During the last few weeks, I was able to travel to NY to visit with Dr. Bitan and observe him in the OR. We scheduled this trip to coincide with a visit from Dr. Karin Buettner-Janz, who would be on 'Grand Rounds' with him. For me, this was an incredible honor and privilege. I've known Dr. Bitan for almost 2 years now. I know many of Dr. Bitan's patients and believe that he's a good man and an excellent doctor. Still, in the past, I've always had to qualify any recommendation I'd give him with, "but I've never seen him work... I don't know what he's like in the OR." It was great to spend several days with him. I was able to spend some time with his wife, friends and family, as my trip began with his 50th birthday party. (Let me tell you that his wife really knows how to throw a party... what an event!)
One of my evenings in NY included dinner with Dr. Bitan and Dr. Buettner-Janz. There was so much that we discussed will be important to the patient community:
ADR and long scoliosis fusions. Dr. Bitan has a great history of scoliosis repairs as he studied under Dr. xxxx, one of the greats in scoliosis surgery who's written several books and pioneered some scoliosis repair technology. Dr. Bitan is also past xxxx of the pediatric scoliosis society??? and ??? and ????
Even with a very successful scoliosis fusion, when there are just 1, 2, or 3 discs that remain below it, adjacent level degeneration is a common occurrence. How many of us with otherwise healthy spines suffer from substantial DDD at L4-5 and L5-S1? Imagine if you were fused from T1 to L4 when you were 17, and now you are 45 with DDD at the only 2 remaining discs! In the past, the only reasonable surgical option was extending the fusion to the sacrum. This comes with it's own set of potential complications.
We discussed the possibilities and special challenges that this situation presents. There are special considerations of balance of the entire spine. This is not just another ADR surgery and should really be considered with a surgeon with not just a high level of ADR experience, but also scoliosis experience too. Dr. Bitan has done a few of these cases with good result, but he's reluctant just say that this is an excellent option.... each case is unique and must be approached with great caution.
This dinner was incredible. I was able to pick the brains of two of the most accomplished spine surgeons on the planet. Dr. Buettner-Janz and Dr. Kurt Shellnack invented the SB Charite' - the first truly viable lumbar disc replacement - back in the early 80's. (B = Buettner-Janz) This is first ADR ever to make it into widespread use. She has the longest experience with ADR of any surgeon in the world. She's still in contact with the first patient who's now more than 22 years post-op and still playing tennis. 18 years plus one day after that first implantation, I received 2 SB Charite' discs that saved my life. Every time I see her, it's great to thank her. On this trip I was also able to thank her for Melody too...
see story here!) Dr. Bitan is one of the most experienced ADR surgeons in the US. He has the advantage of starting his ADR career while he was still practicing in France, so he had a head start on the US surgeons. Being one of the principle investigators during the Charite' clinical trial, and being the head of a large surgery center of NY keeps him near the top for US ADR experience.
Specialized Lumbar ADR: Dr. Buettner-Janz is developing a specialized ADR that may be useful in correcting deformities while preserving motion.
New Spine Clinic in NY: Dr. Bitan is in the process of forming a comprehensive spine clinic that will incorporate all the necessary disciplines in one facility. Aside from providing some of the best surgical options available in the US, this will include pain management, PT, alternative therapies, diagnostic center etc... I'll provide more details as I learn them.
One of the lighter moments of the evening occurred when Dr. Bitan told Dr. Buettner-Janz that he first met her in 1989. She didn't remember... she had no recollection of their meeting. He said, "Well, you were a world-famous surgeon and inventor. I was just the lowly resident, carrying your bags!"
Observing surgeries: For me, this is the most incredible part of what I do. I learn so much that is useful to the patient community when I get into the OR with different surgeons. To be there with Buettner-Janz and Bitan was quite a treat. There were very interesting discussions about
:
- retractor systems
- right sided approach for L5-S1 surgeries to preserve left retroperitoneal approach.
- Anterior flap... removal of annulus and ligament. posterior annulus and ligament too.
- distraction pain, causes, incidence...
- different toolset for Charite' in US
- difficulties in chasing disc fragments
- motivation to implant Charite' 2mm posterior very important at L5-S1... less so at other levels.
At one point when we were waiting to get into the OR, Dr. Buettner-Janz asked me now many types of spine arthroplasty devices I'd seen implanted. I told her I'd seen 10. I was surprised when she replied, "That is much more than me!" I am truly blessed to have the opportunity to see so much and to participate at this level.
I was very impressed with Dr. Bitan's surgical technique. In addition to a perfectly placed Charite', I also got to see him implant at Kineflex lumbar disc... also with perfect placement. He's participating in the Kineflex clinical trial and there are still slots available. If your insurance won't cover, the manufacturer is paying for the surgery, so this is a really sweet deal for those who can get into it. Unlike the earlier ADR clinical trials, the control group for the clinical trial will get a Charite'... not a fusion.
I'll be very anxious to see the results of the Kineflex trial. I'll bet that they'll be better that previous ADR trials... not because of the technology, but because of the the experience level of everyone involved. Many of the surgeons already have a great deal of ADR experience. The Charite' and ProDisc trial compared expert fusion surgeons to novice ADR surgeons. In addition to the surgeons, the manufacturers have learned from Charite' and ProDisc experience about how to better manage the trials, training, etc...
This was an incredible trip! All the best,
Mark
PS. Aside from being star-struck watching Buettner-Janz in the OR, I also had a real treat on the way to NY. I got to meet Little Stevie.... this was way too cool!