Dr. Nancy Epstein Spine Series

SUMMARY: Dr. Nancy Epstein presents actual cases of malpractice surgical errors and discussed how to avoid these mistakes. Cases Include Minimally Invasive Surgery- Arachnoiditis; Failure to diagnose and treat Cauda Equina Syndrome; Failure to remove Abscess in timely fashion with complications; Unnecessary TLIF with. complications. Dr. Epstein provides tips and experience to avoid these complications and others. Practical advice for neurosurgeons and spine surgeons. 31 min (JIA)

SUMMARY: Dr. Nancy Epstein adds a 15th lecture to her Spine Series Controversies talks. This is in two parts; Avoiding Malpractice Claims: Cervical Spine Surgery. followed in a second program on Lumbar Spine Malpractice cases. These talks are limited to case presentations involving real cases with extremely bad complications leading to malpractice suits. All six cases were settled out of court. They included Epidural Spine Injection (ESI) leading to death with warnings about this procedure, required by Medicare. Also cases of Quadriplegia after ACD with surgeon taking bite out of spinal cord; quadriplegia after ACD with surgeon plunging a spacer into cord; quadriplegia after wrong multilevel ACD for Ossification of Posterior Longitudinal Ligament; quadriplegia with mismanaged CSF Leak; She describes how to avoid all of these complications. These cases lead to terrible life changes. What would you do as the surgeon in these cases or as the patent's family? Listen and decide. (51 min). (JIA)

SUMMARY: This is the first South American Neurosurgery Grand Rounds with SNI Digital® organized by Andres Cervio, Head of Neurosurgery at FLENI in Buenos Aires. This is an Interactive discussion of many aspects of the Diagnosis and Surgical Management of Cervical Lamino-Foraminotomy for posterior lateral cervical spine disc or spur. Nancy Epstein was the invited speaker and commentator. Many tips in the management of the patients are presented with the neurosurgeons from FlENI and Dr. Epstein with an excellent operative video and discussion of all aspects of the surgery and patient selection and post-operative course. There are other videos of the excellent work done at FLENI by neurosurgeons presented in Videos on Rasmussen's Encephalopathy, Posterior Mesiale Temporal Occipital AVM removal, and Brain Stem biopsy. ( Put these words in Search to find) (JIA)

SUMMARY: Dr. Nancy Epstein continues her Spine Series discussions with this presentation about cervical spine trauma resulting in C1 to C3 injuries. Jefferson, Odontoid, and Hangman's fractures are discussed with references to the literature. supporting the fact based approaches to treatment. Surgical correction is critical to perform ASAP. With a less than 6 hour goal . 40 minutes of Discussion and Presentation. (JIA)

SUMMARY: Dr. Epstein reviews the literature on the efficacy of anterior vs posterior approaches to the lateral lesion in the cervical spine and concludes that the evidence for the Cervical Laminoforaminotomy is superior to that of the anterior approaches (ACD/ ACDF) for lesions in this region. posterior procedure. This is an excellent review and analysis of this management choice which reveals the problems with the ACDF approaches as inferior to the CLF. It is understood that a large number of physicians were not trained in this procedure, which is simpler and safer than the ACD/ACDF approach. Yet the CLF is simpler, less costly, and associated with less complications although physicians and hospitals are reimbursed less for CLF over ACD/ACDF. The potential complications are more serious with the ACD/ACDF. So this also becomes a healthcare economics issue. While everyone (physicians, Biomedical companies, Hospitals) are gaming the system to make money; the patient loses. What is the standard of care? How can it be changed for everyone's benefit? (ed- James Ausman)

SUMMARY: Dr. Epstein discusses the diagnosis of anterior spine lesions with proper imaging. Is ACDF, or Excision of the Verbal body(s) appropriate? Risks of two and more level body replacements; The need for posterior fusion; how to identify the Ossified Posterior Longitudinal Ligament (OPLL) and the various scenarios of involvement of the dura with potential CSF leak , and how to treat that problem, Management of CSF leak and autograft vs other graft replacements pros and cons; Avoidance of errors leading to poor outcomes and malpractice issues. 37 min Lecture and Discussion. (JIA)