|Dr. Sivaraman, from the UK, shares his clinical experience with the WELLEX™ Interspinous Technology|
Dr. Sivaraman, you have a rather unique cultural background, can you share with us how your extensive personal and professional travels in Europe, Asia and the United States are impacting you today as a person and as a spine surgeon?
I was born in Madurai in South India, which is one of the oldest towns with very significant historic background. I was very fortunate to have come to the UK at the right time and to the right place to secure a position in the prestigious medical training program, which enabled me to specialize as a spinal surgeon. It has been a great opportunity for me to meet people from various backgrounds and work with my professional trainers across the UK. I was trained by numerous leading surgeons in the United Kingdom. I have also travelled widely in Europe, Asia and United States and with the rapidly growing economies in Asia, globalization is a key factor for success of an individual spinal surgeon just as it is for companies.
You are known for your expertise with cutting edge spinal technologies. How is the world of spine surgery changing right now?
Spinal surgery is challenging, very innovative and is also becoming extremely popular amongst trainees. In the recent years, with the advancements in various fields, the arena of spinal surgery is growing at a rapid pace. The new trend, with the internet and the availability of information is that not only surgeons, but also patients are demanding the latest technological innovations, which can sometimes be challenging for us. One thing is for sure, we are moving more towards less invasive technology, quicker recovery time, quicker return to function, which is is important for everyone including “society” as a whole.
When did your passion for “motion preserving technologies” in the spine emerge and why?
When I was doing my spinal specialty training, after my orthopaedic training in the early 2000s, motion preserving technologies were becoming a key component in spinal surgery. We all agreed that the ‘gold standard’ for spinal surgery was still spinal fusion for specific indications, but that it should only be considered a part of the available armamentarium available to surgeons. I do not want to enter the debate of adjacent segment problem and adjacent segment preservation with motion preservation, but certainly return to function is one of the key components in today’s day, and age. Combining motion preservation with a less invasive approach, one can treat some of the earlier and intermediate degenerative pathologies. I trained under surgeons who were early adaptors, who were doing disc arthroplasties 20 years ago, utilizing motion preservation technologies including interspinous devices and flexible stabilisation systems, and I saw patient’s quicker return to function, especially in the young productive age groups. I have been using motion sparing technologies all of my professional life.
You are now using the WELLEX™, can you please tell us when you started using the technology clinically, and why?
As one of my predecessors used to say ‘if I am changing technology it should be for a better one’ and I found that in this particular product. I have extensively used various interspinous devices and have even presented and published my results. However, I had been looking for a while for an interspinous device that was not static, but gave an element of dynamism in extension. The lack of extension was a problem for me with some of the rigid devices that I used in the past, sometimes producing osteolysis around the spinous process. I was introduced to Eden Spine through Mourad Ben Mokhtar, whom I have known professionally in the past. I was very impressed with the concept behind the dynamic technology that he showed me that not only included the element of dynamism in extension that I was looking for, but also allowed me to choose the level of rigidity of the implant to best suit the weight of the patient, and the type of work that they do. I saw it as a new generation technology and decided to make it available to my patients in 2009.
Considering the diversity of the types of back pain, who would be the typical patient to most benefit for the technology?
In my opinion, patients with spinal stenosis, particularly subarticular stenosis with facetal arthritis who do not have a substantial element of central stenosis, would benefit from this technology. As an extended indication, I have also used some interspinous technology in facetal syndrome with good clinical outcomes.
From a pure clinical perspective, how would you describe a standard WELLEX™ surgery?
It is simple, straightforward, low risk procedure with quicker return to function. Typically, for a single level, it takes an incision of less than one inch, about 30 minutes to do the procedure and patients are normally capable of going home later that same day. They are allowed to do all their activities, within reason, pretty much within two weeks from the time of surgery and they start a course of physio and mobilisation, which allows them to get back to normal life within four weeks.
As we all know, sometimes there can be a difference between what surgeons call a “clinical success” and “success” as far as the patient is concerned. How would you describe patient satisfaction inclusive of recovery time and pain relief?
Please keep in mind that I have only been using the technology since 2009, but what I can tell you today is that patient satisfaction has been very good, their recovery time has been excellent, and they are feeling relief of leg pain and symptoms within a few hours of surgery. They can start moving straightaway, but of course they will have some operative back pain until the soft tissue settles. The return to function and pain relief has been remarkable.
From a “longevity” perspective, how long is the implant supposed to last? Is it a permanent solution?
It is a very good question, which leads us to ask what do we mean exactly by long-term? Is it one year, two years, five years, ten years or more than twenty years? We would ideally like to have an implant last for life, without never having to go back for further surgeries. However, if it may be feasible, it is not my personal goal with interspinous technologies. I look at the WELLEX™ as the best solution that we have today for some indications to remove pain, doing the least disruption to the soft tissue and the bones, without burning any bridges. The technology fills the gap between less effective conservative treatments and riskier fusions. It simply provides patients with a better life. Now, what happens next, in the complicated degenerative cascade that all spines go through in a life time is another subject that is much debated.
Have you witnessed any side effects and downsides?
I have had one patient with superficial wound infection, which settled. Also, with my early experience I probably used a downsized implant, which subluxed, which I had to revise to an appropriate sized implant. Apart from this very minor problem, I have not had any significant downsides to this particular procedure.
To conclude, if you had to summarize your experience with the WELLEX™, how would you describe it?
It has been positive and has fulfilled my expectations. I do consider that it is a “best in class” technology, and would invite any surgeon interested in dynamic stabilization to test it. I look forward to sharing my results and experiences in 2011, once I have slightly longer term follow-up.
Thank you very much!
Orthopedic Surgeon from the United Kingdom
Dr. Alagappan Sivaraman completed his higher surgical training in trauma and orthopaedics at Bart’s and The Royal London Hospitals, where he was appointed as an orthopaedic surgeon in 2006. During his training, He worked as a visiting spinal fellow in Germany, the United States and India. He completed his spinal training at Norfolk & Norwich University Hospital and at the Royal National Orthopaedic Hospital in Stanmore, Middlesex. He is the author of a spinal chapter in a medical text book, and has published and presented papers on spinal surgery at international conferences. Dr. Sivaraman specializes in spinal surgery for deformity, inflammatory spinal pathologies, degenerative conditions of the neck and lower back, and the fast-developing field of Posterior Dynamic Stabilization. He has been using some of the pioneering techniques and has published on these various newer technologies and also takes part in various studies.