The future of spinal cord surgery will be cheaper and will not involve rods or screws, according to surgeons who visited Cayman last week to speak about the latest advances in ultrasonic surgery.
Dr. Jeffrey Cantor, a surgeon with the Cantor Spine Institute in south Florida, and his peer, Dr. John Asghar, spoke to a group of doctors and medical professionals at the Grand Cayman Marriott Beach Resort on Thursday afternoon. The surgeons are part of a very small fraternity of doctors that have adopted ultrasonic surgery for work on the spinal cord.
“This is where spine surgery is going. All the big companies know about this,” Dr. Cantor said. “Their plans over the next 10 years all include this type of surgery. The goal of medicine is to eliminate older techniques and to start moving toward safer, less aggressive and less expensive techniques.”
Ultrasonic surgery, Dr. Cantor said, will ultimately allow surgeons to perform more precise procedures without necessitating the removal of important structural bodies that hold the spine together.
Traditional procedures on the spine are problematic, Dr. Cantor said, because they require large incisions that allow the surgeon to go in and work around the nerves. The surgeon then has to remove structures that hold the spine together and replace those structures with metal rods and screws.
But now, with a device that Dr. Cantor says “feels like an electric toothbrush,” the entire process is being thought anew. Dr. Cantor and his peers at the Cantor Spine Institute are able to perform precise operations that relieve the pressure on nerves without creating even bigger structural problems.
“We can work closely to delicate structures safely because this doesn’t spin and doesn’t tear. It essentially melts the bone,” he said. “Typically, what’s happening is bone is pushing on nerves. Traditionally, you have to go in and remove structure. When you do that, you have to do big operations.
“This tool allows us to do these procedures with tiny incisions. And when we’re done, we don’t have to rebuild anything because this allows us to work inside the spine rather than damaging the tissues and the structures that hold us up. We don’t have to rebuild them with rods and screws.”
Dr. Cantor said that the ultrasonic scalpel, which is made by a company named Misonix, is like a butter knife with a blunt edge. It vibrates 22,000 times a second and can operate in small areas next to delicate nerves. Dr. Cantor said there is a long learning curve for surgeons who want to use the device.
After suffering a wrist injury, Dr. Cantor said, he took about three or four months to learn how to wield the next-generation device, and he spent three or four hours a day getting acclimated to it. Now, he says, he can take a tool that can “cut the leg off a chair in a second” and use it in the most delicate spaces.
“Lasers can’t do this. Lasers can only numb nerves. They can’t safely take pressure off nerves,” he said of the difference between lasers and ultrasonic devices. “Lasers can’t be controlled. This thing can shell an egg. Literally, I can put an egg in my hand and take the whole shell off and give you the soft part with no shell on it. Lasers can’t do that. Laser surgery is a temporary fix, but this is a permanent fix.”
And why is that so revolutionary? Traditional operations, Dr. Cantor said, are often creating as many problems as they fix. When rods and screws are placed in the spine, they can start a domino effect that will cause other structures above and below to systematically fail and necessitate more surgeries.
“In ultrasonic surgery, we don’t remove the important stuff,” Dr. Cantor said. “We go inside the spine and clean the bone spurs out from the inside out so only the bad stuff is removed. The good stuff is left, kind of like when you go to the dentist and they take the plaque off your teeth but don’t take your teeth out.
“This removes just the bad stuff that is grown into the spinal canal and leaves everything else.”