Robert Rovner, M.D., an orthopedic spine surgeon at Disc & Spine in Danville, California, talks about a new cutting-edge technique in scoliosis surgery that is removing every visible trace of deformity.
Interview conducted by Ivanhoe Broadcast News in September 2016.
Tell us a little bit about what you have created to help with scoliosis and how it’s different?
Dr. Rovner: I’ve been doing scoliosis surgery for over 30 years. I took that on as a specialty and I’ve watched scoliosis surgical corrections changed from simple Harrington rods to what we have now with screws and much more intricate technology and the improvements in the curve corrections has been excellent as we’ve moved through the years and decades. Going through this process I realized we could be doing a better job than we are with certain aspects of the deformity, particular the rotations, which is what causes the rib hump and the cosmetic deformity that everybody sees when they see scoliosis. By rib hump, I mean when you bend forward you looked down the axis of somebody’s spine. In scoliosis one shoulder or one side of the spine is higher than the other. For example, like the Hunchback of Notre Dame had that and that’s the part of the scoliosis that kids notice and adult’s notice; that’s the deformity. You don’t really very often see the actual ‘s’ shaped curve. Over the years, we’ve done our best to try to correct the deformity not ignoring the rotation, the rib hump, but the technology didn’t really lend itself to correcting it very much till recently. Then I basically came up with an idea to take advantage of the technology we have and to do a better job of correcting that.
How does it work?
Dr. Rovner: The way it works, is you put screws in each bone you want to instrument, two screws per bone, and then you take those screws and you use those to rotate the spine into neutral. When you first put the screws in, the patient’s asleep under anesthesia of course, put the screws in and when you’re done placing all the screws in they form a curve; and not just a curve but they are also rotative because the spine is rotating. We take those screws two at a time and we move them together and do rotate each spinal segment and when we have it right where we want it, we attach it to something that is attached to the operating table so then I can let go and I go to the next vertebrae, the next segment, and rotate it and shift it and correct the curve all at the same time. Then I can basically correct each segment sequentially until they’re perfect and then put the rods in.
That’s something that would hold over time?
Dr. Rovner: The purpose of the rods and the screws is to hold the spine in the position in which we want it to fuse. Then the fusion is bone joining all the vertebrae to each other and that lasts forever.
How long does it take, the procedure?
Dr. Rovner: Should take five hours, four hours depends on how many levels have to be done. Sometimes it could be as little as three hours or as long as six or seven, possibly.
Does the correcting of the rotation add any significant amount of time to the surgery and to addition of correcting the curve?
Dr. Rovner: The actually de-rotation that we do doesn’t add time. What takes the most time is placing all the screws. As we transition over the 30 years that I’ve been doing this is from placing hooks in the spine to placing screws. Placing screws takes more time because the screws have a very narrow window of optimal positioning. Where hooks are pretty easy to put in, screws have to be exact. It takes a while to get them perfectly positioned, but once we have them in position the actually de-rotation, the actually maneuvering to get the spine straight doesn’t take very long at all.
You would put those screws in to correct the curve anyway?
Dr. Rovner: Right.
Because there are a whole lot of patients out there that are just having the curve corrected and not the rotation, is that clear to weakness that we create propensity to injure, for injury?
Dr. Rovner: It doesn’t and I don’t want to mislead people in thinking that scoliosis is corrected by people other than me without attention to the rotation. It is but the focus has always been on the curve itself and not as much as the rotation. That’s been a concern, it just haven’t been addressed I don’t think as well as we have been able to address it with this technique, and surgeons are trying to correct it as best they can but now that we routine put screws in on both sides of every bone we have the ability to correct the rotation much better. I used to see the rotation correct but not enough. I would see patients in my practice that I thought I did a pretty good job. The correction looks great, the curve is gone, then they bend over and you still see the rib hump. I think we can do better than that, so I thought about it for a long time and came up with this idea, and we are doing it and it works.
Can you tell me a little bit about the patent?
Dr. Rovner: Basically I had this idea that we could rotate the spine and correct the rotational part of the deformity by using both screws in each vertebra at the same time and originally didn’t realize that a technique could be patented. It turns out it could be patented and I did receive a patent for the technique. I have worked with one company that made instruments enabling me to use the technique and these instruments have allowed me to use this idea to use this technique to get the de-rotation and better curve correction. I am now working with another company that is working to improve the instruments further.
How many patients do you think have benefited from this?
Dr. Rovner: Probably done about 20 patients so far, give or take a couple.
Are training other doctors to do the same thing?
Dr. Rovner: So far, it’s just my partner and I; I’ve trained him. We work together on all of these, but that’s the plan going forward. We are working with a company now that will create instruments that will make it even easier to do this and then they will market that to other doctors and hopefully, eventually I’ll have made a contribution here and other people will be doing the same thing or something like it.
Could this be something that other doctors if they had the technique and the tools would be able to use?
Dr. Rovner: Sure, everybody would want to get a better result for the patient; of course.
Is the correction of the rotation then and the rib bump, is that what you call it, the rib bump?
Dr. Rovner: Rib hump.
Is it strictly a cosmetic thing or is it also a functional correction?
Dr. Rovner: It’s really, I hate to say it’s just cosmetic but it is; but if you are 13 years old or if you are 40 and you are going through a big scoliosis operation and you have to have it for reasons other than cosmetics, it’s compressing your lungs, or it’s causing you pain, or whatever the issue or the curvature is progressing, then if you go through this operation you would like to at least fix the cosmetic part of it as well. That’s never been ignored but hasn’t been able to be addressed as well as we can now.
How about cost, has it added any significant cost to the procedure?
Dr. Rovner: No, it doesn’t. The cost is in the surgical time and implants, the screws and rods, which are the same. So the cost is unchanged using this new technique.
How about the patient that we are about to speak with and get video with, how were you able to help her?
Dr. Rovner: Well, she was pretty classic for exactly this situation. She has scoliosis, it’s progressive, she put off the surgery for I don’t know a few years because she has little kids; was waiting for them to get older. Then of course she had a big rotational deformity and a big rib hump, and the curve itself. We were able to correct both and without an additional expense, but mostly it was just a better outcome.
Does it add to recovery time at all?
Dr. Rovner: No, not at all.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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Disc & Spine
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