[mmglobal]

I'm still here in Straubing with a series of clients. Earlier this week, one of them had a VERY interesting surgery. With his permission, I'll provide you with and overview. I'll leave it up to him to provide the level of detail that he feels appropriate.

This man had a 2-level Charite (L4-S1) done in early 2005. The surgery was an early success, but after about a year, his leg pain and back pain returned. With the Charite's highly mobile core, something that allows or causes the core to be pushed to one side, is amplified... as the core is pushed off center, it increases the force, essentially trapping the core in an off center position. It's even more of a problem in multi-level configurations, as one core can go one way and the other core can go the other way, forcing the vertebral body in the middle to tilt. Sadly, I've seen this many times in single, double and triple level systems.

The patient had a 2-level Dynesys procedure done in an effort to address the tilt and stabilize the system. Not only did that not work, but he wound up with a broken screw to add to his problems.

The revision surgery to remove both Charite's and implant 2 ProDiscs in their place, plus removal of the Dynesys hardware lasted over 11 hours. The repeat anterior approach was very difficult and tedious. With the formation of adhesions and scar tissue from the prior surgery, each step went very slowly. It was tough enough getting to L5-S1, but remobilizing the great vessels at L4-5 was even more difficult. This surgery is not for the average surgeon and I see why.

The first travel client of mine (Mr. B) had a Charite explanted and a new one reimplanted at L3-4. Since I was so early in my career, I still didn't know what I was looking at. Now, with 4 more years, a dozen conferences and hundreds more surgeries obsevered I am better equipped to absorb so much more information. I've been paying attention to tool sets and retractor systems. With spine, everything is a trade-off. Some retractor systems make things easier for the surgeon and allow smaller access for the original surgery, but make things much more difficult for revisions. Seeing these types of issues play out in the OR in cases that I'm intimately familiar with is incredibly interesting.

Again, I'll leave it up to my client to determine the level of detail that he'd like to include in the story. All I can say is that Bertagnoli is truly amazing and they way he handled so many difficulties with such skill and determination was something to behold. I've seen so many unbelivably complex surgeries and revisions that I can say this was the top, but it certainly is up there in the top few! Utterly amazing!

All the best,

Mark