1 00:00:00,160 --> 00:00:02,399 This is Carly Beam with the Becker Spine 2 00:00:02,399 --> 00:00:03,699 and Orthopedics podcast. 3 00:00:04,240 --> 00:00:06,240 I'm thrilled to be joined today by doctor 4 00:00:06,240 --> 00:00:09,059 Alex Vaccaro, president of Rothman Orthopedics. 5 00:00:09,759 --> 00:00:12,160 Doctor Vaccaro, thank you so much for being 6 00:00:12,160 --> 00:00:14,400 here today. Oh, sure, Carly. It's a pleasure 7 00:00:14,400 --> 00:00:15,219 and an honor. 8 00:00:15,835 --> 00:00:16,335 Absolutely. 9 00:00:16,875 --> 00:00:18,635 And before we get started, can you just 10 00:00:18,635 --> 00:00:20,815 share a little bit more about your background? 11 00:00:21,995 --> 00:00:23,595 Sure. I grew up I was born in 12 00:00:23,595 --> 00:00:25,675 New York. I grew up in Northern New 13 00:00:25,675 --> 00:00:26,175 Jersey. 14 00:00:26,475 --> 00:00:27,935 I went to school in Boston, 15 00:00:28,475 --> 00:00:29,769 and and then I went to med school 16 00:00:29,769 --> 00:00:30,350 at Georgetown. 17 00:00:30,730 --> 00:00:32,030 I I did an internship 18 00:00:32,649 --> 00:00:34,809 in Cedars Sinai in Los Angeles, and I 19 00:00:34,809 --> 00:00:38,170 did a residency at Thomas Jefferson University in 20 00:00:38,170 --> 00:00:40,509 orthopedics. And then I did a fellowship at 21 00:00:41,045 --> 00:00:43,445 University of California, San Diego in spine surgery. 22 00:00:43,445 --> 00:00:46,004 And now I'm a professor of neurosurgery and 23 00:00:46,004 --> 00:00:46,984 professor of orthopedics 24 00:00:47,765 --> 00:00:50,644 at Thomas Jefferson University. I'm the chairman of 25 00:00:50,644 --> 00:00:52,484 the department of orthopedic surgery, and I'm the 26 00:00:52,484 --> 00:00:54,484 president of the Rothman Institute. So that's my 27 00:00:54,484 --> 00:00:54,984 background. 28 00:00:55,770 --> 00:00:58,090 Thank you. And to kick things off, can 29 00:00:58,090 --> 00:01:00,729 you tell me about some interesting research projects 30 00:01:00,729 --> 00:01:03,469 that is going on at Rothman this year? 31 00:01:04,170 --> 00:01:06,090 Well, I'll tell you what I'm interested in. 32 00:01:06,090 --> 00:01:08,009 I I I've always been a big fan 33 00:01:08,009 --> 00:01:11,025 of spinal cord injury research. So we as 34 00:01:11,025 --> 00:01:11,685 a university 35 00:01:12,625 --> 00:01:16,084 have participated in all the medicinal pharmaceutical trials. 36 00:01:16,305 --> 00:01:17,844 But what's really fascinating 37 00:01:18,704 --> 00:01:21,125 is the department of neurosurgery, 38 00:01:22,064 --> 00:01:22,885 and neurology 39 00:01:24,019 --> 00:01:25,399 have developed a lab 40 00:01:25,780 --> 00:01:27,879 where it's called the Rafael Center, 41 00:01:28,259 --> 00:01:30,099 and I'm involved with that, helping that. And 42 00:01:30,099 --> 00:01:31,640 what we were doing is 43 00:01:32,179 --> 00:01:34,099 as a group, and it's under the, 44 00:01:34,659 --> 00:01:38,734 auspices of of my neurology partner, Michelle Saruri. 45 00:01:39,435 --> 00:01:40,255 We're developing 46 00:01:40,954 --> 00:01:41,454 exoskeletons 47 00:01:41,834 --> 00:01:42,495 and sensors 48 00:01:43,194 --> 00:01:45,454 to sort of recreate motion, 49 00:01:46,555 --> 00:01:48,909 until we figure out a cure which we 50 00:01:48,909 --> 00:01:50,510 don't see on the horizon for spinal cord 51 00:01:50,510 --> 00:01:52,829 injury. So using chips that can be placed 52 00:01:52,829 --> 00:01:53,569 in the brain 53 00:01:54,430 --> 00:01:54,930 to 54 00:01:55,230 --> 00:01:56,930 utilize Bluetooth to control 55 00:01:57,310 --> 00:01:59,709 stimulators and implantables that are placed in a 56 00:01:59,709 --> 00:02:02,644 patient or to mobilize an exoskeleton. 57 00:02:02,944 --> 00:02:05,444 So this is done at the Rafael Center, 58 00:02:05,984 --> 00:02:06,484 and 59 00:02:06,944 --> 00:02:07,844 I have a 60 00:02:08,705 --> 00:02:10,164 patient that is, 61 00:02:10,544 --> 00:02:11,444 his name is 62 00:02:11,745 --> 00:02:12,564 mister Reynolds, 63 00:02:13,025 --> 00:02:13,764 who unfortunately 64 00:02:14,064 --> 00:02:16,164 was involved in a motor vehicle collision 65 00:02:16,909 --> 00:02:18,290 where he became a paraplegic, 66 00:02:18,669 --> 00:02:21,330 and he's been a very gracious donor 67 00:02:21,870 --> 00:02:22,770 to this project. 68 00:02:23,629 --> 00:02:25,810 We've written several papers on it using 69 00:02:26,189 --> 00:02:26,689 implantables, 70 00:02:27,710 --> 00:02:29,169 contact surface electrodes, 71 00:02:30,224 --> 00:02:31,905 and the goal is to sort of use 72 00:02:31,905 --> 00:02:34,384 your mind to control your extremities in the 73 00:02:34,384 --> 00:02:36,965 future. So that's what I'm personally 74 00:02:37,584 --> 00:02:40,705 interested in. We have a very large research 75 00:02:40,705 --> 00:02:42,724 group in the Department of Orthopedic Surgery. 76 00:02:43,340 --> 00:02:46,060 We publish about 30 to 50 peer reviewed 77 00:02:46,060 --> 00:02:47,979 papers a year where we do a lot 78 00:02:47,979 --> 00:02:50,080 of clinical studies because it's a high volume 79 00:02:50,780 --> 00:02:53,180 spine institution. We we get along really well 80 00:02:53,180 --> 00:02:55,280 with different disciplines such as rehab, 81 00:02:55,645 --> 00:02:58,384 general surgery, neurosurgery, orthopedics work together, 82 00:02:58,844 --> 00:03:01,245 and we look at our patient population in 83 00:03:01,245 --> 00:03:04,284 spinal trauma, spinal cord injury, and degenerative disease, 84 00:03:04,284 --> 00:03:06,625 and deformity, and infection, and tumor. 85 00:03:07,085 --> 00:03:09,669 And, we just every week get together, and 86 00:03:09,669 --> 00:03:11,590 we we ask questions. We developed a very 87 00:03:11,590 --> 00:03:12,810 robust database. 88 00:03:13,430 --> 00:03:13,930 So 89 00:03:14,229 --> 00:03:16,409 doing research and writing papers is great. 90 00:03:16,789 --> 00:03:18,409 We train four fellows 91 00:03:19,110 --> 00:03:21,669 a year, and one fellow has a two 92 00:03:21,669 --> 00:03:22,330 year position. 93 00:03:22,870 --> 00:03:25,324 And he's in the basic science lab. And 94 00:03:25,324 --> 00:03:27,344 that lab is headed by Chris Kepler. 95 00:03:27,645 --> 00:03:30,444 And we do animal studies looking at, like, 96 00:03:30,444 --> 00:03:30,944 different 97 00:03:31,805 --> 00:03:32,784 things such as, 98 00:03:33,165 --> 00:03:34,305 the effect of nicotine 99 00:03:35,004 --> 00:03:38,465 and GLP ones on bony fusions, on outcomes, 100 00:03:38,525 --> 00:03:39,210 and so forth. 101 00:03:39,689 --> 00:03:41,689 And then our basic science lab, we're we're 102 00:03:41,689 --> 00:03:43,389 the highest NIH 103 00:03:44,250 --> 00:03:46,409 recipient in terms of dollar amount at Thomas 104 00:03:46,409 --> 00:03:48,110 Jefferson Art Department of Orthopedics, 105 00:03:48,650 --> 00:03:49,610 and we do a lot of, 106 00:03:50,250 --> 00:03:50,909 disc regeneration 107 00:03:51,210 --> 00:03:51,710 work 108 00:03:52,090 --> 00:03:54,090 there in disc regeneration. So it's it's it's 109 00:03:54,090 --> 00:03:54,645 great. It's 110 00:03:55,365 --> 00:03:56,405 we have a lot of fun. And I 111 00:03:56,485 --> 00:03:58,004 and I'm I'm so thankful I'm at the 112 00:03:58,004 --> 00:04:01,224 university because if I was just doing surgery, 113 00:04:02,324 --> 00:04:04,885 that would be gratifying helping people. But the 114 00:04:04,885 --> 00:04:07,224 extra dimension of teaching and research really 115 00:04:07,764 --> 00:04:09,959 makes what we do at Thomas Jefferson very 116 00:04:09,959 --> 00:04:10,459 satisfying. 117 00:04:11,240 --> 00:04:12,360 So it sounds like you touch a lot 118 00:04:12,360 --> 00:04:14,439 of different areas in your research, and I 119 00:04:14,439 --> 00:04:16,699 imagine all of that will touch more lives 120 00:04:17,160 --> 00:04:18,779 just exponentially in the future. 121 00:04:20,040 --> 00:04:21,879 Oh, I I think so. So I always 122 00:04:21,879 --> 00:04:22,379 say, 123 00:04:22,759 --> 00:04:23,660 when you decide 124 00:04:24,214 --> 00:04:26,055 when you're younger to go into research, I 125 00:04:26,055 --> 00:04:27,915 said, just don't jump all over the place. 126 00:04:28,214 --> 00:04:30,535 Have a theme. So the theme at Thomas 127 00:04:30,535 --> 00:04:32,775 Jefferson when I was younger in the nineteen 128 00:04:32,775 --> 00:04:35,115 eighties and early nineteen nineties was spinal trauma. 129 00:04:35,574 --> 00:04:36,955 And we took that theme 130 00:04:37,495 --> 00:04:38,795 and through the AO 131 00:04:39,100 --> 00:04:42,000 and through different study groups, we developed classification 132 00:04:42,220 --> 00:04:44,080 systems, management protocols. 133 00:04:45,259 --> 00:04:47,680 We worked on the biomechanics of various instrumentation, 134 00:04:47,740 --> 00:04:50,879 and we became very aggressive in certain traumatic 135 00:04:51,100 --> 00:04:53,259 injuries. And we became less aggressive than others 136 00:04:53,259 --> 00:04:54,560 when we found out through our 137 00:04:55,045 --> 00:04:56,884 registry studies that surgery really didn't make a 138 00:04:56,884 --> 00:04:58,985 difference or it didn't really move the needle. 139 00:04:59,205 --> 00:05:01,925 So that's where we sort of made made 140 00:05:01,925 --> 00:05:04,004 the move. And I think in spinal injury 141 00:05:04,004 --> 00:05:04,904 and spinal trauma, 142 00:05:05,365 --> 00:05:07,944 we've sort of made great strides in anesthesia 143 00:05:08,324 --> 00:05:10,519 care and operating on patients in their mid 144 00:05:10,519 --> 00:05:12,839 eighties after trauma when in the past, we 145 00:05:12,839 --> 00:05:14,279 would never do that. We moved away from 146 00:05:14,279 --> 00:05:16,540 halos, and we moved more to 147 00:05:16,920 --> 00:05:19,019 implants to stabilize his internal, 148 00:05:19,879 --> 00:05:21,720 support structure so we can get people out 149 00:05:21,720 --> 00:05:23,365 of out of the hospital the next day. 150 00:05:23,365 --> 00:05:25,225 I mean, if you have an odontoid fracture 151 00:05:25,845 --> 00:05:28,084 in an 80 year old and we operate 152 00:05:28,084 --> 00:05:30,105 on you, we could literally send you home 153 00:05:30,485 --> 00:05:32,425 without a collar the next day. 154 00:05:33,205 --> 00:05:33,944 That's impressive. 155 00:05:34,324 --> 00:05:35,225 Yeah. And before, 156 00:05:35,610 --> 00:05:36,729 and I can tell you when I first 157 00:05:36,729 --> 00:05:38,589 got here, they were in the hospital forever. 158 00:05:38,649 --> 00:05:40,410 They got a halo, and then they developed 159 00:05:40,410 --> 00:05:41,930 a nonunion. And then they got a Brooks 160 00:05:41,930 --> 00:05:43,930 Fusion, which is a wire and bone graft, 161 00:05:43,930 --> 00:05:45,610 and they went back in a halo. And 162 00:05:45,610 --> 00:05:48,329 now you do c two c one toaster 163 00:05:48,329 --> 00:05:48,829 fixation, 164 00:05:49,954 --> 00:05:51,314 and you can get the patient out the 165 00:05:51,314 --> 00:05:52,055 next day. 166 00:05:52,754 --> 00:05:54,595 Oh. And the goal is the goal is 167 00:05:54,595 --> 00:05:55,254 to mobilize. 168 00:05:55,634 --> 00:05:56,535 The goal is 169 00:05:56,915 --> 00:05:59,795 to provide motion and mobility to a patient. 170 00:05:59,795 --> 00:06:00,935 So it's exciting. 171 00:06:01,634 --> 00:06:03,209 So then I had a couple quick follow-up 172 00:06:03,289 --> 00:06:03,789 questions 173 00:06:04,089 --> 00:06:06,250 circling back on what you're talking about in 174 00:06:06,250 --> 00:06:07,789 terms of exo exoskeletons 175 00:06:08,569 --> 00:06:10,589 and then these brain chips. 176 00:06:11,050 --> 00:06:14,269 One, I want to know, you know, obviously, 177 00:06:15,129 --> 00:06:17,985 there are other companies and groups out there 178 00:06:17,985 --> 00:06:20,305 looking at the potential of brain chips in 179 00:06:20,305 --> 00:06:22,625 spinal cord injury patients. I was wondering what 180 00:06:22,625 --> 00:06:23,444 your outlook 181 00:06:23,745 --> 00:06:26,225 is for that technology. And then kind of 182 00:06:26,225 --> 00:06:28,145 hand in hand with that, we were thinking 183 00:06:28,145 --> 00:06:29,444 about the ask the exoskeleton 184 00:06:29,899 --> 00:06:32,319 technology and the in the brain implants. 185 00:06:33,019 --> 00:06:34,800 Which of those two do you think will 186 00:06:35,180 --> 00:06:36,560 take off sooner? 187 00:06:37,019 --> 00:06:38,479 Okay. So they're here now. 188 00:06:38,939 --> 00:06:40,939 And I'll I'll use there's four companies that 189 00:06:40,939 --> 00:06:42,539 I know of, but Neuralink is the most 190 00:06:42,539 --> 00:06:43,039 advanced. 191 00:06:43,754 --> 00:06:44,975 So just 192 00:06:45,275 --> 00:06:46,335 using the mind 193 00:06:46,955 --> 00:06:48,495 to send a signal through Bluetooth 194 00:06:48,955 --> 00:06:49,775 to a computer, 195 00:06:50,314 --> 00:06:51,694 and that computer then 196 00:06:52,634 --> 00:06:53,935 tells an exoskeleton 197 00:06:54,634 --> 00:06:56,715 what type of motion to do, or it 198 00:06:56,715 --> 00:06:58,254 can be you can have a direct 199 00:06:58,889 --> 00:06:59,389 implantable 200 00:07:00,490 --> 00:07:00,990 electrode 201 00:07:01,290 --> 00:07:02,269 into an extremity 202 00:07:03,129 --> 00:07:04,509 that can power that extremity. 203 00:07:05,370 --> 00:07:07,209 It could be wiring from the brain or 204 00:07:07,209 --> 00:07:08,729 it could be through Bluetooth and so forth. 205 00:07:08,729 --> 00:07:11,629 So that's here now, and it's being experimented 206 00:07:11,850 --> 00:07:13,389 on at the present time. 207 00:07:14,074 --> 00:07:16,074 And I know that Barrows is sort of 208 00:07:16,074 --> 00:07:16,574 leading 209 00:07:17,035 --> 00:07:18,014 in that. So 210 00:07:18,395 --> 00:07:21,215 we have developed a whole series of exoskeletons 211 00:07:21,595 --> 00:07:22,095 through 212 00:07:22,634 --> 00:07:25,115 the Rafael Center under the gentleman I mentioned 213 00:07:25,115 --> 00:07:26,175 previously, the neurologist, 214 00:07:26,715 --> 00:07:28,014 who's heading that program. 215 00:07:28,660 --> 00:07:29,959 And they're very advanced, 216 00:07:30,339 --> 00:07:32,180 very advanced. And I'm excited to be able 217 00:07:32,180 --> 00:07:32,839 to participate, 218 00:07:34,019 --> 00:07:35,779 in that in those studies. I mean, it's 219 00:07:35,779 --> 00:07:36,519 it's exciting. 220 00:07:37,060 --> 00:07:38,819 But that's here now, and it makes so 221 00:07:38,819 --> 00:07:39,639 much sense 222 00:07:40,339 --> 00:07:40,839 developing 223 00:07:41,425 --> 00:07:43,345 devices in the extremities to help move the 224 00:07:43,345 --> 00:07:44,725 foot, help move the hand. 225 00:07:45,504 --> 00:07:46,884 They've developed sensors 226 00:07:47,985 --> 00:07:51,345 that tell someone with a severe neuropathy or 227 00:07:51,345 --> 00:07:52,564 someone with who's insensate 228 00:07:53,360 --> 00:07:55,519 to move their extremity so they don't get 229 00:07:55,519 --> 00:07:57,519 get it to cubit eye. And these braces 230 00:07:57,519 --> 00:07:59,279 can also move to the cubit eye. So 231 00:07:59,279 --> 00:08:01,300 if it senses a certain amount of pressure, 232 00:08:01,439 --> 00:08:04,100 it automatically moves the extremity with a brace. 233 00:08:04,399 --> 00:08:04,899 So 234 00:08:05,375 --> 00:08:07,395 that is phenomenal. And and and people have 235 00:08:07,775 --> 00:08:09,955 phantom limb discomfort after an amputation. 236 00:08:10,335 --> 00:08:12,675 And with these type of sensors, it gives 237 00:08:12,814 --> 00:08:14,735 a patient a sensation that they do have 238 00:08:14,735 --> 00:08:17,295 an extremity. So instead of feeling pain, they 239 00:08:17,295 --> 00:08:18,435 feel another sensation. 240 00:08:19,039 --> 00:08:21,680 So it it's a phenomenal technology, and that's 241 00:08:21,680 --> 00:08:22,740 that's here now, 242 00:08:23,279 --> 00:08:24,660 going through development 243 00:08:25,759 --> 00:08:26,660 at our university. 244 00:08:27,439 --> 00:08:29,599 And it's just it's just mind boggling. But, 245 00:08:29,599 --> 00:08:31,439 you know, because as you know, all the 246 00:08:31,439 --> 00:08:33,379 medicinal or slash pharmaceutical 247 00:08:34,664 --> 00:08:35,164 interventions, 248 00:08:36,024 --> 00:08:37,804 none of them have proven to be 249 00:08:38,424 --> 00:08:40,764 efficacious in clinical studies. And all the 250 00:08:41,304 --> 00:08:42,284 beginning studies, 251 00:08:42,825 --> 00:08:44,504 they've been found to be safe than these 252 00:08:44,504 --> 00:08:46,105 medications. But when it when you look at 253 00:08:46,105 --> 00:08:50,149 a a larger study with multiple patients and 254 00:08:51,170 --> 00:08:53,809 control groups, we really haven't moved the needle. 255 00:08:53,809 --> 00:08:55,170 So people say to me, well, what do 256 00:08:55,170 --> 00:08:56,290 you do when you have a spinal cord 257 00:08:56,290 --> 00:08:58,149 injury? I say there's three things I do. 258 00:08:58,610 --> 00:09:01,144 Number one, I stabilize the spine because a 259 00:09:01,144 --> 00:09:02,985 bruised spinal cord doesn't like to move around 260 00:09:02,985 --> 00:09:03,804 and be unstable. 261 00:09:04,345 --> 00:09:05,945 Number two, I get the blood pressure up 262 00:09:05,945 --> 00:09:07,785 so I can profuse the spinal cord. And 263 00:09:07,785 --> 00:09:09,565 number three, I take the pressure off surgically. 264 00:09:10,665 --> 00:09:12,985 And we've done studies to show all three 265 00:09:12,985 --> 00:09:13,804 make sense. 266 00:09:15,120 --> 00:09:16,559 Everything else we do, if you look at 267 00:09:16,559 --> 00:09:18,180 hypothermia, if you look at 268 00:09:18,559 --> 00:09:19,059 all 269 00:09:19,920 --> 00:09:21,059 steroids and 270 00:09:21,519 --> 00:09:22,660 ganglucides and 271 00:09:23,279 --> 00:09:25,540 esethrin and all the, you know, no go, 272 00:09:26,240 --> 00:09:27,220 you know, medications, 273 00:09:28,514 --> 00:09:30,834 It really hasn't moved the needle yet, so 274 00:09:30,834 --> 00:09:31,574 we'll see. 275 00:09:31,875 --> 00:09:34,115 But but the exoskeletons make sense to me. 276 00:09:34,115 --> 00:09:35,414 That that is here today, 277 00:09:35,954 --> 00:09:36,355 and, 278 00:09:36,995 --> 00:09:38,274 they come to my today, we had a 279 00:09:38,274 --> 00:09:39,554 meeting in my office where they brought a 280 00:09:39,554 --> 00:09:40,294 bunch of, 281 00:09:41,154 --> 00:09:43,154 prototypes over. And and we we put them 282 00:09:43,154 --> 00:09:43,799 on ourselves, 283 00:09:44,360 --> 00:09:46,600 and we stimulate through the robot to make 284 00:09:46,600 --> 00:09:48,440 our extremities move. It's really it's fun to 285 00:09:48,440 --> 00:09:50,700 do. It's fun to do. That's fascinating. Absolutely. 286 00:09:50,839 --> 00:09:51,339 Yeah. 287 00:09:51,879 --> 00:09:53,959 And then I want to, pivot a little 288 00:09:53,959 --> 00:09:56,379 bit. Can you talk about some most valuable 289 00:09:56,784 --> 00:10:00,144 tech resources that Rothman has invested in over 290 00:10:00,144 --> 00:10:02,085 the last five years? 291 00:10:02,945 --> 00:10:04,465 Okay. So the number one so it's interesting. 292 00:10:04,465 --> 00:10:05,985 You could look at Rothman as a business, 293 00:10:05,985 --> 00:10:07,205 and you could look at Rothman 294 00:10:08,144 --> 00:10:10,200 when it comes to treatment of patients. So 295 00:10:10,200 --> 00:10:12,120 I think the most important and it's and 296 00:10:12,120 --> 00:10:14,379 it's just blossoming now 297 00:10:15,240 --> 00:10:17,240 is AI companies. And I won't mention the 298 00:10:17,240 --> 00:10:19,240 AI company we use because I'm sure there's 299 00:10:19,240 --> 00:10:21,419 competitors, and I I don't wanna promote one. 300 00:10:21,639 --> 00:10:23,100 But the one thing that 301 00:10:23,480 --> 00:10:23,980 every 302 00:10:24,825 --> 00:10:25,325 RCM, 303 00:10:26,345 --> 00:10:27,644 revenue cycle management, 304 00:10:28,264 --> 00:10:29,644 we we get 305 00:10:30,105 --> 00:10:32,524 hung up on when we do a procedure 306 00:10:32,825 --> 00:10:34,445 and we go to build a procedure 307 00:10:35,465 --> 00:10:37,725 with so many check boxes for prior authorization, 308 00:10:38,105 --> 00:10:39,879 then you have to get an explanation of 309 00:10:39,879 --> 00:10:41,720 benefits, then you have to send it to 310 00:10:41,720 --> 00:10:44,039 the insurance company, and the insurance company says, 311 00:10:44,039 --> 00:10:45,639 okay. You didn't do this, this, or that, 312 00:10:45,639 --> 00:10:47,000 and they send it back to you. And 313 00:10:47,000 --> 00:10:48,360 then you have to scrub it to make 314 00:10:48,360 --> 00:10:50,279 sure that the bill is appropriate and then 315 00:10:50,279 --> 00:10:51,799 goes to insurance company, and then they pay 316 00:10:51,799 --> 00:10:54,144 you. And they may pay you according to 317 00:10:54,144 --> 00:10:56,144 the contract you have. But how do you 318 00:10:56,144 --> 00:10:58,065 know? They may or may not. Sometimes you 319 00:10:58,065 --> 00:10:59,424 just check off a box as you get 320 00:10:59,424 --> 00:11:01,684 paid. And using artificial intelligence 321 00:11:03,024 --> 00:11:05,745 that can look at a bill and can 322 00:11:05,745 --> 00:11:06,245 say, 323 00:11:06,639 --> 00:11:09,600 this has been documented appropriately through the medical 324 00:11:09,600 --> 00:11:13,360 records because it scanned your preoperative note. It 325 00:11:13,360 --> 00:11:16,000 scanned the operative report. It makes sure that 326 00:11:16,000 --> 00:11:17,059 the codes are appropriate. 327 00:11:17,519 --> 00:11:19,919 It understands what the insurance company wants to 328 00:11:19,919 --> 00:11:20,419 see. 329 00:11:20,915 --> 00:11:22,595 And then if the insurance company sends it 330 00:11:22,595 --> 00:11:25,175 back, it develops an instantaneous 331 00:11:25,875 --> 00:11:26,375 appeal 332 00:11:26,675 --> 00:11:28,754 to send it back again, and then it 333 00:11:28,754 --> 00:11:30,675 tells you where you paid according to your 334 00:11:30,675 --> 00:11:31,175 contract. 335 00:11:31,715 --> 00:11:34,870 That is the most important technological investment that 336 00:11:34,870 --> 00:11:36,790 we have. And that's not just not for 337 00:11:36,790 --> 00:11:39,050 private practice. I'm I'm I'm in a academic 338 00:11:39,830 --> 00:11:42,309 group that's private practice, but this is for 339 00:11:42,309 --> 00:11:43,529 any private equity, 340 00:11:44,309 --> 00:11:45,370 hospital system, 341 00:11:45,794 --> 00:11:46,855 university system, 342 00:11:47,315 --> 00:11:49,554 you just to make sure that everyone's in 343 00:11:49,554 --> 00:11:51,654 compliance with the contracts you have. 344 00:11:52,115 --> 00:11:54,514 Mhmm. It's it's and and again and again, 345 00:11:54,514 --> 00:11:56,034 you could take this technology and you could 346 00:11:56,034 --> 00:11:57,014 use it for anything. 347 00:11:57,714 --> 00:12:00,000 I would exploit it for patient safety, you 348 00:12:00,000 --> 00:12:01,940 know, just using that concept of checklist. 349 00:12:02,320 --> 00:12:04,080 Like, I I say to the residents all 350 00:12:04,080 --> 00:12:06,340 the time, go slow to go fast, 351 00:12:07,360 --> 00:12:08,899 be quick, but don't hurry, 352 00:12:10,080 --> 00:12:11,759 get things done. And these are quotes from 353 00:12:11,759 --> 00:12:13,754 famous people. I I didn't make these quotes 354 00:12:13,754 --> 00:12:15,355 up. These are from people who are in 355 00:12:15,355 --> 00:12:17,514 the business. But and I'm and and and 356 00:12:17,514 --> 00:12:18,975 I love the checklist concept 357 00:12:19,434 --> 00:12:22,394 that pilots use. I said, you walk into 358 00:12:22,394 --> 00:12:24,634 an Operating Room. You have these six things 359 00:12:24,634 --> 00:12:25,774 you wanna get done. 360 00:12:26,100 --> 00:12:27,779 You do a briefing before you begin the 361 00:12:27,779 --> 00:12:28,279 operating 362 00:12:28,659 --> 00:12:29,319 the operation. 363 00:12:29,620 --> 00:12:30,679 You do the operation. 364 00:12:31,139 --> 00:12:31,879 You read 365 00:12:32,259 --> 00:12:34,839 the checklist off before you begin the closure. 366 00:12:34,899 --> 00:12:36,500 Did I do everything I planned to do? 367 00:12:36,500 --> 00:12:38,019 Did I do the biopsy like I wanted 368 00:12:38,019 --> 00:12:39,779 to do? Did I check this level? Did 369 00:12:39,779 --> 00:12:41,595 I check it off? And then when the 370 00:12:41,595 --> 00:12:44,394 case is complete, run the checklist again when 371 00:12:44,394 --> 00:12:45,995 you're signing the case out to the resident 372 00:12:45,995 --> 00:12:46,735 or the fellow. 373 00:12:47,115 --> 00:12:50,154 And but now exploiting technology to help us 374 00:12:50,154 --> 00:12:52,654 do that is phenomenal. Today, 375 00:12:53,129 --> 00:12:54,910 I did five spine surgeries, 376 00:12:55,450 --> 00:12:57,769 and one of my cases was a deformity 377 00:12:57,769 --> 00:12:58,269 case. 378 00:12:58,730 --> 00:13:00,670 I went anteriorly at multiple levels, 379 00:13:02,170 --> 00:13:03,070 performed osteotomies, 380 00:13:03,450 --> 00:13:04,830 placed interbody spacers, 381 00:13:05,834 --> 00:13:07,134 and then I went posteriorly 382 00:13:07,434 --> 00:13:08,954 fused down to the pelvis, and I used 383 00:13:08,954 --> 00:13:09,534 a robot. 384 00:13:10,235 --> 00:13:12,714 And the robot, what it does for me, 385 00:13:12,714 --> 00:13:14,014 who's been operating forever, 386 00:13:14,475 --> 00:13:15,855 is that it just dramatically 387 00:13:16,314 --> 00:13:17,534 reduces the stress 388 00:13:19,289 --> 00:13:19,789 psychologically. 389 00:13:20,649 --> 00:13:23,389 And we did a study here 390 00:13:24,009 --> 00:13:27,070 at Thomas Jefferson in the joint arthroplasty division 391 00:13:27,450 --> 00:13:27,950 where 392 00:13:28,889 --> 00:13:31,470 the surgeons put undergarment sensors on. 393 00:13:32,475 --> 00:13:34,735 And then they did, like, revision surgery 394 00:13:35,355 --> 00:13:35,855 normally, 395 00:13:36,394 --> 00:13:38,335 and the sensors looked at perspiration, 396 00:13:38,955 --> 00:13:39,774 heart rate, 397 00:13:40,394 --> 00:13:43,274 respiration rate, all that. And then they used 398 00:13:43,274 --> 00:13:43,769 the robot, 399 00:13:44,330 --> 00:13:45,929 and they showed that the robot it may 400 00:13:45,929 --> 00:13:47,290 take longer. By the way, it doesn't mean 401 00:13:47,290 --> 00:13:48,910 it's gonna go faster. It may take longer. 402 00:13:49,210 --> 00:13:51,389 But the stress, as long as the robot 403 00:13:52,330 --> 00:13:54,190 is accurate and it's working. 404 00:13:54,970 --> 00:13:56,809 So, again, we we have so many checks 405 00:13:56,809 --> 00:13:57,470 and balances 406 00:13:58,024 --> 00:13:59,384 in an operating room. When I use a 407 00:13:59,384 --> 00:13:59,884 robot, 408 00:14:00,504 --> 00:14:02,445 you just have to have so many different 409 00:14:02,745 --> 00:14:05,384 strategies to make sure the robot's accurate. It's 410 00:14:05,384 --> 00:14:06,924 taking you where you need to go, 411 00:14:07,544 --> 00:14:09,465 when you drill, when you burr, anything like 412 00:14:09,465 --> 00:14:11,480 that. You you you have to figure out 413 00:14:11,480 --> 00:14:12,940 ways of double checking everything 414 00:14:13,399 --> 00:14:15,500 before you use the precision of a robot. 415 00:14:15,799 --> 00:14:17,959 But if it's working well, like it did 416 00:14:17,959 --> 00:14:18,459 today, 417 00:14:19,639 --> 00:14:20,779 you're a happy man. 418 00:14:21,399 --> 00:14:23,959 It's you're happy. Happens. You're you're able to 419 00:14:23,959 --> 00:14:24,699 do five 420 00:14:25,105 --> 00:14:26,644 spine surgeries pretty 421 00:14:27,105 --> 00:14:27,605 comfortably, 422 00:14:27,985 --> 00:14:30,325 not as much stress as usual, I'd imagine. 423 00:14:30,785 --> 00:14:32,544 Yeah. And the most important thing, Carly, is 424 00:14:32,544 --> 00:14:33,044 that 425 00:14:34,304 --> 00:14:34,804 I 426 00:14:35,985 --> 00:14:37,365 the rep for the 427 00:14:37,679 --> 00:14:39,120 robot told me that he had a case 428 00:14:39,120 --> 00:14:41,039 the day before, but the surgeon canceled the 429 00:14:41,039 --> 00:14:41,860 case because 430 00:14:43,200 --> 00:14:45,679 the o arm wasn't working. And that's one 431 00:14:45,679 --> 00:14:46,580 thing that 432 00:14:48,320 --> 00:14:49,539 I'm disappointed with. 433 00:14:50,184 --> 00:14:51,725 These are enabling technologies. 434 00:14:52,504 --> 00:14:55,384 They shouldn't be supplanting our ability to do 435 00:14:55,384 --> 00:14:57,805 surgery without the enabling technology. So, 436 00:14:58,504 --> 00:15:00,345 it's so important when you train the young 437 00:15:00,345 --> 00:15:00,845 surgeons 438 00:15:01,545 --> 00:15:03,545 that they understand the anatomy. They could do 439 00:15:03,545 --> 00:15:04,285 any operation. 440 00:15:04,745 --> 00:15:07,169 For me, getting a spine operation done without 441 00:15:07,169 --> 00:15:09,570 enabling technology, I'm a lot faster because I've 442 00:15:09,570 --> 00:15:11,909 been doing it forever. And enabling technology 443 00:15:12,610 --> 00:15:16,070 decreases the stress level, potentially increases the precision, 444 00:15:16,129 --> 00:15:17,429 potentially, but not always. 445 00:15:18,129 --> 00:15:18,629 But 446 00:15:19,024 --> 00:15:20,644 it takes away the stress, 447 00:15:21,424 --> 00:15:23,904 and it takes away the radiation exposure to 448 00:15:23,904 --> 00:15:26,004 the operative staff and surgeon. 449 00:15:26,785 --> 00:15:29,184 But when that technology is not available or 450 00:15:29,184 --> 00:15:30,644 if that technology fails, 451 00:15:31,589 --> 00:15:34,069 you should just transition seamlessly into doing the 452 00:15:34,069 --> 00:15:34,569 operation. 453 00:15:35,269 --> 00:15:36,789 I I hope we never get to the 454 00:15:36,789 --> 00:15:37,610 point where 455 00:15:38,230 --> 00:15:40,230 the computer's not working, and therefore, we can't 456 00:15:40,230 --> 00:15:42,069 do the surgery. That's what we can't do. 457 00:15:42,069 --> 00:15:43,909 We can't get to that point. We become 458 00:15:43,909 --> 00:15:46,089 so dependent yeah. You become so dependent 459 00:15:46,504 --> 00:15:47,565 on enabling technology, 460 00:15:48,504 --> 00:15:49,865 then you're lost. Because then you don't really 461 00:15:49,865 --> 00:15:52,504 under I mean, everything's about anatomy. But once 462 00:15:52,504 --> 00:15:54,504 you master anatomy, and I and I I 463 00:15:54,504 --> 00:15:55,784 love it when we have to teach the 464 00:15:55,784 --> 00:15:58,345 residents and the fellows anatomy. I love dissecting 465 00:15:58,345 --> 00:16:00,629 out the vertebral artery both from the front 466 00:16:00,629 --> 00:16:02,149 and the back, and I love dissecting out 467 00:16:02,149 --> 00:16:03,910 the aorta. I love I love doing that 468 00:16:03,910 --> 00:16:04,410 because 469 00:16:04,790 --> 00:16:06,389 I love to feel it. I love to 470 00:16:06,389 --> 00:16:08,870 dissect out the pelvic anatomy because you don't 471 00:16:08,870 --> 00:16:10,309 really I mean, how often do you see 472 00:16:10,309 --> 00:16:12,445 it? You don't see it. I've I've never 473 00:16:12,445 --> 00:16:14,205 seen it. I've never dissected anything, but I 474 00:16:14,205 --> 00:16:15,345 can imagine it's very 475 00:16:16,205 --> 00:16:17,184 thorough and intricate. 476 00:16:17,725 --> 00:16:19,404 Oh my good. Well, remember, you were in 477 00:16:19,404 --> 00:16:20,785 earth science back in 478 00:16:21,404 --> 00:16:23,644 sixth grade. You dissected out the earthworm. Right? 479 00:16:23,644 --> 00:16:24,545 That was a frog? 480 00:16:25,320 --> 00:16:26,920 Did a sheep heart when I was in 481 00:16:26,920 --> 00:16:27,660 middle school. 482 00:16:28,200 --> 00:16:29,259 Okay. That's disgusting. 483 00:16:31,879 --> 00:16:33,480 No. But that's cool. I I remember I 484 00:16:33,480 --> 00:16:36,040 loved it. I remember the earthworm dissecting all 485 00:16:36,040 --> 00:16:38,134 the organs, and I remember trying to dissect 486 00:16:38,134 --> 00:16:39,514 out the frog's brain 487 00:16:39,894 --> 00:16:41,595 and not in any way 488 00:16:41,975 --> 00:16:44,134 blemishing the brain and doing it perfectly. It's 489 00:16:44,214 --> 00:16:45,654 but that's when you say to yourself, oh, 490 00:16:45,654 --> 00:16:46,794 I'd like to be a surgeon. 491 00:16:47,334 --> 00:16:49,595 So, you know, so we do that now 492 00:16:49,735 --> 00:16:51,899 in cadaver labs, you know, which I love. 493 00:16:51,899 --> 00:16:53,820 I love cadaver labs dissecting the and, of 494 00:16:53,820 --> 00:16:55,500 course, you die you dissect cell things you 495 00:16:55,500 --> 00:16:57,259 would never want to see in the Operating 496 00:16:57,259 --> 00:16:58,940 Room. Like, you don't wanna see the vertebral 497 00:16:58,940 --> 00:16:59,440 artery. 498 00:16:59,899 --> 00:17:01,340 But you wanna but you wanna know how 499 00:17:01,340 --> 00:17:02,379 to get to it if you need to 500 00:17:02,379 --> 00:17:04,299 get to it. Like, if there's an injury, 501 00:17:04,299 --> 00:17:06,934 you wanna be able to expose it, stop 502 00:17:06,934 --> 00:17:09,095 the bleeding, and repair it. So that's why 503 00:17:09,095 --> 00:17:11,414 I just love the concept of always a 504 00:17:11,414 --> 00:17:13,515 good surgeon is great at anatomy. 505 00:17:14,454 --> 00:17:14,954 Definitely. 506 00:17:15,335 --> 00:17:17,095 And then last question I have for you 507 00:17:17,095 --> 00:17:18,394 today, doctor Vaccaro. 508 00:17:18,855 --> 00:17:19,674 I was wondering 509 00:17:20,454 --> 00:17:21,900 what's an area of 510 00:17:22,700 --> 00:17:25,740 AI use in spine surgery that you'd like 511 00:17:25,740 --> 00:17:26,320 to see 512 00:17:26,700 --> 00:17:27,200 utilized 513 00:17:27,660 --> 00:17:28,160 more? 514 00:17:28,700 --> 00:17:30,220 Okay. So I I this is what I 515 00:17:30,220 --> 00:17:32,380 would love. And it's kinda here and kinda 516 00:17:32,380 --> 00:17:34,299 not here yet. I would like to have 517 00:17:34,299 --> 00:17:35,519 a patient come in 518 00:17:36,234 --> 00:17:38,315 and get an imaging study. And right off 519 00:17:38,315 --> 00:17:38,894 the bat, 520 00:17:39,434 --> 00:17:41,774 AI labels all the vertebral bodies, 521 00:17:42,474 --> 00:17:43,615 labels all the measurements. 522 00:17:43,994 --> 00:17:46,015 Now you may be a a measurement believer 523 00:17:46,794 --> 00:17:48,414 or a non measurement believer, 524 00:17:48,875 --> 00:17:50,174 but put it all together. 525 00:17:50,690 --> 00:17:53,170 Tell me what the normative value should be 526 00:17:53,170 --> 00:17:54,549 for a patient of that age. 527 00:17:55,170 --> 00:17:57,410 Tells me what the bone mineral density is. 528 00:17:57,410 --> 00:17:59,009 So if I decide to use an implant, 529 00:17:59,009 --> 00:18:00,549 I know what's the potential 530 00:18:01,089 --> 00:18:01,829 for subsidence. 531 00:18:02,289 --> 00:18:04,929 And then suggest to me, if I plan 532 00:18:04,929 --> 00:18:05,750 to do surgery, 533 00:18:06,105 --> 00:18:07,005 what the surgical 534 00:18:07,545 --> 00:18:08,605 approach and procedure 535 00:18:08,904 --> 00:18:09,565 should be. 536 00:18:09,865 --> 00:18:11,625 And on top of that, that's that's just 537 00:18:11,625 --> 00:18:12,765 on the objective 538 00:18:13,224 --> 00:18:14,444 quantitative aspect. 539 00:18:15,224 --> 00:18:17,384 I also want AI to say, in the 540 00:18:17,384 --> 00:18:20,119 whole vast universe of patients of that age 541 00:18:20,119 --> 00:18:21,500 and that pathology 542 00:18:21,880 --> 00:18:23,419 and that neurologic presentation, 543 00:18:24,359 --> 00:18:26,119 this is what has been proven to be 544 00:18:26,119 --> 00:18:27,419 the best in terms of outcome. 545 00:18:27,720 --> 00:18:28,619 Do not operate 546 00:18:29,160 --> 00:18:29,660 or 547 00:18:30,440 --> 00:18:32,599 operate but do a minimal procedure or operate 548 00:18:32,599 --> 00:18:33,819 and do a larger procedure. 549 00:18:34,325 --> 00:18:37,384 And that can happen within seconds with AI 550 00:18:37,605 --> 00:18:40,484 as it amasses data and accumulates data and 551 00:18:40,484 --> 00:18:42,505 analyzes it. It's like a propensity 552 00:18:43,845 --> 00:18:46,744 analysis. It just comes up with predictive modeling 553 00:18:46,964 --> 00:18:48,025 that tells me 554 00:18:48,380 --> 00:18:50,220 what the outcome is. Now, again, you're the 555 00:18:50,220 --> 00:18:52,299 doctor, so you have to sort of digest 556 00:18:52,299 --> 00:18:53,519 everything it gives you 557 00:18:53,820 --> 00:18:55,759 and say thank you very much for that. 558 00:18:55,900 --> 00:18:57,500 Now I'm gonna use this and I'm gonna 559 00:18:57,500 --> 00:18:59,660 use that. I might disagree with that. And 560 00:18:59,660 --> 00:19:01,615 because it's the art of medicine, and and 561 00:19:01,615 --> 00:19:03,774 I'm gonna use this as the educational process 562 00:19:03,774 --> 00:19:06,194 with patient. When that happens, Carly, 563 00:19:07,054 --> 00:19:09,054 life is gonna get really interesting. Now remember, 564 00:19:09,054 --> 00:19:10,575 we are the physicians, so we're not gonna 565 00:19:10,575 --> 00:19:12,815 let a computer, I e a I, tell 566 00:19:12,815 --> 00:19:14,595 us who and who not to operate on. 567 00:19:14,654 --> 00:19:16,274 But it can inform us 568 00:19:17,339 --> 00:19:19,339 on what has happened in the past that 569 00:19:19,339 --> 00:19:21,500 if that patient has this operation, what are 570 00:19:21,500 --> 00:19:22,720 the more likely outcomes? 571 00:19:23,339 --> 00:19:25,500 That sounds like a really good assistant and 572 00:19:25,500 --> 00:19:27,519 tool more than anything else. 573 00:19:28,220 --> 00:19:29,279 100%. 574 00:19:30,115 --> 00:19:32,674 Awesome. Well, thank you so much for joining 575 00:19:32,674 --> 00:19:35,315 us on the podcast today, doctor Vaccaro. It's 576 00:19:35,315 --> 00:19:36,835 been a pleasure speaking with you, and I 577 00:19:36,835 --> 00:19:39,394 look forward to connecting down the line. Thank 578 00:19:39,394 --> 00:19:40,934 you, Carlin. You have a nice day.