mastering the cervical hybrid artificial disc replacement 16/pazmino track c 6... · 2018-05-30 ·...
TRANSCRIPT
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Mastering the Cervical Hybrid Artificial Disc Replacement
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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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
![Page 3: Mastering the Cervical Hybrid Artificial Disc Replacement 16/Pazmino Track C 6... · 2018-05-30 · Hybrid ADR 1. Setup 2. Special Instrumentation 3. Case Specifics Combination of](https://reader033.vdocument.in/reader033/viewer/2022060515/5f8e032f457d2c1dc62b3c64/html5/thumbnails/3.jpg)
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
![Page 4: Mastering the Cervical Hybrid Artificial Disc Replacement 16/Pazmino Track C 6... · 2018-05-30 · Hybrid ADR 1. Setup 2. Special Instrumentation 3. Case Specifics Combination of](https://reader033.vdocument.in/reader033/viewer/2022060515/5f8e032f457d2c1dc62b3c64/html5/thumbnails/4.jpg)
![Page 5: Mastering the Cervical Hybrid Artificial Disc Replacement 16/Pazmino Track C 6... · 2018-05-30 · Hybrid ADR 1. Setup 2. Special Instrumentation 3. Case Specifics Combination of](https://reader033.vdocument.in/reader033/viewer/2022060515/5f8e032f457d2c1dc62b3c64/html5/thumbnails/5.jpg)
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
![Page 6: Mastering the Cervical Hybrid Artificial Disc Replacement 16/Pazmino Track C 6... · 2018-05-30 · Hybrid ADR 1. Setup 2. Special Instrumentation 3. Case Specifics Combination of](https://reader033.vdocument.in/reader033/viewer/2022060515/5f8e032f457d2c1dc62b3c64/html5/thumbnails/6.jpg)
Preparation
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Surgical Duration
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Surgical TimeSpeed
Efficiency
Infections
Frustration
Postoperative Pain
Proficiency
Level Marked2 Min 48 Seconds
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Prior ADR Time
Incision to Xray
Case Time
10 min
77 Min
2 min 48sec
69 min 12sec
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Step by Step
While that is exciting….Looking back…How Did I Get Faster?
Preparation
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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• 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
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Pre ProcedureMaximizing Each Phase of Surgery
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Next we insert the implant Setup
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Postop Posterior Cervical PainSetup
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Eliminate Cervical PainsSetup
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Mark LevelSetup
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Mark LevelSetup
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Setup
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Setup
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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• 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
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• 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
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• 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
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TimingMaximizing Each Phase of Surgery
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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• 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
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Game PlanMaximizing Each Phase of Surgery
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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• Surgeon
• Nurses
• Circulator
• Fluorscopy Technologist
• Neuromonitoring
• Representative
Maximizing Each Phase of Surgery
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Microsect Curette
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Kerrisons
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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BUY YOUR OWN INSTRUMENTS• Cost?
• New Conferences $500-$750• Ebay $450
• No One Else Allowed to Use them
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Mallet
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Bedside Mounted Retractor
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Custom Instrumentation
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
Custom Intervertebral Spreader
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Ruler Trick
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Trialing
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Trialing
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Nerve Hook Trick
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Nerve Hook Trick
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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Nerve Hook Trick
Pablo Pazmiño, MD Cervical Arthroplasty
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Eliminate Unnecessary Steps
Pablo Pazmiño, MD Cervical Arthroplasty
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Custom Instrumentation
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
Custom Nerve Root Retractors
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Pablo Pazmiño, MD Cervical Hybrid Arthroplasty
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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
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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
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Thank You
Pablo Pazmiño, MD Cervical Hybrid Arthroplasty