Author: Dr David Edis

Oblique Lumbar Interbody Fusion (OLIF)

Why I do it?

Why OLIF rather than other fusion techniques.

OLIF is a technique using the anterior to psoas approach to place an interbody cage and bone graft in the lumbar spine. The choice to place interbody cage and graft has to be made by the surgeon after considering multiple factors in the case concerned. An interbody cage is used to achieve fusion and restore interbody height and segmental alignment. Another theoretic advantage is that an anterior cage and graft in the lumbar spine will be loaded in compression during weight bearing and this can result in a more reliable fusion rate than posterolateral fusion used alone.

An interbody cage can be placed from a posterior approach (PLIF or TLIF). The posterior approach requires mobilisation and retraction of the dural sac and only allows for relatively small cages due to the access window being limited by the neural elements. Typically cage sizes of up to 14 or 15mm in height by 26mm long and 8mm wide can be placed with TLIF or PLIF. If the endplate is breached during disc removal or if the bone density is compromised then these small footprint cages can subside following surgery and lead to recurrent stenosis or deformity.

The amount of disc removed and surface area of endplate that is prepared for graft can also be limited and can be technically difficult in a degenerate disc stiffened by annular calcification or osteophytes. Overlying the disc there exists a venous plexus that often bleeds during the posterior approach and can make visualisation difficult as well as lead to significant blood loss if not controlled.

The transpsoas approach (DLIF and XLIF) can also be used to place an interbody cage that is much larger in width (typically 18-24mm) and length (typically 45-60mm) than the TLIF or PLIF cages. This allows for a larger contained graft volume and better coverage of the endplates. This approach is from the side and after separating the muscles of the abdominal wall, the retroperitoneal space is opened to gain access to the psoas muscle and then the disc. Multiple studies have demonstrated excellent interbody height restoration and fusion rates.

Spine pain in COVID-19

5 Things you can do for spinal pain during the COVID-19 pandemic?

If you have had a flare up of spinal pain during the COVID-19 pandemic there are a number of things that can be done despite restricted access to the health system and social distancing. Many of us have found we have more time on our hands and we can use this time for making positive change. Spinal pain rarely means spinal surgery and there are more options than ever for less invasive options of treatment. In this blog I want to share what I think you can do for yourself.

i) Time is a great healer

The first thing to remember is that for many people with spinal pain there will be fluctuations in pain from day to day and month to month and many times flare ups will be self-limiting. Even if this is your first episode of severe spinal pain, in a number of days the pain is likely to settle. So be patient and stay calm. Being overly anxious about pain can exacerbate and prolong symptoms.

ii) Find your comfortable place

Most patients with spinal pain conditions can find some relief with certain postures or positions. If you find bending forwards painful, try lying face down and performing a back arch. If you find standing and walking painful then try lying with hips and knees bent. You can go to your comfortable place as often as you need to for 15-30mins in between other activities.

iii) Do something active everyday

Even if you have quite severe spinal pain, most people find being active helpful. You will find that you will be less active than usual but there will be some activities that you can do that do not aggravate your pain. If you have not been active for a while it is important to pace yourself with step wise reactivation. For example; If your activity is walking then you should plan to begin by walking a short distance that you know will not cause an exacerbation of pain and then plan to increase that everyday by a small amount so that you might double your distance in the first week and subsequent weeks.

If you have a set-back during the program then just reset your distances to remain within pain thresholds.

3 Signs You Need to See an Orthopaedic Specialist for Your Back Pain

Back pain isn’t an extraordinary problem for most people. In most cases, some rest and over-the-counter medications are enough to alleviate the pain. If your condition worsens, however, there is a root problem that needs to be addressed. The solution? Schedule a check-up with an orthopaedic specialist.

Why consult with an orthopaedic surgeon?

Orthopaedic surgeons are dedicated to studying everything about the bones, joints, tendons, ligaments, and muscles. Their study involves the diagnosis, prevention, and treatment of any disorders relating to these body parts.

It’s important to consult with an orthopaedic surgeon when you experience extreme back pain. They are experts equipped with extensive knowledge and training in proper diagnosis and treatment (both the surgical and non-surgical) for injuries and diseases relating to the body’s musculoskeletal system.

What causes back pain?

Several factors can cause back pain: bad posture, an intense injury, or even overexertion during exercise. To know and address the real cause of the pain, its intensity, and the appropriate treatment, consult with an expert. They have the experience and technical expertise to evaluate your situation and recommend ways to bring your body back to normal. They can also perform pain-relief injections or recommend therapy to patients who don’t want invasive treatments.

When should you see an orthopaedic surgeon?

Set an appointment with your orthopaedic surgeon as soon as you experience any of the following:

1. Acute back pain that lasts for more than a week without fading
2. Severe discomfort that inhibits your ability to perform daily tasks
3. Pain in your back along with weakness or numbness in your groin area, hip, or leg

These symptoms could be pointing to underlying conditions, such as:

Herniated Disc

The discs act as the shock absorber between the vertebrae bones of your spine, each one helping to make your back more flexible for movement. When the outer layer of your disc herniates or tears apart, it’s centre will begin to leak. This leakage can cause irritation and add pressure on your spinal cord and its nerves, resulting in back pain.

Sciatica

The sciatic nerve is the thickest and longest nerve found in the body. It begins on your lower back and stretches down the back of each leg up until your feet. When this nerve becomes compressed or inflamed, it can cause shooting pain from the lower back to radiate throughout your leg and all the way down your foot. It is accompanied by weakness, numbness, and a tingling sensation.

Degenerative Disc Disease

Your spinal discs lose water content as you age. Because of this, they become less flexible and shorter, making them more prone to injury, rupture, and collapse. When spinal discs lose water, it will prevent them from getting enough blood supply which can lead to a deterioration called degenerative disc disease.

These conditions, however, can be successfully treated by an orthopaedic surgeon. You just need to go to one as soon as you see the early signs.

Conclusion

While a little rest and some pain reliever can help ease your back pain condition, you have to know when you need a real medical intervention. Prevention is always better than cure. As soon as you observed that there is something wrong in your back area, consult a professional immediately.

If you’re looking for a trusted orthopaedic surgeon in Frankston, VIC, contact Dr David Edis. As an orthopaedic surgeon with extensive experience in all facets of spine surgery, he’s more than ready to help!

What Treatment Options are Available for Chronic Back Pain

Chronic back pain is a condition that stems from various issues. Trauma, aging, sports-related damage, and abnormalities can lead to back pain. This condition also manifests differently among individuals and requires specialized treatments from various healthcare providers. If you’re suffering from back pain, you need all the information you can get to help you make a decision that improves your overall quality of life.

For example, you should know whether surgery is necessary, or if a non-surgical treatment will get you the results you need. In case you need an operation, would a traditional spine surgery be advisable, or would a minimally-invasive one be better? Most people do not know the differences among these treatments, and an orthopaedic surgeon would tell patients to be familiar with all options so they understand why their physician is advising one over another.

What to do before diagnosis

If you have undiagnosed pain or are experiencing related symptoms, you should first get an evaluation from a primary care practitioner. A person with chronic pain in their lower back or neck area, they would need to be observed over a period of time.

They would probably be advised to maintain physical activity—nothing too strenuous, but stable enough for exercising affected musculoskeletal groups. If the pain disappears on its own, then it might have been an isolated strain or another negligible ailment.

If the issue persists after exercise, topical ointments, or over-the-counter anti-inflammatories, it may be time to see a specialist. The best solutions to back pain are time and surgery; everything else is used to manage symptoms while the body heals itself.

Conservative methods of treatment

Some ways to help speed up the body’s healing are physical therapy, home exercises, medications, and even spinal injections. Most patients with spine issues can see significant improvements with conservative treatments. These treatments will need commitment, however, and patients should not expect results over only a few days or weeks.

Patients who have spinal cord problems or significant weakness in one limb might be recommended immediately for surgery. Those who have tried all their conservative options and had not seen improvement might also be referred to a surgeon.

Spinal surgery—what to expect

In traditional surgery, there is a complete exposure of the spine. For minimally invasive procedures, there is little visibility of the patient’s internal anatomy. Patients recover more easily with minimally-invasive surgery, and the results can be comparable to traditional kinds through the use of technology like CAT scans and 3D imaging.

Both types of surgery have one aim; that is, to see a good prognosis for the condition, or prevent degeneration altogether. Though controlled, surgery is still a form of trauma; as such, a spinal surgeon would want minimal blood loss, shorter hospital stays, and lower infection rates.

What to look for in a surgeon

Aside from the usual things expected of physicians—patient-centred, communicative, and competent, among others—a good surgeon should have expertise in risk management and pre- or post-operative care. An orthopaedic surgeon’s duties do not stop after the last procedure in the operating room; they have to ensure that the patient recovers fully and gets the most out of their new lease on life.

Conclusion

Chronic back pain can prevent you from enjoying many activities you used to, a visit to your physician might be in order. A good orthopaedic doctor in Frankston will help you figure out a sensible treatment plan for your condition, and guide you through maintenance measures.

If you are looking for an orthopaedic surgeon in Frankston, contact Dr David Edis today. Dr Edis specializes in minimally invasive techniques but has experience in all areas of spine surgery including cervical and lumbopelvic issues.

When to visit your orthopaedic doctor

Muscle and bone issues are common in our daily lives, regardless of the amount of physical activity you go through. Athletes may find themselves in a variety of muscle pains and strains, but so will the average adult when undergoing more activity than they’re used to. Although easily disregarded as “old age” or simply mild discomfort, these can be signs of bigger musculoskeletal disorders.

A majority of muscle pains can be resolved with basic rest and massaging, but improper care and treatment can result in more chronic conditions. For this reason, a proper diagnosis from an accredited orthopaedic doctor should be made to assure the best possible healing.

Orthopaedic Doctors—What They Are

Orthopaedic doctors and surgeons handle the prevention, diagnosis, and treatment of all disorders related to bones, joints, ligaments, tendons, and muscles. They are experts of the musculoskeletal system and can handle any musculoskeletal disorder that they are faced with.

While generally diverse in handling conditions with bone or muscle, they can specialize in a particular section such as hip and knee, foot and ankle, shoulder and elbow, hands, or the spine. Diagnosis can come from any orthopaedic doctor, but the specific treatment for more chronic conditions are best handled by a specialist.

When Should You Approach One?

The most common reason to approach an orthopaedic doctor is usually for more obvious causes such as sprains or dislocations—these are incredibly painful and immediately noticeable. Painful recurring conditions such as fractures and bone breaks may require more complex procedures and therapy to health, which is why consulting a specialist should be your first step for treatment.

Although the more immediate conditions such as the above obviously need an expert’s opinion, subtle, yet chronic pains should merit a check-up as well. While these are usually more bearable at the onset, in the long run, it could worsen enough to become debilitating.

If you find yourself facing any of these common recurring problems, then visit your nearest orthopaedic doctor immediately for help.

– Shooting pains when climbing stairs or inclined areas
– Recurring joint pains (either due to specific conditions or chronic)
– Recurring back or hip pains
– Swelling joints
– Reduced or limited range of motion for any appendage or joint
– Numbness or tingling in hands or feet
– Recurring pain from previous injuries (sprains, breaks, fractures, etc.)
– Swelling from an area related to a previous injury

What to do when you have recurring pain?

Seeking the help of an orthopaedic doctor is always the best call, but taking note of some details can help speed along the diagnosis and treatment process. Certain factors such as where the pain occurs and when it began are basic questions to answer, but knowing the frequency and degree of pain can be helpful for your doctor. For swelling and tingling, knowing what could have caused the trigger can be telling—especially if it’s weather-related or allergy-induced.

Conclusion

Muscle, joint, and bone pains aren’t things you should disregard; prolonged conditions without treatment can result in lifelong complications for you. If in doubt, then consult with an orthopaedic doctor for the best diagnosis—this way, early detection and treatment can be implemented.

Looking for an orthopaedic doctor but don’t know where to find one? Get in touch with Dr David Edis look into what pains you.

Dr David Edis Frankston – Your Handy Guide To Knee Arthroscopy

Knee arthroscopy is a less invasive surgical procedure, which is used to diagnose and treat joint issues. Here, a surgeon investigates and corrects through the use of a small tool called an arthroscope. Through a camera attached to the said tool, doctors can inspect and treat the joint for any identified damage.

Knee arthroscopy has risen in popularity over the years, as the procedure requires only small cuts in the skin and shorter recovery times. The procedure also takes less than an hour, rarely ever leading to serious complications.

When is it necessary?

Knee arthroscopy is usually recommended for painful conditions that do not respond to nonsurgical treatment, which includes physical therapy, rest, and other anti-inflammatory medications. The less invasive procedures can help relieve painful symptoms, especially those that damage surfaces and other soft tissues around the joint. Here are some of the most common conditions that require knee arthroscopy:

● Repair or removal of a torn meniscus
● Treatment of patella (kneecap) problems
● Removal of loose fragments of bone or cartilage
● Treatment of knee sepsis (infection)

The Preparation for Knee Arthroscopy

Although depending on your healthcare provider, most doctors recommended a tailored preparation plan, which will include gentle exercises you are required to perform. You will also be barred from taking any prescription medicine, such as ibuprofen. Around 12 hours before the procedure, you will also be asked to stop eating to accommodate general anaesthesia.

The Recovery Period

As mentioned, the knee arthroscopy period is quicker than that of open surgery. You will likely be able to leave the hospital on the day of the operation, with specific instructions to help you handle recovery. However, it is crucial to note that recovery times can vary. Some individuals will be able to return to light activities in only one to three weeks, whereas others need six to eight weeks to recover. Here are some things you need to know about the recovery process:

1 – General recovery practices

Although less invasive, the procedure will still leave you in pain. Applying ice packs on the dressing and around the area is recommended, as this helps reduce pain and any swelling. You will also be required to keep your leg elevated for several days, and resting well and often is tantamount to a speedy recovery.

2 – Medication

Your doctor will provide you with specific instructions, especially when it comes to prescriptions. You will likely be prescribed with painkillers or OTC drugs for pain management. Aspirin may also be recommended, as this helps reduce the risk of blood clot formation.

3 – Exercises

Performing exercises before and after knee arthroscopy surgery can be beneficial, as these strengthen the muscles around the knee to help it recover fully. Your doctor will also show some simple stretches and exercises you can do at home. Remember that exercises are crucial to your recovery, so never skip out on them!

Conclusion

Although recovery is a given, some people may need lifestyle changes to protect the joint. Your exercise routines may be compromised, as with your other physical activities. Although the goal of knee arthroscopy is to help your joint heal, understand that your knee may not work as well as it did before. Such decisions still require the guidance of your doctor, however, so never hesitate to ask questions!

Do you need a knee arthroscopy? For the best possible results, Dr. David Edis of Victorian Orthopaedic in Frankston, VIC, is ready to answer any questions you may have. Let us help you recover—contact us today!

Innovation creates world-first in operating room

A world-first operation using advanced software and clever robotics has demonstrated the benefits of a new approach to spinal surgery.

Last month, at The Valley Private Hospital in Melbourne, Dr David Edis used a breakthrough development in the Mazor Renaissance Robotic Guidance system to undertake an entire spinal operation with the patient lying on their side, reducing the time needed for the procedure.

‘‘This addition to the Mazor Renaissance system, the PROlat mounting option, means we don’t have to turn the patient face down halfway through the operation,’’ Dr Edis says.

‘‘Not doing ‘the flip’ saves about 60 minutes, which means less time under anaesthetic for the patient.’’

Many degenerative problems of the spine occur when the cushioning discs between the vertebrae become damaged or diseased.

This may reduce space between the vertebrae and compress nerves that branch off from the spinal cord, causing chronic back pain.

Single Position Lateral Spine Fusion Surgery – What’s the Big Deal?

On Friday 20th July the Sydney Morning Herald published an article relating to a case that I performed at The Valley Private Hospital in Melbourne a few weeks ago.

The case was novel in the sense that I was able to utilise the Mazor Renaissance Spine Guidance Robot to place pedicle screw fixation with the patient in the lateral position. This was the first case that the ProLat system had been used in Australasia.

The patient initially had 2 levels of OLIF interbody cages placed in the mid lumbar spine to manage a degenerate scoliosis and stenosis problem that was causing considerable pain and dysfunction for the patient. Pedicle screws are routinely placed to stabilise the spinal segments after placing interbody cages so that the correction is maintained and healing rates improved.

Leadership in Health

Time for a respectful approach

Sometimes I am ashamed to be a member of the medical profession, when I hear from my patients how they have been mistreated by my colleagues. I don’t mean that the treatment they received did not follow reasonable medical guidelines or was incompetent. I mean that they were not treated with respect. They were treated as inferiors or of lesser intelligence and they came away feeling they were not worthy of the doctor’s time or efforts.