First Spinal Cord Endoscope Surgery Conducted in Iran

Can you imagine in this 21st century with so much of medical knowledge and medical care a first spinal endoscope surgical procedure is done on Oct 14, 2008?. A first spinal surgery in Iran, wow....finaly a surgical procedure to help patients with back or spinal problems is introduced in Iran by an American spine surgeon?.

Iran News Page One > Iran News First Spinal Cord Endoscope Surgery Conducted in Iran Oct 15, 2008 Iranian.ws The first spinal cord endoscope surgery was conducted in Iran, yesterday morning, by Professor John Chio, head of California Vertebrarium Research Center. Shedding light on details of such a surgery, Chio said: “During this surgery the tissues are not cut and the muscles are placed aside with highly delicate tools in order to reach the spinal cord and to lower disc pressure. Meanwhile, in order to stitch the wound, laser is used.” He added that in this surgery the patient does not bleed and therefore blood transfusion does not take place. The surgeon further underlined that the patient can leave three hours after surgery, resuming his social life within six days and commencing his athletic activities within three weeks. “The operation is also economically justified,” he added. He further said that one of his main goals is to train Iranian physicians, stressing that Iranian physicians are intelligent and can easily learn this operation.

Neuromonitoring:-Failing to be Assertive to communicate the neurophysiological abnormalities will cost you a Lot?

   Josh Colemna's back surgery went wrong during surgical procedure that involved possibly a scoliosis correction or posterior spinal correction, though the exact procedure done and details are not available, it is important to notice the role of neuromonitoring, fialing to do the right thing at right time will not only cost money, job but also someone's life.  
Neuromonitoring companies must make sure they have the competent neurophysiologists with a PhD or MD, or a neurologist is overlooking the technicians or else pay for the mistake. But, a neurophysiologist or neurologist will be able to warn the surgeon and anesthesiologist providing feed back instantly. Why it is so important to have this highly qualified professionals for doing some technical job is that they have the expert knowledge to troubleshoot as well as identify the causes of any changes if takes place, compared to a technician, he/she might be able to perform the technique but will have hard time in interpreting and convince the surgeon of a danger of injury to sensory, motor pathways or spinal cord injuries during back surgery. Anyways, this is an example of how much it will cost and how it will cost you if you fail to alert timely?.

March 24th, 2007 at 9:51 am

$11.7 M verdict against bystander doctor

» by Ted Frank

March 24th, 2007 at 9:51 am

$11.7 M verdict against bystander doctor

» by Ted Frank

A team of doctors at North Fulton Medical Center worked on Josh Coleman’s back surgery in 2003. Dr. Frank Puhalovich had a minor role: “he was only in the operating room for about 10 minutes making sure a technician properly hooked up a monitor that tracks nerve impulses along the spinal [cord] through electrodes attached to Coleman’s head and feet.” But after Puhalovich left, during surgery, the alarm went off: attorneys blame the surgeons’ failure to respond to the alarm in a timely fashion for Coleman’s paralysis. Coleman sued everyone involved, and all the doctors settled, except Puhalovich. So Coleman proceeded to trial against Puhalovich, blamed him also, and a jury awarded $11.7 million. The press coverage gives no indication what the theory of liability is against Puhalovich.

Joshua Coleman, sitting in a wheelchair next to his attorneys, Bill Stone and David Boone, smiled as the verdict was announced after the two-week civil trial.

“Josh is high as a kite right now,” Stone said. “He’s going to have a great weekend.”

(Beth Warren, “Paralyzed man awarded $11.7 million”, Atlanta Journal-Constitution,Mar. 24).

Update: Kevin, MD post with clever title Shotgun yields a jackpot.

 SATURDAY, MARCH 24, 20078

Shotgun yields a jackpot

A neurologist loses a verdict in a back surgery case. He was in the OR for less than 10 minutes, and didn't even operate on the patient. He got caught in the crossfire of a shotgun lawsuit. An unfortunate outcome, but the wrong doctor was targeted.

Cochlear Microphonics & CNAP recording in Neuromonitoring??

Anatomy of Ear (pic fromHearing and Hair Cells John S. Oghalai, M.D.Baylor College of Medicine ) (human ear pic: Muni's_neuromonitoring1)Jorge Bohorquez et al describes a system in their recent publication listed below, according to their study one can test both outer hair cell and inner hair cell electrical activity during surgical procedures. Though this work is evaluated in aniamal study, it is pretty interesting if this can be moved to the OR in our neuromonitoring procedures. I am not sure if this is already practiced in the OR by any neuromonitoring companies. It is a very common procedure to do auditory brain stem evoked potentials in tumor resection or craniotomy procedure that might put the 8th nerve in risk, nevertheless, this CM, CAP and CNAP will be a very important approach in certain cases where injury to both IHC and OHCs can be avoided?. 

Neuromonitoring of cochlea and auditory nerve with multiple extracted parameters during induced hypoxia and nerve manipulation

Jorge Bohórquez et al 2005 J. Neural Eng. 2 1-10   doi: 10.1088/1741-2560/2/2/001

Abstract.  A system capable of comprehensive and detailed monitoring of the cochlea and the auditory nerve during intraoperative surgery was developed. Jorge Bohórquez et al 2005 J. Neural Eng. 2 1-10 E-mail: jbohorquez@miami.edu

The cochlear blood flow (CBF) and the

electrocochleogram (ECochGm) were recorded at the round window (RW) niche using a specially designed otic probe.

The ECochGm was further processed to obtain cochlear microphonics (CM) and compound action potentials (CAP). The amplitude and phase of the CM were used to quantify the activity of outer hair cells (OHC); CAP amplitude and latency were used to describe the auditory nerve and the synaptic activity of the inner hair cells (IHC). In addition, concurrent monitoring with

a second electrophysiological channel was achieved by recording compound nerve action potential (CNAP)

obtained directly from the auditory nerve. Stimulation paradigms, instrumentation and signal processing methods were developed to extract and differentiate the activity of the OHC and the IHC in response to three different frequencies. Narrow band acoustical stimuli elicited CM signals indicating mainly nonlinear operation of the mechano-electrical transduction of the OHCs. Special envelope detectors were developed and applied to the ECochGm to extract the CM fundamental component and its harmonics in real time. The system was extensively validated in experimental animal surgeries by performing nerve compressions and manipulations.

Medical & Legal Issues Regarding Brain Injury

What are the medical and legal aspects of Brain Damage or Axonal damage? 

what type of knowledge is neccessary to deal with court cases that may require background knowledge and expertise in looking at the area of brain damage and discuss the intricacies of brain damage and axonal damage to the court officials as well as to the lay people in the jury??. This following article appeared in the latest issue of the newsletter of IBIA (International Brain Injury Association) discusses in detail about what health care professionals should know?.

Medical-Legal Illustration: What Health Care Professionals Should Know

By Robert L. Shepherd, MS, Certified Medical Illustrator, Vice President and Director of Eastern Region Operations, MediVisuals Incorporated

Professionals of numerous medical as well as health care subspecialties are often called upon to provide expert opinions in the context of litigation. Those providing medical-legal opinions may either be called due to their role as a treater of a patient involved in litigation or retained to provide so called “expert witness” testimony because these specialists are recognized as experts in a specific area (even though they may not have treated a patient involved in litigation). In either case, the role of the testifying professional is very important in helping decision makers or triers of fact identify and appreciate the truth in order to achieve just resolution of the contested issue(s). 

For Instance: 

Figure 1:  Example of graphics that can aid expert testimony:  This particular series of illustrations helps demonstrate one of the most difficult concepts for layperson decision makers to appreciate – that is, how brain injuries (traumatic axonal and shear injury) can occur in an individual with only a minor, or sometimes even no significant blow to the head.  The illustrations are also particularly helpful in explaining how an individual can have these injuries, yet the injuries are not evidenced on traditional brain imaging studies such as CT or MRI.   Another very effective animation demonstrating this same phenomenon even more convincingly can be seen at the following link:  http://medivisuals.com/mildtbi