healthyrounds.podbean.com
Bonus Episode: Remarkable Advances in Spine Surgery | Healthy Rounds With Dr. Anthony Alessi
A glimpse into the future of surgery came last year, when a surgeon in Orlando operated on a patient 7,000 miles away! Yet diagnosing a painful disc still comes with a number of challenges. Could figuring that out lead to better decisions on surgery versus conservative management? Dr. Alessi revisits his conversation with Dr. Moss, chair of UConn Health’s Department of Orthopaedic Surgery, particularly in the area of advances in spine surgery, including robotic and augmented reality procedures.
Submit questions for Healthy Rounds:
HealthyRounds@uchc.edu
Dr. Isaac Moss:https://www.uconnhealth.org/providers/profiles/moss-isaac
UConn Health Comprehensive Spine Center:https://www.uconnhealth.org/spine
The Brain and Spine Institute at UConn Health:https://www.uconnhealth.org/brain-spine
UConn Health Orthopedics and Sports Medicinehttps://www.uconnhealth.org/orthopedics-sports-medicine
UConn Health:https://www.uconnhealth.org
Grant support from Coverys:www.coverys.com
Transcript
Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. This podcast is not designed to direct your personal health care, which should only be done by your physician.
I’m your host, Dr. Anthony Alessi, and today what we’re doing is what has come to be known as our deep dive, where we talk a little bit about the previous week’s interview. And in this case, it was done with Dr. Isaac Moss, who is professor and chairman of the Department of Orthopaedic Surgery at the University of Connecticut. He’s also a fellowship-trained spine surgeon. And there were several issues that he brought up that I feel need further attention and I went back and dug out a little bit more information on that I’d like to share with all of you.
I think one of the things he talked about is comparing our system with that in Canada, where we have so many spine surgeons in Hartford as opposed to Montreal, and he talks about increased access here in the United States to surgery. And I think that that’s important because, and it’s not necessarily a bad thing, but nevertheless, it has us shy away from conservative management. In many cases, when he discusses diagnostics, it appears that over a period of time where you may be waiting for surgery, your symptoms resolve.
What I found also interesting was that from a diagnostic standpoint, we really can’t diagnose a painful disc, and I see that in electrodiagnostics all the time in EMG, which is what I do, in the sense that I’m going to see someone who has a painful disc and you would think that would have neurologic impairment and does not. By the same token, you’ll see somebody who has a horrible MRI and has no pain at all, but clearly has neurologic deficit on their exam and on the electrodiagnostic studies. So he raises such a good point with respect to how we are lacking in the field of diagnostics. We haven’t really figured that out yet.
And as he points out, as you get to over the age of 50, you’ve got a 50% chance of having an abnormal MRI. So is it an imaging issue? Is it a clinical issue? And I think we really have to resolve that if we’re going to be treating the right patients with surgery or conservative management in order to make that decision.
The other thing, the two other things actually I wanted to talk about: First, he talked about these enabling technologies, and I thought that was a good way to put it. You know, we’re dealing a lot with robotics now and how much that has really changed the practice of surgery, and medicine in general. But in terms of surgery, with these enabling technologies that we are fortunate to have here at the University of Connecticut through UConn Health, it really gives you a totally different image. Now, he brought up something I didn’t know about, and that is using robotics through augmented reality. And with this augmented reality, he’s able to make a smaller incision, right, so really a limited surgery from the standpoint of it being invasive and at the same time really making it more accessible to him. So he can see the same things that he would if he did a much broader surgery, with a bigger incision and being more invasive, with this new technology. And with these robotics, it’s really eliminated a lot of complication and longer recovery times.
Let’s just think about that. I mean, smaller incision with augmented reality, less recovery time, and people are enabled, a good word for it, to get back to work sooner, get back to their life, get back to their sports, rather than being more sedentary.
So these enabling technologies were interesting, but he also mentioned the idea of telesurgery, and I wanted to really discuss that a little bit. In May of last year, 2025, they performed the first long-distance surgery from the standpoint that a patient in Angola had prostate surgery by a physician in Orlando, Florida.
So how does that happen? Well, you have to understand this telesurgery is really where the patient is in an operating room, in this case, in Angola, with a surgeon, with a nurse and a full operating room. But when it comes to the particular part of the surgery that requires more skill, someone who is fellowship trained, as in this case, Dr. Patel in Orlando, he can take over the surgery. And it’s an interesting device. I mean, his head goes into, I mean, it’s a computer with a kind of virtual reality kind of thing here, and he’s able to do surgery. Now, the biggest obstacle has been, whenever you do something online, there’s a lag time, right? So there’s a time where there’s a lag between when you do something and when it gets done, when that motion happens. And that’s been the biggest difficulty. We’ve now, thanks to technology, been able to get that down to six milliseconds, so six thousandths of a second. And that allows enough surgical accuracy and precision to do the surgery. And again, it’s done in three dimensions. The vision of the surgeon in Orlando was three dimensional.
That is also going to be the case with complicated spine surgeries, as Dr. Moss mentioned. And this opens up really a tremendous opportunity for patients who live in isolated areas, in the United States and throughout the world. Again, you need technology on the other end as well. So there is a mobile 3D unit operating in Africa, in Angola in this case, so that it can go from hospital to hospital. So not every hospital has to invest millions of dollars in this technology.
Just thinking about this in terms of brain surgery, in terms of cancer, removing complex tumors of people who can’t get to huge medical centers, I believe is fascinating and really, for me, just so hopeful of the future of medicine. So I’m so happy Dr. Moss brought that up so we have some time to really delve into it, and I recommend you read more about it. There’s a lot of it online, a lot of articles, about telesurgery.
With that, I want to once again thank Dr. Moss for his time in doing this podcast.
If you have any questions or ideas for future programs, you can reach out to me at healthyrounds@uchc.edu. Jennifer Walker is the executive producer of the Healthy Rounds podcast. Chris DeFrancesco is the studio producer of Healthy Rounds, and really the guy who puts all this together. Tessa Rickart is in charge of all our social media and does a phenomenal job of getting the word out, and you could always get this podcast on Apple, or you’ll see it on Instagram and other outlets.
I look forward to next week, when we will have as our guest, Dr. Kristina Zdanys. Dr. Kristina is going to talk to us about dementia and potential treatments for dementia.
Until next time, this is Dr. Anthony Alessi. Please stay healthy.
