Dr. Marco Capogrosso Spinal Stimulation, Tonja B., Dr. Alfred Bonati on Conscious IV Sedation

welcome to American medicine today I'm Kimberly benady alongside Ethan uker so stroke victims who lost use of an arm have regained Mobility following a revolutionary spinal cord stimulation treatment joining us to discuss is Dr Marco caparaso assistant professor and director of the spinal cord stimulation laboratory at the University of Pittsburgh thank you for joining us doctor thank thank you for having me certainly so let's get right into it can you first explain how stroke causes paralysis yeah so um basically stroke is an event that occurs inside the brain but the reason why it causes paralysis is that by um means of a of a loss of blood inside the brain there's a damage to the accents which are basically cables if you want that connect our brains with our spinal cord and inside the spinal cord is the neurons that control our movement so when this connection is lost our brain can't communicate to the cord anymore and so we have paralysis what actually led to the idea like hey I think using little pulses of electricity might be able to because essentially you're trying to like bridge the gap right because after that you why don't you explain it you're the doctor I don't know what I'm talking about actually I think it's right because so basically for a long time because as I said stroke of in the brain people have been focused on the brain try to make therapies that fix the brain but the problem isn't really the brain but rather this connection so this Gap that you said is created between these two parts of our nervous system however um the the key here is the fact that this um damage is never complete there is always some um accents that are still there they survive so some of these signals can reach the cord but they're too weak our neurons can't hear them essentially so they don't know what to to do so our idea was to stimulate the spinal cord to provide some sort of amplification of the signals so that now the neurons below the lesion could could hear these signals coming from the brain and now they would be able to interpret them and do and do what the brain wanted and so we we develop this technology to essentially do this electrical amplification if you want of the signals and that allows particip patients to control better their movements CU now the spinal cord has um Can can listen to this weaker signal and be able to to to move the armor and you're in human trials right now so what are some of those early results that you're seeing so we published already a paper in nature medicine because um usually one would wait at the end of the trial but the results that we got was actually larger than we expected in the sense that some of our participants even on the first day uh as soon as you turn on the stimulation they were able to control their hand also let me make here an important distinction because we're seeing also this other potential technologies that control or stimulate the brain here we're really facilitating whatever is left in a person so people volitionally regain their ability to move they just want to they try to control their hand as they would normally and then they start opening their hands now this the things that we're studying now is okay they get these effects but do they get better over time and now we are increasing number of participants in the trial to study exactly that how much better do they get over time and most importantly to what type of stroke our our technolog is most indicated put simply you can imagine that if somebody's very impaired May benefit less than somebody that is more impaired uh less impaired but it's not it's not exactly like that there is a lot of variables and that's what we're trying to discover what's what's the the patients that would benefit the most now in the write up it talked about how you delivered the stimulation into the spine via a needle so technically the stimulator was put in the spinal cord but the wires were actually sticking out of the person is this something you're thinking will become maybe an implantation or is it something where if you do this enough that the individual that had had a stroke will be able to keep whatever advancements they make during that stimulation process yeah this is this is a great question actually so we think that uh we want to make this into an implant so in our study we left the wires out just for safety reason it was the first time in the in the history that this was done in stroke so we needed to be cautious and that's why we did that but um what we want to do next is actually implant completely the system inside the body so the participants patients will have the ability to control the stimulation on their own with a little device now I don't think that that patients will ever get rid of the stimulation in the sense that even if they keep improving and benefiting every time they will turn on the stimulation they will get better and so that additional benefit will always be there and so you would you would see this as some sort of Pac maker you know a device that now it's part of your body and then helps you move for your entire life electrodes are implanted and then you so they're connected to the device that's uh stimulating and that allows for the movement but as soon as the stimulation is turned off what's the percentage that that remains and they retain versus does it completely go away and so that's what we're studying now actually okay you know because that percent that Gap that you lose when you turn on the stimulation really depends on the specific stroke so for some participants there's no Gap EV eventually they can recover and there is no difference from others there is however I want to say something that you know this sensation to control one's own body is so strong that actually some of our participants um over time this Gap reduced at the beginning was really big whenever the stimulation was start there were huge improvements and then they kept improving even when the stimulation was off to a point that there wasn't that much difference on the measures that we could do but psychologically there was every time that the stimulation was on for them it felt easier and that's a quite an addictive feeling because you know some suddenly you have control again of a part of your body that's been paralyzed for years so you want you want to feel that and so that's why I'm also saying you that there's also a psychological component of a benefit here for people that can suddenly feel again their body you know absolutely um actually and Kimberly you might recall this we several years ago uh spoke with somebody it's called deep brain stimulation and it treated this man who had uh Parkinson's I believe and just sending that signal into that part of the brain that kept him from shaking yes it uh it basically cured his his uh Tremors and and all of that so I see parallels in what you're doing with stroke people now my next question is do you see this uh technology and research that you're conducting um being applied to other conditions thank you for uh no problem helping me out there yeah so actually um I started this work in spanac cord injury and uh there there's already clinical trials going on for the recovery of the lower limb in Louisville in the Mayo Clinic uh in in Europe where I was and now here in the US we started doing this on stroke because we're focusing on the on the arm and hand um so certainly yes now uh it really depends on the on the type of of condition but yes certainly span codinger is one of of this there's actually promising investigations going on at the University of Washington in Seattle and also UCLA where they're trying to explore some sort of less invasive way to stimulate the spinal cord so they can so that it can be done in children with cerebral pulse you know children that essentially had a stroke in the womb and unfortunately they are paralyzed we can't put an implant in them um just yet but maybe there is something that we can do in the meantime to facilitate their movements there researchers in the United States that are trying to do that following um what we're doing in stroke but trying to translate into children it's something I think it's very promising and interesting uh Direction and where can people learn more about what you're doing and help to get involved uh yeah so if you go on the website of the University of Pittsburgh there is a resource called pit plusme that is a website where we install the the clinical trials uh where one can enroll and in fact the federal government has a has a web page called clinical trial.gov that you can go there and search for keywords such as stroke and spinal cord stimulation and there will be all the active clinical trials in the country and abroad on this topic amazing technology thank you so much for what you're doing to help stroke victims move again with the spinal cord stimulation Dr Marco capaso thank you for being on the program thank you so much make sure you stay tuned coming up after the break we'll have more two neurosurgeons couldn't figure out anything that was wrong with me or what I would need surgery for dror benady without even seeing me knew I was hurting knew they could help me first time I came in here was Monday and today is Thursday I've had two surgeries and am doing fantastic I'm still in shock that I can walk that's all within 4 days visit ask pat.com Tanya is an active grandmother who enjoys spending time with family taught high school for 28 years I teach line dance classes and I have uh grandbabies that I take care of I lift weights and I do like yoga I don't recall an event I started experiencing um pain in my right hip and I just I moved and got this really strange um nervy sciatica pain and it's just almost like my right side of my body just um my my leg kind of collapsed um I started experiencing uh some low back pain all on the same right side where my hip was hurting it would hit me very suddenly especially if I had been in a seated position my leg would just no go numb and would give out and then of course like I said I have a 3-month-old grandbaby so my biggest fear was you know what if I'm holding him and I take a step and and I can't you know control that that leg movement I used to run a lot I I got where I couldn't was not running at all I could not ride in the car for long periods of time and driving for long periods of time so I would avoid those situations avoid being in the car or sitting or standing for long um as I said I teach dance and so I would feel like I would have to rest up all day long to be able to do my class in the evenings looking for a way to relieve the pain Tanya tried numerous conservative treatments I'd used uh heat and ice at one time had a little at home red light therapy tried resting topical medications dry needling I had done the um PT and um go chiropracting and different different things like that and then it would subside what gave me the most Comfort was probably um either the laser therapy or massage therapy i' started use a as therapy Tanya met with her primary care physician seeking help they ordered an MRI and referred her to a neurologist when I had to get the MRI I had go back to my um my primary care physician he had looked at the MRI and wanted me to go see a neurologist the neurologist wanted to do um a fusion and that just wasn't something I was ready to do especially after talking to my PT he just felt like that I would be kind of sliding down a slipper slope it would be I would get those vertebrae fused and then it probably in his opinion would not be long before I would have to have other verteb fused and I just you know I still think I'm young young at heart I didn't want to deal with that I wanted something that I could keep my activity level the same and something that be a lot less invasive when her friend and physical therapist recommended The bonady Spine Institute she decided to call for an appointment there is a lady in my hometown I actually did not speak with her but I spoke with her husband and she had surgery here like 25 years ago and has not had a surgery since I think knowing someone that had had or at least knowing of someone that had had a successful experience made it um a little bit less intimidating I think I went online to um get information about sending my MRI and um I was not exactly sure how to do it online so I just looked at at the phone number and called and just asked if someone could walk me through procedure of of um getting my MRI to the clinic and that's when they assign me to galain and she explain the process of how I would get my uh MRI um through a Dropbox and get it here after um I sent my MRI I actually spoke to Dr benady um after um he had looked at my MRI and told me that you know that he felt like I would need two surgeries and then got me back in touch with um galain she helped me do through you know through all the paperwork and uh scheduling my appointment Tanya's experience at The benady Spine Institute was a little different than most upon arriving she was given a physical exam received updated X-rays at the oncampus Imaging Center and had her first targeted benady spine procedures all on the same day I was very nervous um but um even you know just when I signed in was very comfortable and everyone was very nice and greeted me my appointment was at 8 and I was here at 7:55 and got right in I ended up having an x-rays because they already had my MRI here oh that that was very nice to not have to get um back in and leave the leave the grounds to go do that we were able to to walk uh my husband and I walked over to the Imaging it did that and then walked back over and really by the time I got back over they already had my images over here and was ready to consult uh Dr Noak did explain and and showed me um which vertebrae that he would do the surgery on gosh I was probably in surgery by 11 or 11:30 so I felt like that was a pretty quick um morning to be already you know do my consultation and and then to have my surgery as well the exclusive benady spine procedures are performed incrementally using conscious IV sedation where the patient remains awake and communicating with their surgeon to ensure their source of pain is eliminated before leaving the operating table being awake was was interesting I think it was very helpful my husband being in there that we had no idea that he would be able to observe in surgery and so I think that is is a big plus is having someone kind of your own little personal advocate in there with you and I think that made me feel less nervous so I was experiencing pain walking to the to the um o getting up on the table when um he was testing the different I guess nerve areas to see um I can remember um feeling the pain and then not having the pain at all no pain on your but no no pain back of the leg oh no pain back of the calf oh surgical guests at The bonady Spine Institute are often surprised by how quickly they can be up and walking following surgery following a brief walk in the recovery room patients return home or to their hotel rooms to continue recovering the recovery time was very fast I felt like the staff was very attentive taking my bottles my husband just drove around and picked me up I just walked out no hospital stay which was very nice I don't will not have to have uh Physical Therapy any any extra therapy which is was is very nice um the main thing that um is rard is for me to walk which is good because I'm very I'm active anyway that helped me a lot last night we walked around the pier I didn't feel quite as stiff we're um going to stay somewhat in the area we're not going to hit the road and go back it's about a 16-hour drive back to Arkansas we have friends that live in Cape Coral about 3 hours away so we're going to do some s sing today and walk around and then go there and walk around and um so that that is the main activity that um I will continue doing as I recover is as to continue to walk Tanya is looking forward to returning to her active lifestyle and enjoying time with her friends and family I will definitely uh recommend uh The benady Spine Institute I'm anxious to get back and um tell especially my PT who recommended uh the surgery center how successful and to also let him know to tell any of his um patients that if they would like to speak to me about my experience I would be happy to to share the positive experience that I've had I'm just um looking forward to just being more confident in my movement and to not have pain get back to my normal activities to see more stories of recovery just like this search The benady Spine Institute on YouTube Roku Amazon Fire TV Google Play Store and Apple's App [Music] Store welcome back to American medicine today I'm Kimberly benady alongside Dr benady and we'll be discussing conscious IV sedation doc why is that such an important feature of the bonady spine procedures when I start my practice in orthopedic surgery initially I did fra cures and bags and in the process doing bags I did open surgery every time that they did open surgery one of the major concerns was the time that we invest taking the patient under an anesthetic not only the complications that can happen postoperative time that is usually that elimination of the anesthetic to through the liver create some types of some abnormalities in older people right so the concern about the treatment was not only associated with the difficulty of the surgery the time that consume this patient under anesthesia and the recovery of this patient post surgery and to eliminate that some of the problems we eliminate the ones that I believe they were the one that impede the patients to be treated all right for example there were people that they have some liver problems people that they have heart problems and the anesthesiologist always thought about these patients shouldn't have surgery then those patients were practically put in the backline of treatment because they were not good candidates to have the surgery but at the same time this patient had so much pain that we need to do some solutions and then they were treated in different ways that they were not really successful okay so and and that's due to general anesthesia that's why they weren't good candidates exactly okay I start to think how about if we treat these patients in a different way and that's when I start to see we need to minimize the incision we need to minimize the damage to the bones to the ligaments and to the muscles right so we can create an access to the area operate these patients Without Really the the the the rad backs of general anesthesia that was an initial part how I develop those tubes to do a surgical procedure using an oscope and H using the tubes to arrive directly to the area where the problem was located all right but when I did that we still being using general anesthesia well I thought that if we block the skin and then we block the fascia probably we can put the tubes inside without creating pain anesthetize those areas yes use some anesthetic in that areas like cyoe sure a minimal amount maybe around 5 cc's or something like that okay when we did that I realized that cutting the skin was not a problem because was num right numbing the the fascia did remove a lot of discomfort because the fash is very sensitive right so when we num those areas we were able to put the tubes to the area that we need to operate but at that time also we have an another important element the bones and when we touch the bones that was pain all right so the problem was well we also we need to numb the periosteum in this area so we put some very small injections on the peros and we found that to our surprise that we can do surgery where we can use the instrumentation and and the patient is not going to have pain right but the beauty of this is not only is not going to have pain but also he will be able to talk to us will communicate with us and with that hype we combine some sedation so the patient will not be with some fear thinking I'm going to hurt right and and that is a drawback so they're slightly ated but they're able to communicate through the entire procedure with not only you but the rest of the surgical staff yeah by the 90s we already we're already thinking in that's how we are going to treat this right so for more than 30 years you've been doing that and what's really weird is nowadays you see people promoting the fact that they're the first doing Conscious Sedation and they're a new company after 880,000 procedures performed right uh a lot of this one was just think in the medical society that that is a way to do it and today different special start to test that technique now let me tell you this this is not something that was so easy correct because I was fly attack thinking that was practically not hard on my on myself to treat a patient in that way because the horrendous pain that that patient may have right today we know that those patients they never hurt now there are sometime situations where patients are scared and when you do that you sedate them a little bit and the patient responds normal we are going to take a quick break we'll be right back with Dr benat talking about conscious IV sedation I think everybody was shocked like really you had surgery today had drain tube I was at my desk doing payroll for 200 employees worked till night got up went to bed this is honest to God truth and was recovering I didn't feel anything the pain that I was suffering is gone I can go back to work in like 3 days 6 days after surgery I was back in the gym slowly but surely working my way back to back to fighting back back to basically 100% of fighting you know so 6 days and everybody was in all like didn't you just get out of surgery like yeah I feel great first time I came in here was Monday and today is Thursday I've had two surgeries and am doing fantastic I'm still in shock that I can walk that's all within 4 days bat succeeds where others [Music] fail welcome back to American medicine today we're in the middle of discussing conscious IV sedation but they can still feel if you're at the root cause of their pain and that interaction during your surgery is what brings about the incredible results because you said is this your pain and they're able to locate it yes this is it and then you go and and you take away the impingement you make more room for the nerve and suddenly they go pain is gone the patient becomes the owner of the body is telling you what you are doing right and if what you are doing is helping or not mhm and not only that they're able to walk watch and they go oh that's what was causing me that agonizing pain yet if they were put under general anesthesia they would never know usually the general anesthesia still is necessary when you need to do procedures like open surgery sure in the spine and unfortunately people continue doing fusions and you know my feelings about Fusion not only I don't think they don't work I think they are a situation where they recovery for the patient takes too long it does so you don't never know if the surgery work for you or not because you are in so much pain for so long that you expect that this is part of the treatment and the real truth is with our procedure the patient is walking one hour after the surgery right and we'll talk more about those procedures and the incredible 98. 75% patient reported satisfaction in another episode thank you for watching American medicine today you can check us out anytime anywhere if you search AMT on all your streaming platforms if you have any comments or questions contact us at the numbers below or you can tweet at Dr benady using the hash American medicine today or # AMT we would like to hear from you [Music]