Dr. Pablo Pazmiño is an orthopedic surgeon specializing in lumbar disc replacement, primarily treating younger patients with recurring back pain. He utilizes the prodisc lumbar arthroplasty technique, which involves a minimally invasive approach and requires healthy facet joints for effective surgery. The document also discusses foundational concepts in spinal anatomy and imaging, the history of arthroplasty, and the importance of personalized implant sizing for successful outcomes.

1. Pablo Pazmiño, MD

2. Orthopaedic Surgery American Academy of Orthopaedic Surgeons Clinical Faculty Olympia Medical Center Cedars Sinai Medical Center Century City Doctors Hospital Education The University of California, Los Angeles The University of Michigan, Ann Arbor

4. Patients are usually younger 20- 50 years of age History of recurring or persistent back pain Occasional buttocks pain and referred pain radiating down the legs

5. Pain: Deep, dull ache in the lower lumbar region Increased pain with : Rotation, Flexion, and side bending, prolonged sitting , standing, or walking Is your pain similar to this? You are not alone….

6. Dr Pazmino removes the Degenerated Disc and replaces it with a Prodisc Lumbar Arthroplasty / Disc Replacement

7. With my background as a Third grade teacher I always make it a point to build a foundation concept before moving on to more complex ideas. I would like to take a moment to build some foundations before continuing to discuss MRIs.

8. Here is what I mean by a foundation concept. You will see side view images and top down images throughout this presentation and on your MRIs. This can be hard to grasp unless we stop and point a few things out initially The Sagittal view is also called the lateral view and this is pictured here it displays the spine as viewed from the SIDE.

9. Here is what I mean by a foundation concept. You will see side view images and top down images throughout this presentation and on your MRIs. This can be hard to grasp unless we stop and point a few things out initially The Axial view is a top down view of the spine. This image repsents a slice obtained as if an Axe were to chop you, therefore the name Axial view.

10. Next we will review some basic anatomy Some images will be in the Sagittal plane

11. Others will be in the Axial Plane

12. Joint Facet Nucleus Pulposus Right Nerve Root Left Nerve Root As you can see here on MRI and CT scans the Facet joints end up looking like the buns of a hamburger. Its just the way the happen to look when they are sliced in this plane. We will show you this on some examples later Annulus Fibrosus Axial View of the Disc and Neural elements

14. As we age we start to lose our hydration in our discs As we lose hydration the discs lose their “ white ” well hydrated colors on the MRI views and start to darken , turn “ black/grey ”

15. Are located posteriorly, these are the joints of the spine and are essential for control of normal motion and based on their orientation Compromised facets will alter the distribution of mechanical forces throughout the spine

16. Healthy Facet Joints are a pre-requisite for a lumbar disc replacement because you will require the joints to move after surgery: Flexion Rotation Extension are all controlled by the Facet Joints

17. In the 1960s, Sir John Charnley pioneered modern arthroplasty, or joint replacement with the Total Hip Arthroplasty /Replacement (THA) Sir John Charnley at his lathe working on the first artificial joint

18. Arbeitsgemeinschaft für Osteosynthesefragen (commonly called AO) (German for Association for the Study of Internal Fixation) is a non profit organization dedicated to improving the care of patients with musculoskeletal injuries and their sequelae through research, development, education and quality assurance in the principles, practice, and result of fracture treatment. Distribution and sales of all AO products is done through Synthes

19. The Prodisc concept was developed in the late 1980’s by Dr. Thierry Marnay, a French orthopedic surgeon. Since early 1990, Dr. Marnay has been implanting a series of Prodisc implants in the lumbar spine.

21. The endplates have a patented central keel and small spikes for initial fixation to the vertebrae,.

22. A plasma sprayed titanium coating on all bone-contacting surfaces to promote bony on growth.

23. The Prodisc-L implant is available in a variety of sizes to allow Dr Pazmino to accurately match the patient’s anatomy.

24. Here you can see how Dr Pazmino custom sizes the Prodisc according to your body type, bone structure and endplate morphology

25. 15 degrees of Flexion and Extension

26. Six degrees of side to side motion

28. Team approach All procedures are done by two Spinal Surgeons

29. All our procedures are performed in a minimally invasive manner. All approaches are performed by a specially trained vascular surgeon All patients receive a plastics closure and are followed closely afterwards

31. Our results on both Lumbar and Cervical Arthroplasties have been presented at various meetings and Conferences Spine Arthroplasty Society NASS: North American Spinal Society CNS: Congress of Neurological Surgeons ANS/CNS Spine Section

33. Levin DA, Bendo JA, Quirno M, et al. (2007) Comparative charge analysis of one- ant tow-level lumbar total disc arthroplasty versus circumferential lumbar fusion. Spine 32(25): 2905-9 Ogon M, Howanietz N, Tuschel A, et al. (2007) Implantation of the ProDisc intervertebral disk prosthesis for the lumbar spine. Oper Orthop Traumator 19(2):209-30 Panjabi M, Henderson G, Adjornson C, et al. (2007) Multidirectional testing of one- and two-level ProDisc-L versus simulated fusions. Spine 32(12):1311-9 Ziegler J, Delamarter R, Spivak JM, et al. (2007) Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine 32(11):1155-62 Siepe CJ, Mayer HM, Wiechert K, et al. (2006) Clinical results of total lumbar disc replacement with ProDisc II: three-year results for different indications. Spine 31(17):1923-32 Bertagnoli R, Yue JJ, Kershaw T, et al. (2006) Lumbar total disc arthroplasty utilizing the ProDisc prosthesis in smokers versus nonsmokers: a perspective study with 2-year minimum follow-up. Spine 31(9):992-7 Bertagnoli R, Yue JJ, Nanieva R, et al. (2006) Lumbar total disc arthroplasty in patients older than 60 years of age: a prospecitve study of the ProDisc prosthesis with 2-year minimum follow-up period. J Neurosurg Spine 4(2):85-90 Bertagnoli R, Yue JJ, Fenk-Mayer A, et al. (2006) Treatment of symptomatic adjacent-segment degeneration after lumbar fusion with total arthroplasty by using the prodisc prosthesis: a prospective study with 2-year minimum follow up. J Neurosurg Spine 4(2):91-7

34. Thank you for your time. If you know someone who could benefit from a consultation for a Lumbar Artificial Disc Replacement please refer them to our online website or call toll free to schedule an appointment 1-8SPINECAL-1 www.beverlyspine.com www.santamonicaspine.com