Abbasi would like to make RiverView a renowned 'center of excellence' for not just the procedure itself, but for training surgeons on how to perform it
"There's nothing funny about hitting your funny bone. Now, just imagine that awful feeling lasting for not for just a few seconds, but it's ongoing...day in and day out, without relief."
That's how Dr. Hamid R. Abbasi, a neurosurgeon at RiverView Health in Crookston, best describes for those who don't suffer from chronic back pain what it's like to deal with that constant, excruciating pain.
"That kind of pain changes not just the person's entire life, but the entire person," Abbasi said in an interview with the Times at RiverView, adding that he's had several patients who have given birth multiple times and reported that they'd gladly deal with the labor pains of childbirth over the stabbing, crippling back pains that afflict them.
Well, Abbasi is not just trying to do something to help those who suffer from that severe brand of pain, he's trying to do something with a revolutionary procedure that, when it comes to invasiveness and the amount of time it takes for a patient to recover, is nothing less than groundbreaking. And, to date, with around 200 procedures performed, Abbasi said he's building an incredibly strong case for the innovative Oblique Lateral Lumbar Interbody Fusion (OLLIF) to become the norm when it comes to back surgery, not just a cutting-edge exception.
Back pain, and OLLIF
The discs in a person's back function much like the tires on a car, Abbasi explained, providing a cushion between the vehicle and the road. "But have you ever seen a tire last 45 years?" he said.
Discs are able to repair themselves for many years, but people age their discs become less elastic and are, therefore, less able to keep themselves in top working condition.
In the 1950s, doctors recognized that discs could collapse and pinch the nerve, causing tremendous pain. In order to ease that pain, way back in those days physicians would remove a piece of the patient's hip bone, open their belly and place the piece of hip bone inside the disc space in order to lift it up and take pressure off the nerve.
While the procedure certainly helped countless patients, the problem with back-related injuries, Abbasi said, is that they're not like a broken arm that can simply be properly set and placed in a cast and given time to heal. "You cannot not use your spine," he said, adding that it often took a patient six months to fully recover. "By then, there's barely any muscle left from all that inactivity," Abbasi continued. "So there was no strength because the muscles hadn't been used for so long."
Times changed and spinal surgery technology did, too. Soon screws and plates were being inserted during spinal disc surgeries. Titanium soon gave way to specialized plastic. "That was revolutionary, too," Abbasi said.
That’s basically been the "standard of care" right up to the present time. "You lift up, you put something in and you take pressure off the nerve," he explained, adding that in his career he's probably placed 20,000 screws in patients' spines.
It might sound basic, but it's a major procedure and one not lacking in risk, however. "It's a hole in the spinal cord; if someone's paralyzed as a result, it's devastating," Abbasi said. "You move it up or down too much and push on a nerve root, it's terrible. You could hit the aorta or other vessels."
And it's just so invasive. One procedure takes seven to eight hours and multiple liters of blood are necessary. "It's such a big incision, and you're still separating all that muscle from the bone from three levels above and below; you're destabilizing so much," Abbasi said.
But around eight years ago he began asking himself why. "Why are we cutting into muscle and bone to get the job done? How can we better deliver the material we need to deliver?" Abbasi wondered.
The answer to those questions can be found in the new OLLIF procedure. A recent, sample patient of Abbasi's was out of the operating room in 42 minutes, lost an ounce of blood in a procedure that involved incisions no wider than a finger, and was discharged from the hospital less than two days. "Literally, you're almost walking right out of the hospital," he said. "It's minimally invasive, all of that trauma is gone. This was unimaginable at one time, but we're making it happen right here."
Just think of the minimized financial impact on the health care industry, insurance industry, and society as a whole from such a minimized surgical procedure, too, he added.
And yet, Abbasi said, ask 80 percent of spine surgeons about OLLIF and "they haven't even heard of it."
The challenge for Abbasi and others who perform OLLIF procedures is changing the way they look at things, or actually see things. Surgeons are accustomed to basing what they do anatomically on what they see, while in the OLLIF procedure a tremendous amount of training results in neurosurgeons using x-ray imagery to guide their way.
Abbasi is currently conducting four OLLIF studies, and it's proving so far to be a "game-changer." He compares it to the breakthrough of learning that peptic ulcers were caused by a bacterial disease. "Until that point, they'd cut the whole stomach out," he said. "Now you treat with a pill."
OLLIF is on that level, he said. "This deserves scrutiny, it deserves skepticism and strict peer review, and that's what we're doing, researching it at its core," Abbasi said. "But in every category there is big improvement. In my profession, most doctors try to prove that what they're doing is equal or 5 percent better than the standard of care. This is 100 to 120 percent better. That is what makes this a game-changer."
Abbasi didn't invent OLLIF. A neurosurgeon in Georgia did. He calls himself an "early adapter" who has performed more procedures on more levels of the spine than anyone in his field. Around 30 surgeons across the country perform this particular OLLIF procedure. With his Alexandria, Minn.-based Tristate Brain and Spine Institute, Abbasi performs around 65 percent of his OLLIF procedures there and the rest at RiverView Health in Crookston.
Center of excellence?
Abbasi has performed OLLIF procedures on patients from near and far in Alexandria and Crookston, and he'd like to make RiverView in Crookston an OLLIF "center of excellence" that attracts patients in need of relief from debilitating back pain, whether they live nearby or far away.
Abbasi, definitely not a fan of the big city life, loves the family atmosphere in a small community and a community hospital. "Many hospitals aim to be good at everything; that's admirable, but difficult," he said. "But if you're known as a center of excellence for certain types of procedures, it doesn't matter how small you are. You will attract patients who want to feel better and live better lives."
So, instead of patients always going from smaller hospitals to big city hospitals, the path, at least when it comes to OLLIF, is being reversed. "Patients are more savvy today, more than they get credit for," Abbasi said. "They are more adaptable than many medical facilities."
Before screaming about OLLIF from the rooftops, however, Abbasi said the most important, current step continues to be "validating the data." After that, once data has been verified on 200 patients, a "landmark paper" will be written and submitted with the goal of eventually "proving this is something everyone can do."
It's called a "landmark paper" for a reason, Abbasi said. A procedure involving 15 to 20 patients might get a write-up in a medical journal. But for the purposes of proving statistical trends, 30 to 40 patients are needed. "But the first paper we submitted for OLLIF, the group had 62 patients and 50 in a control group," he explained. Now they have more than 200 patients. "Two hundred and up, that's landmark level," he said.
At some point, Abbasi would like to establish a "learning center" to pass the knowledge of the procedure onto other medical professionals. "We could have a center of excellence for training, where Crookston and Alexandria wouldn't be just places where you get treatment, these will also be the places you go to get trained," he said.
"At the end of the day, you're achieving the same result without cutting the patient open," Abbasi said.
So, naturally, OLLIF – which Abbasi said was the 'a-ha!' moment of his career – has led to much happiness and satisfaction when it comes to making people feel better without drastically invading their bodies.
"Most of us doctors go into this profession to see what kind of impact we can have on people's lives," he said. "There are very sad moments along the way, but proud moments, too, like when you see someone walk out of the hospital the next day smiling, when there was a time that person would have been hospitalized for weeks."
He recalls recently performing an OLLIF procedure on a 72-year-old patient at RiverView, which the patient's insurance covered. At the same time, a 28-year-old patient in a similar spinal predicament was denied coverage for the procedure by his insurance. "So I had to do the open surgery on him and he was in agonizing pain and faced a long recovery," Abbasi said. "The 72 year old was moving around freely and happily and walked out two days later. It was interesting for our staff to actually witness that kind of a true difference."
At RiverView and in Alexandria, Abbasi said his goal is to "invent the next OLLIF" by bringing new technologies and new devices to the industry, particularly in the thoracic region. "Traditional surgery, you're literally cutting the thorax open and removing a rib; you're doing huge damage," he said. But he has a handful of patients who have undergone sort of thoracic OLLIF, and the results are promising. "We want the next groundbreaking procedure to come from Crookston or Alexandria rather than somewhere else," he said.
RiverView has played a huge role in what he's been able to do, Abbasi said, and he anticipates continued support as he tries to break new ground. "People like to be in bigger places, but I think if we put the right people and the right technology together, we can have the care people need right here," he said.
He recalled a patient in the Twin Cities who mentioned the OLLIF procedure to his physician. "He called, wondering how they could get that there," Abbasi said. He sent the physician all the data relating to OLLIF's track record to date, and, Abbasi said, "His chin hit the floor. He said, 'this is the future.' But the future, right here, is now."
Right here, as in RiverView in Crookston. "You get doctors here to train and you get Crookston and the Riverview name out to the world," Abbasi said. "You could have a physician in India, and someone asks where he was trained and he says, 'RiverView Health in Crookston, Minnesota. We're a small town here, but we have all we need to make that happen."
Abbasi has 10,000 followers of his blog. Learn more at tristatebrainspine.com. There are resources on Facebook as well: Visit https://www.facebook.com/NSPatient?fref=ts and https://www.facebook.com/NSReview