Nuvasive in Scoliosis Surgery

How is the XLIF being perceived by the surgeons who have used it. Any failures to report?

 

In a Scoliosis surgery? Why would you use XLIF and fuse the spine for a scoli case?

 

wow... Are you serious Clark? I am glad that the market is being flooded with reps that pose this question seriously.

 

That is exactly why I am asking - saw it on the surgery schedule the other day - T2-L5 on a 14 y.o.female. If you visit the NuVasive site, they are collecting data on their scoli cases.

 

If a 14 y.o. is being fused from T2-L5 without a trauma that surgeon should be shot. That is insane!

 

ok, high thoracic curve is most likely a secondary curve, correcting with screws and mild derotation. Primary curve could be low thoracic - high lumbar using XLIF for both the anterior release and the using spacers to keep enplates parallel. It is not right to question a surgical plan from just looking at a schedule. This pt. , although 14, may need an anterior release in the TL region and post stab could be could be done with perc screws. New technologies and refined techniques are allowing very skilled surgeons to treat their pt.'s with the least amount of disruption and (especially with teenage girls) cosmesis in mind. This is all theory from what has been posted.

 

How do you fuse L5 with XLIF?

 

This doctor is a BUTCHER. He/she is not treating this pt. He/she is destroying her spine. Her spine will never be right after this surgery. And you know that. But all you see is the money. What if this pt. was your sister or daughter? Disgusting!

 

Have you seen the films, cobb angles, flexion/ extension and side bending? Maybe this pt. has neuromuscular scoli. I would love to compete against reps that have a view this narrow. I would also love to engage this surgeon and ask her/him about this op plan. Scoli is is extremely complex and every surgeon goes in having a plan. I have seen pt's recieve treatment along these lines and they really needed action this agressive. Obviously no one is treating a 40 degree flexible curve with this op plan.

I treat every case a surgeon books with me the same. It is someone's sister/brother, mother/father, son/daughter should be treated like they were mine. As far as the $$ is concerned, most cases of this magnitude are at large institutions that bust balls on pricing. You are likely looking at capitated $500 screws.

And finally as far as the patients spine never being right again... If she is having this surgery, was her spine "right" in the first place? I would much rather have a rep in my daughter's OR that knew his sh*t and came prepared by understanding EXACTLY what the surgeon was there to accomplish and how he was going to do it. If the rep knows how much the case bills out to, so what.

 

L4-5 all the time. 5-1 never. Prob refering to were the inst would end, meaning post screws.

 

How many redo's have you had to do? What %? You know it is a very high %. Instrumentation does not work.

 

Scoliosis left untreated can be a fatal condition effecting pulmonary fuction and or organ function. Bracing has been proven to help slow or even halt the progression. The downside to bracing is that most require the patient to wear 23 hrs per day. Most teenagers do not comply with this at all. Most deformity surgeons wait until this conservative treatment fails before recomending surgical intervention. Current techniques and technology in deformity restore balance and correct any 3D curvature. Their long term effects are certainly better than slowly dying. These are MAJOR surgeries and should never be taken lightly by anyone. I would say that the anecdotal revision rates of the surgeons I work with are somewhere in the 5%. I make a note of every case I do and to ask the surgeon and his/her pa how they are doing at 6, 12 and 24 mos. out. I really care about the patient. In these cases, the rep and their knowledge do make a difference in the patient's care. If you want to be a spine rep and do 1 and 2 level TLIF's all day, you will make a great living by just dropping off trays and showing up for surgery. But there are some of us who work very hard to grow our knowledge to be a real resource for the surgeon, and we want to make a difference.

 

good response

 

I disagree. I think you are stepping to the area of thinking you are FAR more instrumental to the surgery than you really are. Regardless of how well you can explain to a tech how to load a screw, and as many times as you look at the surgeon and nod or offer some "input". You are a sales rep. Your job is to accompany your product into the operating room so the surgeon can use it in the appropriate manner and to ensure that it is well represented.

Beyond that, you have no impact on the surgery or the patient's outcome. Im sure you like to tell your friends and pals that you are some important member of the surgical team but the truth is - you aren't peanuts. Go to med school, enter a 5-7 year residency program, then complete a 1-2 year fellowship... then maybe you can contribute.

Its idiots like you....

 

Thanks Doc! I personally drag some of my surgeons through their procedures and have made a large impact on the outcomes of the cases. I am no surgeon; however, I am a specialist with my products, implanting techniques, and make more $ than many of my surgeons.

Try your cases without your reps and let me know how it works out.

 

Which surgeons do you make more than? The residents at 40k or the fellows at 55?

I'll tell you right now, that unless you are working with some real hack surgeons at terrible facilities, you are not making what they make. Orthopedic spine surgeons are making, on average, 600+ while their neurosurgeon counterparts are in the 800+ range.

Go pound sand.

 

Although many reps think they are more instrumental to the surgical process then they are, they "can" provide support. I am no expert but I worked with a Spine rep during training who was the most knowledgeable rep I have ever met. Former PA, First Assist and Coast Guard.....this guy had the surgeons calling him doc.

 

Why are some of you saying the XLIF is a fusion when the vertebrae are never bolted together?

What's doing the fusing?