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Titan Nano Lock Revision Spine Surgery

Palmdale Regional Medical Center offers a comprehensive range of procedures to treat a number of spine injuries and conditions. A dedicated team of surgeons, nurses and skilled therapists at Palmdale Regional treat patients by using advanced technology, including nano technology.

In this segment, Dr. Kamran Parsa discusses Titan Nano Lock Revision Spine Surgery and how this advanced new technology can achieve better outcomes for patients undergoing revision spine surgery.
Titan Nano Lock  Revision Spine Surgery
Featured Speaker:
Kamran Parsa, DO
Kamran Parsa, DO., is a Neurosurgeon and a member of the medical staff at Palmdale Regional Medical Center.

Learn more about Kamran Parsa, DO

Melanie Cole (Host): Revision spine surgery is surgery performed in certain patients to correct the problems of earlier spine surgery. Revision surgery may be indicated in patients with chronic pain even after surgery. A dedicated team of surgeons, nurses, and skilled therapists at Palmdale Regional treat patients by using advanced technology, including nanotechnology. Welcome to the show, Dr. Parsa. What is revision spine surgery and when would it be needed?

Dr. Kamran Parsa (Guest): Revision spine surgery is exactly as the title says, for individuals who've had surgery before and did not obtain the benefits of the surgery the first round of having surgery. As an example, if you have neck pain radiating to your arms and you have neck surgery, then you wake up and a couple months pass and you still have neck pain and you still have arm pain. Those are the scenarios where nowadays we can go back in and revise the surgery and help bring back functions they had that they wanted to gain from the first surgery. That’s one way of looking at revision surgery.

Another way is for surgeries that were done well but now other areas of the spine – above or below the prior surgical site – have broken down or if someone gets in a car accident or has a bad fall and breaks what was done the first time around, and now the pain has come back. These are essentially the indications or scenarios we've seen for revision spine surgery.

Melanie: Dr. Parsa, it would seem in revision surgery, is it uncomfortable for patients to ask you about fixing something that another doctor did?

Dr. Parsa: I think some do. I've had some patients who are slightly uncomfortable. They feel it’s betraying a former physician or what not. Generally, I don’t think that should be the concern. I believe all physicians are doing their best in trying to help their patients, and some just don’t have the training or haven't been exposed to some things that others have. It’s the same I'm sure, possibly, for me as well. There are scenarios where I haven't been able to help patients and I would be happy for that patient to go to somebody who can help them. I see how the patients feel, maybe that they're uncomfortable, but I don’t think the physicians look at it that way. We all just want to help the patients get better, and if we can't do it, I would more than happy or never to have someone else who can take care of them.

Melanie: Tell us about some of the procedures intended to repair previous interventions. What kinds of procedures are we talking about?

Dr. Parsa: A common one is fusion surgeries, especially with the older technology. The fusion didn’t take or didn’t occur. I’ll give you an example. If you have a C4-C5 neck surgery and the idea was to fuse it, you place a cage in the middle, you take the disc out, take the pressure off all the nerves and place screws and plates. The idea behind that fusion surgery is that the bone will grow from the C4 to the C5 and it will all become one block of bone within a year. When that occurs, you don’t really need to screw the plates anymore. The way the screws and plates are designed is to hold everything together – fixated for a year and a half. If that fusion doesn’t occur, then you're at risk of a failed surgery or a fusion surgery called pseudo orthosis – where a fusion hasn’t taken and you can potentially have recurrences or worsening neck pain, a very common scenario, and sometimes arm pain, but usually neck pain or mechanical pain is a very common presenting symptom. That’s a very common one.

Another scenario would be say you had a C4 or C5, along the same track as a C4-C5 surgery, and it goes great and you do fuse, but now there's now stress on the levels above or below that level at the C3-4 or the C5-6 level, and now those have broken down and they need to go back and revise and fix them to a new level below it. That’s two common scenarios. A less common scenario is if someone gets in a car accident or falls and breaks the implementation or the healing process that was trying to take after the first surgery and now needs a revision surgery to fix that.

Melanie: You're using a new fascinating bit of technology called nanotechnology and specifically the Titan nanoLOCK in revision spinal surgery. Explain what this is and how the textured surface impacts that fusion process because I think this is absolutely fascinating for listeners.

Dr. Parsa: It is. It’s a great technology. In the past, what we used to use for cages were plastic in reality, and the surface technology was nonexistent – it just had some ragged edges so that it doesn’t slip out. The Titan company essentially first started doing laboratory research and later to progressive clinical research to help advance the surface technology to match the osteoblast cells that are trying to form bone. They found out that if they have the correct size and angles to the surface, they can promote the fusion of the bone onto the cage. That was their major breakthrough, and by using titanium instead of plastic, that also helps incorporate with the bone better than plastic – it doesn’t form what we call biofilm or film that stops of the fusion process essentially. By using those two together, they’ve really enhanced the recovery rate not only for revision surgery, but even for first time surgeries for recovery and healing.

Melanie: Because our bones are not smooth like a piece of plastic – they've got little bumps, they're porous – so when you're talking, and so that the listeners understand this, when these bones have to form and you talk about the cages and that adherence to whatever material you're using to do this revision spine surgery, is this a cellular thing? Do our bones natural adhere to surfaces? Explain a little bit about the physiology of it.

Dr. Parsa: That’s a good question. That’s exactly where Titan did their research – it’s at the cellular level. They found that bone doesn’t adhere to anything by itself. It likes to go to itself to another bone, but it doesn’t like to adhere to other material unless they have the correct environment. They found out that by using specific angles of pores – the nanotechnology is actually their second generation – what they did is they used their research to find the right angles and the different depths from nanoscale to microscale to help the podocytes from the osteoblastic cells basically capture or stick onto the surface of the cage. What I mean by "nano" is 10 to the power of minus nine. Obviously it’s not visible to the naked eye, so there are really small porous structures that helps the cell stick to the surface of the cage.

Melanie: That’s absolutely fascinating. In summary, wrap it up with your best advice for listeners about revision spine surgery, when that might be indicated and what should they think about when seeking a physician to do revision spine surgery.

Dr. Parsa: First of all, for surgeries, the most important thing is if you're going to have a spine surgery the first time around and you don’t improve from the surgery, then generally that means you need a revision. Yes, you can get better. I have had a lot of patients come to me who are afraid of surgery because they’ve heard of a lot of failure rates and people never improving. If you're not better from your first surgery, then you always essentially need an evaluation to see what's wrong and why you are not better. That’s the important thing. Whenever you're thinking of a second surgery, I think it’s very important to have multiple opinions. You’ve been through it this once, so if you're going to go back to your same surgeon, great and wonderful, but also keep in mind to see other surgeons as well. I always recommend at least two, preferably three surgeons. The type of surgeons I would recommend are generally board certified surgeons who are fellowship trained in revision surgeries, deformity surgeries, and some more complexed ones because everyone hasn’t had the same training. These are the second opinions I would generally recommend to go and seek to get the right care.

Melanie: Why should they come to Palmdale Regional Medical Center for their care?

Dr. Parsa: I think Palmdale is a great asset to the community. They're new, they have wonderful staff, they're clean – all my patients essentially have been very happy with their care. The nursing has been superb. They have a specific unit for spine and brain surgeries where the nurses are specifically trained in that field to help adhere to the patient’s needs. I think that these are all benefits that individuals will get that they won't potentially get at a smaller or different community hospital. I'm very happy with them from a surgeon aspect and that they have very good equipment, they allow me to use Titan and different products that I feel are best for my patients. Their ORs, as I said, are very clean, infection rates are low, and it’s just a comfortable pleasant experience for both surgeons and patients.

Melanie: Thank you so much, Dr. Parsa for such a fascinating segment. It’s such great information. You're listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, please visit That’s Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if minimally invasive surgery is right for you. This is Melanie Cole. Thanks so much for listening.