May 28, 2025 • 50 mins
Spine surgery has evolved significantly over the last decade, and Dr. Phil Saville walks us through the new approaches. As an orthopedic spine surgeon specializing in minimally invasive techniques, Dr. Seville shares how his journey from the UK's NHS system to America's leading medical institutions shaped his passion for motion preservation surgery.
We dive deep into the advantages of disc replacements over traditional fusion surgery – a game-changing approach allowing patients to maintain their natural range of motion while experiencing less pain and fewer complications down the road. You'll learn how these procedures can help avoid the common problem of adjacent segment degeneration that often leads to multiple surgeries following fusion.
Dr. Seville explains his surgical techniques with remarkable clarity, from the finger-width incisions that minimize tissue damage to the specialized tubes and instruments that allow precise targeting of problem areas. Whether you're dealing with neck pain, lower back issues, or considering surgical options, you'll appreciate his breakdown of recovery timelines and what to realistically expect.
Perhaps most valuable are his insights on when back pain might indicate something more serious. Dr. Seville outlines the "red flags" that should prompt immediate medical attention and helps distinguish between pain that might resolve with conservative treatment versus symptoms requiring surgical intervention.
The conversation takes a fascinating turn as we explore innovative rehabilitation technologies, including electromagnetic muscle stimulation that helps maintain muscle function during nerve recovery. This holistic approach to spine care reflects Dr. Seville's commitment to getting patients back to their active lifestyles with the least invasive means possible.
Ready to learn more about modern spine surgery or struggling with back or neck pain? Connect with Dr. Seville through SevilleSpine.com to explore your options for lasting relief and recovery.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
Y'all, welcome back to theDriven Athlete Podcast.
It's your man, dr Kyle, andwe've got a really cool special
guest with us, dr Phil Seville.
He's a spine surgeon,orthopedic surgeon, and coming
(00:24):
from a super busy schedule, he'sbeen able to come hang out with
us and share more about what hedoes and what you know the fat
things he's into.
But introduce people like whereyou're at, what's your practice
and what y'all do.
Speaker 2 (00:36):
Well, thanks for having me, Kyle Good to get it
done.
We've been talking about thisfor a while.
Yeah, it's been like honestlyit's been like a little over a
year.
Yeah, it's been a while, beenlike 18 months.
Yeah, well, that's my fault.
No, no, no, me too, me too,okay, um, so, yeah, my, my
office in palm beach gardens.
We specialize in kind ofminimally invasive uh spine
(00:56):
surgery.
So less, less damage to the uh,the healthy tissues to fix the
problem and, in particular, I'minterested in motion
preservation.
So disc replacements,non-fusion options for patients,
which is certainly gainingpopularity.
People recover faster, get backto active lifestyles and have a
lot less side effects down thedown the line.
I trained in England, initiallyfor med school, a place called
(01:20):
Leicester, and then came overhere, did my residency at
University of Pennsylvania, myfellowship in HSS in New York
and then came down to Floridaaround 2018 and opened up my own
office about three years agonow cool.
Speaker 1 (01:36):
yeah, that's because we had met um up in Juneau at Dr
Daniel at one of his firstthere yeah, they had like an
open house thing, exactly rightand that was like right after
you opened, is that?
Speaker 2 (01:46):
right, yeah, that was uh.
Yeah, I was busy poundingpavements and just trying to
meet everyone in the areabecause there's a new area.
I moved up from boca raton and,uh, I had to meet all the all
the people up in the area.
Speaker 1 (01:56):
But yeah, that was then so you all, right, I knew
you were from london originally,right?
Let me tell by the accent ifyou guys can't tell.
But so you went to LeicesterMedical School.
What brought you over to US?
To think?
To go to University ofPennsylvania?
Speaker 2 (02:11):
It was.
I mean, the NHS is a socialistsystem and there were some
issues with that.
But the main issue I noticedwas the case volumes were just
decreasing.
It's not a very efficientsystem, so surgeons weren't
doing a lot of cases and theguys that were just decreasing.
It's not a very efficientsystem, so surgeons weren't
doing a lot of cases and theguys that were a few years ahead
of me in training didn't seemto be progressing and really
(02:31):
achieving what the guys five orten years before them were able
to achieve.
So it was kind of a decision ofdo I stay here and and
potentially extrapolate thattrend and just not be very good,
or do I go somewhere else andtry and become good at what I do
?
And that was what really drovethe decision-making Interesting.
Speaker 1 (02:52):
Did you always know you wanted to go to orthopedics
or spine?
Speaker 2 (02:56):
Not really.
It all kind of just happened.
In England the rugby boys allwent into orthopedics.
I played rugby, so I went intoorthopedics and then when I was
doing my orthopedic rotations, Ihad an Irish surgeon, dennis
Calthorpe, who did spine.
And we just got on and he justtook me under his wing and that
(03:17):
was it.
I was like I'll do spine.
Speaker 1 (03:19):
And was that during one of your rotations in medical
school?
Speaker 2 (03:24):
It was actually after medical school, so I was doing
some residency equivalent in theUK and worked for Dennis and I
was on his service for like sixmonths and we had a really good
time.
It made sense and I justenjoyed the surgeries and it
just kind of led from therereally.
Speaker 1 (03:38):
So, then, you started investigating residency
programs in the US.
Speaker 2 (03:42):
Yeah, I looked at a couple of options and canada and
the us were kind of top of thelist and ultimately the us was
probably the better fit.
It's easier surprisinglyactually to to match over here
as a foreign grad than in canada.
Canada's really closed, closedshop, um and uh.
And yeah then came over hereinterviewed.
Uh, I was lucky enough to getinto a good program in upenn and
(04:07):
it all just kind of led on toeach other really and was that?
Speaker 1 (04:10):
I mean upenn?
Yeah, it's a great institution,yeah I was really lucky.
Speaker 2 (04:14):
I just just got on well with the team there and and
they they, you know made a spotfor me and it went from there
that's cool.
Speaker 1 (04:21):
and uh, that first residency was it orthopedic
residency, orthopedic residency,and then you do fellowship for
spine, exactly so we do inorthopedics.
Speaker 2 (04:30):
you do spine as part of your general rotations and
you kind of do when you're doneyou're capable of doing spine
surgery and general orthosurgery like joint replacements,
fracture care.
But to get kind of the nextlevel of training, you then go
on to like a fellowship for ayear, uh and, and that was done
in new york at hss, which isobviously quite a well-known
(04:51):
place down here, and um, thatwas kind of where we learned
like the next level of really ofhow to treat spine care yeah,
and do you?
Speaker 1 (05:01):
is that specifically like cervical lumbar or lumbar,
or like the whole spine Top tobottom?
Got it, and then, right now,for your guys' cases like do you
see equally distributed likeneck and back.
Speaker 2 (05:12):
Yeah, probably 50-50, .
Pretty close actually.
I mean there's a little bit inthe thoracic spine, but for
various reasons you just getless pathology there.
Speaker 1 (05:21):
Yeah.
Speaker 2 (05:22):
Probably less than 5% in the thoracic spine.
The vast majority is in theneck or the the lumbar spine.
Um, you know, the books willsay it's 60, 40 lumbar favored,
but I think generally it's morelike 50 50 now, yeah, pretty
close like um, that'sinteresting and I remember we
had you had referred somebodyover.
Speaker 1 (05:41):
He was a young guy mid 30s who had like thoracic.
I tell the story on otherpodcasts that were just also
mentorship stuff with some ofthe fellows that we trained, but
he was like a young dude early30s and he had thoracic region
pain and it was weird.
It was just like this isinteresting, it's kind of
puzzling, and it was referringlike a dermal tunnel pattern
(06:03):
like across his rib cage and Iwas like all right if it's
neural, if it's musculoskeletalI'm thinking rib pathology, you
know core stability, thoracicspine mobility is important.
Look at the tlga, like thoracicthoracolumbar junction mobility
.
But anyway he's like I'm gonna,mri, just to you know, rule out
some stuff and he anyway hissymptoms were like it hurts when
(06:24):
he was sleeping.
He didn't feel good in general,like general lethargy.
I remember you're talking aboutnow, yeah, and then he we talked
, spoke on the phone and he wasgoing to mri.
I was like, hit me back, youknow, check out the imaging and
then hit me back and we'llschedule.
But anyway I didn't hear fromhim and I reached out.
I was like, have you heard fromthis patient?
You're like, yeah, he hadactually had a tumor.
Yeah, no, he did.
Speaker 2 (06:43):
Yeah, he's fine, he had an intradural tumor, I think
that was, um, just uh, yeah,it's unexpected.
Uh, certainly a young person,right?
Uh, he actually went up to newyork, I think to some of the
guys I trained with, to get itfixed.
We sent him up to uh sloancatering.
Have you heard from since?
Speaker 1 (07:02):
uh, I haven't, actually no with a young he was
in his early 30s.
Uh, somebody coming in withlike mid thoracic region, pain
hurts with breathing rightacross like the rib cage.
Yeah, um, but besides, likewhat other pathology?
What would be the, what wouldbe the protocol for that?
It's like, hey, immediatelyjust imaging, just to rule
(07:24):
things out.
Speaker 2 (07:29):
Yeah.
So I mean it depends on historyand duration.
So I mean the vast majority of30-year-olds with thoracic level
pain, it's going to besomething benign, nothing to
worry about.
So it's going to be a musclesprain.
They've been playing tennis,golf, something's happened.
But if it's not getting better,if it's interfering with sleep,
if it's been going on for awhile, then that's more of a red
(07:51):
flag and that's something morethat would send us towards
workup, towards.
Is there something more going on?
If the pain's kind of comingacross like a dermatomal
distribution, so it kind ofstarts in the middle of the back
and comes along and a rib uh ina line to the middle.
But that sounds a lot more likenerve pain.
So you maybe start thinkingabout is this a disc herniation?
Pushing on, pushing on athoracic nerve can even be
(08:14):
something uh unusual, like a umshingles flare.
I've seen young patients withthat.
I had one last week who uh hadsome uh pain raining down his
arm in his shoulder.
Everyone thought it was a discherniation and that the disc MRI
was negative.
That he came with and I askedhim to take his shirt off to
actually examine him.
He had a classic shingles rashall down.
(08:37):
And so we sent him to hisprimary care doctor actually to
get antiviral treatment, and itall got better Interesting.
Speaker 1 (08:44):
So besides before that, nobody does like take your
shirt off no, no, I mean he'd.
Speaker 2 (08:48):
He kind of came to me um slightly unusual.
He's a friend of a friend.
I saw him out, uh, when we'reout having drinks one night and
his friend was like hey, go gosee phil, he'll, you know, he'll
be able to help you out, figureout what's going on.
So he came to see me the nextday and uh had his mri already
and it it was reallyunimpressive and I just, you
(09:10):
know, by chance, asked him totake his shirt off, which you
don't often do, to be fair andhe just had this clear uh
dermatomal rash and it wasshingles, uh 100.
And now you got better, uh,just with um antivirals and a
bit of time interesting yeah, uh, yeah, that's super interesting
.
Speaker 1 (09:29):
And then with your.
So you did your fellowship withhss.
Were you employed with them atall?
Like, what did you do when youwork with them while, like right
after fellowship, or did youimmediately come down to boca?
Speaker 2 (09:39):
no, I came down here immediately.
My um, my wife, uh, is frombrazil and wanted to be done in
florida and, yeah, away from newyork.
Yeah, I mean when when we met,she was moving to miami.
But uh put that on hold becauseof me, and so we we made the
deal that you know, if we werestill together at the end of
training, we're coming down todown to florida and, and so I
(10:01):
had to keep keep that deal.
So we came down here, I joineda group down in Boca and it was
a good experience, butultimately I wanted to do
something a little bit differentand be my own boss, and that's
what led that to change in aboutthree years ago now.
Speaker 1 (10:18):
What things different ?
Speaker 2 (10:21):
I tend to run a lower volume practice.
So I mean, I guess the term downhere is concierge, but it's
kind of more lower volume out ofnetwork and able to spend a
little bit longer with thepatients where I was before.
It was a good practice, but itwas.
It was a volume volume play.
Basically had to see newpatients every 15 minutes and
(10:44):
it's hard to examine someone,take their shirt off and you
know, talk to them about surgeryin 15 minutes and then do your
documentation, yeah, and youknow if people have questions,
if they've got, um, you know alittle bit of understanding that
they're going to have a lot ofquestions before you operate on
them and it becomes challengingto do that, and so the the goal
(11:07):
was to run something a littlebit more like yourself, where
you're able to focus more on youknow individual, what's
actually going on with them,what the right thing to do for
them is, rather than just youknow this is what we do, this is
what we do, this is what we dogive me, uh, what give listeners
an idea of, like, what if a newpatient came to see you, right?
Speaker 1 (11:27):
hey, I'm dr seville nice to meet you, right?
It's day one.
What does that first dayusually look like?
Speaker 2 (11:33):
I mean it depends really.
I mean ideally they've had anmri, uh, already.
So it could be a more, morefruitful discussion if, if they
come in with you know symptomsand mri, then yeah, it's going
to be a more, more fruitfuldiscussion.
If, if they come in with youknow symptoms and mri, then yeah
, it's going to be like 25, 30minutes.
We'll go through exam, lookingat the imaging, talking about
what the options are, dependingon what they've done already.
We may go for some injections ifthey come fresh and have had
(11:56):
nothing done, if they've done aload of injections already.
This has been going on formonths and they're kind of
getting to the point now wherethey hey, like let's just get
this fixed and we start talkingabout surgery.
To the point now where they hey, like let's just get this fixed
and we start talking aboutsurgery.
And it really depends where inthat spectrum these people come
in.
You know some people come inhaven't dealt with this for
years and done injections foryears and injections stopped
working.
Other people that you know theytweak the back two weeks ago
(12:19):
and and you know that's clearlynot a surgical talk, that's
that's more of a let's trysomething to settle this down,
maybe get you over to see Kyledo some therapy, and then we go
from there.
Yeah, yeah, gotcha.
Speaker 1 (12:29):
And then exam-wise what would people expect when
you do an exam on somebody Likerange of motion?
Speaker 2 (12:37):
Yeah, so it's range of motion, the neck, the lumbar
spine.
Then we look at you knowpainful motions, you know.
We look at you know painfulmotions, you know.
Does it hurt when you'rerotating, when you're looking up
, looking down?
Then we start looking at theindividual muscles which are
supplied by the nerves in thearea.
So in the neck, we're lookingat the arms, looking at the
shoulders, the biceps, thetriceps, the hands, the wrists,
looking to make sure there's noweakness associated with nerve
(12:58):
compression.
Right, check the sensation.
Again, each patch of skin issupplied by individual nerve
roots from the neck or the lowback, and so we test each of
those, check your reflexes inthe neck, we'll often check
balance and coordination.
A lot of people are surprisedto know that compression on the,
the spinal cord, may bepainless but can affect your
(13:18):
balance and coordination.
So that's something we alwayslike to check, especially on the
neck patients.
Right, like cervical myelopathy.
Exactly myelopathy is whatwe're looking for in that case.
Um, and, and that's that really.
Again, it's kind of tailoreddepending on what's going on
with that.
Uh, yeah, someone it's just gota little bit of back pain when
they're golfing and it's on thekind of the follow-through and
(13:39):
we're probably not going tomaybe do quite so much.
Speaker 1 (13:42):
On then on someone who's come in with with more
neurologic symptoms gotcha andif something come in
neurological symptoms, um, whereyou're discovering, like
testing, myotomes and dermatomes, like weakness in the hands and
arms, um, leaning more towardsand they've had pain for a long
time then you're talkingsurgical considerations and that
you guys are.
Speaker 2 (14:02):
You said you're leaning more towards, like, as
an example, if needed, discreplacements over instead of
fusions yeah, so discreplacements are something that
have really become a lot morepopular over the last five to
ten years.
Uh, you look at initially, uh,around 20 years ago when they
started being put in, they werebeing put into very young
patients who had no degenerationin their neck or the low back
(14:26):
and they were for for soft discherniations, which is kind of
what we describe an acute discherniation without any
degenerative changes.
Certainly over the last fiveyears that that has kind of
changed a lot.
And now really quitedegenerative necks that we would
not have put a disc replacementin 10 years ago and now
becoming candidates for discreplacements.
(14:47):
The advantages of a discreplacement over a fusion are
pretty well known and wellstudied now.
You have a lot less pain.
You maintain range of motion.
You have less revisionsurgeries at the level of
surgery and at the adjacentlevels.
So if you have a fusion in theneck or the low back, you end up
transferring motion at thelevels above and below, so they
(15:09):
try to maintain your range ofmotion, so they work twice as
hard, which means those discsthen wear out and so you end up
chasing yourself up up the neckor the low back with further
surgeries and I think you knowmost listeners will have known
someone who had a surgery andhad another surgery, had another
surgery in their back andit's's kind of not a great story
right?
Everyone always is worriedabout that, whereas with disc
(15:31):
replacements we see that that'snot the case.
You have far lower rates ofadjacent segment wear out and
less surgeries at the indexlevel as well.
Speaker 1 (15:40):
Interesting, interesting with uh disc injury,
right, what would cause like anacute, non-degenerative type of
a disc soft disc injury, likeyou said it?
Speaker 2 (15:54):
can be anything.
Um, I mean, it's nice whenthere's a like a clear
precipitating event.
So you know you lean forwardsto pick up something heavy, you
feel a pop in your back.
That story is nice and everyonekind of agrees and understands
that's when it happened.
But often that doesn't happen.
You can have like just a discthat's been injured years ago.
(16:15):
It's hanging on by a thread andthen one day it just goes.
It can be when you sneeze, whenyou roll over in bed, and it
can be something so innocuousthat starts it.
The way to think about a discis it's really made up of two
layers.
You have the outer layer, whichis like a thick car tire it's
rubbery and the inner layer iskind of like a gooey crab meat
type material and so it workswell together as like a shock
(16:37):
absorber.
And when you have a discherniation what happens is that
outer layer gets a hole in itand so the crab meat can squeeze
out, pushes on the nerves andit really can be like you hurt
your back playing football or atthe gym 10 years ago and it's
just hanging on and one day thatthread just goes and then you
get some disc squeeze outinteresting.
Speaker 1 (16:59):
Um what, what evidence?
Or like what do uh cause?
People will ask me like dodiscs heal?
What have you?
Speaker 2 (17:06):
found in the research for that.
So it depends what you mean byheal.
So if you injure a disc, itwill break down.
Unfortunately, the disc doesn'thave any real blood supply, so
it doesn't have a tremendoushealing potential.
And once you injure a disc itwill go down a degenerative
cascade, but that may or may notbe painful and a lot of people
(17:28):
will come in and they will havevery degenerative backs or necks
and they have no symptoms.
And that's just because somepeople go down this cascade
where it's not painful and otherpeople go down this cascade
where they have a lot of backpain and there's some genetic
component to that and I don'tthink we entirely know that yet,
but it's certainly.
(17:49):
Some people have no pain, somepeople have a lot of pain.
If you're getting a lot of lowback pain and we look at the mri
and you've got one or two ofthese worn out discs at the
bottom of the back then andyou've tried all the other
things like the, the therapy tostrengthen the core, the
injections and all these thingsaren't working, then you may be
a candidate for a discreplacement where we scrape out
(18:09):
the disc and we put a new one in, and in my experience, patients
have been very, very happy withthose and do very well return
to activity.
I mean, we have several videoson our website now of young
patients who couldn't play withtheir kids, couldn't lean over
to pick them up, and now they'reback playing sports with their
kids, which is what they youknow they want to do it's
(18:30):
amazing.
Yeah, yeah, it's, it's been,it's been really changing, for I
think spine surgery, that thearthroplasties, and that's still
what's the with the invasivenature, like with our, it's
arthroscopic no so.
So disc replacements in thelumbar spine we do with an
anterior incision okayinteresting we we make a
transversal, vertical incision,depending on the level, and we
go between the um, the abdominalmuscle, the abdominal muscle,
(18:54):
so we're not cutting musclegoing through the tendon in
between which we can stitch andheals well.
And then from the front we havean approach surgeon, a vascular
surgeon typically, who movesthe uh, the blood vessels, and
the, the peritoneum, the, thebowels, out the way.
So we're looking straight atthe spine and we just scrape out
the disc, open up the nerves ifthere's any compression on the
nerves and then put the new discin um.
(19:17):
It takes about an hour, maybean hour and a half if you're
taking a bit longer for a singlelevel.
Speaker 1 (19:22):
Would y'all do multiple levels at once?
Speaker 2 (19:24):
yeah, yeah, I would do two.
Two is typically at once, oneor two um three can be pushing
it through a lot, but usuallyit's one or two.
Speaker 1 (19:31):
Level pathology so a two level would be like two
levels at the same time.
Speaker 2 (19:35):
Hour and a half surgery hour and a half to two
hours.
Speaker 1 (19:38):
Yeah, interesting so there's two surgeons in there
the same like you, and then avascular surgeon, correct?
Speaker 2 (19:44):
yeah.
Speaker 1 (19:44):
He moves everything out of the way.
Speaker 2 (19:45):
Yeah, so it's interesting it depends where you
train.
In Europe a lot of the spinesurgeons will do their own
approaches In the US for mainlymedical legal reasons.
There's an approach surgeonthere.
I think on balance it makessense because the real risk is
if you injure one of the bloodvessels when you're exposing the
(20:08):
spine and to have thespecialist to fix them there.
That just makes sense.
Speaker 1 (20:13):
Yeah, for sure.
I mean the descending aorta.
Where does it split into thecommon iliac artery?
Is that correct?
Speaker 2 (20:26):
the common iliac order.
Is that correct?
Yeah, so it's variable um.
I'll tell you that l5, s1 isdefinitely not split there, so
you've got a wide open window tothe bottom level.
L45 is usually around the levelof the bifurcation and it
actually tends to be the vein.
That's more of an issue becauseit's it's less um, less robust,
so it doesn't take me flimsy'sflimsy, yeah, yeah.
So four, five is technicallythe harder level to get, and so
(20:48):
it's essential to have a goodapproach surgeon, which we're
blessed with several in the area, and then, above that, l34 is
actually easier, again, becauseyou're dealing without the
bifurcation there.
So four, five's the the hardlevel interesting.
Speaker 1 (21:01):
Uh, if it does, if an accident happens like that and
the vascular surgeon is there torepair, is it just a quick
stitch Like how's that work?
Speaker 2 (21:10):
Yeah, I mean typically, yeah, If.
If we're doing these regularlywith with experienced approach
surgeons, it's usually like asmall branch of the vessel pulls
off.
Oh, I see.
And so it's just a small stitchand it's an easy fix, but not
the trunk, yeah, basically.
Speaker 1 (21:26):
And I'm actually super and I'm sure it's super
uncommon.
Speaker 2 (21:30):
Yeah, Very, very uncommon.
I mean it happens a couple oftimes a year, it's not.
It's not like it's every weekwith vessel injuries.
That would not be.
Speaker 1 (21:37):
But that's really, I mean, that makes a lot of sense.
That's also, I'd imagine, veryum uh, makes people feel more
secure.
Speaker 2 (21:44):
Yeah.
Speaker 1 (21:44):
Having two surgeons on hand right there doing it?
I think so.
Speaker 2 (21:47):
And and it's, I think it just makes sense.
It makes me, uh, feel a lotmore comfortable having the
specialist there to get it allready for me, and then I can
just focus on getting the discin right, and he just focuses on
the blood vessels.
So it just makes sense.
Speaker 1 (22:04):
Yeah, that's good.
Do the best job possible.
Yeah, so, patients, you don'tgo through the abdominal muscle
tissue, you go through thetendon that heals up quick with
a stitch and then physicaltherapy after that.
Like what do you all recommend?
Speaker 2 (22:19):
So for the first uh week I asked them to wear a back
brace, just when they're upwalking around, just because the
bone grows into the implant soit becomes part of them, and
that takes a few weeks.
You can't really speed that up,yeah, and then they're just
walking for the next six weeks.
Okay, once they get out to sixweeks we start to use the
elliptical, the stationary bike.
Then once you get out to threemonths, you can go back to full
activity at the gym.
Now we'll start some gentle PTaround six weeks.
(22:40):
Got it?
Okay, we don't want to crank onit.
You don't want to dislodge theimplants because then you're
going to have to go back in andredo it.
So you just got to wait and bepatient while the bone grows
into the titanium which theyspray the ends with mimics bone,
so the bone grows into it.
It looks like bone to bone andso it makes this solid bond too.
(23:01):
That's really cool, yeah, it'scool.
And the neck similar.
It's an anterior incision inthe neck.
Usually hide it in one of thesecreases that most of us have
and we just go between themuscles here, so we're not
cutting any muscle again.
And the same thing.
That and the same same thing.
That's done usually just by me.
(23:21):
There's no approach surgeon upthere um the uh, the vessels
aren't such an issue therethat's good, and the the trachea
also.
Speaker 1 (23:27):
Yeah, so you just move that away yeah, it's all.
Speaker 2 (23:30):
It all moves very easily out the way.
I mean the issues up in theneck.
Some people will have a littlebit of a sore throat for a few
days afterwards.
Um, but it usually settlespretty quick and we put them in
a collar again for a week.
They take it off to sleep justwhen they're up, walking around
really, um and similar.
No lifting anything heavierthan a gallon of milk for the
(23:51):
first six weeks.
Then six weeks you start doinggentle therapy, gentle um
activity with the elliptical,the stationary bike, and then at
then at three months you'reback golfing, tennis, full go
yeah.
Speaker 1 (24:03):
Do y'all do multiple levels at this neck, the same
way as the lumbar spine?
Pretty commonly?
Speaker 2 (24:08):
Yeah, yeah, so frequently we're doing like
three levels at the same timenow in the neck.
It's not uncommon.
Speaker 1 (24:13):
Interesting Timeframe .
How long is the surgery forthat?
About an hour level typicallywhat we recommend.
Oh, okay, gotcha.
Speaker 2 (24:21):
So three hours for three levels or two hours for
two levels.
Speaker 1 (24:24):
And what are the most common levels?
You guys usually do Five six.
Speaker 2 (24:29):
Yeah, four to seven is probably the most common, and
I think five, six and six,seven are the most common too.
Speaker 1 (24:36):
Interesting, yeah, and that makes sense from what
we've gathered've gathered yeah,it's to do with the angulation,
the shear.
Speaker 2 (24:42):
So um the the five, six and six, seven are at the
most angle, so they see moreshear force.
Those discs tend to wear outfaster.
Discs don't do very well undershear.
That's similarly why the fiveone wears out the fastest in the
low back.
Speaker 1 (24:55):
It's just it's the most sheer yeah, you had
mentioned um to me in the pastabout uh like a multifidus
muscle stimulator post-op orjust for back pain.
Speaker 2 (25:06):
Yeah, so that's the reactivate uh device.
Um, it's interesting, it's didvery well in clinical trials so
it had um around like a 70improvement in people with this
chronic low back pain withoutany real surgical target.
I think in practice most peoplefeel it's not quite as
(25:30):
successful as that.
It's probably more like 50-50.
I think it's useful in theolder patients who have had a
lot of muscle wasting.
And I've implanted in a fewpatients who have had scoliosis
and with just back pain, nonerve symptoms, no neurologic,
just pure back pain, and wherethe fix would be a 7-8 level
(25:54):
fusion, which is a pretty bigsurgery and not something that
they were either medically ableto undertake or had the had the
desire to undertake.
And so we've implanted in thosepatients and I think we've
we've had good success withthose um.
Certainly their back pain'simproved.
They've avoided a much largersurgery.
There's some uh thinking thatthe multifidus muscle, which
(26:15):
stabilizes the lumbar spine,when you have a painful stimuli
it turns off.
It's a reflex muscle.
It's not one that you can just,you know, do a bicep curl to
strengthen.
It's one that yousubconsciously contract and it
stabilizes the spine by bygiving you a solid base.
So now, if you've got a baddisc, you've got a bad joint in
the lumbar spine.
If you were to compress itwould hurt.
(26:35):
So your body doesn't do thatand over time, when that
insult's gone away, so it's nolonger painful, that muscle
doesn't turn back on, and so youhave this instability in the
back, which which causes somepain.
And so this, this um device,stimulates that muscle for 30
minutes twice a day and there'ssome neuroelasticity where you
re-innovate that muscle and itstarts to get back under the
(26:58):
reflex control from the spine.
And I say it's certainlyinteresting.
I don't think we've got all theanswers yet for it, but it
certainly is another tool in thetoolbox, right, yeah yeah,
exactly what of the discreplacements, or just like a
debridement discectomy?
Speaker 1 (27:18):
I'm sure you guys do a lot of that too.
Speaker 2 (27:19):
yeah, so I do a lot of just disc herniations, uh,
decompression.
So if you've got really no backpain, mainly leg pain, uh,
going down down the legs whenyou walk or when you're standing
up, um, then yeah, you reallyjust want to remove the
compression on the nerves and soyou do that a couple of ways.
If it's a younger patient, ittends to be a disc herniation.
(27:40):
So you just make a smallincision, remove that fragment
of disc, leaving the rest of thedisc behind, take the pressure
off the nerve and the pain goesaway.
I'm sure we've we've hadpatients with that do very well.
It's a finger width incision,um, and takes, you know, 40
minutes probably.
If it's an older patient wherethey've got more arthritis and
it's more of a stenosis typepicture, well then you have to
(28:02):
kind of do a little bit morework.
The same size incision takes alittle bit longer, more like an
hour, hour and 20 minutes andyou're kind of removing some of
the arthritic bone and some ofthe hypertrophied ligament
that's compressing on the nerves.
Both do very well and you'reavoiding a fusion, you're
avoiding any metal being put inthe back, which is great.
Speaker 1 (28:24):
Would that be the ligamentum flavum?
Speaker 2 (28:26):
Is that the main one?
Speaker 1 (28:28):
Exactly the flavum.
Yeah, describe to people whatstenotic changes mean.
Speaker 2 (28:35):
So stenosis just means narrowing, I mean, I think
the way to think about it iswe're just like plumbers
essentially.
The spinal canal is a big, longpipe and the spinal cord and
the spinal nerves run through it.
As you get older and thearthritis in the joints, the
facet joints in the spine, andthe disc starts to degenerate
(28:56):
and bulge, it starts to narrowand you get these kinks in the
pipe, the pipe, and so the thenerves get pinched and the the
signal, the flow doesn't go downthe nerves very well.
So all we do is go in there andjust basically, like a rotor
router guy that cleans out yourtoilet, we just open up the
nerve shave off the um yeah, sotrim the ligament, shave some of
the arthritic joint sometimesit's discs, because we remove
(29:19):
some of the discs.
It really depends on on, youknow, when you look at the MRI,
sometimes it can be a cyst.
You can have a cyst from one ofthe uh facet joints and in that
case we just remove the cystand and uh and open up the
nerves between uh this,discectomy and debridement,
decompression and anterior discreplacement.
Speaker 1 (29:39):
What do you find yourself doing?
More like most most often um inthe lumbar spine.
Speaker 2 (29:44):
I think we probably still do more decompressions um
than than disc replacements.
Some of that's the populationdown here.
I mean we have an olderpopulation.
They're not all necessarilycandidates for disc replacements
, but disc replacements growingum.
Some of it's just patientawareness.
Uh, we're getting more and morepatients I've been told they
have to have a fusion coming inand being told well, actually,
(30:07):
no, you, you're probably acandidate for disc replacements.
I think over the next few yearsthat number's going to change,
you're going to continue to goin that direction?
Speaker 1 (30:13):
I think so, yeah, interesting.
Uh, what do you do for your ownback?
Uh, like, how was your back?
Speaker 2 (30:20):
it's surprisingly good.
Actually, I played rugby and uhother silly things when I was
younger um well, rugby's fun.
Speaker 1 (30:29):
It's not silly, right like sports.
Speaker 2 (30:30):
Yeah, you pay for it in the long run, exactly I mean
I try to stay in shape, which isI've got two young kids and a
busy practice.
I'm not doing quite as well asyou at that, it seems, but
that's always a goal.
Speaker 1 (30:45):
For practice management, oh man.
Speaker 2 (30:46):
No, staying in shape for me.
Speaker 1 (30:49):
Oh well, I'm trying, you know.
It makes it easy when myclinic's a gym.
You know I have no excuse atthat point.
Speaker 2 (30:55):
Yeah, maybe I'll need to put a gym in my office and
something like that.
But yeah, I mean just trying tostay in shape, work on the core
strengthening.
Putting on weight, especiallyfor men, is bad for your back.
We tend to carry the weight outin front and that just puts
extra force on the low back.
Women tend to put it more lowerdown, more pear-shaped, and
that tends to be lessproblematic for back pain.
Speaker 1 (31:18):
Yeah, yeah, yeah.
But yeah, I mentioned with yourwife because we had worked
together for some stuff a littlebit, and she's doing her the
med spa, the re-spa, which we'lltalk about in a sec too.
She was saying that you guys doyou all work out together at
Tremble or the kickboxing?
She goes to Tremble.
Speaker 2 (31:39):
Sometimes we tremble, or the kickboxing, or is that
only she goes to tremble?
Um, sometimes we'll go to likelifetime together and just just
work out there.
I tend to go to there.
I do a little bit of um likejujitsu mma at a local gym, just
something to, to learnsomething new and challenge
myself really keep it fresh yeah, because it gets a bit boring,
just kind of lifting weightsevery day yeah, that's one of my
goals.
Speaker 1 (31:57):
You know, I have never really done any MMA.
I did some kickboxing a littlebit back a little while ago, but
because I think it's just alsofun like to get some aggression
out and like hit some stuff yeah.
Speaker 2 (32:08):
I mean I'm pretty lucky there's a gym really near
our house.
I found them during COVIDbecause everything else was shut
and he was still running itbecause it was kind of I guess
he had different rules becauseit was a smaller, smaller
business and it was onlyone-on-one and he was like, hey,
look, if you're okay with it,I'm okay with it.
And I was, yeah, let's give ita go.
And I've been going and youknow when I get busy that gets
(32:29):
cut out, unfortunately myschedule.
But I need to see I'll comeback there more.
But it's excellent.
It's really really challenging.
He does a lot of like bodyweight stuff, movement stuff, so
kind of bear crawls and hopsand stuff like that to try and
work coordination.
It's just stuff you don't do asan adult anymore.
Yeah, I think that stuff'simportant yeah, I uh.
Speaker 1 (32:47):
No, I definitely have visions of trying to get into
jujitsu or muay thai orsomething.
You know it's humbling, that'swhat I've heard.
Speaker 2 (32:54):
Yeah, it's um, I mean , I'm pretty strong and used to
doing physical stuff and uh,yeah, you lose every time so
people like have your size.
They're like yeah old peoplethat you are like this guy
should be no challenge and they,they destroy you every time.
(33:15):
That's funny.
Yeah, so, but that's good,though.
Speaker 1 (33:17):
Yeah, get get ready for that.
It's definitely humbling.
What so are you doing Brazilianjiu-jitsu or what's-.
Speaker 2 (33:25):
Yeah, I think that's what they describe it as.
Speaker 1 (33:28):
Where are you right now?
On like your journey with yourbelt.
Speaker 2 (33:30):
Oh, it's not.
I'm not doing any belts oranything like that, it's more
just kind of casual Gotcha.
I'm casual gotcha.
I mean I'm sure we could gothrough gradings if we wanted,
but yeah no, it's more justsomething to do for fun.
Yeah, that's cool but also Imean, like you know, and I think
a little um self-defense andconfidence yeah, I mean, I used
to do karate when I was younger,and so it's kind of something
(33:51):
I've always done and been around, um yeah, but it's definitely,
um, definitely interesting.
Speaker 1 (33:57):
It's definitely something, something good so,
besides, all right, anythingelse, what?
So?
What would you recommend, likefrom the patients that you've
seen in success stories, forpatients that have had battling
back pain and you're you did adecompression on them or, um,
maybe not even doing that, butyou're like, definitely need to
do this to help your back.
I mean losing weight.
Speaker 2 (34:17):
You said, I think losing weight, I think
definitely doing some therapy orjust strengthening your core,
whether you do that with yoga,uh, yourself just doing planks,
or with directed therapy orsomeone like yourself.
I mean, I think those are thesimple things that you know you
should be able to try yourself.
If those aren't working, ifyou're still battling back pain,
(34:38):
then I think you need to get anMRI and see someone and you
know whether that's injectionsyou try next or other options
really comes down to what'sgoing on, how bad it is, you
know.
If this is, you know it achesonce a year.
If you do a little bit too much, well, yeah, then it's probably
not worth doing too much.
Speaker 1 (34:56):
I was going to say much.
Well, yeah, then it's probablynot worth doing too much.
It doesn't say, like patientsask me.
Well, I'll frequently like atwhat point do we get an mri?
Speaker 2 (35:03):
what do you recommend for that?
So if you're getting neurologicsymptoms like pain down the
legs, weakness in the legs,heaviness in the legs, then yeah
, definitely time for an mri.
If it's just back pain, I mean,the red flags are if you're
having weight loss, if youyou're having night pains that
wake you up, then yeah, youshould get an MRI to make sure
it's not cancer or somethingserious that we're missing.
(35:25):
Otherwise, it just comes downto quality of life.
If you're getting to the pointwhere you can't do what you want
to do, then I think it's timeto think about getting an MRI.
Take some action.
Yeah, and those goals aredifferent for everyone.
You know some patients come inand they're frustrated because
(35:45):
they can't do two iron men inthe same month and other
people's goals are.
You know, I want to be able towalk to the fridge, get some
food and sit down and and you'vegot to understand, like, what
everyone's goals are and that'sdifferent for everyone.
And that's one of theadvantages of having a slightly
lower volume practice is youhave the time to figure that out
and talk to them and understandwhere they're trying to be and
(36:06):
where they are now, Becausethat's really it's unique and
it's different for everyone.
Speaker 1 (36:11):
Yeah, it's interesting.
You say like I'm battling someback pain, I ran it.
Like I'm saying, like I get apatient that comes in, I'm
battling some back pain.
I ran it.
Like I'm saying like I get apatient that comes in, I'm
battling back pain I've had, orknee pain, whatever.
I ran an Ironman, I'm trainingfor another one, I have a
marathon coming up next week.
Yeah, I mean, we get that.
That's awesome, you know.
Speaker 2 (36:27):
Hey, I love the enthusiasm you know we get them
and then we get the other people.
Minutes, my back hurts andyou've got to try and figure out
.
You know what they're lookingfor and what's realistic.
Because you know if they'recoming to you because they want
to be able to do do that secondiron man in the same month and
(36:47):
you know the goals are it'sgoing to be hard to make that
goal, yeah.
But if they're just coming tosay, hey, look, I just can't
stand anymore, then then youknow, I think your, your runway
for success is much clearer.
Speaker 1 (37:00):
Yeah, you mentioned red flags.
Speaker 2 (37:02):
Explain to people what that means, so red flags
are symptoms that should warnyour, your provider, that
there's something more seriousgoing on, and and would prompt
um more investigation.
So you know, classically weworry about back pain.
(37:23):
As you know, is this amanifestation for cancer,
because a lot of cancers dospread to the back, and so you
know people that complain of,you know, just increasing pain,
pain that's just out ofproportion.
So you know people thatcomplain of, you know, just
increasing pain, pain that'sjust out of proportion.
So you know you can't function.
Pain that wakes you at night,um, and if you're having weight
loss, these are all things thatthat would make someone
(37:44):
concerned that this is more thanjust simple back pain, and so
we should get a goodinvestigation.
Other things that go along withit are, you know, night sweat.
So if you have your okay duringthe, but at night you're
profusely sweating, well, thatmay be an indication that
there's something more going on.
It's either hematological oreffective, and so that's
something that we should bump upto the red flag for let's get
(38:04):
an MRI and make sure it's notanything serious before we just
say this is back pain.
Speaker 1 (38:08):
Right, like you're good, let's just work on this,
just to rule things out and thengo from there.
Exactly, yeah, and we've had acouple mutual patient success
stories.
People have come in One of them, I think, is coming in tomorrow
to see me again, but just forcontinuous stuff.
But they're like man, I feelamazing.
(38:29):
I feel a lot better.
I think they just had adecompression, just from what
I'm thinking in particular.
The other one's very similaractually.
She actually just texted metoday.
I'm not going to say theirnames, but both of which had
just decompression surgery andthe incision's like literally
half an inch long.
Speaker 2 (38:48):
Yeah.
So I mean, what's differentabout the way we do a
decompression as opposed likethe?
The standard is I do it througha tube, so the tube is about 16
millimeters in diameter, abouthalf an inch the width of my
finger, and so what we do is Imake an incision and we put this
hollow tube down to the spineand then I work through that
with a microscope, with specialinstruments and the.
(39:10):
The more classic way is youmake a bigger incision, you
strip all the muscle off thebone and push it out of the way,
so you're looking at the spine,so it's obviously a lot less
damaging yeah and a lot lesspainful, and the reason for that
is most of the pathology in thespine focuses around the disc
level.
So if you imagine the spinesbuild up of vertebrae stacked up
(39:31):
on top of each other andthere's a disc in between,
either through an evolution or adesign flaw, depending on what
your beliefs are, what tends tohappen is at the level of the
disc.
You've got the joint which canbecome arthritic and expand into
the spinal canal.
You've got the disc which, asit ages and degenerates, will
tend to bulge into the spinalcanal.
It's like if I go let the airon your car tires, the car sinks
(39:53):
down right.
Well, the tire bulges into the,into the spinal canal, so that
that creates problem and theligament of flavin, which you
spoke about earlier, also uminfolds at that exact level and
hypertrophies as it gets moreunstable as the disc breaks down
.
So you're trying to stabilizethe segment.
So all those pathologies justline up at this same level and
(40:16):
you'll see on the MRI, if youlook at it carefully, that
you'll have narrowing at thelevel of the disc and then as
you go up the vertebrae it opensup and looks normal and then it
narrows again at the disc aboveand you can repeat it to the
pathological normal level.
So you just really need to goin and address that that little
level.
Speaker 1 (40:32):
You don't need to strip the whole spine, you just
need to target the levels whereit's narrowed and open them up
interesting, uh, the, and withthe tube that you and like the
incision, are you able to move alot of the muscle out of the
way?
Or do you have to go throughthe multifidus or the right,
your spinning group?
Speaker 2 (40:51):
yeah, so you, you go through the muscle, um, so you,
but you're going through thebody of the muscle and the
muscle fibers run longitudinally, so you end up just splitting
between the fibers.
So you're not really cuttingthe muscle, you're not removing
muscle, um, you're certainly notdetaching the muscle from the,
from the bone, which is theimportant part, whereas if you
go midline, the more classic wayof doing it, then you have to
(41:12):
strip the muscle off the um, offthe bone, and you often
actually de-innovate it.
So the segmental branches, thenerves, and as you're stripping
the muscle off, you're going toend up damaging those, and so
the muscle becomes de-innovated.
Speaker 1 (41:25):
Interesting, yeah um, wasn't it like another
interesting one of thesepatients I was describing doing
really well?
Um, they had decompressionbecause they had pain in their
leg and then also sensory.
Their sensor was affected right, it was less sensory and then
she had a lot more pain down herleg, down her ankle and her
(41:46):
foot and she was at footweakness.
They had decompression surgerybut the residual nerve
involvement still lingers for acouple, like for several weeks,
you know yeah, I mean.
Speaker 2 (41:57):
So if you're actually getting weakness in the ankle,
the foot drop, um, that thatdoesn't always come back.
So depending on how weak it is,uh, we grade it out of five.
Um, if you've still got somestrength, kind of like a three
or four out of five power, it'llprobably come back.
But if you start getting downto the ones or the zeros where
(42:17):
there's really no motion, it'skind of 50 50.
If that comes back and that'sjust due to the, the nerves been
injured and it has to regrowalong the, um, the, the sheath
of the nerve, the, the myelinsheath, which is what coats the
nerve, like an electrical cable.
Unfortunately it grows reallyslowly, about a millimeter a day
, and by which point the, themuscle, may no longer be
(42:40):
receptive to the nerve once itgrows back in and in, the, uh,
in respire, which which you kindof touched on just now.
We've actually got someinteresting technology there
called the m sculpt and we'vebeen using that in these
patients that come in with thisweakness.
This foot drop, either in thelegs or in the arms we have some
arm weakness as well but westimulate the, the muscle
outside the body.
(43:01):
So we use like a, an electricalplate and it gives them like 20
000 contractions in a 30 minutecycle and uh, and we've been
finding that actually that keepsthe muscle ready.
So when the nerve finally doesgrow back in, you're actually
getting higher recovery rates.
It's actually pretty, prettyexciting because it can be
pretty debilitating if you can'tlift your ankle up, you, you
walk funny and you trip on itand it's a problem.
(43:22):
And we were actually part ofthe fda study for approval for
this device because it'sactually used in the um, in the
body sculpt, in the beauty world.
Initially that's what it'sdesigned for and that's what
it's sold as.
But the the company has startedto realize, as as more and more
orthopedic surgeons have beenbeen using it, actually there
may be something here for rehab,and so it's now got approved
(43:44):
for post-op rehab, so for likeknee replacements, hip
replacements, to try and regainthe muscle that's injured and
damaged during those surgeries,and similarly after spine
surgery for like muscle weaknessas well.
Yeah, and we've had really goodresults with that that's
awesome.
Speaker 1 (43:58):
Um this and this patient.
I was saying like I wouldimagine, like the expected um
protocol, like expectations ofdevelopment, if somebody's been
battling like a kind of a severeit's been going on for a couple
months like nerve referred pain, they would still have some of
that after surgery.
(44:19):
It would just take a little bitof time for that to come it
varies, it varies.
Speaker 2 (44:24):
So what do you find with that?
Often the leg pain issignificantly better immediately
after surgery or more like,depending on which site you're
operating on.
They may still have a littlebit, but it's a lot better at
some point during the recovery.
As the nerve heals, it becomessuper sensitive.
So they may have a return ofthe pain, usually around two
(44:45):
weeks after surgery.
But that's variable and it'sjust due to the fact that as the
nerve heals it becomes supersensitive.
So stimuli that should not bepainful, like your clothes
rubbing on it, the bed sheets,someone touching it can generate
pain and some people say theyfeel like ants on the skin, they
feel fire or just pain, andthat can variable.
It doesn't always happen, butdefinitely can happen.
(45:06):
The sensation loss tends to beslower, so it'll often be better
after surgery, but that cantake a few weeks or months to
fully resolve and it doesn'talways fully come back.
So you may have some numbnessin the tip of the toes or
something like that which neverreally comes back unfortunately.
Speaker 1 (45:22):
Yeah, yeah, we have another patient that um has been
badly hit.
This person had a stroke and uhand also back pain and had
referred like sadicus typesymptoms on their leg and foot
drop because of that.
But the stroke wasn't relatedto his foot and this part, like
(45:43):
he.
We've been working this similarkind of thing with m sculpt and
working on foot strength andstuff and just reactivation.
It's getting better, which iscool, and he's older, you know.
So, my god, the ceiling ofexpectation here is a little
lower than somebody maybe whoyeah definitely would be in
their 20s, you know, but anyway,um, and residual like toe, and
he like foot numbness, um, butanyway, previous to that he on
(46:06):
the other leg had a similarthing going on and he said after
two years all of a suddenturned a corner and his
sensation returned it's 24months post yeah, like there's
the beginning of this pain.
It'd be developing unusual butyeah it's super, anyone's like
because it's interesting.
I would agree with you like itseems like most times it's like
there's a lower ceiling at thispoint, depending how involved it
is, and then randomly get somepeople that's like after like an
(46:29):
18 to 24 month period, for somereason just came back.
Speaker 2 (46:32):
I mean, there's a lot we still don't know.
There's definitely some.
I think it's super interestingin the brain that there's some
like ability to rewire.
Some people have more more thanothers.
Um, I mean, there's definitelysome degree of the longer the
compression on the nerve beforesurgery.
You know we arbitrarily havethis one year cut off, that you
do better after less than a yearor worse after a year, but it's
(46:56):
definitely a continuation.
So you know, six months isprobably worse than three months
and 18 months is worse than 12months.
Yeah, yeah, um, but there'salso this individual variation
that some people are just ableto heal nerve tissue better than
others and interesting it is.
It really is unpredictable andit's always hard to explain to
some patients that, look, you'rejust in the slower recovery
(47:18):
group.
I think we're going to getthere, but it's going to take a
little longer.
Yeah, and and you know mostpeople understand that but it
and they'll say oh you know, Iheal slow.
Anyway, you're off to othersurgeries and usually that's.
They kind of have this likehistory of just slow healing.
Speaker 1 (47:33):
Yeah um, so that's about respawn.
So you guys in your office, uh,where you do your consults and
your clinical, you also havelike a med spa type facility so
it's more like a functional medspa.
Speaker 2 (47:46):
Um.
It's my wife's um passionproject really.
I think she um after herpregnancy, uh, in particular I
think she had well, we had twinsand I think it hit her pretty
hard and so she was looking atlike ways to to get back to her
activity level and and that waskind of when we discovered this
m sculpt and the m cellar, thesekind of um machines that use um
(48:12):
radio frequency and uhelectromagnetic field to to
stimulate muscle uh growth andstrengthening and and uh.
I mean there's prettyimpressive results when you when
you pair the m sculpt on theabs and the m cellar for the
pelvic floor in terms of um likeuh young mothers who are, who
(48:35):
are like one or two yearspostpartum, in terms of recovery
of urinary function, strengthand back pain regeneration is
pretty impressive.
And even in the elderly patients, in some of the studies that
got the machine approved for therehab, they looked at
65-year-olds and stimulated thecore with the m sculpt on the
(48:57):
abs and the low back and thepelvic floor and they showed
improvements in agility.
So time to get up and go, howlong it takes them to stand up
and walk a distance and sit downagain.
Back pain was significantlyimproved and, uh, more
interestingly was their abilityto stand on one leg, how long
they could do a single legstance improved, and that's
(49:18):
actually the most predictableabout your longevity.
So once you get over the age of65, the longer you can stand on
one leg without falling overand losing balance indicates how
long you're going to live, andit's actually the best predictor
of that, which is very littleknown fact interesting.
Speaker 1 (49:35):
Yeah, yeah, um, and I would imagine like kind of a
correlation with that would bethe um in order to be able to
balance on one leg.
There's like a lot that needsto kind of be maintained in
order to do that.
Speaker 2 (49:48):
Oh yeah I mean it's so.
It's just.
I think it's a marker for yourgeneral um, just function
overall functionality fitnessyeah totally well, that's cool.
Speaker 1 (49:58):
Well, I appreciate you coming in.
Uh, where can people find you?
Like how can people reach outif they're battling back issues
neck pain, nerve related pain,like I think they get a consult
or check it out.
Where how do I how they reachyou?
Speaker 2 (50:09):
yeah, so I mean you can just email info at seville
spine or or look on the websiteat SevilleSpinecom and there's
lots of like chatbot and formsto just put your details in and
one of the team will call yousame day, next day, and we'll
see what we can do to helpGotcha.
Well, thanks for coming in.
Speaker 1 (50:27):
Kyle thanks for having me.
I'm glad we did it.
Yeah, I'm glad we finally gotit on the books and we'll
definitely be collaborating andstuff and patients in the future
.
And if you have any questions,don't hesitate to reach out.
We're always open to questions,comments, concerns, conflicting
opinions and if you're alreadybattling any issues that you
feel like we could help, feelfree to reach out.
The best way to reach us isprobably our phone number at
561-899-8725.
(50:48):
Or like our website, like DrPhil is saying for his too, and
then we'll catch.
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
Y'all, welcome back to theDriven Athlete Podcast.
It's your man, dr Kyle, andwe've got a really cool special
guest with us, dr Phil Seville.
He's a spine surgeon,orthopedic surgeon, and coming
(00:24):
from a super busy schedule, he'sbeen able to come hang out with
us and share more about what hedoes and what you know the fat
things he's into.
But introduce people like whereyou're at, what's your practice
and what y'all do.
Speaker 2 (00:36):
Well, thanks for having me, Kyle Good to get it
done.
We've been talking about thisfor a while.
Yeah, it's been like honestlyit's been like a little over a
year.
Yeah, it's been a while, beenlike 18 months.
Yeah, well, that's my fault.
No, no, no, me too, me too,okay, um, so, yeah, my, my
office in palm beach gardens.
We specialize in kind ofminimally invasive uh spine
(00:56):
surgery.
So less, less damage to the uh,the healthy tissues to fix the
problem and, in particular, I'minterested in motion
preservation.
So disc replacements,non-fusion options for patients,
which is certainly gainingpopularity.
People recover faster, get backto active lifestyles and have a
lot less side effects down thedown the line.
I trained in England, initiallyfor med school, a place called
(01:20):
Leicester, and then came overhere, did my residency at
University of Pennsylvania, myfellowship in HSS in New York
and then came down to Floridaaround 2018 and opened up my own
office about three years agonow cool.
Speaker 1 (01:36):
yeah, that's because we had met um up in Juneau at Dr
Daniel at one of his firstthere yeah, they had like an
open house thing, exactly rightand that was like right after
you opened, is that?
Speaker 2 (01:46):
right, yeah, that was uh.
Yeah, I was busy poundingpavements and just trying to
meet everyone in the areabecause there's a new area.
I moved up from boca raton and,uh, I had to meet all the all
the people up in the area.
Speaker 1 (01:56):
But yeah, that was then so you all, right, I knew
you were from london originally,right?
Let me tell by the accent ifyou guys can't tell.
But so you went to LeicesterMedical School.
What brought you over to US?
To think?
To go to University ofPennsylvania?
Speaker 2 (02:11):
It was.
I mean, the NHS is a socialistsystem and there were some
issues with that.
But the main issue I noticedwas the case volumes were just
decreasing.
It's not a very efficientsystem, so surgeons weren't
doing a lot of cases and theguys that were just decreasing.
It's not a very efficientsystem, so surgeons weren't
doing a lot of cases and theguys that were a few years ahead
of me in training didn't seemto be progressing and really
(02:31):
achieving what the guys five orten years before them were able
to achieve.
So it was kind of a decision ofdo I stay here and and
potentially extrapolate thattrend and just not be very good,
or do I go somewhere else andtry and become good at what I do
?
And that was what really drovethe decision-making Interesting.
Speaker 1 (02:52):
Did you always know you wanted to go to orthopedics
or spine?
Speaker 2 (02:56):
Not really.
It all kind of just happened.
In England the rugby boys allwent into orthopedics.
I played rugby, so I went intoorthopedics and then when I was
doing my orthopedic rotations, Ihad an Irish surgeon, dennis
Calthorpe, who did spine.
And we just got on and he justtook me under his wing and that
(03:17):
was it.
I was like I'll do spine.
Speaker 1 (03:19):
And was that during one of your rotations in medical
school?
Speaker 2 (03:24):
It was actually after medical school, so I was doing
some residency equivalent in theUK and worked for Dennis and I
was on his service for like sixmonths and we had a really good
time.
It made sense and I justenjoyed the surgeries and it
just kind of led from therereally.
Speaker 1 (03:38):
So, then, you started investigating residency
programs in the US.
Speaker 2 (03:42):
Yeah, I looked at a couple of options and canada and
the us were kind of top of thelist and ultimately the us was
probably the better fit.
It's easier surprisinglyactually to to match over here
as a foreign grad than in canada.
Canada's really closed, closedshop, um and uh.
And yeah then came over hereinterviewed.
Uh, I was lucky enough to getinto a good program in upenn and
(04:07):
it all just kind of led on toeach other really and was that?
Speaker 1 (04:10):
I mean upenn?
Yeah, it's a great institution,yeah I was really lucky.
Speaker 2 (04:14):
I just just got on well with the team there and and
they they, you know made a spotfor me and it went from there
that's cool.
Speaker 1 (04:21):
and uh, that first residency was it orthopedic
residency, orthopedic residency,and then you do fellowship for
spine, exactly so we do inorthopedics.
Speaker 2 (04:30):
you do spine as part of your general rotations and
you kind of do when you're doneyou're capable of doing spine
surgery and general orthosurgery like joint replacements,
fracture care.
But to get kind of the nextlevel of training, you then go
on to like a fellowship for ayear, uh and, and that was done
in new york at hss, which isobviously quite a well-known
(04:51):
place down here, and um, thatwas kind of where we learned
like the next level of really ofhow to treat spine care yeah,
and do you?
Speaker 1 (05:01):
is that specifically like cervical lumbar or lumbar,
or like the whole spine Top tobottom?
Got it, and then, right now,for your guys' cases like do you
see equally distributed likeneck and back.
Speaker 2 (05:12):
Yeah, probably 50-50, .
Pretty close actually.
I mean there's a little bit inthe thoracic spine, but for
various reasons you just getless pathology there.
Speaker 1 (05:21):
Yeah.
Speaker 2 (05:22):
Probably less than 5% in the thoracic spine.
The vast majority is in theneck or the the lumbar spine.
Um, you know, the books willsay it's 60, 40 lumbar favored,
but I think generally it's morelike 50 50 now, yeah, pretty
close like um, that'sinteresting and I remember we
had you had referred somebodyover.
Speaker 1 (05:41):
He was a young guy mid 30s who had like thoracic.
I tell the story on otherpodcasts that were just also
mentorship stuff with some ofthe fellows that we trained, but
he was like a young dude early30s and he had thoracic region
pain and it was weird.
It was just like this isinteresting, it's kind of
puzzling, and it was referringlike a dermal tunnel pattern
(06:03):
like across his rib cage and Iwas like all right if it's
neural, if it's musculoskeletalI'm thinking rib pathology, you
know core stability, thoracicspine mobility is important.
Look at the tlga, like thoracicthoracolumbar junction mobility
.
But anyway he's like I'm gonna,mri, just to you know, rule out
some stuff and he anyway hissymptoms were like it hurts when
(06:24):
he was sleeping.
He didn't feel good in general,like general lethargy.
I remember you're talking aboutnow, yeah, and then he we talked
, spoke on the phone and he wasgoing to mri.
I was like, hit me back, youknow, check out the imaging and
then hit me back and we'llschedule.
But anyway I didn't hear fromhim and I reached out.
I was like, have you heard fromthis patient?
You're like, yeah, he hadactually had a tumor.
Yeah, no, he did.
Speaker 2 (06:43):
Yeah, he's fine, he had an intradural tumor, I think
that was, um, just uh, yeah,it's unexpected.
Uh, certainly a young person,right?
Uh, he actually went up to newyork, I think to some of the
guys I trained with, to get itfixed.
We sent him up to uh sloancatering.
Have you heard from since?
Speaker 1 (07:02):
uh, I haven't, actually no with a young he was
in his early 30s.
Uh, somebody coming in withlike mid thoracic region, pain
hurts with breathing rightacross like the rib cage.
Yeah, um, but besides, likewhat other pathology?
What would be the, what wouldbe the protocol for that?
It's like, hey, immediatelyjust imaging, just to rule
(07:24):
things out.
Speaker 2 (07:29):
Yeah.
So I mean it depends on historyand duration.
So I mean the vast majority of30-year-olds with thoracic level
pain, it's going to besomething benign, nothing to
worry about.
So it's going to be a musclesprain.
They've been playing tennis,golf, something's happened.
But if it's not getting better,if it's interfering with sleep,
if it's been going on for awhile, then that's more of a red
(07:51):
flag and that's something morethat would send us towards
workup, towards.
Is there something more going on?
If the pain's kind of comingacross like a dermatomal
distribution, so it kind ofstarts in the middle of the back
and comes along and a rib uh ina line to the middle.
But that sounds a lot more likenerve pain.
So you maybe start thinkingabout is this a disc herniation?
Pushing on, pushing on athoracic nerve can even be
(08:14):
something uh unusual, like a umshingles flare.
I've seen young patients withthat.
I had one last week who uh hadsome uh pain raining down his
arm in his shoulder.
Everyone thought it was a discherniation and that the disc MRI
was negative.
That he came with and I askedhim to take his shirt off to
actually examine him.
He had a classic shingles rashall down.
(08:37):
And so we sent him to hisprimary care doctor actually to
get antiviral treatment, and itall got better Interesting.
Speaker 1 (08:44):
So besides before that, nobody does like take your
shirt off no, no, I mean he'd.
Speaker 2 (08:48):
He kind of came to me um slightly unusual.
He's a friend of a friend.
I saw him out, uh, when we'reout having drinks one night and
his friend was like hey, go gosee phil, he'll, you know, he'll
be able to help you out, figureout what's going on.
So he came to see me the nextday and uh had his mri already
and it it was reallyunimpressive and I just, you
(09:10):
know, by chance, asked him totake his shirt off, which you
don't often do, to be fair andhe just had this clear uh
dermatomal rash and it wasshingles, uh 100.
And now you got better, uh,just with um antivirals and a
bit of time interesting yeah, uh, yeah, that's super interesting
.
Speaker 1 (09:29):
And then with your.
So you did your fellowship withhss.
Were you employed with them atall?
Like, what did you do when youwork with them while, like right
after fellowship, or did youimmediately come down to boca?
Speaker 2 (09:39):
no, I came down here immediately.
My um, my wife, uh, is frombrazil and wanted to be done in
florida and, yeah, away from newyork.
Yeah, I mean when when we met,she was moving to miami.
But uh put that on hold becauseof me, and so we we made the
deal that you know, if we werestill together at the end of
training, we're coming down todown to florida and, and so I
(10:01):
had to keep keep that deal.
So we came down here, I joineda group down in Boca and it was
a good experience, butultimately I wanted to do
something a little bit differentand be my own boss, and that's
what led that to change in aboutthree years ago now.
Speaker 1 (10:18):
What things different ?
Speaker 2 (10:21):
I tend to run a lower volume practice.
So I mean, I guess the term downhere is concierge, but it's
kind of more lower volume out ofnetwork and able to spend a
little bit longer with thepatients where I was before.
It was a good practice, but itwas.
It was a volume volume play.
Basically had to see newpatients every 15 minutes and
(10:44):
it's hard to examine someone,take their shirt off and you
know, talk to them about surgeryin 15 minutes and then do your
documentation, yeah, and youknow if people have questions,
if they've got, um, you know alittle bit of understanding that
they're going to have a lot ofquestions before you operate on
them and it becomes challengingto do that, and so the the goal
(11:07):
was to run something a littlebit more like yourself, where
you're able to focus more on youknow individual, what's
actually going on with them,what the right thing to do for
them is, rather than just youknow this is what we do, this is
what we do, this is what we dogive me, uh, what give listeners
an idea of, like, what if a newpatient came to see you, right?
Speaker 1 (11:27):
hey, I'm dr seville nice to meet you, right?
It's day one.
What does that first dayusually look like?
Speaker 2 (11:33):
I mean it depends really.
I mean ideally they've had anmri, uh, already.
So it could be a more, morefruitful discussion if, if they
come in with you know symptomsand mri, then yeah, it's going
to be a more, more fruitfuldiscussion.
If, if they come in with youknow symptoms and mri, then yeah
, it's going to be like 25, 30minutes.
We'll go through exam, lookingat the imaging, talking about
what the options are, dependingon what they've done already.
We may go for some injections ifthey come fresh and have had
(11:56):
nothing done, if they've done aload of injections already.
This has been going on formonths and they're kind of
getting to the point now wherethey hey, like let's just get
this fixed and we start talkingabout surgery.
To the point now where they hey, like let's just get this fixed
and we start talking aboutsurgery.
And it really depends where inthat spectrum these people come
in.
You know some people come inhaven't dealt with this for
years and done injections foryears and injections stopped
working.
Other people that you know theytweak the back two weeks ago
(12:19):
and and you know that's clearlynot a surgical talk, that's
that's more of a let's trysomething to settle this down,
maybe get you over to see Kyledo some therapy, and then we go
from there.
Yeah, yeah, gotcha.
Speaker 1 (12:29):
And then exam-wise what would people expect when
you do an exam on somebody Likerange of motion?
Speaker 2 (12:37):
Yeah, so it's range of motion, the neck, the lumbar
spine.
Then we look at you knowpainful motions, you know.
We look at you know painfulmotions, you know.
Does it hurt when you'rerotating, when you're looking up
, looking down?
Then we start looking at theindividual muscles which are
supplied by the nerves in thearea.
So in the neck, we're lookingat the arms, looking at the
shoulders, the biceps, thetriceps, the hands, the wrists,
looking to make sure there's noweakness associated with nerve
(12:58):
compression.
Right, check the sensation.
Again, each patch of skin issupplied by individual nerve
roots from the neck or the lowback, and so we test each of
those, check your reflexes inthe neck, we'll often check
balance and coordination.
A lot of people are surprisedto know that compression on the,
the spinal cord, may bepainless but can affect your
(13:18):
balance and coordination.
So that's something we alwayslike to check, especially on the
neck patients.
Right, like cervical myelopathy.
Exactly myelopathy is whatwe're looking for in that case.
Um, and, and that's that really.
Again, it's kind of tailoreddepending on what's going on
with that.
Uh, yeah, someone it's just gota little bit of back pain when
they're golfing and it's on thekind of the follow-through and
(13:39):
we're probably not going tomaybe do quite so much.
Speaker 1 (13:42):
On then on someone who's come in with with more
neurologic symptoms gotcha andif something come in
neurological symptoms, um, whereyou're discovering, like
testing, myotomes and dermatomes, like weakness in the hands and
arms, um, leaning more towardsand they've had pain for a long
time then you're talkingsurgical considerations and that
you guys are.
Speaker 2 (14:02):
You said you're leaning more towards, like, as
an example, if needed, discreplacements over instead of
fusions yeah, so discreplacements are something that
have really become a lot morepopular over the last five to
ten years.
Uh, you look at initially, uh,around 20 years ago when they
started being put in, they werebeing put into very young
patients who had no degenerationin their neck or the low back
(14:26):
and they were for for soft discherniations, which is kind of
what we describe an acute discherniation without any
degenerative changes.
Certainly over the last fiveyears that that has kind of
changed a lot.
And now really quitedegenerative necks that we would
not have put a disc replacementin 10 years ago and now
becoming candidates for discreplacements.
(14:47):
The advantages of a discreplacement over a fusion are
pretty well known and wellstudied now.
You have a lot less pain.
You maintain range of motion.
You have less revisionsurgeries at the level of
surgery and at the adjacentlevels.
So if you have a fusion in theneck or the low back, you end up
transferring motion at thelevels above and below, so they
(15:09):
try to maintain your range ofmotion, so they work twice as
hard, which means those discsthen wear out and so you end up
chasing yourself up up the neckor the low back with further
surgeries and I think you knowmost listeners will have known
someone who had a surgery andhad another surgery, had another
surgery in their back andit's's kind of not a great story
right?
Everyone always is worriedabout that, whereas with disc
(15:31):
replacements we see that that'snot the case.
You have far lower rates ofadjacent segment wear out and
less surgeries at the indexlevel as well.
Speaker 1 (15:40):
Interesting, interesting with uh disc injury,
right, what would cause like anacute, non-degenerative type of
a disc soft disc injury, likeyou said it?
Speaker 2 (15:54):
can be anything.
Um, I mean, it's nice whenthere's a like a clear
precipitating event.
So you know you lean forwardsto pick up something heavy, you
feel a pop in your back.
That story is nice and everyonekind of agrees and understands
that's when it happened.
But often that doesn't happen.
You can have like just a discthat's been injured years ago.
(16:15):
It's hanging on by a thread andthen one day it just goes.
It can be when you sneeze, whenyou roll over in bed, and it
can be something so innocuousthat starts it.
The way to think about a discis it's really made up of two
layers.
You have the outer layer, whichis like a thick car tire it's
rubbery and the inner layer iskind of like a gooey crab meat
type material and so it workswell together as like a shock
(16:37):
absorber.
And when you have a discherniation what happens is that
outer layer gets a hole in itand so the crab meat can squeeze
out, pushes on the nerves andit really can be like you hurt
your back playing football or atthe gym 10 years ago and it's
just hanging on and one day thatthread just goes and then you
get some disc squeeze outinteresting.
Speaker 1 (16:59):
Um what, what evidence?
Or like what do uh cause?
People will ask me like dodiscs heal?
What have you?
Speaker 2 (17:06):
found in the research for that.
So it depends what you mean byheal.
So if you injure a disc, itwill break down.
Unfortunately, the disc doesn'thave any real blood supply, so
it doesn't have a tremendoushealing potential.
And once you injure a disc itwill go down a degenerative
cascade, but that may or may notbe painful and a lot of people
(17:28):
will come in and they will havevery degenerative backs or necks
and they have no symptoms.
And that's just because somepeople go down this cascade
where it's not painful and otherpeople go down this cascade
where they have a lot of backpain and there's some genetic
component to that and I don'tthink we entirely know that yet,
but it's certainly.
(17:49):
Some people have no pain, somepeople have a lot of pain.
If you're getting a lot of lowback pain and we look at the mri
and you've got one or two ofthese worn out discs at the
bottom of the back then andyou've tried all the other
things like the, the therapy tostrengthen the core, the
injections and all these thingsaren't working, then you may be
a candidate for a discreplacement where we scrape out
(18:09):
the disc and we put a new one in, and in my experience, patients
have been very, very happy withthose and do very well return
to activity.
I mean, we have several videoson our website now of young
patients who couldn't play withtheir kids, couldn't lean over
to pick them up, and now they'reback playing sports with their
kids, which is what they youknow they want to do it's
(18:30):
amazing.
Yeah, yeah, it's, it's been,it's been really changing, for I
think spine surgery, that thearthroplasties, and that's still
what's the with the invasivenature, like with our, it's
arthroscopic no so.
So disc replacements in thelumbar spine we do with an
anterior incision okayinteresting we we make a
transversal, vertical incision,depending on the level, and we
go between the um, the abdominalmuscle, the abdominal muscle,
(18:54):
so we're not cutting musclegoing through the tendon in
between which we can stitch andheals well.
And then from the front we havean approach surgeon, a vascular
surgeon typically, who movesthe uh, the blood vessels, and
the, the peritoneum, the, thebowels, out the way.
So we're looking straight atthe spine and we just scrape out
the disc, open up the nerves ifthere's any compression on the
nerves and then put the new discin um.
(19:17):
It takes about an hour, maybean hour and a half if you're
taking a bit longer for a singlelevel.
Speaker 1 (19:22):
Would y'all do multiple levels at once?
Speaker 2 (19:24):
yeah, yeah, I would do two.
Two is typically at once, oneor two um three can be pushing
it through a lot, but usuallyit's one or two.
Speaker 1 (19:31):
Level pathology so a two level would be like two
levels at the same time.
Speaker 2 (19:35):
Hour and a half surgery hour and a half to two
hours.
Speaker 1 (19:38):
Yeah, interesting so there's two surgeons in there
the same like you, and then avascular surgeon, correct?
Speaker 2 (19:44):
yeah.
Speaker 1 (19:44):
He moves everything out of the way.
Speaker 2 (19:45):
Yeah, so it's interesting it depends where you
train.
In Europe a lot of the spinesurgeons will do their own
approaches In the US for mainlymedical legal reasons.
There's an approach surgeonthere.
I think on balance it makessense because the real risk is
if you injure one of the bloodvessels when you're exposing the
(20:08):
spine and to have thespecialist to fix them there.
That just makes sense.
Speaker 1 (20:13):
Yeah, for sure.
I mean the descending aorta.
Where does it split into thecommon iliac artery?
Is that correct?
Speaker 2 (20:26):
the common iliac order.
Is that correct?
Yeah, so it's variable um.
I'll tell you that l5, s1 isdefinitely not split there, so
you've got a wide open window tothe bottom level.
L45 is usually around the levelof the bifurcation and it
actually tends to be the vein.
That's more of an issue becauseit's it's less um, less robust,
so it doesn't take me flimsy'sflimsy, yeah, yeah.
So four, five is technicallythe harder level to get, and so
(20:48):
it's essential to have a goodapproach surgeon, which we're
blessed with several in the area, and then, above that, l34 is
actually easier, again, becauseyou're dealing without the
bifurcation there.
So four, five's the the hardlevel interesting.
Speaker 1 (21:01):
Uh, if it does, if an accident happens like that and
the vascular surgeon is there torepair, is it just a quick
stitch Like how's that work?
Speaker 2 (21:10):
Yeah, I mean typically, yeah, If.
If we're doing these regularlywith with experienced approach
surgeons, it's usually like asmall branch of the vessel pulls
off.
Oh, I see.
And so it's just a small stitchand it's an easy fix, but not
the trunk, yeah, basically.
Speaker 1 (21:26):
And I'm actually super and I'm sure it's super
uncommon.
Speaker 2 (21:30):
Yeah, Very, very uncommon.
I mean it happens a couple oftimes a year, it's not.
It's not like it's every weekwith vessel injuries.
That would not be.
Speaker 1 (21:37):
But that's really, I mean, that makes a lot of sense.
That's also, I'd imagine, veryum uh, makes people feel more
secure.
Speaker 2 (21:44):
Yeah.
Speaker 1 (21:44):
Having two surgeons on hand right there doing it?
I think so.
Speaker 2 (21:47):
And and it's, I think it just makes sense.
It makes me, uh, feel a lotmore comfortable having the
specialist there to get it allready for me, and then I can
just focus on getting the discin right, and he just focuses on
the blood vessels.
So it just makes sense.
Speaker 1 (22:04):
Yeah, that's good.
Do the best job possible.
Yeah, so, patients, you don'tgo through the abdominal muscle
tissue, you go through thetendon that heals up quick with
a stitch and then physicaltherapy after that.
Like what do you all recommend?
Speaker 2 (22:19):
So for the first uh week I asked them to wear a back
brace, just when they're upwalking around, just because the
bone grows into the implant soit becomes part of them, and
that takes a few weeks.
You can't really speed that up,yeah, and then they're just
walking for the next six weeks.
Okay, once they get out to sixweeks we start to use the
elliptical, the stationary bike.
Then once you get out to threemonths, you can go back to full
activity at the gym.
Now we'll start some gentle PTaround six weeks.
(22:40):
Got it?
Okay, we don't want to crank onit.
You don't want to dislodge theimplants because then you're
going to have to go back in andredo it.
So you just got to wait and bepatient while the bone grows
into the titanium which theyspray the ends with mimics bone,
so the bone grows into it.
It looks like bone to bone andso it makes this solid bond too.
(23:01):
That's really cool, yeah, it'scool.
And the neck similar.
It's an anterior incision inthe neck.
Usually hide it in one of thesecreases that most of us have
and we just go between themuscles here, so we're not
cutting any muscle again.
And the same thing.
That and the same same thing.
That's done usually just by me.
(23:21):
There's no approach surgeon upthere um the uh, the vessels
aren't such an issue therethat's good, and the the trachea
also.
Speaker 1 (23:27):
Yeah, so you just move that away yeah, it's all.
Speaker 2 (23:30):
It all moves very easily out the way.
I mean the issues up in theneck.
Some people will have a littlebit of a sore throat for a few
days afterwards.
Um, but it usually settlespretty quick and we put them in
a collar again for a week.
They take it off to sleep justwhen they're up, walking around
really, um and similar.
No lifting anything heavierthan a gallon of milk for the
(23:51):
first six weeks.
Then six weeks you start doinggentle therapy, gentle um
activity with the elliptical,the stationary bike, and then at
then at three months you'reback golfing, tennis, full go
yeah.
Speaker 1 (24:03):
Do y'all do multiple levels at this neck, the same
way as the lumbar spine?
Pretty commonly?
Speaker 2 (24:08):
Yeah, yeah, so frequently we're doing like
three levels at the same timenow in the neck.
It's not uncommon.
Speaker 1 (24:13):
Interesting Timeframe .
How long is the surgery forthat?
About an hour level typicallywhat we recommend.
Oh, okay, gotcha.
Speaker 2 (24:21):
So three hours for three levels or two hours for
two levels.
Speaker 1 (24:24):
And what are the most common levels?
You guys usually do Five six.
Speaker 2 (24:29):
Yeah, four to seven is probably the most common, and
I think five, six and six,seven are the most common too.
Speaker 1 (24:36):
Interesting, yeah, and that makes sense from what
we've gathered've gathered yeah,it's to do with the angulation,
the shear.
Speaker 2 (24:42):
So um the the five, six and six, seven are at the
most angle, so they see moreshear force.
Those discs tend to wear outfaster.
Discs don't do very well undershear.
That's similarly why the fiveone wears out the fastest in the
low back.
Speaker 1 (24:55):
It's just it's the most sheer yeah, you had
mentioned um to me in the pastabout uh like a multifidus
muscle stimulator post-op orjust for back pain.
Speaker 2 (25:06):
Yeah, so that's the reactivate uh device.
Um, it's interesting, it's didvery well in clinical trials so
it had um around like a 70improvement in people with this
chronic low back pain withoutany real surgical target.
I think in practice most peoplefeel it's not quite as
(25:30):
successful as that.
It's probably more like 50-50.
I think it's useful in theolder patients who have had a
lot of muscle wasting.
And I've implanted in a fewpatients who have had scoliosis
and with just back pain, nonerve symptoms, no neurologic,
just pure back pain, and wherethe fix would be a 7-8 level
(25:54):
fusion, which is a pretty bigsurgery and not something that
they were either medically ableto undertake or had the had the
desire to undertake.
And so we've implanted in thosepatients and I think we've
we've had good success withthose um.
Certainly their back pain'simproved.
They've avoided a much largersurgery.
There's some uh thinking thatthe multifidus muscle, which
(26:15):
stabilizes the lumbar spine,when you have a painful stimuli
it turns off.
It's a reflex muscle.
It's not one that you can just,you know, do a bicep curl to
strengthen.
It's one that yousubconsciously contract and it
stabilizes the spine by bygiving you a solid base.
So now, if you've got a baddisc, you've got a bad joint in
the lumbar spine.
If you were to compress itwould hurt.
(26:35):
So your body doesn't do thatand over time, when that
insult's gone away, so it's nolonger painful, that muscle
doesn't turn back on, and so youhave this instability in the
back, which which causes somepain.
And so this, this um device,stimulates that muscle for 30
minutes twice a day and there'ssome neuroelasticity where you
re-innovate that muscle and itstarts to get back under the
(26:58):
reflex control from the spine.
And I say it's certainlyinteresting.
I don't think we've got all theanswers yet for it, but it
certainly is another tool in thetoolbox, right, yeah yeah,
exactly what of the discreplacements, or just like a
debridement discectomy?
Speaker 1 (27:18):
I'm sure you guys do a lot of that too.
Speaker 2 (27:19):
yeah, so I do a lot of just disc herniations, uh,
decompression.
So if you've got really no backpain, mainly leg pain, uh,
going down down the legs whenyou walk or when you're standing
up, um, then yeah, you reallyjust want to remove the
compression on the nerves and soyou do that a couple of ways.
If it's a younger patient, ittends to be a disc herniation.
(27:40):
So you just make a smallincision, remove that fragment
of disc, leaving the rest of thedisc behind, take the pressure
off the nerve and the pain goesaway.
I'm sure we've we've hadpatients with that do very well.
It's a finger width incision,um, and takes, you know, 40
minutes probably.
If it's an older patient wherethey've got more arthritis and
it's more of a stenosis typepicture, well then you have to
(28:02):
kind of do a little bit morework.
The same size incision takes alittle bit longer, more like an
hour, hour and 20 minutes andyou're kind of removing some of
the arthritic bone and some ofthe hypertrophied ligament
that's compressing on the nerves.
Both do very well and you'reavoiding a fusion, you're
avoiding any metal being put inthe back, which is great.
Speaker 1 (28:24):
Would that be the ligamentum flavum?
Speaker 2 (28:26):
Is that the main one?
Speaker 1 (28:28):
Exactly the flavum.
Yeah, describe to people whatstenotic changes mean.
Speaker 2 (28:35):
So stenosis just means narrowing, I mean, I think
the way to think about it iswe're just like plumbers
essentially.
The spinal canal is a big, longpipe and the spinal cord and
the spinal nerves run through it.
As you get older and thearthritis in the joints, the
facet joints in the spine, andthe disc starts to degenerate
(28:56):
and bulge, it starts to narrowand you get these kinks in the
pipe, the pipe, and so the thenerves get pinched and the the
signal, the flow doesn't go downthe nerves very well.
So all we do is go in there andjust basically, like a rotor
router guy that cleans out yourtoilet, we just open up the
nerve shave off the um yeah, sotrim the ligament, shave some of
the arthritic joint sometimesit's discs, because we remove
(29:19):
some of the discs.
It really depends on on, youknow, when you look at the MRI,
sometimes it can be a cyst.
You can have a cyst from one ofthe uh facet joints and in that
case we just remove the cystand and uh and open up the
nerves between uh this,discectomy and debridement,
decompression and anterior discreplacement.
Speaker 1 (29:39):
What do you find yourself doing?
More like most most often um inthe lumbar spine.
Speaker 2 (29:44):
I think we probably still do more decompressions um
than than disc replacements.
Some of that's the populationdown here.
I mean we have an olderpopulation.
They're not all necessarilycandidates for disc replacements
, but disc replacements growingum.
Some of it's just patientawareness.
Uh, we're getting more and morepatients I've been told they
have to have a fusion coming inand being told well, actually,
(30:07):
no, you, you're probably acandidate for disc replacements.
I think over the next few yearsthat number's going to change,
you're going to continue to goin that direction?
Speaker 1 (30:13):
I think so, yeah, interesting.
Uh, what do you do for your ownback?
Uh, like, how was your back?
Speaker 2 (30:20):
it's surprisingly good.
Actually, I played rugby and uhother silly things when I was
younger um well, rugby's fun.
Speaker 1 (30:29):
It's not silly, right like sports.
Speaker 2 (30:30):
Yeah, you pay for it in the long run, exactly I mean
I try to stay in shape, which isI've got two young kids and a
busy practice.
I'm not doing quite as well asyou at that, it seems, but
that's always a goal.
Speaker 1 (30:45):
For practice management, oh man.
Speaker 2 (30:46):
No, staying in shape for me.
Speaker 1 (30:49):
Oh well, I'm trying, you know.
It makes it easy when myclinic's a gym.
You know I have no excuse atthat point.
Speaker 2 (30:55):
Yeah, maybe I'll need to put a gym in my office and
something like that.
But yeah, I mean just trying tostay in shape, work on the core
strengthening.
Putting on weight, especiallyfor men, is bad for your back.
We tend to carry the weight outin front and that just puts
extra force on the low back.
Women tend to put it more lowerdown, more pear-shaped, and
that tends to be lessproblematic for back pain.
Speaker 1 (31:18):
Yeah, yeah, yeah.
But yeah, I mentioned with yourwife because we had worked
together for some stuff a littlebit, and she's doing her the
med spa, the re-spa, which we'lltalk about in a sec too.
She was saying that you guys doyou all work out together at
Tremble or the kickboxing?
She goes to Tremble.
Speaker 2 (31:39):
Sometimes we tremble, or the kickboxing, or is that
only she goes to tremble?
Um, sometimes we'll go to likelifetime together and just just
work out there.
I tend to go to there.
I do a little bit of um likejujitsu mma at a local gym, just
something to, to learnsomething new and challenge
myself really keep it fresh yeah, because it gets a bit boring,
just kind of lifting weightsevery day yeah, that's one of my
goals.
Speaker 1 (31:57):
You know, I have never really done any MMA.
I did some kickboxing a littlebit back a little while ago, but
because I think it's just alsofun like to get some aggression
out and like hit some stuff yeah.
Speaker 2 (32:08):
I mean I'm pretty lucky there's a gym really near
our house.
I found them during COVIDbecause everything else was shut
and he was still running itbecause it was kind of I guess
he had different rules becauseit was a smaller, smaller
business and it was onlyone-on-one and he was like, hey,
look, if you're okay with it,I'm okay with it.
And I was, yeah, let's give ita go.
And I've been going and youknow when I get busy that gets
(32:29):
cut out, unfortunately myschedule.
But I need to see I'll comeback there more.
But it's excellent.
It's really really challenging.
He does a lot of like bodyweight stuff, movement stuff, so
kind of bear crawls and hopsand stuff like that to try and
work coordination.
It's just stuff you don't do asan adult anymore.
Yeah, I think that stuff'simportant yeah, I uh.
Speaker 1 (32:47):
No, I definitely have visions of trying to get into
jujitsu or muay thai orsomething.
You know it's humbling, that'swhat I've heard.
Speaker 2 (32:54):
Yeah, it's um, I mean , I'm pretty strong and used to
doing physical stuff and uh,yeah, you lose every time so
people like have your size.
They're like yeah old peoplethat you are like this guy
should be no challenge and they,they destroy you every time.
(33:15):
That's funny.
Yeah, so, but that's good,though.
Speaker 1 (33:17):
Yeah, get get ready for that.
It's definitely humbling.
What so are you doing Brazilianjiu-jitsu or what's-.
Speaker 2 (33:25):
Yeah, I think that's what they describe it as.
Speaker 1 (33:28):
Where are you right now?
On like your journey with yourbelt.
Speaker 2 (33:30):
Oh, it's not.
I'm not doing any belts oranything like that, it's more
just kind of casual Gotcha.
I'm casual gotcha.
I mean I'm sure we could gothrough gradings if we wanted,
but yeah no, it's more justsomething to do for fun.
Yeah, that's cool but also Imean, like you know, and I think
a little um self-defense andconfidence yeah, I mean, I used
to do karate when I was younger,and so it's kind of something
(33:51):
I've always done and been around, um yeah, but it's definitely,
um, definitely interesting.
Speaker 1 (33:57):
It's definitely something, something good so,
besides, all right, anythingelse, what?
So?
What would you recommend, likefrom the patients that you've
seen in success stories, forpatients that have had battling
back pain and you're you did adecompression on them or, um,
maybe not even doing that, butyou're like, definitely need to
do this to help your back.
I mean losing weight.
Speaker 2 (34:17):
You said, I think losing weight, I think
definitely doing some therapy orjust strengthening your core,
whether you do that with yoga,uh, yourself just doing planks,
or with directed therapy orsomeone like yourself.
I mean, I think those are thesimple things that you know you
should be able to try yourself.
If those aren't working, ifyou're still battling back pain,
(34:38):
then I think you need to get anMRI and see someone and you
know whether that's injectionsyou try next or other options
really comes down to what'sgoing on, how bad it is, you
know.
If this is, you know it achesonce a year.
If you do a little bit too much, well, yeah, then it's probably
not worth doing too much.
Speaker 1 (34:56):
I was going to say much.
Well, yeah, then it's probablynot worth doing too much.
It doesn't say, like patientsask me.
Well, I'll frequently like atwhat point do we get an mri?
Speaker 2 (35:03):
what do you recommend for that?
So if you're getting neurologicsymptoms like pain down the
legs, weakness in the legs,heaviness in the legs, then yeah
, definitely time for an mri.
If it's just back pain, I mean,the red flags are if you're
having weight loss, if youyou're having night pains that
wake you up, then yeah, youshould get an MRI to make sure
it's not cancer or somethingserious that we're missing.
(35:25):
Otherwise, it just comes downto quality of life.
If you're getting to the pointwhere you can't do what you want
to do, then I think it's timeto think about getting an MRI.
Take some action.
Yeah, and those goals aredifferent for everyone.
You know some patients come inand they're frustrated because
(35:45):
they can't do two iron men inthe same month and other
people's goals are.
You know, I want to be able towalk to the fridge, get some
food and sit down and and you'vegot to understand, like, what
everyone's goals are and that'sdifferent for everyone.
And that's one of theadvantages of having a slightly
lower volume practice is youhave the time to figure that out
and talk to them and understandwhere they're trying to be and
(36:06):
where they are now, Becausethat's really it's unique and
it's different for everyone.
Speaker 1 (36:11):
Yeah, it's interesting.
You say like I'm battling someback pain, I ran it.
Like I'm saying, like I get apatient that comes in, I'm
battling some back pain.
I ran it.
Like I'm saying like I get apatient that comes in, I'm
battling back pain I've had, orknee pain, whatever.
I ran an Ironman, I'm trainingfor another one, I have a
marathon coming up next week.
Yeah, I mean, we get that.
That's awesome, you know.
Speaker 2 (36:27):
Hey, I love the enthusiasm you know we get them
and then we get the other people.
Minutes, my back hurts andyou've got to try and figure out
.
You know what they're lookingfor and what's realistic.
Because you know if they'recoming to you because they want
to be able to do do that secondiron man in the same month and
(36:47):
you know the goals are it'sgoing to be hard to make that
goal, yeah.
But if they're just coming tosay, hey, look, I just can't
stand anymore, then then youknow, I think your, your runway
for success is much clearer.
Speaker 1 (37:00):
Yeah, you mentioned red flags.
Speaker 2 (37:02):
Explain to people what that means, so red flags
are symptoms that should warnyour, your provider, that
there's something more seriousgoing on, and and would prompt
um more investigation.
So you know, classically weworry about back pain.
(37:23):
As you know, is this amanifestation for cancer,
because a lot of cancers dospread to the back, and so you
know people that complain of,you know, just increasing pain,
pain that's just out ofproportion.
So you know people thatcomplain of, you know, just
increasing pain, pain that'sjust out of proportion.
So you know you can't function.
Pain that wakes you at night,um, and if you're having weight
loss, these are all things thatthat would make someone
(37:44):
concerned that this is more thanjust simple back pain, and so
we should get a goodinvestigation.
Other things that go along withit are, you know, night sweat.
So if you have your okay duringthe, but at night you're
profusely sweating, well, thatmay be an indication that
there's something more going on.
It's either hematological oreffective, and so that's
something that we should bump upto the red flag for let's get
(38:04):
an MRI and make sure it's notanything serious before we just
say this is back pain.
Speaker 1 (38:08):
Right, like you're good, let's just work on this,
just to rule things out and thengo from there.
Exactly, yeah, and we've had acouple mutual patient success
stories.
People have come in One of them, I think, is coming in tomorrow
to see me again, but just forcontinuous stuff.
But they're like man, I feelamazing.
(38:29):
I feel a lot better.
I think they just had adecompression, just from what
I'm thinking in particular.
The other one's very similaractually.
She actually just texted metoday.
I'm not going to say theirnames, but both of which had
just decompression surgery andthe incision's like literally
half an inch long.
Speaker 2 (38:48):
Yeah.
So I mean, what's differentabout the way we do a
decompression as opposed likethe?
The standard is I do it througha tube, so the tube is about 16
millimeters in diameter, abouthalf an inch the width of my
finger, and so what we do is Imake an incision and we put this
hollow tube down to the spineand then I work through that
with a microscope, with specialinstruments and the.
(39:10):
The more classic way is youmake a bigger incision, you
strip all the muscle off thebone and push it out of the way,
so you're looking at the spine,so it's obviously a lot less
damaging yeah and a lot lesspainful, and the reason for that
is most of the pathology in thespine focuses around the disc
level.
So if you imagine the spinesbuild up of vertebrae stacked up
(39:31):
on top of each other andthere's a disc in between,
either through an evolution or adesign flaw, depending on what
your beliefs are, what tends tohappen is at the level of the
disc.
You've got the joint which canbecome arthritic and expand into
the spinal canal.
You've got the disc which, asit ages and degenerates, will
tend to bulge into the spinalcanal.
It's like if I go let the airon your car tires, the car sinks
(39:53):
down right.
Well, the tire bulges into the,into the spinal canal, so that
that creates problem and theligament of flavin, which you
spoke about earlier, also uminfolds at that exact level and
hypertrophies as it gets moreunstable as the disc breaks down
.
So you're trying to stabilizethe segment.
So all those pathologies justline up at this same level and
(40:16):
you'll see on the MRI, if youlook at it carefully, that
you'll have narrowing at thelevel of the disc and then as
you go up the vertebrae it opensup and looks normal and then it
narrows again at the disc aboveand you can repeat it to the
pathological normal level.
So you just really need to goin and address that that little
level.
Speaker 1 (40:32):
You don't need to strip the whole spine, you just
need to target the levels whereit's narrowed and open them up
interesting, uh, the, and withthe tube that you and like the
incision, are you able to move alot of the muscle out of the
way?
Or do you have to go throughthe multifidus or the right,
your spinning group?
Speaker 2 (40:51):
yeah, so you, you go through the muscle, um, so you,
but you're going through thebody of the muscle and the
muscle fibers run longitudinally, so you end up just splitting
between the fibers.
So you're not really cuttingthe muscle, you're not removing
muscle, um, you're certainly notdetaching the muscle from the,
from the bone, which is theimportant part, whereas if you
go midline, the more classic wayof doing it, then you have to
(41:12):
strip the muscle off the um, offthe bone, and you often
actually de-innovate it.
So the segmental branches, thenerves, and as you're stripping
the muscle off, you're going toend up damaging those, and so
the muscle becomes de-innovated.
Speaker 1 (41:25):
Interesting, yeah um, wasn't it like another
interesting one of thesepatients I was describing doing
really well?
Um, they had decompressionbecause they had pain in their
leg and then also sensory.
Their sensor was affected right, it was less sensory and then
she had a lot more pain down herleg, down her ankle and her
(41:46):
foot and she was at footweakness.
They had decompression surgerybut the residual nerve
involvement still lingers for acouple, like for several weeks,
you know yeah, I mean.
Speaker 2 (41:57):
So if you're actually getting weakness in the ankle,
the foot drop, um, that thatdoesn't always come back.
So depending on how weak it is,uh, we grade it out of five.
Um, if you've still got somestrength, kind of like a three
or four out of five power, it'llprobably come back.
But if you start getting downto the ones or the zeros where
(42:17):
there's really no motion, it'skind of 50 50.
If that comes back and that'sjust due to the, the nerves been
injured and it has to regrowalong the, um, the, the sheath
of the nerve, the, the myelinsheath, which is what coats the
nerve, like an electrical cable.
Unfortunately it grows reallyslowly, about a millimeter a day
, and by which point the, themuscle, may no longer be
(42:40):
receptive to the nerve once itgrows back in and in, the, uh,
in respire, which which you kindof touched on just now.
We've actually got someinteresting technology there
called the m sculpt and we'vebeen using that in these
patients that come in with thisweakness.
This foot drop, either in thelegs or in the arms we have some
arm weakness as well but westimulate the, the muscle
outside the body.
(43:01):
So we use like a, an electricalplate and it gives them like 20
000 contractions in a 30 minutecycle and uh, and we've been
finding that actually that keepsthe muscle ready.
So when the nerve finally doesgrow back in, you're actually
getting higher recovery rates.
It's actually pretty, prettyexciting because it can be
pretty debilitating if you can'tlift your ankle up, you, you
walk funny and you trip on itand it's a problem.
(43:22):
And we were actually part ofthe fda study for approval for
this device because it'sactually used in the um, in the
body sculpt, in the beauty world.
Initially that's what it'sdesigned for and that's what
it's sold as.
But the the company has startedto realize, as as more and more
orthopedic surgeons have beenbeen using it, actually there
may be something here for rehab,and so it's now got approved
(43:44):
for post-op rehab, so for likeknee replacements, hip
replacements, to try and regainthe muscle that's injured and
damaged during those surgeries,and similarly after spine
surgery for like muscle weaknessas well.
Yeah, and we've had really goodresults with that that's
awesome.
Speaker 1 (43:58):
Um this and this patient.
I was saying like I wouldimagine, like the expected um
protocol, like expectations ofdevelopment, if somebody's been
battling like a kind of a severeit's been going on for a couple
months like nerve referred pain, they would still have some of
that after surgery.
(44:19):
It would just take a little bitof time for that to come it
varies, it varies.
Speaker 2 (44:24):
So what do you find with that?
Often the leg pain issignificantly better immediately
after surgery or more like,depending on which site you're
operating on.
They may still have a littlebit, but it's a lot better at
some point during the recovery.
As the nerve heals, it becomessuper sensitive.
So they may have a return ofthe pain, usually around two
(44:45):
weeks after surgery.
But that's variable and it'sjust due to the fact that as the
nerve heals it becomes supersensitive.
So stimuli that should not bepainful, like your clothes
rubbing on it, the bed sheets,someone touching it can generate
pain and some people say theyfeel like ants on the skin, they
feel fire or just pain, andthat can variable.
It doesn't always happen, butdefinitely can happen.
(45:06):
The sensation loss tends to beslower, so it'll often be better
after surgery, but that cantake a few weeks or months to
fully resolve and it doesn'talways fully come back.
So you may have some numbnessin the tip of the toes or
something like that which neverreally comes back unfortunately.
Speaker 1 (45:22):
Yeah, yeah, we have another patient that um has been
badly hit.
This person had a stroke and uhand also back pain and had
referred like sadicus typesymptoms on their leg and foot
drop because of that.
But the stroke wasn't relatedto his foot and this part, like
(45:43):
he.
We've been working this similarkind of thing with m sculpt and
working on foot strength andstuff and just reactivation.
It's getting better, which iscool, and he's older, you know.
So, my god, the ceiling ofexpectation here is a little
lower than somebody maybe whoyeah definitely would be in
their 20s, you know, but anyway,um, and residual like toe, and
he like foot numbness, um, butanyway, previous to that he on
(46:06):
the other leg had a similarthing going on and he said after
two years all of a suddenturned a corner and his
sensation returned it's 24months post yeah, like there's
the beginning of this pain.
It'd be developing unusual butyeah it's super, anyone's like
because it's interesting.
I would agree with you like itseems like most times it's like
there's a lower ceiling at thispoint, depending how involved it
is, and then randomly get somepeople that's like after like an
(46:29):
18 to 24 month period, for somereason just came back.
Speaker 2 (46:32):
I mean, there's a lot we still don't know.
There's definitely some.
I think it's super interestingin the brain that there's some
like ability to rewire.
Some people have more more thanothers.
Um, I mean, there's definitelysome degree of the longer the
compression on the nerve beforesurgery.
You know we arbitrarily havethis one year cut off, that you
do better after less than a yearor worse after a year, but it's
(46:56):
definitely a continuation.
So you know, six months isprobably worse than three months
and 18 months is worse than 12months.
Yeah, yeah, um, but there'salso this individual variation
that some people are just ableto heal nerve tissue better than
others and interesting it is.
It really is unpredictable andit's always hard to explain to
some patients that, look, you'rejust in the slower recovery
(47:18):
group.
I think we're going to getthere, but it's going to take a
little longer.
Yeah, and and you know mostpeople understand that but it
and they'll say oh you know, Iheal slow.
Anyway, you're off to othersurgeries and usually that's.
They kind of have this likehistory of just slow healing.
Speaker 1 (47:33):
Yeah um, so that's about respawn.
So you guys in your office, uh,where you do your consults and
your clinical, you also havelike a med spa type facility so
it's more like a functional medspa.
Speaker 2 (47:46):
Um.
It's my wife's um passionproject really.
I think she um after herpregnancy, uh, in particular I
think she had well, we had twinsand I think it hit her pretty
hard and so she was looking atlike ways to to get back to her
activity level and and that waskind of when we discovered this
m sculpt and the m cellar, thesekind of um machines that use um
(48:12):
radio frequency and uhelectromagnetic field to to
stimulate muscle uh growth andstrengthening and and uh.
I mean there's prettyimpressive results when you when
you pair the m sculpt on theabs and the m cellar for the
pelvic floor in terms of um likeuh young mothers who are, who
(48:35):
are like one or two yearspostpartum, in terms of recovery
of urinary function, strengthand back pain regeneration is
pretty impressive.
And even in the elderly patients, in some of the studies that
got the machine approved for therehab, they looked at
65-year-olds and stimulated thecore with the m sculpt on the
(48:57):
abs and the low back and thepelvic floor and they showed
improvements in agility.
So time to get up and go, howlong it takes them to stand up
and walk a distance and sit downagain.
Back pain was significantlyimproved and, uh, more
interestingly was their abilityto stand on one leg, how long
they could do a single legstance improved, and that's
(49:18):
actually the most predictableabout your longevity.
So once you get over the age of65, the longer you can stand on
one leg without falling overand losing balance indicates how
long you're going to live, andit's actually the best predictor
of that, which is very littleknown fact interesting.
Speaker 1 (49:35):
Yeah, yeah, um, and I would imagine like kind of a
correlation with that would bethe um in order to be able to
balance on one leg.
There's like a lot that needsto kind of be maintained in
order to do that.
Speaker 2 (49:48):
Oh yeah I mean it's so.
It's just.
I think it's a marker for yourgeneral um, just function
overall functionality fitnessyeah totally well, that's cool.
Speaker 1 (49:58):
Well, I appreciate you coming in.
Uh, where can people find you?
Like how can people reach outif they're battling back issues
neck pain, nerve related pain,like I think they get a consult
or check it out.
Where how do I how they reachyou?
Speaker 2 (50:09):
yeah, so I mean you can just email info at seville
spine or or look on the websiteat SevilleSpinecom and there's
lots of like chatbot and formsto just put your details in and
one of the team will call yousame day, next day, and we'll
see what we can do to helpGotcha.
Well, thanks for coming in.
Speaker 1 (50:27):
Kyle thanks for having me.
I'm glad we did it.
Yeah, I'm glad we finally gotit on the books and we'll
definitely be collaborating andstuff and patients in the future
.
And if you have any questions,don't hesitate to reach out.
We're always open to questions,comments, concerns, conflicting
opinions and if you're alreadybattling any issues that you
feel like we could help, feelfree to reach out.
The best way to reach us isprobably our phone number at
561-899-8725.
(50:48):
Or like our website, like DrPhil is saying for his too, and
then we'll catch.
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