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- Welcome my friends, to the "Bob & Brad Podcast",
produced by Bob and Brad,
the two most famous physical therapists on the internet.
I am Bob and I exactly one half of the Bob and Brad team.
Today is truly an honor,
to be joined once again by Dr. Hamid Abbasi,
a neurosurgeon, it means he's smart.
And we've had him on before
to talk about minimally evasive surgery
he does for the lumbar spine.
But this one is a minimally evasive surgery
for the sacroiliac joint.
And you're going to find out that you know,
maybe your back pain is coming from your sacroiliac.
We'll discuss all that today,
along with what the procedure is, where it's at,
how to get it,
and it'll be worth your time to watch
and listen to the show.
Welcome to the show Dr. Abbasi.
Thank you so much again for joining us.
And we're going to talk about a new topic today.
We're going to jump right in.
We're talking about sacroiliac joint dysfunction.
Let's talk about the treatment.
Let's let's go into it.
- Well, the first order in treating the sacroiliac joint
is people like you Bob.
People who bring balance
like somebody who's using all the time,
just one of the sacroiliac joint.
You teach them to have a good posture,
to have a good balance in using that.
Second order is still what you do.
Strengthening the muscles that protect the joint
or pelvic muscle.
Many of those treatments are identical to the treatment of
lumbar spine.
The posture, strengthen of spinal and gluteal muscle,
even in lip SOS.
And as well, the overall management of the pain
pain expectation to reduce the inflammation.
Pain medication like Non-Steroidal Anti-Inflammatory
medication like Ibuprofen, Aspirin and so on.
Braces has not been great to manage these braces.
There are not really good enough braces that can stabilize
that contrary to our extremities or spine.
And on top of that, some behavioral modification,
Bob I don't need to tell you,
if you go and play tennis and you come back
and your elbow is hurting,
you shouldn't play tennis for a while.
So behavioral modification is obviously important.
Beyond that, please.
- Just what percentage would you say that don't require
surgery? I mean.
- Majority of them.
- Majority do not require.
- Majority, like many of the patients love
the after giving birth of sacroiliac joint as you said,
they go on, may take a year and so on
but they go on and get it.
They become stronger and they get better.
A vast majority of the people after spinal fusion may have
sacroiliac problem because temporarily it has to take more
but then they as well learn
and the ligament becomes stronger,
they don't need the sacroiliac fusion.
But still the number of the people
who all the other means fail
and even the injection.
You remember we talked about that?
Many of these people take therapeutic injection,
say diagnostic injection.
I do as well therapeutic injection at the same time by
giving steroids, many of them, they go and get better.
They don't need a surgery.
As well I think there are some other
like Radiofrequency Ablation
and some other injection that are not diagnostic
that can help, contrary to lumbar spine.
Those burning the nerve doesn't really work really well for
sacroiliac joints.
- I see.
- But physical therapy, behavioral modification,
and Anti-Inflammatory drugs,
are a good first-line treatment.
Second-line treatment, and the less successful,
significantly less successful is any kind of bracing or
Radio Frequency Ablation.
People talk about the stem cell
and this and all of that is experimental.
There is no evidence that any of that really works,
it's like taking your plasma and centrifuging it,
taking your platelets or stem cell injecting there.
All of that is experimental.
There is no evidence that any of that really contribute.
For that reason most of insurances don't pay for that.
It's cash pay.
So it's expensive and it really doesn't provide much benefit
to my best knowledge at this point,
based on any evidence provided.
- So now we're moving on to the surgical options
and what are those?
- So I think nature threw us a bone there.
Now certainly there are lots of problems
with the sacroiliac joint,
but this a joint that has no function.
Besides opening up during the pregnancy and delivery.
But even that my OBGYN colleagues have told me,
now it's irrelevant.
We don't really rely on that these days.
If baby doesn't want to come out,
you're not going to wait for sacroiliac joint to open.
- Sure.
- You're just going to take that baby out
and you're good at it.
So they're telling me it's irrelevant.
Fusion of the sacroiliac joint is irrelevant,
except extraordinary circumstance.
And obviously everybody in that situation need as well to
consult their OBGYN doctor regarding that.
But beside that, it has no function.
And so the solution is easy.
If too much motion stretches,
the ligament can cause significant horrible pain.
We just have to stop that process,
for that joint to move too much.
Unfortunately for 70 years, the way to do that,
it was a horrendous, very evasive surgery.
But those times are over.
We've figured out finally how to stabilize the spine without
causing too much surrounding damage.
- So how do you do that?
I mean, I know you go through the little triangle
on the lumbar spine,
so it's a similar spot on the sacred leg?
- Yeah. But let's first talk about how it used to be done,
why it was bad and why the new method is better.
See what here you see that just the sacrum
and the iliac crest is connected to that.
And there are tremendous amount of vessel, muscle,
nerve ligament here.
To get there, you have to go through all of that.
And then you get to the sacroiliac joint.
It's not unusual to lose just one fourth of your body blood,
just to get to that joint.
- Oh wow.
- Because you have to go through all the structure.
Until we figured that out,
we can go to sacroiliac joint
without going through the back.
We just have to go from the side
and go to your iliac crest
and then go put literally like, like two bits of wood.
We have to put screws
or something that will stabilize that joint,
that that joint doesn't move anymore the wrong way.
Now, initially people start obviously putting
just orthopedic screws there.
The orthopedic people have been using screws
for a very long time, it did work.
And then some people came out with putting
something that looked like a nail.
Actually, as a matter of fact,
they first stack pins like orthopedic surgeons start using
pins before they start using screws.
Because it's easier to make a pin.
And based on the pin technology,
people start using what we call plugs, sacroiliac plugs.
And those plugs are in different form.
Some of them look like a nail,
some of them look like a triangular kind of plugs
or nail and so on.
But we know that orthopedic surgeon,
they have come away from pins.
They mostly use screws now for a good reason
because you know,
the same size nail is somewhere between four
and seven times stronger than the same,
the same size screw,
seven times four to seven times stronger than same size
nail.
So I started with those plugs.
But I noticed that many of those patients,
I have to go back and revise that.
By the way, the company who made those plugs,
I'm not going to say any brand names here.
They finally came with the screw system themselves.
They recognize that screws are better.
But most of the system that exists right now,
you know actually they use two
or three screws that they go from outside to
inside and I will send you some x-rays as well of those.
- I will really appreciate that, yes.
- And those screws what they do, they stabilize the joint.
Now the idea is that if you have only one screw or nail,
it can rotate around it, like by putting two or three,
it not only make it that tight together,
but you cannot rotate around that screw.
So the motion completely goes away
and hence the magic joint.
These people do so much better with that.
The idea of the surgery is that to stabilize,
make sure that joint doesn't move
and the joint grows together properly.
And then the ligaments don't have
to carry our entire weight anymore.
- So that's two or three on one side?
- On each side.
And as a matter of fact, we have a new method of doing that.
You know, when every time you pass from outside to inside,
you have to pass through tissue.
They have created a method that you pass only once
but then you put three screws
through the same path that are connected.
That looked like the Roman God of the Z,
you know, say then, that trident.
We call it, trident because it looked like it's trident.
And the advantage of that is you pass only once.
So you put the tissue only one time passing
and one time trauma, but you still get three screws.
And it works really well.
As a matter of fact today morning,
I did two of those surgeries.
Both patients went home within one and a half hours after
the surgery.
- Amazing.
- You made the surgery that used to be five hours,
half a gallon of blood loss to a 20 minute procedure,
a patient go home same day.
Almost faster than going to your dentist.
- I want to clarify.
So you would do both sides at the same time?
- Some surgeons do that,
but Bob I don't like to do both sides
at the same time for two reasons.
Number one is when we do that surgery,
I tell my patient not to step on that joint, makes sense.
You just go the surgery on that joint,
you don't want to step on that.
Imagine if I do both sides, how are they going to walk?
- They can't.
- And if they don't walk,
they may have blood clot in their leg and other problems,
that can be dealt with.
There's no reason to do that.
So I do one side,
I let them heal so they can walk on that
before I do the other side.
And now here comes again the magic part
of the sacroiliac joint being a magic joint.
Half of the time that I fix one side,
people can use it more.
It's stable, bone is growing, the other side get better.
I don't even have to go and do the other side
because the stress of the other side goes away.
- It really makes sense.
- Hence magic.
So two reason not to do both sides at the same time.
- How long does the patient have
to be non-weightbearing on that?
- When I started this eight years ago,
I would tell the patient four weeks,
walking with a Walker,
not Toe Touch Weight Bearing
and I'll explain that to your audience.
That means your toes can touch the ground,
but you don't put weight on them.
But with the new system, my patient are telling me,
after two weeks are fine.
They can because this system so stable,
much more stable than those plugs
or nail kind of instrument.
And we made a study, a similar size,
actually sacroiliac screws are four and a half,
4.3 times stronger than those plugs.
So for that reason,
these patients within two weeks,
they can put full weight on that
and return to their basic activities.
Generally, still wait about two months or so.
So if you're sure you're not going to overstress,
because if you do the other side,
you have to know not to step on the other side.
- So does insurance generally approve this?
- Absolutely. Not only they approve it,
now they understand some of insurances,
they want us to go and fix it after two injection.
- Yeah, that is unusual.
- Yeah it is unusual but they know that
if two had been positive,
the third is going to be the positive
and then they have to pay for their surgery.
They want to skip paying for that for the injection.
Makes sense, right?
- That's true.
So I got to ask you the question,
how many of these surgeries have you done?
- I have done closer to 250 of that.
- Oh my gosh.
- Of this surgery.
So I'm not only I'm an expert,
but you know,
I used all the knowledge I gained from treating this,
not only to creating a trident a new way of making it,
now even be that screw system and plugs,
it's still a one hour surgery.
It used to be five-hour surgery.
Now they made it to one hour surgery.
Now we make that one hour surgery to 15 minute procedure,
by trident, being so efficient of doing everything
that needs to get done within 15 to 20 minutes.
Now but this is not the only thing we did.
We as well, we truly streamlined the diagnostic
and the treatment for this and teaching as well.
How, how, if somebody's a fully credentialed surgeon,
what do you, how can you make them efficient
at that in the fastest and
most efficient way?
Meaning that you know,
what it takes to make a spine surgeon,
absolutely an expert on the sacroiliac joint
in the best way possible that it's good for patient.
- Now we failed to mention your website,
inspiredspine.com and you are up in the Minnesota area,
but you will take patients from outside of the state, right?
- Correct, we take actually patient international.
Patient from Canada, Europe,
Middle East, and even thanks to your podcast,
actually a patient from Philippine called us,
and is planning to get treatment.
So you're famous Bob, thank you for having me on your show.
- Well, again you know,
this is such a benefit to so many listeners
and we'll make sure we get the word out.
We'll make sure we go to the website.
And you know, if you haven't seen already,
we had two other previous videos with Dr. Abbasi,
and we'll put the links below for those.
And those are on the spinal fusions.
And again, just as amazing technique, less invasive,
less blood loss, recovery time.
So anything else you want to add Doctor Abbasi?
- Yeah, actually what I want to add there
is the human cost of not getting this right.
This is our duty as a physician, as a provider,
I see you as a provider Bob, is to educate our patient.
And as my hero and poet, Maya Angelou said,
"Do the best you can,
until you can do better then do better."
This is on us providers to be hungry for knowledge,
to look at the data analyze them.
Yes, we deserve to go to vacation and so but,
and have a family life and so on.
We deserve as a doctor,
we deserve that as well.
- Yes.
- But the burden on us is much higher than a random people.
People entrust their loved one.
They let me open their skull
and spine operate two millimeter from their spinal cord.
They trust to come in my operation room
being completely naked and just they trust their family,
their loved one, their body to us.
So we as provider, we have to do the best we can
and always try to do better.
But when we can do better, we have to do better.
This is one of those area that the nature is,
has made it easy for us to make it better.
So I'm offering and truly offering everybody,
even my competitors here in this town to come,
I'll make I teach you this
because our patients truly deserve that.
- You are truly an amazing man.
I'm really inspired every time I inspired fine,
I'm really inspired.
So it was really a truly an honor for you to be on our show.
- Thank you, I appreciate that.
- So again, the invitation is open.
If there's any other procedures you come up with,
we'll make sure to present those too.
So, again, we'll have his website down below
in the comments, as well as the links
for the previous presentations on the lumbar spine.
So thanks again, Dr. Abbasi.
- Always my pleasure.
- Take care.
- Thank you. Bye-bye.
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