January 5, 2024 • 45 mins
Each year, an estimated half-million people will undergo spinal fusion surgery in the U.S. alone. In most cases, surgeons will implant rods and screws into a patient’s fused vertebrae as part of the procedure. There’s just one enormous problem: according to the published medical literature, the screws provide little to no benefit for patients. Dr. Ardavan Aslie is a board-certified Harvard-trained university fellow spine surgeon who recently published his book called Corporate Spine: How Spine Surgery Went Off Track and How We Put It Right; in his research, he sounds the alarm with overwhelming evidence that pedicle screws used for spine surgery often do more harm than good, even though device manufacturers continue to push profits over patients.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
intro (00:01):
Get ready to hear the truth, the whole truth, and
nothing but the truth about theUnited States healthcare system
with your host of the medicaltruth podcast, James Egidio.
James Egidio (00:19):
Hi, I'm James.
welcome to the medical truthpodcast.
Each year, an estimated halfmillion people will undergo
spinal fusion surgery in theUnited States In most cases,
surgeons will implant rods andscrews into a patient's fused
vertebrae as part of theprocedure.
There's just one enormousproblem.
According to the publishedmedical literature, the screws
(00:40):
provide little to no benefit forpatients.
My guest is a board certifiedHarbor train university fellow
spine surgeon who recentlypublished his book called
corporate spine.
How spine surgery went off trackand how we can put it right.
In his research, he sounds thealarm with overwhelming evidence
that per pedicle screws used forspine surgery often do more harm
(01:04):
than good.
Even though device manufacturerscontinue to push profits over
patients.
It is an honor and a pleasure tohave on the medical truth
podcast.
My guest, Dr.
Ardavan Aslie.
Dr.
Astley, welcome to the medicaltruth podcast.
How are you doing today?
Dr. Ardavan Aslie (01:21):
Doing very well.
Thank you for inviting
James Egidio (01:23):
me.
Absolutely.
A little bit about who you areand what you do.
Yes.
Dr. Ardavan Aslie (01:29):
I'm a orthopedically trained spine
surgeon.
That means I did a residency inorthopedic surgery.
Then I did a year of fellowshipin spine surgery.
And I'm a practicing spinesurgeon here in Sacramento area
in Northern California.
And the reason I said thatbecause there's two ways of
becoming a spine surgeon.
One is through orthopedicsurgery.
(01:49):
The other one is throughneurosurgery.
So you can become neurosurgeonand then.
Learn spine surgery and practiceas a spine surgeon.
I see.
James Egidio (01:59):
So you're a spine surgeon through the orthopedic
route.
Correct.
Yes.
Okay.
So you wrote a book calledcorporate spine, how spine
surgery went off track and howwe put it, let's talk a little
bit about some of your findingsand research when it pertains to
spine surgery.
Dr. Ardavan Aslie (02:21):
Sure.
Boy, where do I start?
Because it goes way back.
I'll tell you how it allstarted.
I've been in practice for 20years.
The first 10 years, I practicedbasically what I was trained,
what I was told.
I did everything by the numbers,and I did very well.
About 10 years, like into 10years of my practice, I became
(02:42):
very dissatisfied.
I was like, what are we doing toour patients?
I started asking questions.
Then I said, maybe I can findbetter methods of what we're
doing.
And then that led into someinventions that I had.
And actually one of myinventions won an innovation
showcase in Congress ofNeurological Surgeons.
So I won an award actually formy invention.
(03:04):
Then as I was developing that, Ihad some problems that I went
back and had to study theliterature that we have to see
if this problem exists or isjust a problem that I have
faced.
And what I found out was jawdropping.
What I found out in literaturewas, just bad.
(03:26):
And basically what I found outin literature was that paper
after paper shown that themethods that we use these days
in spine surgery don't work.
So I was like, wait, what isgoing on?
So I started digging deeper.
I started going to theseconferences and actually.
(03:48):
Start talking to the so calledleaders of the field when we go
to conferences, let's say NorthAmerican Spine Society or
American Academy of OrthopedicSurgeons these lecturers that
are university professors, afterthe lectures, I would it's
Approach them.
I start talking to them.
I start asking these questions.
What is going on, which I'mgoing to explain what I'm
talking about, and they wouldjust not answer me.
(04:11):
They would just want to justtear me apart.
As soon as I start questioningthe methods, they not only they
didn't want to hear it.
The questions, they actually,they reacted like I was just
like insulting them or somethinglike that.
It was just such a bad reactionfrom professor to professor.
(04:33):
And I have to say.
What is going on?
Why is this like this evidence,these papers that's been
published in our own literature,these guys know about these
papers.
So why is this such a resistanceto this wealth of knowledge?
So I spent about four yearsactually to find out what the
(04:53):
answer is.
And I eventually found theanswer, and I will explain.
Let's go back to see how thespine surgery started.
One of the spine is a bunch ofbones that are stacked up on top
of each other.
Like this.
A bunch of bones that arestacked up on top of each other,
separated by these cushions wecall them discs.
(05:14):
These discs are cartilage.
They're like a jelly donut.
They're like a they have a jellyin the middle and then the tough
ring around it.
So it's like a cushion.
If there is a stress like a caraccident or fall, this can get
ruptured and the jelly can seepout like that.
(05:35):
And therefore, slowly over time,a good spine can become a
diseased spine and causing pain.
Initially, in 60s and 70s, wehad x rays.
We didn't have MRIs.
We could get an x ray and seethat the disc between the two
bones had gone bad, and wecalled that degenerative disc
disease, because we didn't knowwhat was going on with the
(05:56):
discs.
Treatment for that, we came upwith a treatment, and the
treatment for that was a surgerycalled fusion surgery.
In this surgery, you would go infrom the front and the back,
take the disc out, and this isan example of a fusion surgery.
So you go in, take the disc out,put a spacer here, and then you
go through the back, put somescrews and rods.
(06:17):
Basically, you mobilize Thesetwo vertebrae, so the two
vertebrae become one bone.
So the disc is gone, now thebones have been mobilized.
That has eliminated the motionand eliminated the pain.
This surgery actually startedworking pretty good, except
there was a problem.
Every time you do this surgery,You're hoping that within the
(06:40):
next few months, the bone willgrow between the two bones to
the middle of that prosthesisand the two bones become one.
The problem is in some number ofpeople, that didn't happen.
And we call that a nonunion.
And that is basically patient'sbiology.
In these cases, the pain cameback a lot worse.
(07:01):
And the results were very bad.
So we were all looking tosomehow increase this fusion
rate, and the fusion ratewithout the screws was about
75%.
So 3 out of 4 people will healit, 1 out of people, 1 out of 4
will not, and they end up in thenon union.
So right around late 80s andearly 90s, a couple of surgeons
(07:24):
from France, figured out a wayto put a screw into the
backbone.
Now, backbone is a very complexbone, but we somehow found a way
to insert a screw we callpedicle screw.
It's a large screw that has atulip that can accept a rod.
This is Screw gets inserted fromback to the front.
(07:46):
So if I have a picture of it,this is the back of the spine,
you can see from back to thefront is inserted through what
we call pedicle.
Pedicle are these bony columnsthat connects the front part of
the vertebrae to the back partof the vertebrae.
So these are pedicles, right?
Basically two bone.
And this is the surgery.
(08:08):
So you put the screws from Backto the front and these can
accept a rod.
You put a rod between them andtie them so that Immobilizes the
spine and hopefully increase thefusion rate.
Why?
Because as orthopedic surgeons,we learned quite a bit in the
60s and 70s in terms of fracturefixation.
(08:29):
We developed a technique calledAO spine.
I'm sorry, AO technique.
AO technique is what we callrigid fixation of fracture ends.
When a bone breaks and you havethese two ends that are
floating, What you do inorthopedics, you do a surgery,
you open up, you expose thebone, then you put the bones
(08:51):
together, end to end, and youput a plate next to it with some
screws going, and that way youfix this fracture in a rigid
fashion, we call the rigidfixation.
This worked very well for thefractures, and as orthopedic
surgeons now doing spinesurgeries, we said, Oh, huh,
somebody figured out to put ascrew in.
(09:11):
And we know that immobilizationis the key for healing.
So therefore, let's apply thatknowledge to spine.
And that's when we started doingthese surgeries with addition of
the screws, except there was aproblem initially.
So we started like earlynineties, late 1980s.
(09:31):
We started doing, adding thesescrews, except there was a
problem.
There were really.
Bad results.
At some point in 1993, therewere about 7, 000 lawsuits
against the manufacturer ofthese screws, a company called
currently Medtronic, and it wasreally bad.
Actually, there was aninvestigation by Senate at some
(09:53):
point.
They brought in leaders of thefield to Senate and start asking
them questions.
Right around that time, in 1993,a surgeon called Dr.
Zdablik.
published a key study paper in1993 in Spine Journal.
According to his paper, he saidthat these screws work
(10:13):
beautifully.
It just worked absolutelyawesome.
He had people that didn't getthe screws, and people who had
the screws, and the ones thatthey got the screws, they did
tremendously better.
This gave a green light for thesurgeons to start using these
screws as an adjunct to thefusion.
(10:35):
Now, not to confuse you, I gotto understand, you got to
understand that the fusion hastwo parts.
One is the fusion, which isputting the bone between the two
bones.
And the second part isinstrumentation, which putting
the screws.
For a fusion surgery, you, youcan or you don't have to put the
screws in.
I want the audience tounderstand that.
(10:55):
By late 1990s and early 2000s,and currently, these screws are
standard of care.
This is what we do.
If you have a fusion surgery inthe neck or the lower back,
you're getting these.
Here I come, and I had a problemwith my device.
(11:16):
I said, let me look at theliterature.
When I looked at the literature,I found six multi center,
multinational papers that werepublished in our journal, Spine.
So there were not some papersthat got published in some, not
so important journals.
They were published in our ownjournal, and they were multi
center and multinational.
(11:38):
And all six said that additionof these schools Don't change
the outcome or fusion rate.
Basically, they were saying thatby adding the screws, all you're
doing is increasingcomplications.
When I saw that, I was like,wait, that doesn't sound right.
You know what is going on here?
(11:58):
Let me look at the, there's adoubtless war.
See what is going on over there.
And that's.
When I found out, Oh my God,what is going on?
Whatever I'm saying that I'vefound out, it's not conspiracy
theory.
It's in Google.
It's a known fact.
It's a published data.
So in 1993 there were about 7,000 lawsuits against the
(12:20):
manufacturer of the screws.
Medtronic, I mentioned that,right?
Dr.
Zdeblik publishes this paper in1993.
By 1996, as those losses weredisappearing because of his
paper, he started getting paidfrom the company.
By 2003, he'd gotten paid 34million dollars allegedly for
(12:44):
something that he's invented,which I cannot comment on that.
I've seen it.
Let's not talk about that part.
That's bad.
I was like, Whoa, that's bad.
Wait, it gets worse.
It gets 10 times worse.
So like in early 2000s.
The Medtronic came up withanother product.
(13:05):
This product was a veryimportant product.
It was a substitute for bonegraft.
Originally, I said that for thefusion, we have to put a block
between the two bones.
When you take the disc out, thatspace is void.
So you have to put a spacerthere.
We normally have to harvestpatient's own bone to put it
between the two bones.
That causes problems because nowthe donor side of where you
(13:28):
hacked out the bone now startshurting.
So we were trying to avoid that.
So Medtronic came up with aproduct.
It's a hormone that we all haveit.
When you break your bone, itgets excreted.
We call it BMP, bone morphogenicprotein, and that stimulates
bone healing.
The company actually isolatedthat And it came as a product in
(13:49):
a sponge that we can put thatsponge between the fusion,
between the bones that we haveto fuse so the fusion can take
place so we don't have toharvest.
wE started using this product inthe early 2000s.
We had to study that.
So Medtronic put Dr.
Zdeblik again in charge of thisimportant study.
(14:10):
And he published a paper, Dr.
Zdevlic published another paperfor this new product in 2004,
except this time he got caughtfalsifying his results.
By who?
By the United States Senate.
There was a whistleblower rightat that time One of the workers,
one of the employees of thecompany said that these doctors
(14:32):
are all getting paid from thecompany, like just amazing
number of amount of money.
So that triggered a UnitedStates Senate investigation,
United States Senateinvestigated, and it was the
United States Senate thatconcluded that the paper that
Dr.
Zdeblik published in 2004 wasnot written by him, was written
(14:53):
by company.
I'm like, Oh my God, this isjust crazy.
Now let's go back to that paperthat he published in 1993.
That's even worse.
Every time I think to myselfman, this is really bad.
It can't get worse.
It does.
So let's go back.
(15:14):
I said, I got to study thatpaper in 1993.
This is just crazy.
There are a lot of problems withthat study that I've mentioned
one by one in my book.
But the biggest problem withthat paper is that.
It got published as apreliminary report.
I spent about two years to findthe final result or follow up
(15:35):
result, and I couldn't.
Eventually, I cornered one ofthese leaders of the field, and
I asked him, I said, I can't,what is it?
And he said, Oh, thatpreliminary report is the only
thing that we have.
There is no, that study wasabandoned in the middle and was
never finished.
I was like, Oh my God.
(15:55):
If you Google Zdeblik spinefusion article right now, you
will see that article.
You will see that it waspublished in 1993 and, most
importantly, has been referencedin 1, 127 articles as of today.
That article is the mostreferenced paper in the entire
(16:18):
world of spine surgery.
Everything that we do tracksback to that one unfinished
paper by a guy who later on gotcaught cheating.
And this is all known publisheddata that we have.
So I was like, Oh, my God,that's really bad.
(16:39):
So to top that off now, wait, itgets worse again.
That's bad.
Worse again.
There was another paper that gotpublished in 2018.
This was a paper that had eightyear follow up.
It was a very big study.
We are anticipating it.
And it was a very good study,and it got published in 2018 as
(17:02):
a lead article, so a veryimportant article.
This article, they looked atusing the screws, and they
concluded that adding the screwsdoes not add to the benefit to
the patient.
James Egidio (17:16):
Yeah, I have one question for I want to back up a
little bit about what you'retalking about here because you
mentioned something veryinteresting about some of the
side effects or some of the riskand benefits of these of this
surgery based on the use ofthese pedicle screws.
What are some of those sideeffects?
Dr. Ardavan Aslie (17:36):
Sure.
Let's talk about that.
James Egidio (17:38):
I'm sure there's some people that are listening
that may or may not have hadsome surgery done back surgery,
spinal fusions, and may haveeven had these particular screws
inserted in them.
So they, it would be great totalk about that.
Dr. Ardavan Aslie (17:52):
And the problem is.
Many fold.
One, the worst problem that Ican think of is the amount of
dissection that you have to do.
If you look at these screws, letme give you an example.
If you look at these screws areinserted from corner to corner.
So they're on both outsidecorners of the bone.
(18:13):
So to put those screws in, youhave to open up the spine this
wide.
You have to scrape the muscleoff the bone from corner to
corner.
Literally strip the muscle offthe wall, and all of these are
very important muscles.
That amount of dissection, itjust basically kills the
paraspinal muscle.
(18:34):
It just scars it.
I have had to gone back, go backa few of my patients to do, redo
surgery.
And when I go back, that muscleis dead.
It's just scarred.
For multiple reasons.
One the muscle gets scarred.
Two, when you put these screwsin, this hardware.
The muscle cannot go back andattach itself to the bone
(18:54):
anymore.
So you literally kill the backmuscles.
That has very importantconsequences to the patient.
Why?
And I've mentioned that in mybook, spine surgery.
And sometimes I tell my patientspine surgery is something that.
It's like a controlled trauma.
If you, if let's say somebodydoesn't have any back issues at
(19:16):
all, they have a perfect back.
We do this surgery on them.
They end up in back pain.
So the surgery introduces painto a patient.
The question is why do we dothese searches?
Wait a minute.
What are you saying?
Why do we do this surgery?
The reason is this because thepain is not just one entity.
There are different type of painseverity and all that stuff.
The pain that comes from thedisc is a.
(19:39):
Unbearable, sharp, stabbing painthat you can take all the
narcotics in the world tillyou're barely breathing.
You're still going to have thatpain.
That's not going to take thatpain away.
So that is a pain that you justno treatment for it.
The pain that you get from thedamaged muscles is a dull, achy
(20:00):
pain that you can take a pillhere and there.
You can get a massage and youcan manage it.
It's not.
It's not unbearable.
So in a way, the back surgeryreplaces an unbearable pain with
a manageable pain.
That's why we do thesesurgeries.
And that's why, even thoughwe've done this and we've ruined
(20:21):
your paraspinal muscles,patients are still happy because
they'll still tell you this.
Oh yeah, I will take it again.
Because the other pain that Ihad, I couldn't live with that.
That was just awful.
So that's why we do it.
So that's one thing that thesescrews do to you.
One is just wreck your back andwait, it's even worse.
(20:42):
The worst problem with these isin the cervical spine.
So this is the cervical spine.
When we do like a back cervicalsurgery, you have to open up the
neck from, I got it from cornerto corner.
You literally go in and scrapethe muscle off the bone from
corner to corner because in theneck, you have to put two screws
(21:02):
at the far end.
I'm sorry.
I just so you have to put twoscrews at the far end here and
the far end here.
So that amount of dissection.
It ruins somebody's life.
They are done for life, sothat's one problem.
(21:25):
Two, you put these screws intothese bone columns and guess
what's underneath this columnright here?
It's the nerve that's trying tocome out.
So we are putting these screwsmillimeters away from the
nerves.
So putting the screws is safethese days, but once in a while
you put the screw either throughthe nerve or close to the nerve,
(21:48):
and the patient wakes up, theyeither cannot move their toes,
or they're in severe pain.
So one problem is a nervedamage.
And of course, the third one, Iwould say, is the price.
These screws have absolutelybankrupt the healthcare.
(22:08):
The cost that are associatedwith these screws is
astronomical.
For example, the screw itselfcosts about anywhere between 600
to$1,000 dollars each.
so that cost by itself is quitehigh.
Now, you just don't put thescrew in to put the screw in you
need people in the operatingroom you need one guy that runs
(22:32):
the x ray so you can see whereyou're going.
You need another guy that doesneural monitoring.
When I do surgery, I have a.
person in the O.R.
that has a machine that's beenconnected to all the upper and
lower extremity and monitors thenerve.
So if I get close to a nerve,you can tell me that I'm too
close.
I gotta move away from it.
James Egidio (22:52):
Now, would that be?
Would that be a neurologist?
Dr. Ardavan Aslie (22:56):
There is a technician in the room, but
there's a neurologist in theircenter that's like looking five
or six different surgeries atthe same time.
Okay.
Okay.
So the person that's sittingthere is just a technician.
He must be a licensedtechnician.
He has to go through trainingand all that stuff.
But they all go to a center andone neurologist, I think, I'm
not sure.
I think that's what's happening.
(23:17):
So that's that.
Two, after you, or four, afteryou put these screws, you need
CT scan and additional x ray tosee if you put these screws in
the right side.
And if you put it on the wrong,spot.
You have to take the patientback and reposition and redo it.
It's crazy, but that's not theworst part.
That's of all the things that Itold you, that's not the worst
(23:40):
part.
The worst part is it is that itdoesn't work very well.
And I'm going to explain to youwhy.
So originally I mentioned thatboy, there are all these papers
that screws don't work.
So when I present this data, Tothe leaders of the field that
(24:01):
and they know what's going on.
They are aware of these papersWhen I presented this data to
them, they just don't want totalk to me.
They want to just rip me intoshreds.
I kid you not.
They're just like, why?
Because spine surgery wentthrough quite a bit of trauma in
1990s.
They brought all these leadersof the field in Senate and they
(24:22):
questioned them.
I'm opening the old wounds.
That's why it's so traumatic tothem.
But I have to tell myself, why?
Why is that?
Why is there such a resistanceto data?
If you're not going to listen toresearch, why do research?
Just maybe.
Maybe this research is trying totell me something.
(24:43):
Let me explain to you a story soyou know the severity of this
problem.
Now, one of the things thataudience might ask you is that
have you brought it with leadersof the field?
Have you done this?
Have you?
Absolutely.
I have done everything possible.
And writing the book was thelast resort.
I didn't run to write a book.
That was the absolute lastresort.
(25:05):
So one time, I was in NorthAmerican Spine Society in 2016
in Boston.
I got up in front of a thousandother spine surgeons and I said,
These are, I have six.
Multinational, multi centerpapers said these screws don't
work.
However, these screws are astandard of care.
(25:26):
Why?
So I didn't want, I was, at thattime, I was just starting to ask
these questions.
I didn't know what I know now.
So I didn't want to fight.
These are leaders of the field.
I don't want to piss them off.
I don't want to make them upset.
So the the panel gave some sortof a answer.
Oh, we did look at it and we'regoing to look at it.
(25:47):
And then I sat down anyway.
I didn't want to pick a fight.
I sat down 20 minutes later inthe intermission, I'm in the
line to get coffee.
I was talking to a surgeon andhe introduced me to the surgeon
behind me that was standing inthe line.
I turned around and thissurgeon, my friend.
told him that gentleman that,Oh, Dr.
Asney doesn't like the screws.
(26:07):
He turned around to me and hewas a older, like in sixties,
early sixties, very well known.
He said, Oh, you're thegentleman that made that comment
about the screws.
I want to tell you thateverybody's welcome to their
opinion, but you're very wrong.
I said, it's not about me.
It's about the research.
I'm not saying anything.
All I'm saying is that there'sresearch says.
(26:29):
Stuff doesn't work.
Maybe, just maybe, he's tryingto tell us something.
He said, I know.
I published those papers.
Those are my patients.
I'm like, oh, what's your name?
He told me his name, which I'mnot going to mention, and it was
true.
He was right.
I had the papers in my hand.
I looked at him.
He said, see, that's me.
It was the second paper in mystash.
(26:51):
See, that's me.
He was the fifth author.
So I said, this is you becauseyeah, that's me.
I said let's read what yourpaper says.
At the last sentence, word forword, the paper said, based on
current evidence, we do notrecommend routine use of pedicle
screws.
He looked at it.
(27:11):
He looked at it again.
He said, no, that's wrong.
And he walked away.
I kid you not.
This is not some story thathappens.
This has happened to me, butthat's what I'm dealing with.
Yeah, so yeah, so I have toanswer this.
I have to say what is going on.
I've spent about four or fiveyears trying to come up with
(27:32):
biomechanics, trying toinnovate, and eventually found
the answer.
And this is what the answer is.
We are orthopedic surgeons, as Isaid earlier.
We do five years of orthopedicsurgery, and in that five years,
all we learn is fracturefixation.
Every time we're in theemergency room, trauma comes in,
femur fracture, tibial fracture,we fix those.
(27:55):
And then we do one year in spinesurgery fellowship, one year,
that's it.
And then we go out and becomespine surgeons.
What we did then, what welearned from orthopedic surgery,
we got that knowledge and weapplied that knowledge to spine
surgery.
Now I'm here to tell you that weshould have never done that.
(28:16):
Spine surgery was never meant tobe a subspecialty of orthopedic
surgery.
There is nothing in spinesurgery that overlaps with
orthopedic surgery.
There is nothing in orthopedicsurgery that's going to make you
a better spine surgeon.
Zero.
None.
At all.
And I'll explain why.
(28:37):
Earlier in my argument mypresentation, I talked about
rigid fixation.
You break a bone, you put aplate, you shoot some screws,
and that holds the ends togetherin a rigid fashion.
Rigid fixation works well inarms and legs for one important
reason.
Because in arms and legs you caneliminate gravity.
(28:59):
You can put the patient in slingor you can put the patient on
crotches so you don't have toput weight on it.
In spine, you can't eliminategravity.
You can't tell the patient tolay down for four months at a
time.
So the second that patient getsup, that structure is under
tremendous amount of stress,constant stress.
(29:19):
So the concept is no differentthan Building high rises in the
earthquake zone like SanFrancisco.
We've learned that when youbuild a high rise in the
earthquake zone, you don't makeit stiff.
You make it flexible, notflexible, but bendable.
So you can bend when theearthquake comes in, can bend
and dissipate energy and notcrack and fall and just
(29:41):
everything.
That's the same exact concept.
So in the spine surgery, wecan't have rigid fixation just
cuts out.
And so we have to have a devicethat can not flexible, can bend
and twist.
And so somebody, if it fall downor Something happens to him.
Don't cut out and come out andbe all fail.
(30:04):
It can twist and turn anddissipate the energy and doesn't
lose the grip, right?
That's 1 of the things.
Yeah,
James Egidio (30:13):
I want to talk to a little bit about before I
introduced the book and we closeabout.
What are some of the underlyingcauses for compressed spine, a
compressed spine anddegenerative disc disease number
1 and who is ultimatelyresponsible for the use of these
pedicle screws Who does theresponsibility fall on?
(30:35):
So I guess to answer the firstquestion is what are some of the
underlying causes fordegenerative disc disease?
Dr. Ardavan Aslie (30:43):
So this is the situation that makes answers
to that question reallydifficult.
And one thing I want theaudience to understand is that
spine surgery is a very youngfield.
Invention of MRI that we couldactually see these discs
following and try to figure outwhat's happening to them and
(31:05):
good MRIs were not availabletill 1995.
So if you think about it from1995 till now, we're talking
about 25.
28 years.
That's it.
That's not a lot of time for usto figure out and answer all of
those questions that you justasked.
But, we are understanding thatat some point, something happens
(31:26):
to the disk.
This doesn't just fall off andjust, bust it.
Now, I got him set.
There are two.
Bad.
This is not just a one.
This is a spectrum.
On one end, you have patientsthat they have bad quality
tissue, bad cross linking oftheir of their Collagen,
collagen fibers.
(31:47):
Even though they look, they justlook good, but it's weak.
And then on the other spectrum,you have people that are very
healthy and their disc qualitiesare very good.
So what happens is that at somepoint, Patients do something,
let's say they fall off a horse,they get into a car accident,
and the disc gets injured.
(32:08):
Now, a couple of things canhappen when the disc gets
injured.
One is that you can have pain,and just misery, and you go
around, you look for treatment.
So you have the symptoms rightaway.
The other thing that can happenis that you might not hurt.
You might hurt for overnight,one day you wake up, you're
like, oh my back is sore, andthen I'm okay.
(32:29):
So even though the disc is torn,but you really don't have that
pain.
What happens is that over time,because of the size of that
tear, that mushy stuff startscoming out and the discs start
settling, but it's not causingany problem.
So it's not causing any pain.
Then down the road, one day youcould do something very trivial
(32:51):
just trip over something or geta very light car accident.
That area becomes inflamed andnow you have pain because one
important topic that I want mypatients to understand is that
Damage does not necessarilyequals pain.
Damage plus inflammation equalspain.
(33:11):
It's the inflammation thatcauses the pain That's why
people have good days bad daysfor example If we MRI hundred
people at the age of 60 60 70people to have all sorts of
damaged disc and you know Thisthat are a smooshed or whatever,
but only one to 2 percent ofthose people are in pain.
(33:31):
So why?
Somebody sustained the sameexact injury with a busted disc
and herniated disc and is insevere pain Another guy in the
same car accident has a busted.
They can lose looks exactly likethat and they have no pain Yeah,
we don't understand that part.
We don't
James Egidio (33:50):
know.
Yeah.
What about obesity?
The center of gravity with thebody and all the weight that
people put on through, baddietary intake and gaining
weight and gaining a lot ofweight.
Doesn't that put any pressure onthe spine to where, it just
pushes gravity down andcompresses the spine.
Dr. Ardavan Aslie (34:07):
Absolutely.
Absolutely.
These discs are Cartilage.
So you want to, yeah.
Put least amount of pressure asyou can and two things are very
important your weight and yourjob So let's say I have a lot of
patients that they come in andthey are hard workers There's
some of them are you knowcarpenters mechanic or movers or
so, so I tell them look youdon't need surgery You need to
(34:29):
get a new job.
That's what you need to do.
Why?
Because it's always the liftingthat aggravates your back
lifting.
It's not pushing, pulling.
It's not, there are differentlevels of aggravation.
Of course, you can be in a carride for about two hours and
then you wake up and you'relike, Oh, my muscles.
But that's a different type ofinjury.
That's like just musclesoreness, but something that
(34:51):
aggravates your back, sets youback that you cannot sleep.
You have to go get chiropracticcare.
Those.
Always caused by lifting becausethe spine, these discs are
basically holding you all yourweight and whatever you're
lifting goes right through thesediscs.
Basically, these discs do notshare the weight with anything
(35:14):
else.
So if you are heavy, especiallynow, you got to understand
there's a whole physics involvedas well.
I explained to my, let's say youhave extra one pound and you've
got to walk upright.
Your muscles, your spine gottabalance this with pulling back
about one pound.
So guess what?
Both these weights pulled downon the spine.
(35:36):
So if you lose one pound fromyour gut, you take two, three
pounds pressure off your spine.
That's how important spine islike a flagpole, all to stay
upright, all the pools got toequate.
So if you have extra one poundhere, your muscle, your muscles
got to balance with it.
And they all.
So that's why losing weight issuper important to get your back
(35:59):
healthy.
But of course this happens, it'snot just heavy people that get a
back issue.
I have kids that are skinny,they still have bad, why?
Because their disc is lowquality.
And we just can't tell what thequality of this is by just
looking over the MRIs, right?
James Egidio (36:22):
One last question before we close and we introduce
the book is, again, who isultimately responsible or to
blame for the use of thesepedicle screws?
Dr. Ardavan Aslie (36:33):
You want me to say it?
James Egidio (36:35):
Yeah, go ahead.
Companies.
Okay.
Companies.
You say companies though, andyou do say companies, but I
would think Personally they haveto obviously go through FDA
approval, right?
Correct.
So when the FDA be responsiblebecause they're like the first
line of defense when it comes toapproval of any yes.
Dr. Ardavan Aslie (36:58):
Yes.
Medical.
Correct.
What I've learned now.
I don't know.
I'm not going to say what I'mabout to tell you.
Is it true?
I'm going to tell you what myexperiences was with FDA, what
I've learned when I've gonethrough these Development and
stuff what I've learned from FDAYou gotta understand FDA is not
(37:18):
a body that can test everything.
They're not a university.
They cannot run research, FDAall it does It can determine if
that device is safe or not.
They cannot go test everything.
And they depend on the data thatthe company presents them.
This is the problem.
Company goes in and findsdoctors, and I'm pretty sure
(37:40):
they can find a doctor that canfudge the numbers and write
papers that are favorable to theproduct.
Oh,
James Egidio (37:45):
no question about it.
I've interviewed severalphysicians that We're talking
about just that they weretalking about the fact that
these papers that are put outfor these Are all written by a
lot of them are written byghostwriters.
In fact, just yesterday.
Dr Scott Jensen was reportingwhere a lot of the old articles
(38:09):
when I say dated articles werescrubbed from the internet And
they're scrubbed from some ofthese online sources as credit
supposed to have been crediblesources for information.
So a lot of data is being fudgedand a lot of data is being
scrubbed, like I said, from theInternet.
Dr. Ardavan Aslie (38:27):
I want to show you something.
This is what I brought.
I want to show you something.
So you understand that I am notthe only one saying this.
I'm not some conspiracy theoristthat was starting about this.
Now, this is our journal, SpineJournal, and I want to This is a
November 2020 article.
Let me see if I can put it infront of this.
This is a November 2020 articleand I'm going to read you the
(38:49):
leading article.
The leading article saysundisclosed conflict of interest
is prevalent in spineliterature.
Our journal is telling us thatour data is tainted.
And nobody does anything aboutit.
That's why I wrote that book.
And in that book, I said exactlywhat's happening.
(39:12):
The CEO of a company has onegoal and one goal only.
To make as much money as theycan at that time that he's the
CEO.
That's his goal.
Go.
So what he does, he approaches,he gets a couple of these
surgeons, they write papers theyget that data that is totally
(39:32):
fudged to the FDA, FDA truststhese guys, say, okay, that's
fine, this is good, and then FDAapproves it.
So I don't put the FDA at faultbecause they just don't have the
power, they don't have the therewas an ability to actually see
if a product works or it doesn'twork.
All they can say is that if thisproduct is safe or not safe And
(39:55):
it's left for the it's left forthe universities like harvard
johnson To for theseuniversities run the experiment
to say if they work or don'twork.
So 10 years later we find outthat product didn't work nobody
says anything.
They just move on to the nextproduct, and I'm like no.
Come back here.
Why?
Why is this so important?
Because it's not about thatproduct.
(40:17):
This is why is the problem.
When a product, when you publisha paper that says this product
works, then me as anothersurgeon, I am trying to improve
upon the work that's been donebehind me.
If the work behind me wasfraudulent, I'm going to go in
the wrong direction.
So the way I explain is that notonly the patient that received
(40:39):
that treatment are they gotbasically defrauded.
The entire people that sufferfrom back pain has been
defrauded because thesefraudulent paper makes the
entire spine surgery go in thewrong direction.
For example, and the bestexample of it is that one paper
that Dr.
Zdeblik published in 1993.
(41:01):
Nobody can duplicate thosereports and because of that
paper, when there was so muchdebate about these screws,
because of that paper, onesingle paper, the entire field
went in the wrong direction.
And now, these young people,wait, I gotta tell you something
else, lying.
(41:22):
I'm gonna, I'm gonna say this isvery important.
I go to conferences twice ayear.
Twice a year from 2002 that Ifinished my training.
Every time I go to theseconferences, a leader of the
field gets up and says, there'sPlenty of evidence that shows
these screws work.
Ask this.
If you ask another surgeon,they're going to say the same
(41:43):
thing.
Yeah.
Every time we go, somebody getsup.
Six months later, when I go toanother conference, somebody
else gets up and says, there'splenty of evidence that shows
these screws work.
And then on and on.
So throughout time, we have madeourselves believe it.
That, oh, yeah, screws workbeautifully.
At the same time, there's noevidence.
One time I got in a fight in2018 with one of the professors.
(42:08):
He turned around and says,there's plenty of evidence that
says the screws work.
And I said, it does not work.
So we have not only we haven'tfixed anything, we have lied to
ourselves that these screwssomehow work.
Why?
Because we've been trainedthat's how you fix something.
(42:29):
And the training is wrong.
Sure.
James Egidio (42:32):
Dr.
Aisle I want to close withcorporate spine because I have a
to go on a live stream here in aminute.
Sure.
But just share with thelisteners and viewers of the
Medical Truth Podcast shortclosing on your book, corporate
Spine where they could buy,purchase the book, and
Dr. Ardavan Aslie (42:48):
in, yes, you can purchase it on Amazon, and
it's a good book because thefirst four chapters are to try
to teach my patients what I'velearned treating patients for 20
years through stories of mypatients.
I didn't want it to be just abook complaining about the
matters.
So the first four chapters, I'mtrying to teach the patient what
we go through, what's our viewof things when we see and
(43:11):
evaluate the patients, so theycan understand, for example, why
they go to five surgeons andthey, Come up with five
different recommendations.
So the patients at least havesome sort of an understanding of
what's going on in the world of
James Egidio (43:24):
spine surgery.
And that is on Amazon.
I know you have, I think it'salmost five out of five reviews
so far based on the reviews andand it's written for
specifically for patients, soit's not written, it's an easy
to read book, correct?
Dr. Ardavan Aslie (43:41):
Correct.
It's written for patientsbecause I truly believe spine
surgeons haven't done themselvesa favor, try to teach the public
what we cannot do.
Everybody has the expectation ofgoing in, getting one surgeon,
be all fixed up.
That's sometimes.
possible.
Sometimes that's not the goal.
The goal is to so the patientsneed to understand what they're
(44:03):
dealing with.
And that comes from knowledge.
And we haven't done that.
This book is the first time thatwe try to make the patients
understand what we're dealingwith.
Yeah,
James Egidio (44:15):
Dr.
Asick, thank you so much forjoining me on this episode of
medical truth podcast.
I really appreciate it Iappreciate the information
you're putting out there andkeep up the good work.
I you know, It's we got to getthe word out there on these
kinds of things.
Thank you.
We sure much.
Thank you so much.
Have a good day.
All right
Thanks for listening to theMedical Truth Podcast.
(44:38):
For the latest episodes, go towww.
medicaltruthpodcast.
com.
You can also find the MedicalTruth Podcast on Rumble, as well
as all the major podcastplatforms like Apple Podcasts,
Spotify, Stitcher, and iHeart.
Get ready to hear the truth, the whole truth, and
nothing but the truth about theUnited States healthcare system
with your host of the medicaltruth podcast, James Egidio.
James Egidio (00:19):
Hi, I'm James.
welcome to the medical truthpodcast.
Each year, an estimated halfmillion people will undergo
spinal fusion surgery in theUnited States In most cases,
surgeons will implant rods andscrews into a patient's fused
vertebrae as part of theprocedure.
There's just one enormousproblem.
According to the publishedmedical literature, the screws
(00:40):
provide little to no benefit forpatients.
My guest is a board certifiedHarbor train university fellow
spine surgeon who recentlypublished his book called
corporate spine.
How spine surgery went off trackand how we can put it right.
In his research, he sounds thealarm with overwhelming evidence
that per pedicle screws used forspine surgery often do more harm
(01:04):
than good.
Even though device manufacturerscontinue to push profits over
patients.
It is an honor and a pleasure tohave on the medical truth
podcast.
My guest, Dr.
Ardavan Aslie.
Dr.
Astley, welcome to the medicaltruth podcast.
How are you doing today?
Dr. Ardavan Aslie (01:21):
Doing very well.
Thank you for inviting
James Egidio (01:23):
me.
Absolutely.
A little bit about who you areand what you do.
Yes.
Dr. Ardavan Aslie (01:29):
I'm a orthopedically trained spine
surgeon.
That means I did a residency inorthopedic surgery.
Then I did a year of fellowshipin spine surgery.
And I'm a practicing spinesurgeon here in Sacramento area
in Northern California.
And the reason I said thatbecause there's two ways of
becoming a spine surgeon.
One is through orthopedicsurgery.
(01:49):
The other one is throughneurosurgery.
So you can become neurosurgeonand then.
Learn spine surgery and practiceas a spine surgeon.
I see.
James Egidio (01:59):
So you're a spine surgeon through the orthopedic
route.
Correct.
Yes.
Okay.
So you wrote a book calledcorporate spine, how spine
surgery went off track and howwe put it, let's talk a little
bit about some of your findingsand research when it pertains to
spine surgery.
Dr. Ardavan Aslie (02:21):
Sure.
Boy, where do I start?
Because it goes way back.
I'll tell you how it allstarted.
I've been in practice for 20years.
The first 10 years, I practicedbasically what I was trained,
what I was told.
I did everything by the numbers,and I did very well.
About 10 years, like into 10years of my practice, I became
(02:42):
very dissatisfied.
I was like, what are we doing toour patients?
I started asking questions.
Then I said, maybe I can findbetter methods of what we're
doing.
And then that led into someinventions that I had.
And actually one of myinventions won an innovation
showcase in Congress ofNeurological Surgeons.
So I won an award actually formy invention.
(03:04):
Then as I was developing that, Ihad some problems that I went
back and had to study theliterature that we have to see
if this problem exists or isjust a problem that I have
faced.
And what I found out was jawdropping.
What I found out in literaturewas, just bad.
(03:26):
And basically what I found outin literature was that paper
after paper shown that themethods that we use these days
in spine surgery don't work.
So I was like, wait, what isgoing on?
So I started digging deeper.
I started going to theseconferences and actually.
(03:48):
Start talking to the so calledleaders of the field when we go
to conferences, let's say NorthAmerican Spine Society or
American Academy of OrthopedicSurgeons these lecturers that
are university professors, afterthe lectures, I would it's
Approach them.
I start talking to them.
I start asking these questions.
What is going on, which I'mgoing to explain what I'm
talking about, and they wouldjust not answer me.
(04:11):
They would just want to justtear me apart.
As soon as I start questioningthe methods, they not only they
didn't want to hear it.
The questions, they actually,they reacted like I was just
like insulting them or somethinglike that.
It was just such a bad reactionfrom professor to professor.
(04:33):
And I have to say.
What is going on?
Why is this like this evidence,these papers that's been
published in our own literature,these guys know about these
papers.
So why is this such a resistanceto this wealth of knowledge?
So I spent about four yearsactually to find out what the
(04:53):
answer is.
And I eventually found theanswer, and I will explain.
Let's go back to see how thespine surgery started.
One of the spine is a bunch ofbones that are stacked up on top
of each other.
Like this.
A bunch of bones that arestacked up on top of each other,
separated by these cushions wecall them discs.
(05:14):
These discs are cartilage.
They're like a jelly donut.
They're like a they have a jellyin the middle and then the tough
ring around it.
So it's like a cushion.
If there is a stress like a caraccident or fall, this can get
ruptured and the jelly can seepout like that.
(05:35):
And therefore, slowly over time,a good spine can become a
diseased spine and causing pain.
Initially, in 60s and 70s, wehad x rays.
We didn't have MRIs.
We could get an x ray and seethat the disc between the two
bones had gone bad, and wecalled that degenerative disc
disease, because we didn't knowwhat was going on with the
(05:56):
discs.
Treatment for that, we came upwith a treatment, and the
treatment for that was a surgerycalled fusion surgery.
In this surgery, you would go infrom the front and the back,
take the disc out, and this isan example of a fusion surgery.
So you go in, take the disc out,put a spacer here, and then you
go through the back, put somescrews and rods.
(06:17):
Basically, you mobilize Thesetwo vertebrae, so the two
vertebrae become one bone.
So the disc is gone, now thebones have been mobilized.
That has eliminated the motionand eliminated the pain.
This surgery actually startedworking pretty good, except
there was a problem.
Every time you do this surgery,You're hoping that within the
(06:40):
next few months, the bone willgrow between the two bones to
the middle of that prosthesisand the two bones become one.
The problem is in some number ofpeople, that didn't happen.
And we call that a nonunion.
And that is basically patient'sbiology.
In these cases, the pain cameback a lot worse.
(07:01):
And the results were very bad.
So we were all looking tosomehow increase this fusion
rate, and the fusion ratewithout the screws was about
75%.
So 3 out of 4 people will healit, 1 out of people, 1 out of 4
will not, and they end up in thenon union.
So right around late 80s andearly 90s, a couple of surgeons
(07:24):
from France, figured out a wayto put a screw into the
backbone.
Now, backbone is a very complexbone, but we somehow found a way
to insert a screw we callpedicle screw.
It's a large screw that has atulip that can accept a rod.
This is Screw gets inserted fromback to the front.
(07:46):
So if I have a picture of it,this is the back of the spine,
you can see from back to thefront is inserted through what
we call pedicle.
Pedicle are these bony columnsthat connects the front part of
the vertebrae to the back partof the vertebrae.
So these are pedicles, right?
Basically two bone.
And this is the surgery.
(08:08):
So you put the screws from Backto the front and these can
accept a rod.
You put a rod between them andtie them so that Immobilizes the
spine and hopefully increase thefusion rate.
Why?
Because as orthopedic surgeons,we learned quite a bit in the
60s and 70s in terms of fracturefixation.
(08:29):
We developed a technique calledAO spine.
I'm sorry, AO technique.
AO technique is what we callrigid fixation of fracture ends.
When a bone breaks and you havethese two ends that are
floating, What you do inorthopedics, you do a surgery,
you open up, you expose thebone, then you put the bones
(08:51):
together, end to end, and youput a plate next to it with some
screws going, and that way youfix this fracture in a rigid
fashion, we call the rigidfixation.
This worked very well for thefractures, and as orthopedic
surgeons now doing spinesurgeries, we said, Oh, huh,
somebody figured out to put ascrew in.
(09:11):
And we know that immobilizationis the key for healing.
So therefore, let's apply thatknowledge to spine.
And that's when we started doingthese surgeries with addition of
the screws, except there was aproblem initially.
So we started like earlynineties, late 1980s.
(09:31):
We started doing, adding thesescrews, except there was a
problem.
There were really.
Bad results.
At some point in 1993, therewere about 7, 000 lawsuits
against the manufacturer ofthese screws, a company called
currently Medtronic, and it wasreally bad.
Actually, there was aninvestigation by Senate at some
(09:53):
point.
They brought in leaders of thefield to Senate and start asking
them questions.
Right around that time, in 1993,a surgeon called Dr.
Zdablik.
published a key study paper in1993 in Spine Journal.
According to his paper, he saidthat these screws work
(10:13):
beautifully.
It just worked absolutelyawesome.
He had people that didn't getthe screws, and people who had
the screws, and the ones thatthey got the screws, they did
tremendously better.
This gave a green light for thesurgeons to start using these
screws as an adjunct to thefusion.
(10:35):
Now, not to confuse you, I gotto understand, you got to
understand that the fusion hastwo parts.
One is the fusion, which isputting the bone between the two
bones.
And the second part isinstrumentation, which putting
the screws.
For a fusion surgery, you, youcan or you don't have to put the
screws in.
I want the audience tounderstand that.
(10:55):
By late 1990s and early 2000s,and currently, these screws are
standard of care.
This is what we do.
If you have a fusion surgery inthe neck or the lower back,
you're getting these.
Here I come, and I had a problemwith my device.
(11:16):
I said, let me look at theliterature.
When I looked at the literature,I found six multi center,
multinational papers that werepublished in our journal, Spine.
So there were not some papersthat got published in some, not
so important journals.
They were published in our ownjournal, and they were multi
center and multinational.
(11:38):
And all six said that additionof these schools Don't change
the outcome or fusion rate.
Basically, they were saying thatby adding the screws, all you're
doing is increasingcomplications.
When I saw that, I was like,wait, that doesn't sound right.
You know what is going on here?
(11:58):
Let me look at the, there's adoubtless war.
See what is going on over there.
And that's.
When I found out, Oh my God,what is going on?
Whatever I'm saying that I'vefound out, it's not conspiracy
theory.
It's in Google.
It's a known fact.
It's a published data.
So in 1993 there were about 7,000 lawsuits against the
(12:20):
manufacturer of the screws.
Medtronic, I mentioned that,right?
Dr.
Zdeblik publishes this paper in1993.
By 1996, as those losses weredisappearing because of his
paper, he started getting paidfrom the company.
By 2003, he'd gotten paid 34million dollars allegedly for
(12:44):
something that he's invented,which I cannot comment on that.
I've seen it.
Let's not talk about that part.
That's bad.
I was like, Whoa, that's bad.
Wait, it gets worse.
It gets 10 times worse.
So like in early 2000s.
The Medtronic came up withanother product.
(13:05):
This product was a veryimportant product.
It was a substitute for bonegraft.
Originally, I said that for thefusion, we have to put a block
between the two bones.
When you take the disc out, thatspace is void.
So you have to put a spacerthere.
We normally have to harvestpatient's own bone to put it
between the two bones.
That causes problems because nowthe donor side of where you
(13:28):
hacked out the bone now startshurting.
So we were trying to avoid that.
So Medtronic came up with aproduct.
It's a hormone that we all haveit.
When you break your bone, itgets excreted.
We call it BMP, bone morphogenicprotein, and that stimulates
bone healing.
The company actually isolatedthat And it came as a product in
(13:49):
a sponge that we can put thatsponge between the fusion,
between the bones that we haveto fuse so the fusion can take
place so we don't have toharvest.
wE started using this product inthe early 2000s.
We had to study that.
So Medtronic put Dr.
Zdeblik again in charge of thisimportant study.
(14:10):
And he published a paper, Dr.
Zdevlic published another paperfor this new product in 2004,
except this time he got caughtfalsifying his results.
By who?
By the United States Senate.
There was a whistleblower rightat that time One of the workers,
one of the employees of thecompany said that these doctors
(14:32):
are all getting paid from thecompany, like just amazing
number of amount of money.
So that triggered a UnitedStates Senate investigation,
United States Senateinvestigated, and it was the
United States Senate thatconcluded that the paper that
Dr.
Zdeblik published in 2004 wasnot written by him, was written
(14:53):
by company.
I'm like, Oh my God, this isjust crazy.
Now let's go back to that paperthat he published in 1993.
That's even worse.
Every time I think to myselfman, this is really bad.
It can't get worse.
It does.
So let's go back.
(15:14):
I said, I got to study thatpaper in 1993.
This is just crazy.
There are a lot of problems withthat study that I've mentioned
one by one in my book.
But the biggest problem withthat paper is that.
It got published as apreliminary report.
I spent about two years to findthe final result or follow up
(15:35):
result, and I couldn't.
Eventually, I cornered one ofthese leaders of the field, and
I asked him, I said, I can't,what is it?
And he said, Oh, thatpreliminary report is the only
thing that we have.
There is no, that study wasabandoned in the middle and was
never finished.
I was like, Oh my God.
(15:55):
If you Google Zdeblik spinefusion article right now, you
will see that article.
You will see that it waspublished in 1993 and, most
importantly, has been referencedin 1, 127 articles as of today.
That article is the mostreferenced paper in the entire
(16:18):
world of spine surgery.
Everything that we do tracksback to that one unfinished
paper by a guy who later on gotcaught cheating.
And this is all known publisheddata that we have.
So I was like, Oh, my God,that's really bad.
(16:39):
So to top that off now, wait, itgets worse again.
That's bad.
Worse again.
There was another paper that gotpublished in 2018.
This was a paper that had eightyear follow up.
It was a very big study.
We are anticipating it.
And it was a very good study,and it got published in 2018 as
(17:02):
a lead article, so a veryimportant article.
This article, they looked atusing the screws, and they
concluded that adding the screwsdoes not add to the benefit to
the patient.
James Egidio (17:16):
Yeah, I have one question for I want to back up a
little bit about what you'retalking about here because you
mentioned something veryinteresting about some of the
side effects or some of the riskand benefits of these of this
surgery based on the use ofthese pedicle screws.
What are some of those sideeffects?
Dr. Ardavan Aslie (17:36):
Sure.
Let's talk about that.
James Egidio (17:38):
I'm sure there's some people that are listening
that may or may not have hadsome surgery done back surgery,
spinal fusions, and may haveeven had these particular screws
inserted in them.
So they, it would be great totalk about that.
Dr. Ardavan Aslie (17:52):
And the problem is.
Many fold.
One, the worst problem that Ican think of is the amount of
dissection that you have to do.
If you look at these screws, letme give you an example.
If you look at these screws areinserted from corner to corner.
So they're on both outsidecorners of the bone.
(18:13):
So to put those screws in, youhave to open up the spine this
wide.
You have to scrape the muscleoff the bone from corner to
corner.
Literally strip the muscle offthe wall, and all of these are
very important muscles.
That amount of dissection, itjust basically kills the
paraspinal muscle.
(18:34):
It just scars it.
I have had to gone back, go backa few of my patients to do, redo
surgery.
And when I go back, that muscleis dead.
It's just scarred.
For multiple reasons.
One the muscle gets scarred.
Two, when you put these screwsin, this hardware.
The muscle cannot go back andattach itself to the bone
(18:54):
anymore.
So you literally kill the backmuscles.
That has very importantconsequences to the patient.
Why?
And I've mentioned that in mybook, spine surgery.
And sometimes I tell my patientspine surgery is something that.
It's like a controlled trauma.
If you, if let's say somebodydoesn't have any back issues at
(19:16):
all, they have a perfect back.
We do this surgery on them.
They end up in back pain.
So the surgery introduces painto a patient.
The question is why do we dothese searches?
Wait a minute.
What are you saying?
Why do we do this surgery?
The reason is this because thepain is not just one entity.
There are different type of painseverity and all that stuff.
The pain that comes from thedisc is a.
(19:39):
Unbearable, sharp, stabbing painthat you can take all the
narcotics in the world tillyou're barely breathing.
You're still going to have thatpain.
That's not going to take thatpain away.
So that is a pain that you justno treatment for it.
The pain that you get from thedamaged muscles is a dull, achy
(20:00):
pain that you can take a pillhere and there.
You can get a massage and youcan manage it.
It's not.
It's not unbearable.
So in a way, the back surgeryreplaces an unbearable pain with
a manageable pain.
That's why we do thesesurgeries.
And that's why, even thoughwe've done this and we've ruined
(20:21):
your paraspinal muscles,patients are still happy because
they'll still tell you this.
Oh yeah, I will take it again.
Because the other pain that Ihad, I couldn't live with that.
That was just awful.
So that's why we do it.
So that's one thing that thesescrews do to you.
One is just wreck your back andwait, it's even worse.
(20:42):
The worst problem with these isin the cervical spine.
So this is the cervical spine.
When we do like a back cervicalsurgery, you have to open up the
neck from, I got it from cornerto corner.
You literally go in and scrapethe muscle off the bone from
corner to corner because in theneck, you have to put two screws
(21:02):
at the far end.
I'm sorry.
I just so you have to put twoscrews at the far end here and
the far end here.
So that amount of dissection.
It ruins somebody's life.
They are done for life, sothat's one problem.
(21:25):
Two, you put these screws intothese bone columns and guess
what's underneath this columnright here?
It's the nerve that's trying tocome out.
So we are putting these screwsmillimeters away from the
nerves.
So putting the screws is safethese days, but once in a while
you put the screw either throughthe nerve or close to the nerve,
(21:48):
and the patient wakes up, theyeither cannot move their toes,
or they're in severe pain.
So one problem is a nervedamage.
And of course, the third one, Iwould say, is the price.
These screws have absolutelybankrupt the healthcare.
(22:08):
The cost that are associatedwith these screws is
astronomical.
For example, the screw itselfcosts about anywhere between 600
to$1,000 dollars each.
so that cost by itself is quitehigh.
Now, you just don't put thescrew in to put the screw in you
need people in the operatingroom you need one guy that runs
(22:32):
the x ray so you can see whereyou're going.
You need another guy that doesneural monitoring.
When I do surgery, I have a.
person in the O.R.
that has a machine that's beenconnected to all the upper and
lower extremity and monitors thenerve.
So if I get close to a nerve,you can tell me that I'm too
close.
I gotta move away from it.
James Egidio (22:52):
Now, would that be?
Would that be a neurologist?
Dr. Ardavan Aslie (22:56):
There is a technician in the room, but
there's a neurologist in theircenter that's like looking five
or six different surgeries atthe same time.
Okay.
Okay.
So the person that's sittingthere is just a technician.
He must be a licensedtechnician.
He has to go through trainingand all that stuff.
But they all go to a center andone neurologist, I think, I'm
not sure.
I think that's what's happening.
(23:17):
So that's that.
Two, after you, or four, afteryou put these screws, you need
CT scan and additional x ray tosee if you put these screws in
the right side.
And if you put it on the wrong,spot.
You have to take the patientback and reposition and redo it.
It's crazy, but that's not theworst part.
That's of all the things that Itold you, that's not the worst
(23:40):
part.
The worst part is it is that itdoesn't work very well.
And I'm going to explain to youwhy.
So originally I mentioned thatboy, there are all these papers
that screws don't work.
So when I present this data, Tothe leaders of the field that
(24:01):
and they know what's going on.
They are aware of these papersWhen I presented this data to
them, they just don't want totalk to me.
They want to just rip me intoshreds.
I kid you not.
They're just like, why?
Because spine surgery wentthrough quite a bit of trauma in
1990s.
They brought all these leadersof the field in Senate and they
(24:22):
questioned them.
I'm opening the old wounds.
That's why it's so traumatic tothem.
But I have to tell myself, why?
Why is that?
Why is there such a resistanceto data?
If you're not going to listen toresearch, why do research?
Just maybe.
Maybe this research is trying totell me something.
(24:43):
Let me explain to you a story soyou know the severity of this
problem.
Now, one of the things thataudience might ask you is that
have you brought it with leadersof the field?
Have you done this?
Have you?
Absolutely.
I have done everything possible.
And writing the book was thelast resort.
I didn't run to write a book.
That was the absolute lastresort.
(25:05):
So one time, I was in NorthAmerican Spine Society in 2016
in Boston.
I got up in front of a thousandother spine surgeons and I said,
These are, I have six.
Multinational, multi centerpapers said these screws don't
work.
However, these screws are astandard of care.
(25:26):
Why?
So I didn't want, I was, at thattime, I was just starting to ask
these questions.
I didn't know what I know now.
So I didn't want to fight.
These are leaders of the field.
I don't want to piss them off.
I don't want to make them upset.
So the the panel gave some sortof a answer.
Oh, we did look at it and we'regoing to look at it.
(25:47):
And then I sat down anyway.
I didn't want to pick a fight.
I sat down 20 minutes later inthe intermission, I'm in the
line to get coffee.
I was talking to a surgeon andhe introduced me to the surgeon
behind me that was standing inthe line.
I turned around and thissurgeon, my friend.
told him that gentleman that,Oh, Dr.
Asney doesn't like the screws.
(26:07):
He turned around to me and hewas a older, like in sixties,
early sixties, very well known.
He said, Oh, you're thegentleman that made that comment
about the screws.
I want to tell you thateverybody's welcome to their
opinion, but you're very wrong.
I said, it's not about me.
It's about the research.
I'm not saying anything.
All I'm saying is that there'sresearch says.
(26:29):
Stuff doesn't work.
Maybe, just maybe, he's tryingto tell us something.
He said, I know.
I published those papers.
Those are my patients.
I'm like, oh, what's your name?
He told me his name, which I'mnot going to mention, and it was
true.
He was right.
I had the papers in my hand.
I looked at him.
He said, see, that's me.
It was the second paper in mystash.
(26:51):
See, that's me.
He was the fifth author.
So I said, this is you becauseyeah, that's me.
I said let's read what yourpaper says.
At the last sentence, word forword, the paper said, based on
current evidence, we do notrecommend routine use of pedicle
screws.
He looked at it.
(27:11):
He looked at it again.
He said, no, that's wrong.
And he walked away.
I kid you not.
This is not some story thathappens.
This has happened to me, butthat's what I'm dealing with.
Yeah, so yeah, so I have toanswer this.
I have to say what is going on.
I've spent about four or fiveyears trying to come up with
(27:32):
biomechanics, trying toinnovate, and eventually found
the answer.
And this is what the answer is.
We are orthopedic surgeons, as Isaid earlier.
We do five years of orthopedicsurgery, and in that five years,
all we learn is fracturefixation.
Every time we're in theemergency room, trauma comes in,
femur fracture, tibial fracture,we fix those.
(27:55):
And then we do one year in spinesurgery fellowship, one year,
that's it.
And then we go out and becomespine surgeons.
What we did then, what welearned from orthopedic surgery,
we got that knowledge and weapplied that knowledge to spine
surgery.
Now I'm here to tell you that weshould have never done that.
(28:16):
Spine surgery was never meant tobe a subspecialty of orthopedic
surgery.
There is nothing in spinesurgery that overlaps with
orthopedic surgery.
There is nothing in orthopedicsurgery that's going to make you
a better spine surgeon.
Zero.
None.
At all.
And I'll explain why.
(28:37):
Earlier in my argument mypresentation, I talked about
rigid fixation.
You break a bone, you put aplate, you shoot some screws,
and that holds the ends togetherin a rigid fashion.
Rigid fixation works well inarms and legs for one important
reason.
Because in arms and legs you caneliminate gravity.
(28:59):
You can put the patient in slingor you can put the patient on
crotches so you don't have toput weight on it.
In spine, you can't eliminategravity.
You can't tell the patient tolay down for four months at a
time.
So the second that patient getsup, that structure is under
tremendous amount of stress,constant stress.
(29:19):
So the concept is no differentthan Building high rises in the
earthquake zone like SanFrancisco.
We've learned that when youbuild a high rise in the
earthquake zone, you don't makeit stiff.
You make it flexible, notflexible, but bendable.
So you can bend when theearthquake comes in, can bend
and dissipate energy and notcrack and fall and just
(29:41):
everything.
That's the same exact concept.
So in the spine surgery, wecan't have rigid fixation just
cuts out.
And so we have to have a devicethat can not flexible, can bend
and twist.
And so somebody, if it fall downor Something happens to him.
Don't cut out and come out andbe all fail.
(30:04):
It can twist and turn anddissipate the energy and doesn't
lose the grip, right?
That's 1 of the things.
Yeah,
James Egidio (30:13):
I want to talk to a little bit about before I
introduced the book and we closeabout.
What are some of the underlyingcauses for compressed spine, a
compressed spine anddegenerative disc disease number
1 and who is ultimatelyresponsible for the use of these
pedicle screws Who does theresponsibility fall on?
(30:35):
So I guess to answer the firstquestion is what are some of the
underlying causes fordegenerative disc disease?
Dr. Ardavan Aslie (30:43):
So this is the situation that makes answers
to that question reallydifficult.
And one thing I want theaudience to understand is that
spine surgery is a very youngfield.
Invention of MRI that we couldactually see these discs
following and try to figure outwhat's happening to them and
(31:05):
good MRIs were not availabletill 1995.
So if you think about it from1995 till now, we're talking
about 25.
28 years.
That's it.
That's not a lot of time for usto figure out and answer all of
those questions that you justasked.
But, we are understanding thatat some point, something happens
(31:26):
to the disk.
This doesn't just fall off andjust, bust it.
Now, I got him set.
There are two.
Bad.
This is not just a one.
This is a spectrum.
On one end, you have patientsthat they have bad quality
tissue, bad cross linking oftheir of their Collagen,
collagen fibers.
(31:47):
Even though they look, they justlook good, but it's weak.
And then on the other spectrum,you have people that are very
healthy and their disc qualitiesare very good.
So what happens is that at somepoint, Patients do something,
let's say they fall off a horse,they get into a car accident,
and the disc gets injured.
(32:08):
Now, a couple of things canhappen when the disc gets
injured.
One is that you can have pain,and just misery, and you go
around, you look for treatment.
So you have the symptoms rightaway.
The other thing that can happenis that you might not hurt.
You might hurt for overnight,one day you wake up, you're
like, oh my back is sore, andthen I'm okay.
(32:29):
So even though the disc is torn,but you really don't have that
pain.
What happens is that over time,because of the size of that
tear, that mushy stuff startscoming out and the discs start
settling, but it's not causingany problem.
So it's not causing any pain.
Then down the road, one day youcould do something very trivial
(32:51):
just trip over something or geta very light car accident.
That area becomes inflamed andnow you have pain because one
important topic that I want mypatients to understand is that
Damage does not necessarilyequals pain.
Damage plus inflammation equalspain.
(33:11):
It's the inflammation thatcauses the pain That's why
people have good days bad daysfor example If we MRI hundred
people at the age of 60 60 70people to have all sorts of
damaged disc and you know Thisthat are a smooshed or whatever,
but only one to 2 percent ofthose people are in pain.
(33:31):
So why?
Somebody sustained the sameexact injury with a busted disc
and herniated disc and is insevere pain Another guy in the
same car accident has a busted.
They can lose looks exactly likethat and they have no pain Yeah,
we don't understand that part.
We don't
James Egidio (33:50):
know.
Yeah.
What about obesity?
The center of gravity with thebody and all the weight that
people put on through, baddietary intake and gaining
weight and gaining a lot ofweight.
Doesn't that put any pressure onthe spine to where, it just
pushes gravity down andcompresses the spine.
Dr. Ardavan Aslie (34:07):
Absolutely.
Absolutely.
These discs are Cartilage.
So you want to, yeah.
Put least amount of pressure asyou can and two things are very
important your weight and yourjob So let's say I have a lot of
patients that they come in andthey are hard workers There's
some of them are you knowcarpenters mechanic or movers or
so, so I tell them look youdon't need surgery You need to
(34:29):
get a new job.
That's what you need to do.
Why?
Because it's always the liftingthat aggravates your back
lifting.
It's not pushing, pulling.
It's not, there are differentlevels of aggravation.
Of course, you can be in a carride for about two hours and
then you wake up and you'relike, Oh, my muscles.
But that's a different type ofinjury.
That's like just musclesoreness, but something that
(34:51):
aggravates your back, sets youback that you cannot sleep.
You have to go get chiropracticcare.
Those.
Always caused by lifting becausethe spine, these discs are
basically holding you all yourweight and whatever you're
lifting goes right through thesediscs.
Basically, these discs do notshare the weight with anything
(35:14):
else.
So if you are heavy, especiallynow, you got to understand
there's a whole physics involvedas well.
I explained to my, let's say youhave extra one pound and you've
got to walk upright.
Your muscles, your spine gottabalance this with pulling back
about one pound.
So guess what?
Both these weights pulled downon the spine.
(35:36):
So if you lose one pound fromyour gut, you take two, three
pounds pressure off your spine.
That's how important spine islike a flagpole, all to stay
upright, all the pools got toequate.
So if you have extra one poundhere, your muscle, your muscles
got to balance with it.
And they all.
So that's why losing weight issuper important to get your back
(35:59):
healthy.
But of course this happens, it'snot just heavy people that get a
back issue.
I have kids that are skinny,they still have bad, why?
Because their disc is lowquality.
And we just can't tell what thequality of this is by just
looking over the MRIs, right?
James Egidio (36:22):
One last question before we close and we introduce
the book is, again, who isultimately responsible or to
blame for the use of thesepedicle screws?
Dr. Ardavan Aslie (36:33):
You want me to say it?
James Egidio (36:35):
Yeah, go ahead.
Companies.
Okay.
Companies.
You say companies though, andyou do say companies, but I
would think Personally they haveto obviously go through FDA
approval, right?
Correct.
So when the FDA be responsiblebecause they're like the first
line of defense when it comes toapproval of any yes.
Dr. Ardavan Aslie (36:58):
Yes.
Medical.
Correct.
What I've learned now.
I don't know.
I'm not going to say what I'mabout to tell you.
Is it true?
I'm going to tell you what myexperiences was with FDA, what
I've learned when I've gonethrough these Development and
stuff what I've learned from FDAYou gotta understand FDA is not
(37:18):
a body that can test everything.
They're not a university.
They cannot run research, FDAall it does It can determine if
that device is safe or not.
They cannot go test everything.
And they depend on the data thatthe company presents them.
This is the problem.
Company goes in and findsdoctors, and I'm pretty sure
(37:40):
they can find a doctor that canfudge the numbers and write
papers that are favorable to theproduct.
Oh,
James Egidio (37:45):
no question about it.
I've interviewed severalphysicians that We're talking
about just that they weretalking about the fact that
these papers that are put outfor these Are all written by a
lot of them are written byghostwriters.
In fact, just yesterday.
Dr Scott Jensen was reportingwhere a lot of the old articles
(38:09):
when I say dated articles werescrubbed from the internet And
they're scrubbed from some ofthese online sources as credit
supposed to have been crediblesources for information.
So a lot of data is being fudgedand a lot of data is being
scrubbed, like I said, from theInternet.
Dr. Ardavan Aslie (38:27):
I want to show you something.
This is what I brought.
I want to show you something.
So you understand that I am notthe only one saying this.
I'm not some conspiracy theoristthat was starting about this.
Now, this is our journal, SpineJournal, and I want to This is a
November 2020 article.
Let me see if I can put it infront of this.
This is a November 2020 articleand I'm going to read you the
(38:49):
leading article.
The leading article saysundisclosed conflict of interest
is prevalent in spineliterature.
Our journal is telling us thatour data is tainted.
And nobody does anything aboutit.
That's why I wrote that book.
And in that book, I said exactlywhat's happening.
(39:12):
The CEO of a company has onegoal and one goal only.
To make as much money as theycan at that time that he's the
CEO.
That's his goal.
Go.
So what he does, he approaches,he gets a couple of these
surgeons, they write papers theyget that data that is totally
(39:32):
fudged to the FDA, FDA truststhese guys, say, okay, that's
fine, this is good, and then FDAapproves it.
So I don't put the FDA at faultbecause they just don't have the
power, they don't have the therewas an ability to actually see
if a product works or it doesn'twork.
All they can say is that if thisproduct is safe or not safe And
(39:55):
it's left for the it's left forthe universities like harvard
johnson To for theseuniversities run the experiment
to say if they work or don'twork.
So 10 years later we find outthat product didn't work nobody
says anything.
They just move on to the nextproduct, and I'm like no.
Come back here.
Why?
Why is this so important?
Because it's not about thatproduct.
(40:17):
This is why is the problem.
When a product, when you publisha paper that says this product
works, then me as anothersurgeon, I am trying to improve
upon the work that's been donebehind me.
If the work behind me wasfraudulent, I'm going to go in
the wrong direction.
So the way I explain is that notonly the patient that received
(40:39):
that treatment are they gotbasically defrauded.
The entire people that sufferfrom back pain has been
defrauded because thesefraudulent paper makes the
entire spine surgery go in thewrong direction.
For example, and the bestexample of it is that one paper
that Dr.
Zdeblik published in 1993.
(41:01):
Nobody can duplicate thosereports and because of that
paper, when there was so muchdebate about these screws,
because of that paper, onesingle paper, the entire field
went in the wrong direction.
And now, these young people,wait, I gotta tell you something
else, lying.
(41:22):
I'm gonna, I'm gonna say this isvery important.
I go to conferences twice ayear.
Twice a year from 2002 that Ifinished my training.
Every time I go to theseconferences, a leader of the
field gets up and says, there'sPlenty of evidence that shows
these screws work.
Ask this.
If you ask another surgeon,they're going to say the same
(41:43):
thing.
Yeah.
Every time we go, somebody getsup.
Six months later, when I go toanother conference, somebody
else gets up and says, there'splenty of evidence that shows
these screws work.
And then on and on.
So throughout time, we have madeourselves believe it.
That, oh, yeah, screws workbeautifully.
At the same time, there's noevidence.
One time I got in a fight in2018 with one of the professors.
(42:08):
He turned around and says,there's plenty of evidence that
says the screws work.
And I said, it does not work.
So we have not only we haven'tfixed anything, we have lied to
ourselves that these screwssomehow work.
Why?
Because we've been trainedthat's how you fix something.
(42:29):
And the training is wrong.
Sure.
James Egidio (42:32):
Dr.
Aisle I want to close withcorporate spine because I have a
to go on a live stream here in aminute.
Sure.
But just share with thelisteners and viewers of the
Medical Truth Podcast shortclosing on your book, corporate
Spine where they could buy,purchase the book, and
Dr. Ardavan Aslie (42:48):
in, yes, you can purchase it on Amazon, and
it's a good book because thefirst four chapters are to try
to teach my patients what I'velearned treating patients for 20
years through stories of mypatients.
I didn't want it to be just abook complaining about the
matters.
So the first four chapters, I'mtrying to teach the patient what
we go through, what's our viewof things when we see and
(43:11):
evaluate the patients, so theycan understand, for example, why
they go to five surgeons andthey, Come up with five
different recommendations.
So the patients at least havesome sort of an understanding of
what's going on in the world of
James Egidio (43:24):
spine surgery.
And that is on Amazon.
I know you have, I think it'salmost five out of five reviews
so far based on the reviews andand it's written for
specifically for patients, soit's not written, it's an easy
to read book, correct?
Dr. Ardavan Aslie (43:41):
Correct.
It's written for patientsbecause I truly believe spine
surgeons haven't done themselvesa favor, try to teach the public
what we cannot do.
Everybody has the expectation ofgoing in, getting one surgeon,
be all fixed up.
That's sometimes.
possible.
Sometimes that's not the goal.
The goal is to so the patientsneed to understand what they're
(44:03):
dealing with.
And that comes from knowledge.
And we haven't done that.
This book is the first time thatwe try to make the patients
understand what we're dealingwith.
Yeah,
James Egidio (44:15):
Dr.
Asick, thank you so much forjoining me on this episode of
medical truth podcast.
I really appreciate it Iappreciate the information
you're putting out there andkeep up the good work.
I you know, It's we got to getthe word out there on these
kinds of things.
Thank you.
We sure much.
Thank you so much.
Have a good day.
All right
Thanks for listening to theMedical Truth Podcast.
(44:38):
For the latest episodes, go towww.
medicaltruthpodcast.
com.
You can also find the MedicalTruth Podcast on Rumble, as well
as all the major podcastplatforms like Apple Podcasts,
Spotify, Stitcher, and iHeart.
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