Mastering the Cervical Hybrid Artificial Disc Replacement

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Hybrid ADR

1. Setup

2. Special Instrumentation

3. Case Specifics

Combination of a Fusion and an Artificial Disc Replacement (ADR) in the same neck.

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Prior ADR Time• Incision to Xray

• Carm

• Discectomy

• Decompression

• Implant Trialing multiple times (use Ruler)

• Implant Midline placement (nerve hook trick)

• 10 min

• 18 min

• 12 min

• 15 min

• 12 min

• 10 min

77 Min

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Preparation

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Surgical Duration

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Surgical TimeSpeed

Efficiency

Infections

Frustration

Postoperative Pain

Proficiency

Level Marked2 Min 48 Seconds

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Prior ADR Time

Incision to Xray

Case Time

10 min

77 Min

2 min 48sec

69 min 12sec

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Step by Step

While that is exciting….Looking back…How Did I Get Faster?

Preparation

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

• Stopped Doing Everyone’s Job

• Helped them do it more

efficiently

Framework: 3 Phases of Surgery

Maximizing Each Phase of Surgery

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Pre ProcedureMaximizing Each Phase of Surgery

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Next we insert the implant Setup

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Postop Posterior Cervical PainSetup

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Eliminate Cervical PainsSetup

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Mark LevelSetup

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Mark LevelSetup

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Setup

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Setup

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

• Set up the OR so you do not

have to ask for things…keep

key items within reach

OR Room set upMaximizing Each Phase of Surgery

Insert photo of GELFOAM SET UP

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

• Tools/Equipment

• Anticipation

• Cognizant of Time

• Shave Time

• Assistant

• Mountable Retractors

How Do I Operate Faster?

Maximizing Each Phase of Surgery

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

• Surgeon Preference Cards

• Consider this an entirely new Venture…

• Don’t Expect ANYTHING

– Gloves

– Suction Tips

– Retractors

– Suture

PreferencesMaximizing Each Phase of Surgery

Story: Frustrated Surgeon

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

• Custom Instruments

TimingMaximizing Each Phase of Surgery

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

• One Step Ahead

– Only YOU know what is coming next

– Only YOU know what YOU need next

• Ask for things BEFORE you need them

– Gelfoam

– BMP Soaking

– Floseal

– Tisseal

• Scrub Tech have next instrument in

their hands

AnticipationMaximizing Each Phase of Surgery

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Game PlanMaximizing Each Phase of Surgery

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

• Surgeon

• Nurses

• Circulator

• Fluorscopy Technologist

• Neuromonitoring

• Representative

Maximizing Each Phase of Surgery

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Microsect Curette

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Kerrisons

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

BUY YOUR OWN INSTRUMENTS• Cost?

• New Conferences $500-$750• Ebay $450

• No One Else Allowed to Use them

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Mallet

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Bedside Mounted Retractor

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Custom Instrumentation

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Custom Intervertebral Spreader

Ruler Trick

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Trialing

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Trialing

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Nerve Hook Trick

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Nerve Hook Trick

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Nerve Hook Trick

Pablo Pazmiño, MD Cervical Arthroplasty

Eliminate Unnecessary Steps

Pablo Pazmiño, MD Cervical Arthroplasty

Custom Instrumentation

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Custom Nerve Root Retractors

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Prior ADR Time• Incision to Xray

• Carm (Leave in Position)

• Discectomy (Microsect Curettes)

• Decompression (New Kerrisons)

• Implant Trialing multiple times (use Ruler)

• Implant Midline placement (nerve hook trick)

• 10 min

• 18 min

• 12 min

• 15 min

• 12 min

• 10 min

77 Min

• 2 min 48 sec

• 6 min

• 10 min

• 15 min

• 2 min 30sec

• 4 min

39.98 Min

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Fusion

Done second so the

hardware is not in the

way of the midline

ADR placment

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty

Standalone Implant vs Plating

• Plate impingement

• Screws proximity

Thank You

Pablo Pazmiño, MD Cervical Hybrid Arthroplasty