Oliver Tannous, MD, Orthopedic Spine Surgery at MedStar Washington Hospital Center, talks about a new spine surgery for back pain.
Interview conducted by Ivanhoe Broadcast News in 2024.
Now, we’re talking about the cervical spine. What are we talking about?
Tannous: So the cervical spine is the uppermost aspect of the spine. The spine essentially connects the skull to the pelvis, allows humans to stand up in a bipedal state, meaning on both legs and essentially the function of the spine is number one to protect the spinal cord and the nerves, and number two to help us stand upright and help us with our body mechanics.
When people have a problem with this, what are the symptoms, or rather, the problems?
Tannous: The most common conditions that affect the spine are degenerative conditions, essentially, the layman’s term is arthritis and so the symptoms that people tend to get when they get an arthritic spine or an arthritic segment within the spine is degeneration of a disc, and that degeneration of a disc can either compress a nerve or compress the spinal cord and result in neurologic symptoms, either pain or weakness or numbness or a combination, or sometimes just a very degenerative joint can be very painful and limit range of motion because one may stop moving the neck in that particular direction.
What are the most common treatments right now?
Tannous: The most common treatments by far are actually non-surgical treatments. The vast majority of patients get better with physical therapy, they get better maybe with some injections. Most patients benefit tremendously from good old-fashioned strengthening, conditioning, mobilizing, and that’s essentially the world of physical therapy. Then a very small percentage of those patients when nothing else works, they go through their therapy programs, they go see a non-surgical specialist and try different types of injections to target the joint or to target the part of the spine. When that all fails, then they become surgical candidates, and that’s where I come in.
That’s also where MySpine cervical 3D comes in, right?
Tannous: Exactly.
And what is that?
Tannous: So the Medacta MySpine cervical 3D system is a patient-specific drill guide. So as part of spine surgery, especially when we’re doing fusions, we oftentimes put in screws and rods. Those screws and rods can be placed either with freehand technique, essentially, you look at the spine and you determine the best trajectory for it but now we have the ability to get a CT scan for that patient before surgery, and then use the CT scan image to make a 3D printed mold of the patient’s spine. The beauty of that is that in the operating room, you have a three-day mold of the patient’s spine, and you have a guide that latches onto the spine that allows you to drill the Scroto directories in a very accurate manner.
It takes personalized medicine to even higher level where you’re dealing just with that person’s spine. You know what you’re going into every single operation?
Tannous: Yes, that’s exactly what it is. So in 2024, we have the ability now to target exactly the patient’s anatomy. That becomes important because when you’re putting screws in the spine, you’re trying to put the screw in a narrow corridor where you have the spinal cord on one side, you have the nerve above or below, and then you have the vertebral artery, which is the artery that feeds the brain on the other side of that screw, so that accuracy becomes really important.
What happens when you don’t have that accuracy, what are some of the risks?
Tannous: The risks are the same, as with all surgery. You can risk putting the screw in the wrong spot. You can risk injuring a nerve or injuring the spinal cord. You could risk injuring the vertebral artery that could lead to stroke. So as part of the pre-surgical counseling session, those are always the risks that we talk to patients about. Thankfully, those risks are low, but with these drill guides, they allow you to drill a much more accurate trajectory, which allows you to perform the surgery much faster, safer and eventually the patient gets off the table faster, safer and minimizes the risk of infection, and minimizes the risk of having a screw placed in the wrong trajectory.
Do you have any very specific numbers on that? It’s a 20% less risk, and it takes a two-hour surgery down to a 30-minute. Do you have specific?
Tannous: One of the problems with the numbers is depending on the study that you read, those numbers can vary quite a bit and for aberrant screw trajectory, you’ll read studies that will quote 1% aberrant screw trajectory, and you’ll see other studies that can quote up to 20% aberrant screw trajectory. I think that’s based on the traditional free-handed technique where surgeons would put in screws by just looking at the spine and determining the best trajectory for that particular screw. Obviously, you can imagine that’s very technique-dependent. So I would say in general, with the guides, you can perform the surgery up to 50% faster, and I would say up to 70 or 80% safer.
Can you tell me a little bit about how you did the very first surgery here in the United States? Was that with Mary Hall?
Tannous: That was in Mary Hall. Correct.
Can you tell me a little bit about her?
Tannous: So she is a patient who had a very arthritic C1-C2 joint. So C1 is the first cervical vertebra just below the skull, and C2 is the second cervical vertebra below the skull. And the hallmark of the C1-C2 joint is it’s the joint that allows us to rotate our neck. So 50% of our rotation from left to right comes from C1-C2 and the remainder of the rotation comes from the rest of the spine below C1-C2. In her case, she developed a very arthritic C1-C2 joint, I believe, on the right side, which over time caused the joint to become very arthritic. You can see on the imaging, one side was okay and the other side was so degenerative. She had constant neck pain, and every time she moved her neck, it would hurt on that side and so she went through over a year of physical therapy and more physical therapy and injections. And it got to the point where she just didn’t want to do daily tasks, even just cooking or daily chores became burdensome because every time she moved her neck, it would hurt, and it got to the point where medications didn’t work, physical therapy didn’t really work, and injections didn’t work or very temporarily. So that’s why we talked about fusing her C1-C2 joint, which is a procedure where you remove the joint, you replace it with bone graft, but then you also have to put screws into C1 and C2 to stabilize that segment.
How did that work?
Tannous: You’re going to see her tomorrow. So far, she’s doing really well. Just by immobilizing that joint, people get almost instant relief because when they move their neck, when I say moving the neck, I’m not talking about wild swings from left to right. I’m talking about even a few degrees with looking to your phone on the right side or looking to your left to say hi to somebody, those small micro motions can be really painful, and for her, they were very painful. So just by immobilizing her joint with screws and rods, that alone gives her temporary relief, and then over time, she will fuse that joint so that it’s no longer an issue for her.
Is this something that you’re going to use? Is it a game changer for all your surgeries that you do fusion for?
Tannous: This system has been a gain changer in the spine, not just the cervical spine, but in the thoracic and the lumbar spine. I’ve been using it in the thoracic and lumbar spine for almost three years now in the US and the beauty of the system is, it allows you to preoperatively plan the surgery in a 3D manner. So not only are you able to put in the screws much more accurately during the surgery, you’ve performed much more detailed preoperative planning and really understood the nuances of a patient’s spine that you don’t always pick up on an MRI or just a CT scan, so having the 3D model becomes very helpful and allows a surgeon to perform the surgery safer and faster.
You just said it helped you pick up on nuances. What would some of those nuances be that you would see with find that you wouldn’t see?
Tannous: The nuances of a joint or of a disc or of a vertebra because when you’re looking at an image on a CT scan, you’re looking at a different slice of the image. So you’re looking at a 2D slice of that image, and then you can see multiple slices that allow you to reconstruct a 3D image in your mind, but when you’re looking at a 3D model, it just gives you a different perspective. And so sometimes you get a different vantage point and you get a different 3D image of that patient-specific joint or disc or vertebra which allows you to go in the surgery more prepared.
END OF INTERVIEW
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