EP 50: Neck Injuries and Repairing Discs with Dr. Erik Bendiks (Part 3)

Welcome to the catastrophic comeback podcast with American Injury Lawyer Clark speaks, helping you find hope, purpose and joy after a catastrophic injury.

Let's go back for just a minute because I wanted you mentioned something that you and I had dinner together a year ago, or maybe a couple years ago now. Yeah, but, but this is where I where I got to know you first time, first time we met. And we and so I was talking to you about this practice and about your practice and about your approach to treating people and caring for patients. And I remember we had, we had a young person who had just had a fusion of if you remember, this is about back a neck fusion. I remember and you know, saying, Hey, I wonder if I could let me tell you about this in let me get your opinion about if this went the way that it should. And because the guy had pain, and he had some a lot of unresolved pain, he had mobility issues from this bad accident that he was in. And I was, and I was, I was just trying to find out if really what I was trying to see is what how you would have approached it. And then I was thinking, Well, based on what you were saying, I was like, Man, I would I wonder if if if I could suggest to this client that he treat with you because it sounds like to me that your approach was more comprehensive and thoughtful than not criticizing his his physician, but But it seemed like to me that your approach was more thoughtful and comprehensive. And what I was impressed with most is, is, you know, all these things that you were taking into account, not just the injury, the local injury that he had, was dealing with, but the impact of the treatment on his body and the quality of his life going for. So whereas the the original physician that was dealing with him was like, Okay, you have pain here, I can resolve that pain. And then what your approach was more comprehensive in my rudimentary, and I do remember that

that was I think it was two or three years ago, and it was a young, a young ish patient, they were probably in their late 20s, right, they had damage disc in their neck. The problem with discs is God has designed us perfectly. But unfortunately, discs don't have a good blood supply. No blood, no oxygen, no oxygen, no healing. So once you damage a disc, that's it, it's permanently damaged. The good news is even if you tweak that disc, you tear it get a bulge or herniation, which just means some of the jelly squeezes out of the doughnut. If there's no blood, it's not going to be able to heal that. But the vast majority of people that get disc herniation, disc tears, disc bulges don't need surgery, they just for whatever reason, within two to three months, the pain from from an injured disc just tends to peter out just tends to stop for whatever reason. Now that damage, you'll still see it on an MRI, it just doesn't hurt anymore. And that's the vast majority 80 85% of those

that have other impacts or other problems that develop as a result of that are a lot of those are just resolved on their own overtime.

No, I mean, I can speak from from just personal experience, I've got a herniated disc in my back, it hasn't gone away, I'm able to walk around, I'm good. You know, it took me 10 weeks, from day to day, it was literally almost like the light switch. And it was 10 weeks, and then my pain stopped and I was good to go. But I still have stiffness in my back, I'll still have some days where I feel a little bit worse. But is it bad enough that I gotta go to see a spine surgeon goes do surgery? No, no, I'm good enough for that. But you got to keep in mind that your body keeps a tally, it doesn't forget that disk will never be the same. It is a weaker structure. So once it's been damaged, it will be potentially more easily not potentially is more easily injured in the future. And so for you know what you do with with with people that you treat, once they've had an injury from a car accident or an injury at work or whatever, that body part, especially if you're dealing with a spine, if it's a disc, it's not going to be the same if you've damaged that outer wall. You know, a disc is made of a soft squishy center and a tough outer shell just like I mentioned earlier, like a jelly doughnut. Once you damage that tough outer wall. That's it, it's permanently damaged, it's weaker. And so if that structure is weaker, it is inherently more easily injured in the future. So you get into a car wreck and you have a disc herniation your neck at C five six. That doesn't go away the next time you have a car wreck or fall downstairs or tackle injury playing flag football in the backyard with your kids or whatever you pick up your child or even that you could more easily injure that already weak area before.

So this is something that I struggle with in my business we do With a lot of Orthopedic Surgeons, and they feel like that a lot of times they'll put in there, you know, this person presented with this set of symptoms, and I did an evaluation, I determined this was a problem, I did this therapy, or I did this surgery, and this person has done and that was the end of this conversation. And I'm like, wait a minute. Now, what you're saying is something that comes to my mind is your, you know, this, this other physician was is good doctor did a good job taking care of this person, this person's symptoms are alleviated. But when I see him in the office, I'm like, are you 100%, and they're like, not 100%, I'm better, I'm better, but I'm not 100%. And it, there's just no way that a person is going to make a person as good as God made in the first place. You know, what I mean? There's going to be a deficit. Yeah. And our job a lot of times is to quantify that, that deficit between, you know where you are now versus where you were before, right.

And that that was that that patient that we talked about, ultimately, who was the youngest person, late 20s, ended up getting a disc that was damaged in the neck treated with a fusion. And that's, it's a viable option. There's nothing wrong with doing that. And I would not say that, that that surgeon did a bad job, they did a perfect job, it was it was fine. It's just now we have options, we don't just have one tool in the toolbox. Now we have a few of them. And so one of the other tools would be disc replacement. So when that disc is damaged, if it fails, conservative care, time, rest, pills, therapy, injections, and they're still hurting, surgery may be an option. But now it's not just one surgery, I only have one hammer, no, now I've got several different types to choose from. And so fusion is one. And with that patient in particular, I just felt based on what I saw the I think you had shown me MRIs or something like that, or at least I had reports. And based on their age, they would have been a candidate, at least in my mind for a disc replacement, because there's certain benefits to a disc replacement that a fusion doesn't offer you

this is a more conservative approach to treatment in this particular case is I

wouldn't necessarily say conservative, because it's still surgery. And so you still have all the same risks, death, paralysis, infection, bleeding bubble, all that stuff, you have all of those risks. So it's, it's not more necessarily more conservative. From that standpoint, it's just that I believe there is enough, well designed and convincing research out there that has shown that artificial disc replacement for treatment of neck issues is not just equivalent. Now I believe it's superior. In certain patients, yes, it might be equivalent, or certain number of discs, it might be equivalent. But when you're dealing with a 20, something year old, who's going to be around for at least another 40 years, if you glue that joint together, there's more likely than not chance by the time they hit year 17 or 18 from them. So by the time he's in his late 40s, that he'll have needed another surgery because the disc above or the disc below or both wore out. Versus if you do a fusion, or an artificial disc replacement, forgive me, if you keep that motion there, you're not putting more stress on the neighbors. And so there's a lower chance that 17 or years or so later, that he's going to need a fusion or he's going to need another surgery in his neck. And so that's why I thought an artificial disc might be a better option for that particular patient.

So when we had that conversation, you referred me to a series of studies, I come back to my office, and we go through these studies pretty pretty seriously. And we find exactly what you said, which is that if this is a person's spine, then if you fuse these two, what ends up happening over time, there's a very strong probability that within I forget how many years 15 years or so it goes up to like 90%, that, that one or both of these other ones will have to be fused. And then in another 15 years or so, there's a very high probability that the next one's shirt would have to be would be fused

would even be perhaps even higher than that because the more joints you glue together, now the neighboring ones have that much and more friends to help out. And there's that many fewer joints left and so they can wear out even quicker.

So I find that your analogy with the knee that makes that that makes it very easy for me to understand. Right? The idea that, you know, a long time ago, what we used to do is we would fuse that knee joint together so that a person would just walk on this sort of stiff leg going forward. And then over time, they've said hey, you've developed mineralogy. That'll allow a knee replacement which which lasts longer, produces less wear and tear on the other knee, the hip, the ankle, the bound out no doubt that's better qualified quality of life. Yeah,

that's what's beautiful about orthopedics is that's a specialty that's very technology, technique and technology driven And as the years go by, we're just coming up with more new cool stuff that's coming out in all these different areas, you know, you have, you have knee replacements, now you have partial replacements, you don't have to replace the whole knee, what if it's just wearing off, wearing out over on the inside of the knee over right here or on the outside of the knee, you can just replace that part now. And so there's very, very cool technologies that are that are always constantly coming out within my area of interest is spine, there's there's always something new. So we had fusion, then you have different types of fusion or different implants or different plates and screws. Different materials now are the materials really, very solid and sturdy, are they a little bit more flexible? Do they slowly over time get reabsorbed by the body so they even develop have developed plates that the body will slowly resorbed the plates and the screws until they disappear in a certain preset time. For kids that have scoliosis, they can implant rods to straighten out their curvature and their spine, and the rods will actually grow with them. And so and they can do these with magnets, they can rub the put the magnet over the patient's back and it'll extend just a little bit as the patient grows. Very cool technology. Another area of spine that's that I find fascinating is now and to scopic. So within spine. Normally when we're doing spine surgery, we make a cut on the on the neck or on the back of the neck or in the belly to get to the spine or in the back of the back to get to the spine that way, and then access the anatomy that way. Now with endoscopic spine surgery, you're doing it through an endoscope, you're doing it through basically a straw. So you're actually going through the straw is basically the diameter of a number two pencil. And you're going in with that number two pencil, whether it be in the neck or in the low back, and you can access that particular area. You're now looking on a TV screen over here, and everybody in the room can watch with you as you're looking on the TV screens like okay, there you go. I see the nerve, going to call out a little bit of bone right here, move that out of the way you see the spinal cord slide that over here, you're looking right at the disc, go ahead and take a piece of the disk out. And it's just amazing technology and the less disruption to the tissues to the cutting muscle cutting skin, moving bone moving nerves, the less of that you do, the less pain patients are going to have after surgery and the quicker they recover from and it's absolutely amazing. I see my endoscopic patients who literally before you do an open surgery meaning a standard incision. They're in recovery room for a diskectomy maybe hour and 15 minutes, who knows or something like that. Now with endoscopic they might be leaving the surgery center 25 minutes after surgery. As soon as they wake up. I literally I remember my first patient that I did, I came out after you know I did that first surgery, endoscopic, then I go do a second surgery, whatever it is, and usually, you know, oh, I have enough time. You'll come out after that second surgery and then you'll visit with the patient from the first surgery that you didn't be able to see them before they leave with that patient that was endoscopic. I came out after the second surgery and they already gone. I was like what happened? What happened to the lady? I was thinking something bad happened and they had to go to the hospital. I know we kept them here about 25 minutes. She was just antsy. She was done. It's like why am I gonna stay here any longer. It's like, Well, Dr. Bennett wanted to talk to you. It's like I'll just talk to him and when I see him next week or whatever they had already left. So it's absolutely amazing technology. Now you can you can get in there, see the anatomy, treat it through a number two pencil and the patient can go home that same day. Thank you

for joining us, and we'll see you next time.

Welcome to the catastrophic comeback podcast with American Injury Lawyer Clark speaks, helping you find hope, purpose and joy after a catastrophic injury.

Let's go back for just a minute because I wanted you mentioned something that you and I had dinner together a year ago, or maybe a couple years ago now. Yeah, but, but this is where I where I got to know you first time, first time we met. And we and so I was talking to you about this practice and about your practice and about your approach to treating people and caring for patients. And I remember we had, we had a young person who had just had a fusion of if you remember, this is about back a neck fusion. I remember and you know, saying, Hey, I wonder if I could let me tell you about this in let me get your opinion about if this went the way that it should. And because the guy had pain, and he had some a lot of unresolved pain, he had mobility issues from this bad accident that he was in. And I was, and I was, I was just trying to find out if really what I was trying to see is what how you would have approached it. And then I was thinking, Well, based on what you were saying, I was like, Man, I would I wonder if if if I could suggest to this client that he treat with you because it sounds like to me that your approach was more comprehensive and thoughtful than not criticizing his his physician, but But it seemed like to me that your approach was more thoughtful and comprehensive. And what I was impressed with most is, is, you know, all these things that you were taking into account, not just the injury, the local injury that he had, was dealing with, but the impact of the treatment on his body and the quality of his life going for. So whereas the the original physician that was dealing with him was like, Okay, you have pain here, I can resolve that pain. And then what your approach was more comprehensive in my rudimentary, and I do remember that

that was I think it was two or three years ago, and it was a young, a young ish patient, they were probably in their late 20s, right, they had damage disc in their neck. The problem with discs is God has designed us perfectly. But unfortunately, discs don't have a good blood supply. No blood, no oxygen, no oxygen, no healing. So once you damage a disc, that's it, it's permanently damaged. The good news is even if you tweak that disc, you tear it get a bulge or herniation, which just means some of the jelly squeezes out of the doughnut. If there's no blood, it's not going to be able to heal that. But the vast majority of people that get disc herniation, disc tears, disc bulges don't need surgery, they just for whatever reason, within two to three months, the pain from from an injured disc just tends to peter out just tends to stop for whatever reason. Now that damage, you'll still see it on an MRI, it just doesn't hurt anymore. And that's the vast majority 80 85% of those

that have other impacts or other problems that develop as a result of that are a lot of those are just resolved on their own overtime.

No, I mean, I can speak from from just personal experience, I've got a herniated disc in my back, it hasn't gone away, I'm able to walk around, I'm good. You know, it took me 10 weeks, from day to day, it was literally almost like the light switch. And it was 10 weeks, and then my pain stopped and I was good to go. But I still have stiffness in my back, I'll still have some days where I feel a little bit worse. But is it bad enough that I gotta go to see a spine surgeon goes do surgery? No, no, I'm good enough for that. But you got to keep in mind that your body keeps a tally, it doesn't forget that disk will never be the same. It is a weaker structure. So once it's been damaged, it will be potentially more easily not potentially is more easily injured in the future. And so for you know what you do with with with people that you treat, once they've had an injury from a car accident or an injury at work or whatever, that body part, especially if you're dealing with a spine, if it's a disc, it's not going to be the same if you've damaged that outer wall. You know, a disc is made of a soft squishy center and a tough outer shell just like I mentioned earlier, like a jelly doughnut. Once you damage that tough outer wall. That's it, it's permanently damaged, it's weaker. And so if that structure is weaker, it is inherently more easily injured in the future. So you get into a car wreck and you have a disc herniation your neck at C five six. That doesn't go away the next time you have a car wreck or fall downstairs or tackle injury playing flag football in the backyard with your kids or whatever you pick up your child or even that you could more easily injure that already weak area before.

So this is something that I struggle with in my business we do With a lot of Orthopedic Surgeons, and they feel like that a lot of times they'll put in there, you know, this person presented with this set of symptoms, and I did an evaluation, I determined this was a problem, I did this therapy, or I did this surgery, and this person has done and that was the end of this conversation. And I'm like, wait a minute. Now, what you're saying is something that comes to my mind is your, you know, this, this other physician was is good doctor did a good job taking care of this person, this person's symptoms are alleviated. But when I see him in the office, I'm like, are you 100%, and they're like, not 100%, I'm better, I'm better, but I'm not 100%. And it, there's just no way that a person is going to make a person as good as God made in the first place. You know, what I mean? There's going to be a deficit. Yeah. And our job a lot of times is to quantify that, that deficit between, you know where you are now versus where you were before, right.

And that that was that that patient that we talked about, ultimately, who was the youngest person, late 20s, ended up getting a disc that was damaged in the neck treated with a fusion. And that's, it's a viable option. There's nothing wrong with doing that. And I would not say that, that that surgeon did a bad job, they did a perfect job, it was it was fine. It's just now we have options, we don't just have one tool in the toolbox. Now we have a few of them. And so one of the other tools would be disc replacement. So when that disc is damaged, if it fails, conservative care, time, rest, pills, therapy, injections, and they're still hurting, surgery may be an option. But now it's not just one surgery, I only have one hammer, no, now I've got several different types to choose from. And so fusion is one. And with that patient in particular, I just felt based on what I saw the I think you had shown me MRIs or something like that, or at least I had reports. And based on their age, they would have been a candidate, at least in my mind for a disc replacement, because there's certain benefits to a disc replacement that a fusion doesn't offer you

this is a more conservative approach to treatment in this particular case is I

wouldn't necessarily say conservative, because it's still surgery. And so you still have all the same risks, death, paralysis, infection, bleeding bubble, all that stuff, you have all of those risks. So it's, it's not more necessarily more conservative. From that standpoint, it's just that I believe there is enough, well designed and convincing research out there that has shown that artificial disc replacement for treatment of neck issues is not just equivalent. Now I believe it's superior. In certain patients, yes, it might be equivalent, or certain number of discs, it might be equivalent. But when you're dealing with a 20, something year old, who's going to be around for at least another 40 years, if you glue that joint together, there's more likely than not chance by the time they hit year 17 or 18 from them. So by the time he's in his late 40s, that he'll have needed another surgery because the disc above or the disc below or both wore out. Versus if you do a fusion, or an artificial disc replacement, forgive me, if you keep that motion there, you're not putting more stress on the neighbors. And so there's a lower chance that 17 or years or so later, that he's going to need a fusion or he's going to need another surgery in his neck. And so that's why I thought an artificial disc might be a better option for that particular patient.

So when we had that conversation, you referred me to a series of studies, I come back to my office, and we go through these studies pretty pretty seriously. And we find exactly what you said, which is that if this is a person's spine, then if you fuse these two, what ends up happening over time, there's a very strong probability that within I forget how many years 15 years or so it goes up to like 90%, that, that one or both of these other ones will have to be fused. And then in another 15 years or so, there's a very high probability that the next one's shirt would have to be would be fused

would even be perhaps even higher than that because the more joints you glue together, now the neighboring ones have that much and more friends to help out. And there's that many fewer joints left and so they can wear out even quicker.

So I find that your analogy with the knee that makes that that makes it very easy for me to understand. Right? The idea that, you know, a long time ago, what we used to do is we would fuse that knee joint together so that a person would just walk on this sort of stiff leg going forward. And then over time, they've said hey, you've developed mineralogy. That'll allow a knee replacement which which lasts longer, produces less wear and tear on the other knee, the hip, the ankle, the bound out no doubt that's better qualified quality of life. Yeah,

that's what's beautiful about orthopedics is that's a specialty that's very technology, technique and technology driven And as the years go by, we're just coming up with more new cool stuff that's coming out in all these different areas, you know, you have, you have knee replacements, now you have partial replacements, you don't have to replace the whole knee, what if it's just wearing off, wearing out over on the inside of the knee over right here or on the outside of the knee, you can just replace that part now. And so there's very, very cool technologies that are that are always constantly coming out within my area of interest is spine, there's there's always something new. So we had fusion, then you have different types of fusion or different implants or different plates and screws. Different materials now are the materials really, very solid and sturdy, are they a little bit more flexible? Do they slowly over time get reabsorbed by the body so they even develop have developed plates that the body will slowly resorbed the plates and the screws until they disappear in a certain preset time. For kids that have scoliosis, they can implant rods to straighten out their curvature and their spine, and the rods will actually grow with them. And so and they can do these with magnets, they can rub the put the magnet over the patient's back and it'll extend just a little bit as the patient grows. Very cool technology. Another area of spine that's that I find fascinating is now and to scopic. So within spine. Normally when we're doing spine surgery, we make a cut on the on the neck or on the back of the neck or in the belly to get to the spine or in the back of the back to get to the spine that way, and then access the anatomy that way. Now with endoscopic spine surgery, you're doing it through an endoscope, you're doing it through basically a straw. So you're actually going through the straw is basically the diameter of a number two pencil. And you're going in with that number two pencil, whether it be in the neck or in the low back, and you can access that particular area. You're now looking on a TV screen over here, and everybody in the room can watch with you as you're looking on the TV screens like okay, there you go. I see the nerve, going to call out a little bit of bone right here, move that out of the way you see the spinal cord slide that over here, you're looking right at the disc, go ahead and take a piece of the disk out. And it's just amazing technology and the less disruption to the tissues to the cutting muscle cutting skin, moving bone moving nerves, the less of that you do, the less pain patients are going to have after surgery and the quicker they recover from and it's absolutely amazing. I see my endoscopic patients who literally before you do an open surgery meaning a standard incision. They're in recovery room for a diskectomy maybe hour and 15 minutes, who knows or something like that. Now with endoscopic they might be leaving the surgery center 25 minutes after surgery. As soon as they wake up. I literally I remember my first patient that I did, I came out after you know I did that first surgery, endoscopic, then I go do a second surgery, whatever it is, and usually, you know, oh, I have enough time. You'll come out after that second surgery and then you'll visit with the patient from the first surgery that you didn't be able to see them before they leave with that patient that was endoscopic. I came out after the second surgery and they already gone. I was like what happened? What happened to the lady? I was thinking something bad happened and they had to go to the hospital. I know we kept them here about 25 minutes. She was just antsy. She was done. It's like why am I gonna stay here any longer. It's like, Well, Dr. Bennett wanted to talk to you. It's like I'll just talk to him and when I see him next week or whatever they had already left. So it's absolutely amazing technology. Now you can you can get in there, see the anatomy, treat it through a number two pencil and the patient can go home that same day. Thank you

for joining us, and we'll see you next time.