway. All this bone cut right down to the pedicle level. Okay? And you’re looking at the exposed spinal cord. The bones are still on the front. We’re looking from the back and we remove this bone. And again, what we see is the spinal cord and these particles and these are exiting. So it does just in front of this. We’ve pushed backwards, put pressure on this nerve and cause numbness, pain or weakness. Okay? Now numbness. We really can hold off on, really try a lot of conservative treatments, but what we call rapidly progressing weakness or pain is something that’s more likely to have surgery sooner. Okay. So. And that’s the case where we might want to do surgery a little sooner. In fact, in many cases we wouldn’t. I’ve got a case that I’m going to show you today that is a very interesting case where a patient required that. Um, so what do we do next thing. One second.

Speaker 3: 10:58 Okay. Sorry about that. My bad.

Dr. Sahni: 11:04 I am going to show you in this case. Okay? Okay. Let me transition. I’m sorry. I here. There’s a lot of. I’ve got a lot of buttons going on here. I’m still learning guys. So, so this is a case of a patient that has something called Myelin Malaysia. And you may have seen me post this case a couple of days ago, you know, I wish I had a pointer on here. I don’t have that setup right. It’s more complicated than you think. Trust me. But I think if you look here, you can see the little triangle, the little squares. I’m sorry, are the vertebral bodies and the lighter ones are the bones and the black stuff in between is the disc and you can see there if you look at the bones on the left side and then that stripe down the middle, it looks pretty normal.

Dr. Sahni: 11:44 I can have two white lines around it. That’s a normal spinal cord, but if you move up there you can see where some pretty large disks are pushing out. Let me see if think got a zoom. No, this is just off my. You got to spine center and see this and especially that one right there. That really big this we’re seeing is it c, four five and it’s pressing on the spinal cord and it’s actually causing injury to the spinal cord in such a way that the insulation of the nerves and we talked about this and that. Another talk called the Myelin Sheath is actually being effective. The nutrition and the blood flow is cut off so severely to those axons that they are d myelinating and that and that causes them to have a different appearance on Mri. Mris are shadows. It’s basically a magnet which was exciting electrons, when those electrons will release energy, they give a certain pattern, water turns out to be white, fat tends to be darker and so we expect that core to be a little darker there because it’s not, it’s relatively more white, uh, because the, the, the neurons have lost their sheath which was made up of fat because all cells are made up of fat so fast, not always bad obviously.

Dr. Sahni: 12:49 Um, and so the Myelin Sheath has degenerated off of those axons and this is very serious. Okay. This is a vis is very, very. This can be very serious usually is these patients will lose strength. I’m a sometimes very rapidly as this patient did. I saw him on a Wednesday and it actually ended up operating a motor for operating on a Friday only because he was so sick. He had four stents. He had high blood pressure. I mean, I would never operate on a patient like that unless it were a neurosurgical emergency. In other words, his spinal cord was at risk and so I got him into surgery as quickly as I could. Of course. Got Medical Clearance and made sure that we weren’t going to step on any landmines in terms of having a heart attack on the table, but he had diabetes. He had, you know, all these things are risk factors and I believe even used tobacco, unfortunately.

Dr. Sahni: 13:38 I think hopefully he quit that. I can’t remember, but I think if you did it, but anyway, that Mile Malaysia is very serious. This patient was essentially in a wheelchair. He started to get weak and feel a weakness in his, in his arms and his legs. Um, for about three months maybe. He started to feel the symptoms six months, but they became really noticeable about three months ago. And then over a period of just a couple of weeks, he rapidly deteriorated. His primary care doctor got him over to see me after getting this Mri. Actually his neurologist sent to a neurologist. The neurologist sent him straight to me, didn’t do any other testing on him and he was going to have some other testing done and wanted him to be seen by a surgeon immediately. And of course I got him in for surgery as quick as I could.

Dr. Sahni: 14:20 Another view here. There, I wish I had a pointer, I know, but the white thing in the middle that looks kind of like a, uh, a check sign, our, you know, the white sausage looking thing, that’s the spinal cord being crushed and you can even see the color change there. This is one shot showing where the disc, a disc is pressing back in the spinal cord is a pancake that’s not normal. Um, and that’s what’s causing this patient to lose the strength in his legs and lose the ability to walk. And I ultimately went in from the front of his neck and this is images from that. And I scooped out the disc material. All you see here is extra is only show bones. I’m like an MRI that shows so tissue. I scooped out the disk at the two levels that were really bad. They’re really bad levels. Four, five and then five. Six was also really bad, but he also had mild Malaysia. If you look here as low as six,

Speaker 3: 15:10 seven. Okay. So

Dr. Sahni: 15:15 there’s my own much all the way down as low as six, seven. This is the really bad level. This is the other Bible and we can’t see as well here, but there’s a stripe areas developing model relationship. And so this dish, although it’s really probably not as as big a problem is it could be right now that I keep thinking, I’m pointing, you can’t see my pointer here, but um, we did all three levels mainly because this very sick patient is not a good candidate to have to come back for repeat surgeries. And once I fused four, five and five slash six, the stress that would have been put across that third variable, normal disc would have likely caused it to herniate and then he’d be back having a revision surgery which is not good for anybody. And so we went ahead and did all three levels and, and so I expected this guy told this patient that he would likely be in the hospital for awhile and very, pretty much expect to have to go to rehab to learn to walk again.

Dr. Sahni: 16:09 Because I’ve seen that with other patients and this is a very severe injury to the spinal cord. So amazingly, this patient proved me wrong, uh, and I was so happy that he did. We did his surgery, went very well. In fact, I have some video of it to show you. And he did very, very well and he didn’t, not only did you not have to go to rehab, he actually went home on day three. So miracles do happen. Um, I’ll take some credit for it, but we’ll give the rest to God. So let’s see if I can show you this video now. I’ve talked about showing video. I’ve been a little bit reluctant to do it because I think some people are turned off by blood. So I guess we’re gonna find out today for 15 years. I’ve always avoided showing live surgical video. But I had so many people message me and say, uh, I’m not grossed out by that police show us.

Dr. Sahni: 16:55 So here we go. So here’s some video in this right here. I’ve tried to show the anatomy and I can kind of skip around and show you more now to me, but this is a, those two pins. There’s two metal pins that I’ve actually placed into the vertebral body of four and the vertebral body of five, so that’s hard bone that accepts a screw. Can I use that to control those two particular bodies and actually separate them to open that space up. That actually pulls a disk up to a proper height and does relieve some pressure on the spinal cord. And so ultimately, and it allows us here. I’ll pause real quick to show you what I’m talking about. Just jump back over to here.

Dr. Sahni: 17:35 So those metal screws you saw were. So this is two, three, four, five. Okay. So we’re make sure I’m on the video there were in four or five. Okay. And the screws are in each of these bodies and when these, when the disc collapses, losers type just to like in the lumbar talk that we had the foramen or the whole, but the nerve passes out, becomes tighter and so by increasing the space back to where it was when you were younger, were not only straightening up that disc in the back, which I’m ultimately going to remove, remove, and just a few minutes after that so it doesn’t matter that much, but we’re going to increase the height and opened up the space between these bones and allow this nerve root to have more space. Okay. But, um, that’s what you’re seeing here is basically I have pins in a four and five and I’m scooping out the disc here at four or five.

Dr. Sahni: 18:23 I do that at all three levels, but this just happens to be the four or five level. And so let’s go ahead and hop back over to that and I’ll show you some more of that. And so what I’m doing here is I’ve entered the disc space in. I’m removing that disc material that’s in between those two bones. That’s called a pituitary and uh, and all this kind of fast forward because this would take a lot. We’re just going to jump here a little bit and you can see on progressive moving up, removing the disc and I’m using what’s called Roger to remove all that disc material. There’s, there’s the annulus fibrosis which is the same as the lumbar spine. We talked about it in our last talk a, there is the nucleus pulposus, which is that crab meat. Now you can kind of see why I call it crab meat.

Dr. Sahni: 19:01 This guy was a little bloody, he takes fish oil, um, but I didn’t have time to take him off of his facial oil like I normally would for an elective surgery because this was an emergency. And so he did lose a little bit more, uh, than is typical, but even then it looks like a lot because this is through neuro surgical microscope. He only lost about 100 CCS, but at times it seemed very bloody. That’s a bovie cautery and a suction tip there. And I’m just cleaning up a space. Let’s watch here. As we progressively clean out the space, I now turn this into a joint surgical video and nothing but surgery, especially if it’s grossing people out. We’re sucking. Be Very careful because again, if you press on the spinal cord, just a millimeter or two, especially. This is why the I tell these patients expect to get worse because their spinal cord is already in a very vulnerable state and just going in and stretching these bones apart and taken out this disc.

Dr. Sahni: 19:48 It’s very hard not to put some pressure on the spinal cord and that’s why I almost expect to have a little to have them oftentimes get worse or just not be better immediately after surgery. That’s a nerve hook and I’m reaching down there behind what’s called the annulus annulus fibrosis, just like we talked about last time and something called the poster Longitudal. Longitudinal ligament or pll can. I will take all of that out. I will remove all this very carefully, very slowly so that I don’t paralyze the patient. I use something called neuro monitoring during the case and so someone’s got. It’s basically like real time quotes, so instead of waking up the next day and finding out what the price of a, you know, the Dow Jones was the next day I’m getting. In other words, the patient wake up. They used to literally in the old days do something called the wake up test where they would do the surgery when they won’t.

Dr. Sahni: 20:30 When the patient woke up and asked them to move their legs. If they could move their legs, then they would put them back to sleep and go back and try to figure out why and that’s just what they had. I mean, there wasn’t. That wasn’t malpractice. There’s just worth ahead. I’m now instead of having to do that, wake them up and hope I didn’t do anything bad to have maybe an implant or a screw in the place. I’ve got information coming to me real time. Maybe sometimes it lags by a few seconds, so you still have to be extremely careful, but if I’m starting to anger something where there’s reduced blood flow, even from the anesthesia, from the decreased blood pressure, which we have to address, or the positioning of the patient. In fact, in a patriot of the other day, the operative area wasn’t the problem.

Dr. Sahni: 21:05 It was the way their arm was sitting on the table and their owner nerves started to have problems. Of course they reposition the patient, fix the problem, so it’s not just about surgery, it’s about taking care of your body while you’re asleep, all of your nerves in your body. But again, neuromonitoring really allows me to decompress the spinal cord with impunity, if you will, and not have to worry as much that I’m causing serious injury. So here, if you notice here, I’ve gotten all the way down to the spinal cord, so that’s the spinal cord. You Peek in through there. Through that blood, we’re being very careful. Again, there’s still some disc material, there’s analysts and pll there, posterially, and as we move along here, I’ll just sort of move along because we don’t want to sit here looking at this forever, I’m assuming. Um, unfortunately the camera was not as direct.

Dr. Sahni: 21:49 What I saw through the scope was not what this, what the Cameron. There’s someone I talked to the guy who I was a little bit frustrated with that, that the fit, the video is still usable. It’s still viewable. So that’s all pretty much spinal cord and I’m slowly just very carefully going and removing that material, trying not to put any significant pressure on the spinal cord. This material is very tough. It’s as these fibers are very tough. I have to apply some pretty significant force to get those tissues out of there and I have to be very careful that my hand doesn’t recoil or uh, that I, you know, put any pressure on their own structures. And obviously in this case I didn’t because the patient was walking out of the hospital three days later when I expected him to not do that because he was in a wheelchair.

Dr. Sahni: 22:25 But I’m here now, what I’m doing here, if it will come back, I’m irrigating out the space and now I’m going to put in a trial. So I’m trying to figure out, just like putting, getting your shoes fitted. We’re going to put in trials. Those are epidural bleeders there. That’s very common. Rather than stick a bipolar down there and trying to stop that. I generally will oftentimes just put it. That was the first trial. I’ll just put some medicine or some substance that will decrease that bleeding. So I’m basically just trying to find the right size. I want it to be just snug. I don’t want to stretch the heck out of these bones, but I do want it to be a good interference fit, number one, so it doesn’t fall out. But number two, again, I put those two pins in the bodies of foreign five to stretch them apart because I’m trying to open up the space for that nerve like we talked about earlier.

Dr. Sahni: 23:09 And uh, I’m just basically trying to find the right size. These are all trials. I forgot what size it was, but generally it’s somewhere between nine and 11 and the neck, millimeters in height and it’s just based on fit and of course I get an x ray and I see how good the fit looks on x Ray and all I’m doing here is tapping in very carefully not to press on the spinal cord, um, these trial, uh, implants and then looking at them on an extra day. So we keep going here. And then once I get in there, a lot of times putting the trials in will free up some more soft tissue from the in plates because we want those in plates to be nice and bear. All the cartilage gets removed. There’s employee cartilage. No, that needs to be. We want nice bloody bone because that is the implant implant implant that I ultimately put it in.

Dr. Sahni: 23:52 That’s it right there is filled with bone and we want it to grow through them. It’s like a donut of plastic with a bone graft in the middle and we want those two bones to fuse or connect to one another. This is the material I was talking about that decreases bleeding so I don’t have to go back there with a hot a Buzzer to buzz that, uh, I don’t, I can do that if I’m extremely careful, but when you’re right on the surface, the surface of the spinal cord, you have to be extremely careful. And what I’m doing now is I’m tapping in the implant there and you can see some of the excess. Um, uh, let’s see, what do we do here? It jumped. Oh sure. Where the jump to the right leader or not. My, my video is broken up into segments and it looks like a jump down to the next view.

Dr. Sahni: 24:32 But anyway, we saw what was going on there. Um, and so what that was was me removing the disc material and let’s see if we can jump over here. We’ve, that was me removing the disc material going all the way back to the spinal cord and you see a lot of people, now that I think about it, let me mention this. A lot of people say, what are those two white lines? Well, those, the implants made of plastic and so if I didn’t have those markers in there, there’s radiographic markers in there. If those implants were to move, they shouldn’t because I put a plate across the front. But if those implants were to move then I would know that they’ve fallen out and they’re in the neck or in the case of the lumbar spine there in the belly. Otherwise they’d be invisible and an implant could fall out and we wouldn’t know where it is.

Dr. Sahni: 25:14 So that’s a problem. So we put these two little looks like paperclips, pieces of metal into plastic. So they’re in, they’re embedded into the plastic, so deep inside of it. So anywhere that plastic goes, we can see it by looking at an extra. Um, let me see. Also if I had another view, wouldn’t trip. I had an ap view. It looks like general. That’s okay. That’s okay. So these are the pictures that I put up. It doesn’t matter. I don’t want to get too technical, but I thought you guys might be interested in, in, in, in our run back over here real quick. And so again, this is the, I believe this is the next level. Let me see. The videos are at zero, zero one had a hard time getting these videos to show up. But yeah, that’s the next level. So I’ve already done the four or five level, which is the worst level and now I’m heading down to the five, six level, um, and doing the same thing.

Dr. Sahni: 26:06 This is me just trying. It’s very, very vascular neck, lot of bleeding. So we want to make sure that we keep that bleeding, controlled it when bleeding gets out of control in the neck. Um, so usually when things go well, like this case, did I lose, I lose very little blood. One hundred CC’s of blood is about toothpaste tube of toothpaste tubes, about 75 CCS, a big one I guess. And so, you know, this guy considering the surgery was many hours, who wants to buy a toothpaste tube full of blood? And so we do want to be very cautious. It seems crazy to have to burn in the neck, but it’s extremely important. None of the structures aren’t burning, are important in most of it’s being removed. And then of course we’re putting an implant in at this level as well. So, um, that’s what I wanted to show you. Let me see real quickly,

Patient: 26:50 annotations of dead lifting.

Dr. Sahni: 26:53 So I’m gonna. Uh, like I told you I

Speaker 3: 26:59 alright. Um,

Dr. Sahni: 27:01 had a prerecorded dealing and I’m having a hard time a little bit here with my little book

Patient: 27:07 I slapped or whatnot.

Dr. Sahni: 27:09 Okay. And you and you. So I’m, I’m working with this thing. Hang on, let me open this back up. Sort of bummer. I’m sure I have a patient interview,

Speaker 3: 27:19 so that’s killing me. They’re just give me a second guys and you can watch that surgery while hopefully fix this problem that I’m having with.

Dr. Sahni: 27:34 It’s tough being the it guy and the doctor. Oh, at the same time. Okay. All right. So Lauren, thank you so much for and I’m just trying to get this to work out for me. One more second guy. Just keep watching that surgery if there’s something that I hope. Yeah, I don’t have a fixture for me. One more second. Sorry. Something malfunctioned and now and having to deal with it.

Speaker 3: 28:11 I don’t know what to tell Ya. Total. Bummer.

Dr. Sahni: 28:23 Well, I thought I’d have this. I said No.

Speaker 3: 28:29 So anyway, I had had it all teed up and ready to go for you. Give me one more second. I hate when this happens live. What do you do? Yeah, I think I fixed it. Bummer. Sorry. I’m not the greatest guy in the world apparently.

Dr. Sahni: 29:08 Okay. So I’m going to show you a video prerecorded. Good thing. Trying to pretend like I definitely would have blown that. Trying to lie about that. Um, so here we go. Uh, this is just a few hours old, I promise, and this is a patient that had surgery just a couple of weeks ago and she’s going to share her experience and I thought this was very sweet of her to share this experience with us. And so anyway, here we go. Okay. All right. So Laura, thank you. So for joining

Dr. Sahni: 29:42 me. And, uh, just wanted to real quickly discuss with you your story. So if you could just tell us briefly what your symptoms were, how long you had them, how they were affecting your life and what treatments have you previously had a prior to, um, to seeing us and getting treatment from us.

Patient: 30:03 Well, I started having symptoms of like a pinched nerve and spent about five, five and a half years ago. And a burning barn, a shoulder blades kind of her. So I tried physical therapy, acupuncture injections. I’m burning into the nerves and stuff, but nothing really really helped. It was affecting my life was just like been at work. I can lift certain things or can’t sleep on a certain side or whatnot. So it just kinda started back at me that way.

Dr. Sahni: 30:43 It was it just one arm or both arms. And, and were you able to, you know, go to the gym or do the hobbies that you like to do or how was it affecting your ability to kind of do the things you want me to do?

Patient: 30:56 No, I, I could, I could do pretty much everything that I wanted to do. It’s just certain limitations of, like I said, lifting or way I slept or whatnot.

Dr. Sahni: 31:06 Okay. And you and you dealt with it for, you said about five years you said.

Patient: 31:10 Okay.

Dr. Sahni: 31:11 Did it just kept getting worse and worse over that five year period?

Patient: 31:14 Um, it, it, did, it, it kinda worked. David stayed the same for awhile and then if I did when I was doing acupuncture it worked a little bit, but then it would stop working and just dependent on the different types of treatments, but it was constantly, always there. It never really went away.

Dr. Sahni: 31:30 And I think you just said this, but it did affect your ability to sleep.

Patient: 31:34 Yeah, definitely.

Dr. Sahni: 31:35 Was that one of the, was that, was that one of the bigger issues? The sleep issue?

Patient: 31:41 Just the everyday having a constant pain in my arm. Yeah.

Dr. Sahni: 31:45 Okay. Okay. And um, you had a shot as well as nerve burning and neither one of those things got rid of the pain?

Patient: 31:52 No, not really. Just kind of a temporary thing, but then it came right back.

Dr. Sahni: 31:56 Did we do your shots or if somebody else do your shots?

Patient: 31:59 Um, someone else that you have as well, we did one with at your office,

Dr. Sahni: 32:03 one of my office, what you do, so you have some, uh, pain management over a period of years and then we gave it one attempt that attempt failed and then at that point we did a nerve test on you that showed nerve damage. So the nerve damage, the MRI showing the pressure on your nerve symptoms, the lack of sleep, the failure of the conservative treatment obviously. Did you try physical therapy as well?

Patient: 32:26 I tried it twice, yeah.

Dr. Sahni: 32:27 Okay. And that didn’t really help? Nope, not at all. Not at all. Okay. So we ultimately just did a one level decompression and fusion and that was just a couple of weeks ago. Right,

Patient: 32:39 right.

Dr. Sahni: 32:40 And how, and tell me how, how was that? Tell me your experience there. What’d you think? Honestly? What’d you think about that?

Patient: 32:46 Well, of course I was scared going into it, but you and Dr Nelson and really made me feel comfortable going into the surgery. You explained everything before I went in and when I woke up from the surgery I wasn’t in pain. I could feel my arm was feeling better now, not a hundred percent better that each day that better and I continue to fill that each day of getting better. I don’t have that burning sensation down my left arm anymore.

Dr. Sahni: 33:09 That’s great. So two weeks out, roughly something like that. You’re 50 percent better, 80 percent veteran. How much better do you think you are at the screen?

Patient: 33:16 Hey, that 80 percent better.

Dr. Sahni: 33:18 That’s great. No, that’s wonderful. So is it, you know, a lot of patients after they have this surgery and I don’t blame people for not wanting to have surgery. No, I wouldn’t either unless it really was affecting my life. But now that you’ve had it done to you, would you say that you say yourself, wow, if I had known it was going to work this well and work out like this, I probably would have done it sooner.

Patient: 33:38 Definitely. Yeah. I wouldn’t have waited five years. Yeah.

Dr. Sahni: 33:41 Well good. Well good. So I’m so glad that you’re happy. Happy with happy with the office office, treated you well and you’re happy with the whole experience. Well, and we’ll.

Patient: 33:51 Every time I go around and everybody was so friendly and get my appointments timely and, and just breaks down. I really appreciate your, your health and your staff help.

Dr. Sahni: 34:00 Well, we’re not perfect, but we certainly tried to do our best and uh, and we’re, uh, I put all my focus on doing a good surgery and then I certainly try to be friendly and keep your appointments timely and everything else. I can’t say that that’s always perfect because we have people come in and they have, you know, problems. We got to take care of them, but we certainly do our best. But when it comes to the surgery, you got my 100 percent attention. Your surgery went fantastic. You lost almost no blood. It didn’t take terribly long. Um, I mean everything went real well. You didn’t have any, you know, you had no problem. All that, all those horrible things that you have to sign off on, like paralysis and death and this, that and the other. None of that stuff happened and of course, or I would’ve told you. And um, and you did great and you’ve been a wonderful patient. And we’re, and we’re so happy that you’re doing well and thank you so much for, for talking to us. And uh, but in two weeks out, by the way, guys, a lot of people are very horse a lot. Some people, um, some will not lot, but some people are worse. When I, I didn’t mean horse, I met difficulty swallowing difficulties. Are you having difficulty swallowing?

Patient: 35:03 Not too bad. So now at first couple of days I was on, but now I eat pretty much everything. I do drink with a straw that helps. But um, no, I, I don’t have that much trouble.

Dr. Sahni: 35:15 It’s perfectly normal to have some difficulty. The first few days some people even have difficulty swallowing. There’s a study that shows 17 percent of patients who have dysplasia, but it resolves, it gets better with time. And then occasionally someone gets worse. I’ve never permanently made anyone horse. I’ve made somebody’s horse for three weeks and somebody who works for six weeks. But most of my patients are never worse. In fact, you were speaking perfectly normally from the second that you woke up. So those are a couple of things. Those are a couple of things that we see in this early posts are postoperative period. Another thing we see, um, and I don’t know that I’ve asked you about this, I think I might have at your visit until you start to really fuse at that level in your neck that we did. You may notice some muscle spasm and pain between the shoulder blades. Have you noticed any of that? And natural, normal as everything gets solid and really fuses and there’s no more motion there at all. That should completely go and I expect that to be at least a lot better if not gone in about six weeks. Okay.

Speaker 6: 36:15 Okay. So if you could

Dr. Sahni: 36:29 just tell us briefly what your symptoms were, how

Dr. Sahni: 36:37 it was done. I wasn’t sure if it was done. It was definitely done and I was trying to do a transition and of course I screwed it up.

Dr. Sahni: 36:55 Anyway, guys, that was Laura and I really appreciate her coming on. The reason I wanted to come on was because she just had her surgery a couple of weeks ago and so all the horrors or non horrors, we’re fresh on her mind and I wanted her to share her experience with us. A couple of questions here. Yes, Michelle, that was exactly the surgery that you had. What was the white stuff? The white stuff was the disc material. The stuff that was coming out was the disc material, so I always call the a disc, a crab meat. The nucleus pulposus portion of it. Crab meat. The other ports, the annulus fibrosis is more fibrous, but the center of the disc looks like crab meat and I called that crab meat, so that’s what the white stuff was. And so neck brace for her know she wore a neck brace.

Dr. Sahni: 37:38 She just not wearing it right now. One levels only have to wear a neck brace for a couple of weeks and so she’s out of that. You really don’t even have to probably wear a neck brace with a one level, but my two levels require, um, two weeks and three levels require six weeks. Michelle, since you were talking about your case, yours was a revision and that’s why I had you were a little bit longer. Um, but if everything’s going well, the bone quality is good. I don’t necessarily make people wear a neck brace for a one level of very long at all. Okay. So, um, guys, let’s just real quickly look at this. This is a, another picture that I found on, um, I guess so whatever a Google search that I thought people might find interesting and that is basically the same model that I showed you earlier.

Dr. Sahni: 38:29 There’s the bones that you see a, we’ll just call this four and five. It had really who knows which levels they are. And I, I, uh, the one thing that you didn’t see me put on in that video and we could try to go find it. If I had that video where the plates going in, I’d have to kind of search through there and find it. Uh, but we put that, we stretch those bones apart with pins. We clean out all the pressure on the spinal cord if the number of levels that are necessary to clean out. We put an implant in between and you started to see that on another video. I’ll see if I can’t find that. And then we put a plate on the front to hold everything still so nothing actually will fall out. And here I’ll show you this again.

Dr. Sahni: 39:06 This, I believe I didn’t really get a chance to go through this video and really worked through it, but I believe now I’m at the next level. I don’t because this is a zero, zero one, so I think it’s the next video. So we’ll see if we can kind of skip ahead here. Do the same thing. It looks like the camera might’ve been a little bit better centered on this level so we can see things a little bit less, a little bit better, but I’m sort of skipping along here and again a very carefully removing that material and getting the pressure off the spinal cord. And again there’s the, there’s the Dura, there’s the covering of the spinal cord or we’d be saved. That’s the spinal cord. Again, this guy was on fish oil, but sometimes even when they’re not, it’s even much more bloodier than this.

Dr. Sahni: 39:43 So this isn’t really even terribly bloody, but there’s a little bit of blood back there. Sometimes it’s a lot less bloody. Just depends on the patient to see what happens. We jump down to the next video here and there I am trialing out again. So we’re cleaning out that disc space. You’ve already seen this and so I’m showing you again, maybe it’s a better view. Maybe it’s not, but we’re cleaning up at a space. We’re getting all the pressure off the spinal cord, those little fibers that are hanging, you don’t necessarily need to come out. Um, we tried to get out as much as we can. What I want to make sure that I don’t leave a trapped piece of disk back behind the pit poster long longitudinal ligament or behind the vertebral bodies. And that’s why I’m sort of reaching back with those little hooks and making sure that there’s no disk material that’s been retained because that could cause the patient to continue to have, um, issues.

Dr. Sahni: 40:26 And we certainly don’t want to have to come back and do a revision surgery if we can avoid it. So, uh, in here, let’s just scoot along here. I don’t know when the plate comes in or even if I video the plate here. Obviously I’m getting an x Ray. There’s the. Let’s see if we, if we show the implant getting put in, that’s the implant. So there’s. Yeah. So there’s all scoot back. I’m kind of jumping around. Okay. So I’m cleaning out real nicely. Uh, I probably put some of that blood. Yep. There it is. This is a flow seal. So this basically is a material that’s completely pliable. It’s like a foam, so it doesn’t press on anything, but it stops bleeding and so stops the bleeding in the back. And here I am pressing in, I’ve got a tool and I’m holding onto this cage.

Dr. Sahni: 41:06 It’s made of plastic. It’s a peak cage. P, e k, polyethylene, polyethylene, ether ketone. It’s a plastic that’s been around for decades. It’s the body doesn’t react to it. It’s known to be very safe. I’m using that metal thing. Sticking another is an inserter. That’s what’s attached to it, so I have control over the cage and again, the cages filled with bone. The intention is for the bone to grow from one vertebral body to the other through the center of the cage and there’s the cage in place and you know, you had to have seen before, but this patient’s between those two bones was much narrower. I was able to open, oh, text a couple of millimeters to get pressure off the, off of those exiting nerve roots. Um, and again, uh, I’ll show you,

Dr. Sahni: 41:44 uh, let’s see. Uh, uh, what I want to do is get pressured. When I stick that my implants bigger here, they’re, they’re sort of showing a little sliver of bone. But what I try to do is I want to crank those two bones apart to open up the room for those exiting nerve roots. That’s an indirect decompression. I’m directly decompressing the spinal cord. Okay. But I’m indirectly decompressing those nerve roots by putting this implant in. I want to put as big as I can. I don’t want to crazy here, but I want to put in a large, a large enough implant to be stable so it doesn’t shift around. Yeah, you can see the implant above there. You can still see my implant above, so this is definitely the next level. What I’m doing here is I’m removing the pin that was in the bone and it tends to bleed briskly in some cases and so once we get that pen out because bone bleeds, there’s no way to put a tourniquet on bone.

Dr. Sahni: 42:30 We then used a piece of bone wax that’s bone wax and I’m using to fill that hole and once I successfully press a little pea, sometimes I’ll just shove my finger in there when I get frustrated with that instrument called a peanut that I was trying to use to put it in there and I’ll just sort of press that right down in there and now we’re done with that level and we’ll use that pen for the next level. The next level we’ll put another pin in and say, let’s just skip along here and see. Now we’re starting that next level. I’m cleaning off the disc material. I know you don’t want to see this three times necessarily and I’m just trying to see if I even have a. anything of me putting in a plate or not. I don’t recall. Honestly. I haven’t really watched it.

Dr. Sahni: 43:07 Now it looks like I stopped the video and probably did not put the plate in under the microscope. So. And that doesn’t surprise me. So, uh, here we go. We’re cleaning up that last level. I also think that the video, a USB card that I use only had an hour and so it an hour and three minutes and so, which tells me, took me about an hour later, all three levels, which isn’t bad considering the severity of this patient’s problem or maybe it took me a while longer. I ran out of video, but this is, I’m on the third level, so I’m getting know. Got Almost to the point of putting that third implant in. But it’s the same thing. Pins in the bone, cleaning the cartilage off the plates are moving the osteophytes, removing the disc material, the nucleus pulposus as well as the annulus and getting all the pressure off the spinal cord, putting an implant in there to stabilize the level to open up the space to get done. Not only a direct decompression, which is what you’re seeing here, but an indirect decompression by opening up the space between those bones and opening up the nerve roots and then putting a plate across the entire front of the neck to allow us to. Um, let me see if I’ve got that picture here where it was, I guess. Yeah. And uh, and then to allow us to,

Speaker 6: 44:16 where is it

Dr. Sahni: 44:21 putting a plate across the front to allow us to stabilize the construct and keep those implants from popping out of, of the neck so to speak. So that is um, um, anterior cervical surgery. Obviously if I went through all the different types of cervical surgery, we’d be here all day and I really only scratched the surface on some of the anatomy. But I didn’t want this to be a one and a half hour deal and I wanted you to hear from a patient recently had surgery who’s doing fantastic and she’s a fantastic patient. Uh, really, really, uh, happy to have her and all my patients for that matter. I wanted to show you live surgical video I wanted to show you. Also want to remind you to go to our facebook page and join my mailing list to win a free tee shirt. I will definitely be giving on a tee shirt A.

Dr. Sahni: 45:15 I may not do it right this second, but I’ll, I’ll do it here shortly. Hopefully today or tomorrow and all announced that he won the tee shirt last week and was Jean. And I’m also, please share this video. I really appreciate you sharing. If you, if you don’t mind, if you know somebody who might have a neck problems. Remember guys, this is the last resort. The only reason this guy had this big surgery was because he was literally in a wheelchair and I took him out of a wheelchair. So in that case, conservative treatment with surgery, if I hadn’t done surgery on him, he would have never walked again and probably would have died. And so there was really no choice but to do the surgery, I always save surgical intervention is the last resort. We have lots of tools in our toolbox. Um, if you want to make an appointment, you can call our office, um, and uh, uh, make an appointment.

Dr. Sahni: 46:03 I have had a couple of patients contact me through facebook, private messaging, asking to be seen from multiple states away and I’m happy to see you. What I would tell you is if you really want to get the most use out of your time is contact my office at eight, three, zero, three, seven, nine, 8,800. And let us review your records because I’d hate for you to come all the way to Texas if there’s really nothing that I, if I can pretty much tell that I can’t help you, why waste the plane ticket or the driving? I mean, if you want to come meet me then sure. Happy to see you and we can talk about it. But in an effort to save you time and money and I’ll be happy to review your case and then we can decide whether it’s worth you coming and having a visit with us.

Dr. Sahni: 46:47 So again, please sign up for my mailing list and you’re get all kinds of cool stuff sent to you and let me just make sure that we don’t have any other questions before we close out here. Should have been on my surgery 15 years ago. You found the problem. Yeah, I remember this. We did. And you did so well Michelle. I was so happy that you did so well. And Michelle, we’re going to have to have you on for interview. What am I thinking? So we’ll definitely have you on Michelle for an interview and also a I have to. Michelle’s actually I want to have on for interview, so we’ll have both of my. Michelle’s on that are my star patients that have done fantastic and all such wonderful people. Are you guys, if there’s no other questions, we’re going to end it and thank you for joining us.

Dr. Sahni: 47:27 I hope you. If you didn’t like the video, if you thought the bloody surgery was too much, let me know. Um, I’ve avoided showing that kind of stuff for 15 years because I thought it would freak patients out, scare them or make them sick or whatever. I’ve always been told by people I asked not to show that kind of stuff. So I’ve avoided doing that. Maybe I should have. Maybe that was the wrong thing for me to do and maybe I should have shared that kind of stuff and people would find it interesting. So leave me feedback. Join the mailing list. Please share this video. And uh, remember we do drawings for a free tee shirt because I know everybody wants a free a spine center of Texas tee shirt because that’s so amazing to have one of those. And you guys have a great weekend and I’ll just end it with my outro.

 

Dr. Sahni: 00:09 Okay guys, just getting set up here, getting ready to be well, we are alive. See if we can get a couple people to join, get myself miked up, get myself prepared. Alright, well hello. We’ll let a couple more people hop in here and let me get a little bit more organized. The kids were off today. I had forgotten about that and so I had to go pick my kids up, put me behind a little bit, but that’s okay. No big deal. So what we’re going to talk today about is the cervical spine and a treatment of the cervical spine. A couple of new things that we haven’t had in the past. I’m actually going to have a patient who’s going to come and talk to us who had spine surgery recently. It’s actually prerecorded, but that’s just because of scheduling conflicts, but it’s just a few hours old.

Dr. Sahni: 01:03 We prerecorded a short discussion and put that up. I’ve also got some live surgery to show you and we’ll even discuss interesting cases today, but of course I want to show you guys the anatomy of the spine as we did last time and so I’m going to use my visual aids. I could last time. So here’s my first a visual aid and let’s make sure you can see here. This might be hard to look at it and I won’t spend much time on it. I think when we did the lumbar talk, it ended up lasting like an hour and a half and so I’m certainly not going to. I’m going to try to maybe be a little quicker about this time. I think that’s a little, probably a little bit too much, but this is. I’m looking at the spinal cord and so I think the biggest difference here to really point out is that when we’re in the um, neck, we’re actually dealing with the spinal cord and this is a subtle point that may have gotten past you easily does when I talked about the lumbar spine.

Dr. Sahni: 02:00 That’s the below l one l two. In other words, most lumbar surgeries well below one l, l one l two, does not involve the actual spinal cord and have also been called the Carter Corner, which means Horse’s tail in Latin, but up in the neck or anywhere above at one. Oh, two, of course. Surgery occurs commonly in the neck was coming up in a less commonly land that thoracic spine and actually less commonly as high as l one L two. Although of course it happened scoliosis and in many other types of surgery. Do you require getting up higher with a spinal cord lips, it’s a much more dangerous surgery. If I were to press even just slightly on the spinal cord during surgery, the patient could have a deficit even just a millimeter or two for just a second. Uh, whereas you can actually tug the nerves in the low back and, um, and, and not have to worry about those types of issues. But I’m here. What we’re looking at is if you’re looking from back to front and we’ve cut off those poster elements again, you would have had to have been part of my last talk. So let me show you so I don’t expect everyone to remember.

Dr. Sahni: 03:00 And here’s a spot here. This is the last time we showed a lumbar spine and this time I’ve got a model of a cervical spine. So what you’re seeing here is the brainstem. We’re going to talk much about that. This is the skull here and then below that we’ve got the cervical vertebra. Good. This is one and two that are up at the top aren’t real common, isn’t real common to operate a high. Certainly in some cases, but most of the time we’re operating down here. This is three, four, five, six and seven. And these are the bones called the vertebra and exiting out here. This is looking from the front. This is. This is actually what I see when I’m operating. Okay. Is I’m actually looking at your bones in your disks and put retractors, your esophagus and your trachea. I go from the left.

Dr. Sahni: 03:47 So there’s a study showing that is kind of a, you know, something that’s been thought to be the case for a long time. That the recurrent laryngeal nerve, one of the nerves. It’s important for you to be able to talk is very predictable on the left side, there’s less predictable in the right side, but of course if someone’s left to right here, the is, they may go to the right people, go to the right side all the time and typically do fine. There’s a little bit higher theoretical chance of injuring that nerve, but on the left side, I moved your esophagus and trachea this way in your carotid artery, which isn’t represented here and your a hysterical audit master this way. What’s your muscles of the neck and then divide actually the Muslim club that homo high, like if I’m working in an area that requires that and then I get down and put some retractors and actually expose this area so I can see these desks.

Dr. Sahni: 04:30 And so what happens in, you know, another thing that makes the cervical anatomy very different, and we won’t get terribly into this, but it is important, is that your vertebral artery actually passes up very close to the area where we’re working. When we do surgery in that particular order is key to the circulation of the brain. So anything that particular artery, which thank goodness I’ve never done is a very serious issue, something that you have to be very cautious about because in particular he feeds up into something called the circle of Willis, does get some redundant blood flow to the brand, but you certainly don’t want to injure someone’s perturb for two blogger. It’s very much when you’re doing what’s going to post cervical surgery, which there’s so much to cover that I probably won’t talk much about that today. We’ll talk about the much more common than anterior cervical surgery, but it’s more common when you’re putting screws and these tiny little bows called lateral masses in the vertebral arteries just millimeters away from where you working.

Dr. Sahni: 05:18 And so when we make sure that I’m staying in the view there, I think I am sorry if I’m up here with this. Great. So here’s where your nerves are that are exiting easier lateral masses that we instrument and these your lambda, and just like in the low back, we have the laminate and the laminate can get removed when we have to remove pressure. The big difference being that I have more options in the lumbar spine, I have more options in the lumbar spine because again, I can retract those nerves and not cause a significant neurological injury. In the cervical spine, you have to generally go where the problem is. So if the spine being compressed from the front, you need to do your surgery from the front because you can’t move the spinal cord out of the way. You can’t push her out the way like you came.

Dr. Sahni: 06:03 The nerve roots flow l one L two. If the problem is the back is in the back, then when you approach the spine from the back, and of course again obviating the need to have to put pressure or retract on the spinal cord itself. So again, let’s just go back real quick to this model. This is the front, these are the sides, this is the back. And the very. And the surgeon that I’m going to talk about today is called the anterior cervical decompression and fusion. Why would somebody need that? This is of course, again, is after, um, having all conservative dream. This guys, once you know I, I always preached that you haven’t heard me talk about surgery. We’re going to start doing that now. Um, but we always try physical therapy, activity modification, a medical pain management. I’m a epidural steroid injections and of course you can also do medial branch blocks and we’re in radiofrequency ablation of the neck the same way you can do it in the lumbar spine because the media branches again, branches off these ridiculous nerves just like we have in the lumbar spine, come back and innovate these little lateral masses, the same ones we instrument when we have to do, if you put screws in the back with very, very high risk and difficult surgery, um, but I’ve done many of them and that little branch comes in interface these lateral masses and you can actually numb those to try to get rid of neck pain that is caused by pain.

Dr. Sahni: 07:22 And then ultimately ablate them doing radio frequency ablation, burning the nerve, if you will, to eliminate the pain. But that’s not really the focus of what we’re talking about today. But my point is that we would try injections. We can branch blocks or things, all of these different treatments before choosing to do surgery. Why would we do surgery on someone spinal cord? Well, on someone’s neck and ultimately on the spinal cord. It can be for two basic reasons. One would be for pain and the other pain in the neck and, and even headaches and includes lots of pain, occipital pain, headache, pain, neck pain. Um, again, just like the lumbar spine, we talked about this. I tried very hard to avoid fusing someone solely for pain. These are the people who in my opinion generally don’t do as well, so when just has back pain.

Dr. Sahni: 08:13 Where I find my patients doing extremely well is when they have both leg pain and back pain. I’m not saying I never refuse anyone for neck pain and I have, but I’m very selective. I want to make sure the pain is severe. I want to make sure that I’m that so bad that chances are there’ll be better not worse. People who fuse people’s necks or backs just on some changes in their MRI and don’t really focus on other studies like nerve injury, nerve tests, instability would be a good one. That bones are shifting and the back is unstable. That’s obviously a pretty big deal. Not very common, but a lot of people are using unfortunately, just because your disc changes color a little bit. Well guess what, if you live long enough, everyone’s disc is going to change color. And uh, I myself have some pretty bad looking disks in my lower back and when I lost weight I started eating more of a plant based diet and routine exercise programs, stretching.

Dr. Sahni: 09:05 All those wellness issues had zero pain. And so anyone who offers me surgery, um, just because my MRI looks bad. Um, well that would be crazy. I mean, why would I do that? I could, I could exercise, I can lift weights, I can do like I can rake board, I can serve, you know, why would I have surgery? Just because my MRI looks bad, but unfortunately we see that a lot. Let’s see. It’s uh, it’s unfortunate. So, um, but I think most surgeons are going to go with people who have a weakness in their arm and numbness in their arms. So let’s switch views here and let’s switch views here. And what happens is we’re, again, we’re looking from the back. The disks are in front of the spinal cord here, okay? And so you’re not seeing that real well. See if I can find a better view here.

Dr. Sahni: 09:46 These are the nerve routes that exit out between those bones. And so these are these nerves here that we’re seeing are the same nerves that we’re seeing here except what they’ve done in this image. He’s a cutaway. All this bone cut right down to the pedicle level. Okay? And you’re looking at the exposed spinal cord. The bones are still on the front. We’re looking from the back and we remove this bone. And again, what we see is the spinal cord and these particles and these are exiting. So it does just in front of this. We’ve pushed backwards, put pressure on this nerve and cause numbness, pain or weakness. Okay? Now numbness. We really can hold off on, really try a lot of conservative treatments, but what we call rapidly progressing weakness or pain is something that’s more likely to have surgery sooner. Okay. So. And that’s the case where we might want to do surgery a little sooner. In fact, in many cases we wouldn’t. I’ve got a case that I’m going to show you today that is a very interesting case where a patient required that. Um, so what do we do next thing. One second.

Speaker 3: 10:58 Okay. Sorry about that. My bad.

Dr. Sahni: 11:04 I am going to show you in this case. Okay? Okay. Let me transition. I’m sorry. I here. There’s a lot of. I’ve got a lot of buttons going on here. I’m still learning guys. So, so this is a case of a patient that has something called Myelin Malaysia. And you may have seen me post this case a couple of days ago, you know, I wish I had a pointer on here. I don’t have that setup right. It’s more complicated than you think. Trust me. But I think if you look here, you can see the little triangle, the little squares. I’m sorry, are the vertebral bodies and the lighter ones are the bones and the black stuff in between is the disc and you can see there if you look at the bones on the left side and then that stripe down the middle, it looks pretty normal.

Dr. Sahni: 11:44 I can have two white lines around it. That’s a normal spinal cord, but if you move up there you can see where some pretty large disks are pushing out. Let me see if think got a zoom. No, this is just off my. You got to spine center and see this and especially that one right there. That really big this we’re seeing is it c, four five and it’s pressing on the spinal cord and it’s actually causing injury to the spinal cord in such a way that the insulation of the nerves and we talked about this and that. Another talk called the Myelin Sheath is actually being effective. The nutrition and the blood flow is cut off so severely to those axons that they are d myelinating and that and that causes them to have a different appearance on Mri. Mris are shadows. It’s basically a magnet which was exciting electrons, when those electrons will release energy, they give a certain pattern, water turns out to be white, fat tends to be darker and so we expect that core to be a little darker there because it’s not, it’s relatively more white, uh, because the, the, the neurons have lost their sheath which was made up of fat because all cells are made up of fat so fast, not always bad obviously.

Dr. Sahni: 12:49 Um, and so the Myelin Sheath has degenerated off of those axons and this is very serious. Okay. This is a vis is very, very. This can be very serious usually is these patients will lose strength. I’m a sometimes very rapidly as this patient did. I saw him on a Wednesday and it actually ended up operating a motor for operating on a Friday only because he was so sick. He had four stents. He had high blood pressure. I mean, I would never operate on a patient like that unless it were a neurosurgical emergency. In other words, his spinal cord was at risk and so I got him into surgery as quickly as I could. Of course. Got Medical Clearance and made sure that we weren’t going to step on any landmines in terms of having a heart attack on the table, but he had diabetes. He had, you know, all these things are risk factors and I believe even used tobacco, unfortunately.

Dr. Sahni: 13:38 I think hopefully he quit that. I can’t remember, but I think if you did it, but anyway, that Mile Malaysia is very serious. This patient was essentially in a wheelchair. He started to get weak and feel a weakness in his, in his arms and his legs. Um, for about three months maybe. He started to feel the symptoms six months, but they became really noticeable about three months ago. And then over a period of just a couple of weeks, he rapidly deteriorated. His primary care doctor got him over to see me after getting this Mri. Actually his neurologist sent to a neurologist. The neurologist sent him straight to me, didn’t do any other testing on him and he was going to have some other testing done and wanted him to be seen by a surgeon immediately. And of course I got him in for surgery as quick as I could.

Dr. Sahni: 14:20 Another view here. There, I wish I had a pointer, I know, but the white thing in the middle that looks kind of like a, uh, a check sign, our, you know, the white sausage looking thing, that’s the spinal cord being crushed and you can even see the color change there. This is one shot showing where the disc, a disc is pressing back in the spinal cord is a pancake that’s not normal. Um, and that’s what’s causing this patient to lose the strength in his legs and lose the ability to walk. And I ultimately went in from the front of his neck and this is images from that. And I scooped out the disc material. All you see here is extra is only show bones. I’m like an MRI that shows so tissue. I scooped out the disk at the two levels that were really bad. They’re really bad levels. Four, five and then five. Six was also really bad, but he also had mild Malaysia. If you look here as low as six,

Speaker 3: 15:10 seven. Okay. So

Dr. Sahni: 15:15 there’s my own much all the way down as low as six, seven. This is the really bad level. This is the other Bible and we can’t see as well here, but there’s a stripe areas developing model relationship. And so this dish, although it’s really probably not as as big a problem is it could be right now that I keep thinking, I’m pointing, you can’t see my pointer here, but um, we did all three levels mainly because this very sick patient is not a good candidate to have to come back for repeat surgeries. And once I fused four, five and five slash six, the stress that would have been put across that third variable, normal disc would have likely caused it to herniate and then he’d be back having a revision surgery which is not good for anybody. And so we went ahead and did all three levels and, and so I expected this guy told this patient that he would likely be in the hospital for awhile and very, pretty much expect to have to go to rehab to learn to walk again.

Dr. Sahni: 16:09 Because I’ve seen that with other patients and this is a very severe injury to the spinal cord. So amazingly, this patient proved me wrong, uh, and I was so happy that he did. We did his surgery, went very well. In fact, I have some video of it to show you. And he did very, very well and he didn’t, not only did you not have to go to rehab, he actually went home on day three. So miracles do happen. Um, I’ll take some credit for it, but we’ll give the rest to God. So let’s see if I can show you this video now. I’ve talked about showing video. I’ve been a little bit reluctant to do it because I think some people are turned off by blood. So I guess we’re gonna find out today for 15 years. I’ve always avoided showing live surgical video. But I had so many people message me and say, uh, I’m not grossed out by that police show us.

Dr. Sahni: 16:55 So here we go. So here’s some video in this right here. I’ve tried to show the anatomy and I can kind of skip around and show you more now to me, but this is a, those two pins. There’s two metal pins that I’ve actually placed into the vertebral body of four and the vertebral body of five, so that’s hard bone that accepts a screw. Can I use that to control those two particular bodies and actually separate them to open that space up. That actually pulls a disk up to a proper height and does relieve some pressure on the spinal cord. And so ultimately, and it allows us here. I’ll pause real quick to show you what I’m talking about. Just jump back over to here.

Dr. Sahni: 17:35 So those metal screws you saw were. So this is two, three, four, five. Okay. So we’re make sure I’m on the video there were in four or five. Okay. And the screws are in each of these bodies and when these, when the disc collapses, losers type just to like in the lumbar talk that we had the foramen or the whole, but the nerve passes out, becomes tighter and so by increasing the space back to where it was when you were younger, were not only straightening up that disc in the back, which I’m ultimately going to remove, remove, and just a few minutes after that so it doesn’t matter that much, but we’re going to increase the height and opened up the space between these bones and allow this nerve root to have more space. Okay. But, um, that’s what you’re seeing here is basically I have pins in a four and five and I’m scooping out the disc here at four or five.

Dr. Sahni: 18:23 I do that at all three levels, but this just happens to be the four or five level. And so let’s go ahead and hop back over to that and I’ll show you some more of that. And so what I’m doing here is I’ve entered the disc space in. I’m removing that disc material that’s in between those two bones. That’s called a pituitary and uh, and all this kind of fast forward because this would take a lot. We’re just going to jump here a little bit and you can see on progressive moving up, removing the disc and I’m using what’s called Roger to remove all that disc material. There’s, there’s the annulus fibrosis which is the same as the lumbar spine. We talked about it in our last talk a, there is the nucleus pulposus, which is that crab meat. Now you can kind of see why I call it crab meat.

Dr. Sahni: 19:01 This guy was a little bloody, he takes fish oil, um, but I didn’t have time to take him off of his facial oil like I normally would for an elective surgery because this was an emergency. And so he did lose a little bit more, uh, than is typical, but even then it looks like a lot because this is through neuro surgical microscope. He only lost about 100 CCS, but at times it seemed very bloody. That’s a bovie cautery and a suction tip there. And I’m just cleaning up a space. Let’s watch here. As we progressively clean out the space, I now turn this into a joint surgical video and nothing but surgery, especially if it’s grossing people out. We’re sucking. Be Very careful because again, if you press on the spinal cord, just a millimeter or two, especially. This is why the I tell these patients expect to get worse because their spinal cord is already in a very vulnerable state and just going in and stretching these bones apart and taken out this disc.

Dr. Sahni: 19:48 It’s very hard not to put some pressure on the spinal cord and that’s why I almost expect to have a little to have them oftentimes get worse or just not be better immediately after surgery. That’s a nerve hook and I’m reaching down there behind what’s called the annulus annulus fibrosis, just like we talked about last time and something called the poster Longitudal. Longitudinal ligament or pll can. I will take all of that out. I will remove all this very carefully, very slowly so that I don’t paralyze the patient. I use something called neuro monitoring during the case and so someone’s got. It’s basically like real time quotes, so instead of waking up the next day and finding out what the price of a, you know, the Dow Jones was the next day I’m getting. In other words, the patient wake up. They used to literally in the old days do something called the wake up test where they would do the surgery when they won’t.

Dr. Sahni: 20:30 When the patient woke up and asked them to move their legs. If they could move their legs, then they would put them back to sleep and go back and try to figure out why and that’s just what they had. I mean, there wasn’t. That wasn’t malpractice. There’s just worth ahead. I’m now instead of having to do that, wake them up and hope I didn’t do anything bad to have maybe an implant or a screw in the place. I’ve got information coming to me real time. Maybe sometimes it lags by a few seconds, so you still have to be extremely careful, but if I’m starting to anger something where there’s reduced blood flow, even from the anesthesia, from the decreased blood pressure, which we have to address, or the positioning of the patient. In fact, in a patriot of the other day, the operative area wasn’t the problem.

Dr. Sahni: 21:05 It was the way their arm was sitting on the table and their owner nerves started to have problems. Of course they reposition the patient, fix the problem, so it’s not just about surgery, it’s about taking care of your body while you’re asleep, all of your nerves in your body. But again, neuromonitoring really allows me to decompress the spinal cord with impunity, if you will, and not have to worry as much that I’m causing serious injury. So here, if you notice here, I’ve gotten all the way down to the spinal cord, so that’s the spinal cord. You Peek in through there. Through that blood, we’re being very careful. Again, there’s still some disc material, there’s analysts and pll there, posterially, and as we move along here, I’ll just sort of move along because we don’t want to sit here looking at this forever, I’m assuming. Um, unfortunately the camera was not as direct.

Dr. Sahni: 21:49 What I saw through the scope was not what this, what the Cameron. There’s someone I talked to the guy who I was a little bit frustrated with that, that the fit, the video is still usable. It’s still viewable. So that’s all pretty much spinal cord and I’m slowly just very carefully going and removing that material, trying not to put any significant pressure on the spinal cord. This material is very tough. It’s as these fibers are very tough. I have to apply some pretty significant force to get those tissues out of there and I have to be very careful that my hand doesn’t recoil or uh, that I, you know, put any pressure on their own structures. And obviously in this case I didn’t because the patient was walking out of the hospital three days later when I expected him to not do that because he was in a wheelchair.

Dr. Sahni: 22:25 But I’m here now, what I’m doing here, if it will come back, I’m irrigating out the space and now I’m going to put in a trial. So I’m trying to figure out, just like putting, getting your shoes fitted. We’re going to put in trials. Those are epidural bleeders there. That’s very common. Rather than stick a bipolar down there and trying to stop that. I generally will oftentimes just put it. That was the first trial. I’ll just put some medicine or some substance that will decrease that bleeding. So I’m basically just trying to find the right size. I want it to be just snug. I don’t want to stretch the heck out of these bones, but I do want it to be a good interference fit, number one, so it doesn’t fall out. But number two, again, I put those two pins in the bodies of foreign five to stretch them apart because I’m trying to open up the space for that nerve like we talked about earlier.

Dr. Sahni: 23:09 And uh, I’m just basically trying to find the right size. These are all trials. I forgot what size it was, but generally it’s somewhere between nine and 11 and the neck, millimeters in height and it’s just based on fit and of course I get an x ray and I see how good the fit looks on x Ray and all I’m doing here is tapping in very carefully not to press on the spinal cord, um, these trial, uh, implants and then looking at them on an extra day. So we keep going here. And then once I get in there, a lot of times putting the trials in will free up some more soft tissue from the in plates because we want those in plates to be nice and bear. All the cartilage gets removed. There’s employee cartilage. No, that needs to be. We want nice bloody bone because that is the implant implant implant that I ultimately put it in.

Dr. Sahni: 23:52 That’s it right there is filled with bone and we want it to grow through them. It’s like a donut of plastic with a bone graft in the middle and we want those two bones to fuse or connect to one another. This is the material I was talking about that decreases bleeding so I don’t have to go back there with a hot a Buzzer to buzz that, uh, I don’t, I can do that if I’m extremely careful, but when you’re right on the surface, the surface of the spinal cord, you have to be extremely careful. And what I’m doing now is I’m tapping in the implant there and you can see some of the excess. Um, uh, let’s see, what do we do here? It jumped. Oh sure. Where the jump to the right leader or not. My, my video is broken up into segments and it looks like a jump down to the next view.

Dr. Sahni: 24:32 But anyway, we saw what was going on there. Um, and so what that was was me removing the disc material and let’s see if we can jump over here. We’ve, that was me removing the disc material going all the way back to the spinal cord and you see a lot of people, now that I think about it, let me mention this. A lot of people say, what are those two white lines? Well, those, the implants made of plastic and so if I didn’t have those markers in there, there’s radiographic markers in there. If those implants were to move, they shouldn’t because I put a plate across the front. But if those implants were to move then I would know that they’ve fallen out and they’re in the neck or in the case of the lumbar spine there in the belly. Otherwise they’d be invisible and an implant could fall out and we wouldn’t know where it is.

Dr. Sahni: 25:14 So that’s a problem. So we put these two little looks like paperclips, pieces of metal into plastic. So they’re in, they’re embedded into the plastic, so deep inside of it. So anywhere that plastic goes, we can see it by looking at an extra. Um, let me see. Also if I had another view, wouldn’t trip. I had an ap view. It looks like general. That’s okay. That’s okay. So these are the pictures that I put up. It doesn’t matter. I don’t want to get too technical, but I thought you guys might be interested in, in, in, in our run back over here real quick. And so again, this is the, I believe this is the next level. Let me see. The videos are at zero, zero one had a hard time getting these videos to show up. But yeah, that’s the next level. So I’ve already done the four or five level, which is the worst level and now I’m heading down to the five, six level, um, and doing the same thing.

Dr. Sahni: 26:06 This is me just trying. It’s very, very vascular neck, lot of bleeding. So we want to make sure that we keep that bleeding, controlled it when bleeding gets out of control in the neck. Um, so usually when things go well, like this case, did I lose, I lose very little blood. One hundred CC’s of blood is about toothpaste tube of toothpaste tubes, about 75 CCS, a big one I guess. And so, you know, this guy considering the surgery was many hours, who wants to buy a toothpaste tube full of blood? And so we do want to be very cautious. It seems crazy to have to burn in the neck, but it’s extremely important. None of the structures aren’t burning, are important in most of it’s being removed. And then of course we’re putting an implant in at this level as well. So, um, that’s what I wanted to show you. Let me see real quickly,

Patient: 26:50 annotations of dead lifting.

Dr. Sahni: 26:53 So I’m gonna. Uh, like I told you I

Speaker 3: 26:59 alright. Um,

Dr. Sahni: 27:01 had a prerecorded dealing and I’m having a hard time a little bit here with my little book

Patient: 27:07 I slapped or whatnot.

Dr. Sahni: 27:09 Okay. And you and you. So I’m, I’m working with this thing. Hang on, let me open this back up. Sort of bummer. I’m sure I have a patient interview,

Speaker 3: 27:19 so that’s killing me. They’re just give me a second guys and you can watch that surgery while hopefully fix this problem that I’m having with.

Dr. Sahni: 27:34 It’s tough being the it guy and the doctor. Oh, at the same time. Okay. All right. So Lauren, thank you so much for and I’m just trying to get this to work out for me. One more second guy. Just keep watching that surgery if there’s something that I hope. Yeah, I don’t have a fixture for me. One more second. Sorry. Something malfunctioned and now and having to deal with it.

Speaker 3: 28:11 I don’t know what to tell Ya. Total. Bummer.

Dr. Sahni: 28:23 Well, I thought I’d have this. I said No.

Speaker 3: 28:29 So anyway, I had had it all teed up and ready to go for you. Give me one more second. I hate when this happens live. What do you do? Yeah, I think I fixed it. Bummer. Sorry. I’m not the greatest guy in the world apparently.

Dr. Sahni: 29:08 Okay. So I’m going to show you a video prerecorded. Good thing. Trying to pretend like I definitely would have blown that. Trying to lie about that. Um, so here we go. Uh, this is just a few hours old, I promise, and this is a patient that had surgery just a couple of weeks ago and she’s going to share her experience and I thought this was very sweet of her to share this experience with us. And so anyway, here we go. Okay. All right. So Laura, thank you. So for joining

Dr. Sahni: 29:42 me. And, uh, just wanted to real quickly discuss with you your story. So if you could just tell us briefly what your symptoms were, how long you had them, how they were affecting your life and what treatments have you previously had a prior to, um, to seeing us and getting treatment from us.

Patient: 30:03 Well, I started having symptoms of like a pinched nerve and spent about five, five and a half years ago. And a burning barn, a shoulder blades kind of her. So I tried physical therapy, acupuncture injections. I’m burning into the nerves and stuff, but nothing really really helped. It was affecting my life was just like been at work. I can lift certain things or can’t sleep on a certain side or whatnot. So it just kinda started back at me that way.

Dr. Sahni: 30:43 It was it just one arm or both arms. And, and were you able to, you know, go to the gym or do the hobbies that you like to do or how was it affecting your ability to kind of do the things you want me to do?

Patient: 30:56 No, I, I could, I could do pretty much everything that I wanted to do. It’s just certain limitations of, like I said, lifting or way I slept or whatnot.

Dr. Sahni: 31:06 Okay. And you and you dealt with it for, you said about five years you said.

Patient: 31:10 Okay.

Dr. Sahni: 31:11 Did it just kept getting worse and worse over that five year period?

Patient: 31:14 Um, it, it, did, it, it kinda worked. David stayed the same for awhile and then if I did when I was doing acupuncture it worked a little bit, but then it would stop working and just dependent on the different types of treatments, but it was constantly, always there. It never really went away.

Dr. Sahni: 31:30 And I think you just said this, but it did affect your ability to sleep.

Patient: 31:34 Yeah, definitely.

Dr. Sahni: 31:35 Was that one of the, was that, was that one of the bigger issues? The sleep issue?

Patient: 31:41 Just the everyday having a constant pain in my arm. Yeah.

Dr. Sahni: 31:45 Okay. Okay. And um, you had a shot as well as nerve burning and neither one of those things got rid of the pain?

Patient: 31:52 No, not really. Just kind of a temporary thing, but then it came right back.

Dr. Sahni: 31:56 Did we do your shots or if somebody else do your shots?

Patient: 31:59 Um, someone else that you have as well, we did one with at your office,

Dr. Sahni: 32:03 one of my office, what you do, so you have some, uh, pain management over a period of years and then we gave it one attempt that attempt failed and then at that point we did a nerve test on you that showed nerve damage. So the nerve damage, the MRI showing the pressure on your nerve symptoms, the lack of sleep, the failure of the conservative treatment obviously. Did you try physical therapy as well?

Patient: 32:26 I tried it twice, yeah.

Dr. Sahni: 32:27 Okay. And that didn’t really help? Nope, not at all. Not at all. Okay. So we ultimately just did a one level decompression and fusion and that was just a couple of weeks ago. Right,

Patient: 32:39 right.

Dr. Sahni: 32:40 And how, and tell me how, how was that? Tell me your experience there. What’d you think? Honestly? What’d you think about that?

Patient: 32:46 Well, of course I was scared going into it, but you and Dr Nelson and really made me feel comfortable going into the surgery. You explained everything before I went in and when I woke up from the surgery I wasn’t in pain. I could feel my arm was feeling better now, not a hundred percent better that each day that better and I continue to fill that each day of getting better. I don’t have that burning sensation down my left arm anymore.

Dr. Sahni: 33:09 That’s great. So two weeks out, roughly something like that. You’re 50 percent better, 80 percent veteran. How much better do you think you are at the screen?

Patient: 33:16 Hey, that 80 percent better.

Dr. Sahni: 33:18 That’s great. No, that’s wonderful. So is it, you know, a lot of patients after they have this surgery and I don’t blame people for not wanting to have surgery. No, I wouldn’t either unless it really was affecting my life. But now that you’ve had it done to you, would you say that you say yourself, wow, if I had known it was going to work this well and work out like this, I probably would have done it sooner.

Patient: 33:38 Definitely. Yeah. I wouldn’t have waited five years. Yeah.

Dr. Sahni: 33:41 Well good. Well good. So I’m so glad that you’re happy. Happy with happy with the office office, treated you well and you’re happy with the whole experience. Well, and we’ll.

Patient: 33:51 Every time I go around and everybody was so friendly and get my appointments timely and, and just breaks down. I really appreciate your, your health and your staff help.

Dr. Sahni: 34:00 Well, we’re not perfect, but we certainly tried to do our best and uh, and we’re, uh, I put all my focus on doing a good surgery and then I certainly try to be friendly and keep your appointments timely and everything else. I can’t say that that’s always perfect because we have people come in and they have, you know, problems. We got to take care of them, but we certainly do our best. But when it comes to the surgery, you got my 100 percent attention. Your surgery went fantastic. You lost almost no blood. It didn’t take terribly long. Um, I mean everything went real well. You didn’t have any, you know, you had no problem. All that, all those horrible things that you have to sign off on, like paralysis and death and this, that and the other. None of that stuff happened and of course, or I would’ve told you. And um, and you did great and you’ve been a wonderful patient. And we’re, and we’re so happy that you’re doing well and thank you so much for, for talking to us. And uh, but in two weeks out, by the way, guys, a lot of people are very horse a lot. Some people, um, some will not lot, but some people are worse. When I, I didn’t mean horse, I met difficulty swallowing difficulties. Are you having difficulty swallowing?

Patient: 35:03 Not too bad. So now at first couple of days I was on, but now I eat pretty much everything. I do drink with a straw that helps. But um, no, I, I don’t have that much trouble.

Dr. Sahni: 35:15 It’s perfectly normal to have some difficulty. The first few days some people even have difficulty swallowing. There’s a study that shows 17 percent of patients who have dysplasia, but it resolves, it gets better with time. And then occasionally someone gets worse. I’ve never permanently made anyone horse. I’ve made somebody’s horse for three weeks and somebody who works for six weeks. But most of my patients are never worse. In fact, you were speaking perfectly normally from the second that you woke up. So those are a couple of things. Those are a couple of things that we see in this early posts are postoperative period. Another thing we see, um, and I don’t know that I’ve asked you about this, I think I might have at your visit until you start to really fuse at that level in your neck that we did. You may notice some muscle spasm and pain between the shoulder blades. Have you noticed any of that? And natural, normal as everything gets solid and really fuses and there’s no more motion there at all. That should completely go and I expect that to be at least a lot better if not gone in about six weeks. Okay.

Speaker 6: 36:15 Okay. So if you could

Dr. Sahni: 36:29 just tell us briefly what your symptoms were, how

Dr. Sahni: 36:37 it was done. I wasn’t sure if it was done. It was definitely done and I was trying to do a transition and of course I screwed it up.

Dr. Sahni: 36:55 Anyway, guys, that was Laura and I really appreciate her coming on. The reason I wanted to come on was because she just had her surgery a couple of weeks ago and so all the horrors or non horrors, we’re fresh on her mind and I wanted her to share her experience with us. A couple of questions here. Yes, Michelle, that was exactly the surgery that you had. What was the white stuff? The white stuff was the disc material. The stuff that was coming out was the disc material, so I always call the a disc, a crab meat. The nucleus pulposus portion of it. Crab meat. The other ports, the annulus fibrosis is more fibrous, but the center of the disc looks like crab meat and I called that crab meat, so that’s what the white stuff was. And so neck brace for her know she wore a neck brace.

Dr. Sahni: 37:38 She just not wearing it right now. One levels only have to wear a neck brace for a couple of weeks and so she’s out of that. You really don’t even have to probably wear a neck brace with a one level, but my two levels require, um, two weeks and three levels require six weeks. Michelle, since you were talking about your case, yours was a revision and that’s why I had you were a little bit longer. Um, but if everything’s going well, the bone quality is good. I don’t necessarily make people wear a neck brace for a one level of very long at all. Okay. So, um, guys, let’s just real quickly look at this. This is a, another picture that I found on, um, I guess so whatever a Google search that I thought people might find interesting and that is basically the same model that I showed you earlier.

Dr. Sahni: 38:29 There’s the bones that you see a, we’ll just call this four and five. It had really who knows which levels they are. And I, I, uh, the one thing that you didn’t see me put on in that video and we could try to go find it. If I had that video where the plates going in, I’d have to kind of search through there and find it. Uh, but we put that, we stretch those bones apart with pins. We clean out all the pressure on the spinal cord if the number of levels that are necessary to clean out. We put an implant in between and you started to see that on another video. I’ll see if I can’t find that. And then we put a plate on the front to hold everything still so nothing actually will fall out. And here I’ll show you this again.

Dr. Sahni: 39:06 This, I believe I didn’t really get a chance to go through this video and really worked through it, but I believe now I’m at the next level. I don’t because this is a zero, zero one, so I think it’s the next video. So we’ll see if we can kind of skip ahead here. Do the same thing. It looks like the camera might’ve been a little bit better centered on this level so we can see things a little bit less, a little bit better, but I’m sort of skipping along here and again a very carefully removing that material and getting the pressure off the spinal cord. And again there’s the, there’s the Dura, there’s the covering of the spinal cord or we’d be saved. That’s the spinal cord. Again, this guy was on fish oil, but sometimes even when they’re not, it’s even much more bloodier than this.

Dr. Sahni: 39:43 So this isn’t really even terribly bloody, but there’s a little bit of blood back there. Sometimes it’s a lot less bloody. Just depends on the patient to see what happens. We jump down to the next video here and there I am trialing out again. So we’re cleaning out that disc space. You’ve already seen this and so I’m showing you again, maybe it’s a better view. Maybe it’s not, but we’re cleaning up at a space. We’re getting all the pressure off the spinal cord, those little fibers that are hanging, you don’t necessarily need to come out. Um, we tried to get out as much as we can. What I want to make sure that I don’t leave a trapped piece of disk back behind the pit poster long longitudinal ligament or behind the vertebral bodies. And that’s why I’m sort of reaching back with those little hooks and making sure that there’s no disk material that’s been retained because that could cause the patient to continue to have, um, issues.

Dr. Sahni: 40:26 And we certainly don’t want to have to come back and do a revision surgery if we can avoid it. So, uh, in here, let’s just scoot along here. I don’t know when the plate comes in or even if I video the plate here. Obviously I’m getting an x Ray. There’s the. Let’s see if we, if we show the implant getting put in, that’s the implant. So there’s. Yeah. So there’s all scoot back. I’m kind of jumping around. Okay. So I’m cleaning out real nicely. Uh, I probably put some of that blood. Yep. There it is. This is a flow seal. So this basically is a material that’s completely pliable. It’s like a foam, so it doesn’t press on anything, but it stops bleeding and so stops the bleeding in the back. And here I am pressing in, I’ve got a tool and I’m holding onto this cage.

Dr. Sahni: 41:06 It’s made of plastic. It’s a peak cage. P, e k, polyethylene, polyethylene, ether ketone. It’s a plastic that’s been around for decades. It’s the body doesn’t react to it. It’s known to be very safe. I’m using that metal thing. Sticking another is an inserter. That’s what’s attached to it, so I have control over the cage and again, the cages filled with bone. The intention is for the bone to grow from one vertebral body to the other through the center of the cage and there’s the cage in place and you know, you had to have seen before, but this patient’s between those two bones was much narrower. I was able to open, oh, text a couple of millimeters to get pressure off the, off of those exiting nerve roots. Um, and again, uh, I’ll show you,

Dr. Sahni: 41:44 uh, let’s see. Uh, uh, what I want to do is get pressured. When I stick that my implants bigger here, they’re, they’re sort of showing a little sliver of bone. But what I try to do is I want to crank those two bones apart to open up the room for those exiting nerve roots. That’s an indirect decompression. I’m directly decompressing the spinal cord. Okay. But I’m indirectly decompressing those nerve roots by putting this implant in. I want to put as big as I can. I don’t want to crazy here, but I want to put in a large, a large enough implant to be stable so it doesn’t shift around. Yeah, you can see the implant above there. You can still see my implant above, so this is definitely the next level. What I’m doing here is I’m removing the pin that was in the bone and it tends to bleed briskly in some cases and so once we get that pen out because bone bleeds, there’s no way to put a tourniquet on bone.

Dr. Sahni: 42:30 We then used a piece of bone wax that’s bone wax and I’m using to fill that hole and once I successfully press a little pea, sometimes I’ll just shove my finger in there when I get frustrated with that instrument called a peanut that I was trying to use to put it in there and I’ll just sort of press that right down in there and now we’re done with that level and we’ll use that pen for the next level. The next level we’ll put another pin in and say, let’s just skip along here and see. Now we’re starting that next level. I’m cleaning off the disc material. I know you don’t want to see this three times necessarily and I’m just trying to see if I even have a. anything of me putting in a plate or not. I don’t recall. Honestly. I haven’t really watched it.

Dr. Sahni: 43:07 Now it looks like I stopped the video and probably did not put the plate in under the microscope. So. And that doesn’t surprise me. So, uh, here we go. We’re cleaning up that last level. I also think that the video, a USB card that I use only had an hour and so it an hour and three minutes and so, which tells me, took me about an hour later, all three levels, which isn’t bad considering the severity of this patient’s problem or maybe it took me a while longer. I ran out of video, but this is, I’m on the third level, so I’m getting know. Got Almost to the point of putting that third implant in. But it’s the same thing. Pins in the bone, cleaning the cartilage off the plates are moving the osteophytes, removing the disc material, the nucleus pulposus as well as the annulus and getting all the pressure off the spinal cord, putting an implant in there to stabilize the level to open up the space to get done. Not only a direct decompression, which is what you’re seeing here, but an indirect decompression by opening up the space between those bones and opening up the nerve roots and then putting a plate across the entire front of the neck to allow us to. Um, let me see if I’ve got that picture here where it was, I guess. Yeah. And uh, and then to allow us to,

Speaker 6: 44:16 where is it

Dr. Sahni: 44:21 putting a plate across the front to allow us to stabilize the construct and keep those implants from popping out of, of the neck so to speak. So that is um, um, anterior cervical surgery. Obviously if I went through all the different types of cervical surgery, we’d be here all day and I really only scratched the surface on some of the anatomy. But I didn’t want this to be a one and a half hour deal and I wanted you to hear from a patient recently had surgery who’s doing fantastic and she’s a fantastic patient. Uh, really, really, uh, happy to have her and all my patients for that matter. I wanted to show you live surgical video I wanted to show you. Also want to remind you to go to our facebook page and join my mailing list to win a free tee shirt. I will definitely be giving on a tee shirt A.

Dr. Sahni: 45:15 I may not do it right this second, but I’ll, I’ll do it here shortly. Hopefully today or tomorrow and all announced that he won the tee shirt last week and was Jean. And I’m also, please share this video. I really appreciate you sharing. If you, if you don’t mind, if you know somebody who might have a neck problems. Remember guys, this is the last resort. The only reason this guy had this big surgery was because he was literally in a wheelchair and I took him out of a wheelchair. So in that case, conservative treatment with surgery, if I hadn’t done surgery on him, he would have never walked again and probably would have died. And so there was really no choice but to do the surgery, I always save surgical intervention is the last resort. We have lots of tools in our toolbox. Um, if you want to make an appointment, you can call our office, um, and uh, uh, make an appointment.

Dr. Sahni: 46:03 I have had a couple of patients contact me through facebook, private messaging, asking to be seen from multiple states away and I’m happy to see you. What I would tell you is if you really want to get the most use out of your time is contact my office at eight, three, zero, three, seven, nine, 8,800. And let us review your records because I’d hate for you to come all the way to Texas if there’s really nothing that I, if I can pretty much tell that I can’t help you, why waste the plane ticket or the driving? I mean, if you want to come meet me then sure. Happy to see you and we can talk about it. But in an effort to save you time and money and I’ll be happy to review your case and then we can decide whether it’s worth you coming and having a visit with us.

Dr. Sahni: 46:47 So again, please sign up for my mailing list and you’re get all kinds of cool stuff sent to you and let me just make sure that we don’t have any other questions before we close out here. Should have been on my surgery 15 years ago. You found the problem. Yeah, I remember this. We did. And you did so well Michelle. I was so happy that you did so well. And Michelle, we’re going to have to have you on for interview. What am I thinking? So we’ll definitely have you on Michelle for an interview and also a I have to. Michelle’s actually I want to have on for interview, so we’ll have both of my. Michelle’s on that are my star patients that have done fantastic and all such wonderful people. Are you guys, if there’s no other questions, we’re going to end it and thank you for joining us.

Dr. Sahni: 47:27 I hope you. If you didn’t like the video, if you thought the bloody surgery was too much, let me know. Um, I’ve avoided showing that kind of stuff for 15 years because I thought it would freak patients out, scare them or make them sick or whatever. I’ve always been told by people I asked not to show that kind of stuff. So I’ve avoided doing that. Maybe I should have. Maybe that was the wrong thing for me to do and maybe I should have shared that kind of stuff and people would find it interesting. So leave me feedback. Join the mailing list. Please share this video. And uh, remember we do drawings for a free tee shirt because I know everybody wants a free a spine center of Texas tee shirt because that’s so amazing to have one of those. And you guys have a great weekend and I’ll just end it with my outro.