Pictures of the Week

IPSIS: Formerly the Spine Intervention Society
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This gentleman has had one back surgery in his entire life, and that's it.

Imprison the surgeon. Local huge university hospital.

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MitchLevi said:
This gentleman has had one back surgery in his entire life, and that's it.

Imprison the surgeon. Local huge university hospital.

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I think it’s difficult to criticize this T10-pelvis construct without knowing the history and seeing the preop films. It sure is a lot of hardware for a first wack but sometimes fixing a deformity is better than creating more deformity, such as a flat back, by trying to limit the surgery to 1-2 levels.
 
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NJPAIN said:
I think it’s difficult to criticize this T10-pelvis construct without knowing the history and seeing the preop films. It sure is a lot of hardware for a first wack but sometimes fixing a deformity is better than creating more deformity, such as a flat back, by trying to limit the surgery to 1-2 levels.
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Dude...I respectfully disagree.

If I take your statement and run with it, the only back surgery offered to anyone is a T10-pelvic fusion. What percentage of L3-5 fusions result in adjacent collapse, sagittal balance problems, adjacent scoli, etc? Why would anyone ever have one of those if they're gonna collapse above and below?

This pt is fused posteriorly T10-pelvis AND an ALIF L5-S1.

The guy who did this is roundly hated by virtually every pt I've ever sent his way. I'll never send another BTW.

I once had an entire phone call with him discussing a pt during the COVID lockdowns. Like 4 weeks later he defamed me to a pt I sent to him, and did the exact opposite of what we discussed over the phone.
 
MitchLevi said:
Dude...I respectfully disagree.

If I take your statement and run with it, the only back surgery offered to anyone is a T10-pelvic fusion. What percentage of L3-5 fusions result in adjacent collapse, sagittal balance problems, adjacent scoli, etc? Why would anyone ever have one of those if they're gonna collapse above and below?

This pt is fused posteriorly T10-pelvis AND an ALIF L5-S1.

The guy who did this is roundly hated by virtually every pt I've ever sent his way. I'll never send another BTW.

I once had an entire phone call with him discussing a pt during the COVID lockdowns. Like 4 weeks later he defamed me to a pt I sent to him, and did the exact opposite of what we discussed over the phone.
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There are one or more of those creatures in every town. The intentions are almost always $$$$. I lost count of surgeons like that back East. Perhaps the pro-gun and pro-opioid argument can be applied. It’s not the hardware that’s bad, it’s the surgeon.
 
NJPAIN said:
There are one or more of those creatures in every town. The intentions are almost always $$$$. I lost count of surgeons like that back East. Perhaps the pro-gun and pro-opioid argument can be applied. It’s not the hardware that’s bad, it’s the surgeon.
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Fair. Agreed.

I'm not even sure money is what drives this guy TBH. I think he's crazy, and he will receive zero referrals from me in the future. He may actually be bipolar for all I know.
 
I should publish my case report of the time I got a lumbar MRI on a pt and she said it cured 25 yrs of pain.
 
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MitchLevi said:
I should publish my case report of the time I got a lumbar MRI on a pt and she said it cured 25 yrs of pain.
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Windsor had a patient. Lumbar radic. ANS system implanted. Patient: “It’s like I’m on a vacation.”
Leads coiled up under IPG on right flank.
 
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Not everyone that practices regen just shot guns everyone with blood by the way. I met this dude once, he’s a great ultrasonographer, don’t know much else about him.

Btw I have seen an epidemic of vertebrogenic back pain lately…to every hammer there is a nail..
 
Dr. Ice said:
Not everyone that practices regen just shot guns everyone with blood by the way. I met this dude once, he’s a great ultrasonographer, don’t know much else about him.

Btw I have seen an epidemic of vertebrogenic back pain lately…to every hammer there is a nail..
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His us pics are impressive and helpful (to me).
 
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He's has a good reputation in the regenerative medicine world. I've seen his talks at TOBI, IOF. I know intradiscal orthobiologics are controversial here but plenty of docs doing it much worse
 
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RoloTomassi said:
He's has a good reputation in the regenerative medicine world. I've seen his talks at TOBI, IOF. I know intradiscal orthobiologics are controversial here but plenty of docs doing it much worse
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I really have no problem with the intradiscal biologic… It’s moreso putting that $hit literally everywhere….
 
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RoloTomassi said:
He's has a good reputation in the regenerative medicine world. I've seen his talks at TOBI, IOF. I know intradiscal orthobiologics are controversial here but plenty of docs doing it much worse
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If this is the level of douchebaggery that gets you well respected in the regenmed world, then we all know why there is a problem.
 
I'm not against the PRP carpet bomb, but the caudal D5W is dumb.
 
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Another Linked In hero.
Calling it an epiduroplasty with a catheter on a neck. No prior surgery noted. Enough contrast to kill a kidney. Umm, NO.
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ACDF and posterior decompression/fusion after MVC (not a PI patient though). Sent to me by surgeon for consideration of SCS. She’s several years out and still has neck and arm neuropathic pain, MRI shows good decompression but residual myelomalacia. Has done extensive PT, antineuropathic meds. Discussed extensively before trial risk of Dural puncture or cord injury, and high likelihood of inability to thread past the posterior fusion. Trial done under light sedation so she was responsive. 2 pillows under chest. Entered T3-4. Luckily it threaded up midline very easily. The lead stopped at C6 and would not advance despite trying going back and forth and a few different approaches. I pulled back and steered it into the gutter on the left, then was able to steer it back to midline. She had some brief paresthesia when I did that but overall did very well. Trial results pending. Will update. Hoping the surgeon can do a paddle lead for her for the implant. I’m not eager to try my luck a second time.
 
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They have to do a really wide laminectomy to get a paddle in. Please just do it with percs or don’t do it.
 
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BobBarker said:
They have to do a really wide laminectomy to get a paddle in. Please just do it with percs or don’t do it.
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She already has a wide laminectomy. If she passes the trial I’m going to talk to the neurosurgeon and see if he can get a paddle in safely. Fwiw I’ve sent several cervical SCS patients to him (for example, patient with longstanding arm CRPS, was doing ok with stim until it migrated after she tripped on her dog, and also had some central stenosis that could maybe be addressed at the same time) and they are doing amazingly. Some of the happiest SCS patients I have.
 
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Can anyone explain this flow pattern oblique and lateral looked good to me, obvious AP shot didnt look good, tried to adjust and put more contrast in still didnt get great epidural flow despite multiple adjustments, obviously doesnt look epidural
 

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schmee90 said:
Can anyone explain this flow pattern oblique and lateral looked good to me, obvious AP shot didnt look good, tried to adjust and put more contrast in still didnt get great epidural flow despite multiple adjustments, obviously doesnt look epidural
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Looks like facet capsule. Was there resistance?
 
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schmee90 said:
Yes there was, that was my thought but even redirecting didnt get the flow pattern i was looking for, thanks for the input
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If you get that pattern, keep some pressure on the plunger, and advance very slowly, you will usually feel a LOR when you pass through the capsule and then you'll get epidural pattern, patient may begin feeling paresthesia but usually not bad if you stop advancing right after you feel LOR
 
RoloTomassi said:
If you get that pattern, keep some pressure on the plunger, and advance very slowly, you will usually feel a LOR when you pass through the capsule and then you'll get epidural pattern, patient may begin feeling paresthesia but usually not bad if you stop advancing right after you feel LOR
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Thank you for the feedback it is very much appreciated
 
It is wide and then fused. She will have adjacent segment disease in a couple years if there is another laminectomy and then will have to have a bridging posterior fusion.
 
Not sure if I've ever posted this one or not. Mid 60s obese woman with a migrated L3-4 interbody spacer that is sitting directly in her foramen and compressing her spinal nerve. I implanted her and she's been virtually free of her severe left leg pain. I spout my fair share of anti SCS rhetoric, but this one is a grand slam. You can see that IB spacer at L3-4. Terrible.

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Who here thinks the SIJ was the culprit? I really wish yall would knock off the BS.

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This is wild. Wonder what fluoro time was.
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