"As surgeons we are tasked to give our patients a better quality of life."

	Dr. Juan Dipp Orthopedic Surgeon / Spine Specialist

On His Experience: I have been an orthopedic and spinal surgeon for16 years. I did my orthopedic surgical training in Mexico City, and then completed a spinal surgery fellowship in Spain's Hospital La Paz in Madrid.

On Being Bilingual: I've spoken English since I was a child, when I went to grammar school in the US. I do all my lectures in English. I do medical lectures in the US and Europe; last year I traveled to Europe six different times to train surgeons at Paracelsus University in Salzburg Austria -- this is a European training center, half the school is a university, half a training center. When I go there I train surgeons from all over Europe on this dynamic stabilization procedure; surgeons from London, Berlin, Barcelona, Geneva, Madrid.

About The LDS Procedure: The system we are using for the LDS procedure is one that I have been involved in the actual development of. I performed the initial study for the PercuDyn implant and personally performed the first 50 surgeries as well. We did the first procedure in February, 2006. The outcomes have been reported on extensively -- we have a chapter in a book called Motion Preservation Surgery of the Spine (Advanced Techniques). There are papers that have been presented and are being presented in neurosurgical focused journals such as American Academy of Orthopedic surgeons and the Journal of Neurosurgical Medicine.

A Short History of Back Pain: Everybody has suffered back pain at some point or another, or will. This is something that applies to the general population. We have a saying here in the spinal unit, whoever tells you he has never had back pain is either lying or is from another planet.

When speaking of orthopedic surgery, the spine is something that still needs a lot of investigation. It is a very, very challenging surgery. As surgeons we are tasked to give our patients a better quality of life. Curiously the gold standards even now is fusion, even with all its shortcomings. Spinal fusion has so many shortcomings -- we are immobilizing or getting a segment of the spine completely immobilized not permitting it to do any of its normal functions.

The problem is, the spinal fusion procedure overloads the adjacent levels above and below the diseased segment.....because even with an immobilized segment the spine still has to load mechanically. In fusion, the overloading of these adjacent levels mean s you are not guaranteed a good outcome.

LDS vs. Spinal Fusion: Thankfully now there are a lot of new things we can do to help people get rid of pain, be productive, and have a good quality of life, while being less surgically aggressive than spinal fusion.

Fusion surgery has many serious issues: it is a -4 hour surgery, it is very expensive with a hospital stay of 3-5 days, and it affects the patents biomechanical capabilities forever. That cannot be changed.

LDS is "percutaneously over the wire", the patient is awake with only a local anesthetic and then back home in 3-4 hours, back to work in 7-21 days. Morbidity is very very low. With LDS the patient maintains full range of motion; we have implanted a load sharing device instead of load bearing device like fusion. W e still need to see if degenerative disc disease is reversible, which we still don't know.... but we may have the opportunity to know a few years down the road, especially with advancements like LDS. Delaying a fusion even for several years is, in itself, an excellent outcome for the spinal patient.

Finally, morbidity with fusion is higher - the patient has a much higher possibility of developing some type of complication. Fusion is a big surgery requiring multiple implants, and the patient can suffer neurological damage, blood loss, and infection risk. Adjacent discs will have problems in the future -- that is a given, given the nature of the surgery.

Among our earliest LDS patients -- that is, those that had the procedure in 2006 -- we've had very good results. Our complication index is below 2%. We've had minor complications like skin irritation from the device material, one implant malpositioned, which was replaced in the same surgical event.

LDS allows us to help the patient without fusing them, which is why it is coming to be known as Nonfusion spinal surgery.

LDS gives us a chance to treat the younger patient with incapacitating lower back pain. Like the director right here at Hospital Angeles Tijuana, who had the surgery very recently. He experienced chronic low back pain that was not responsive to physical therapy or medication, but at around age 40 he was far too young for a fusion. That's been the problem in this field -- only two treatments, either conservative or spinal fusion. Now we have a treatment for that very big group of patients that need something in between -- an outpatient surgery that will relieve pain, by employing the main stability principles. LDS gets the patient's spine back to the neutral zone, restoring it to the normal range of movement, without fusion, so you can go about your normal life.

LDS: Who Is a Candidate: In the US 250,000 people have fusion surgery a year. But the number of patients that have back pain that are candidates for LDS spine surgery is easily three or four times that.

The typical patient is male, since degenerative disc disease is an outcome of the type of hard labor work that men are more likely to perform. But of course we have female patients as well -- back pain knows no gender barrier, or for that matter age barrier.

Our youngest patient is 21 our oldest patient is right around 70. Most of the patients we have treated in Mexico are patients with intractable lower back pain due to degenerative disc disease attributable to hard physical labor. LDS is also indicated for mild to moderate spinal stenosis. Spinal stenosis is fairly common for patients 65 plus.

A patient that had microdiskechtomy and in pain again is a candidate for this procedure. Although microdiskechtomy is for treating disc herniations, when I do microdisckechtomy or nuclopasty I use the PercuDyn implants to protect the disc. A normal disc should not herniate --a microdiskechtomy will relieve the nerve from pain, but we still have the problem of an overloaded disc and a potential for the pain to return. Typically the incidence of a person having another diskechtomy is about 28% - that's the incidence of reherniation. The PercuDyn device --the same one used in LDS -- protects from this.

On Authoring the Global LDS Protocol: About400 LDs procedures have been performed worldwide -- I have performed more than 200 of these. Results have been very good, and complications have been very low, which is to be expected. This is a new implant, but dynamic stabilizing surgery has been around for over 20 years, started in Bordeaux France, where Interspinus dynamic stabilizers were first introduced. Interspinus has not been approved in the United States but has been around for a very long time in Europe.

With the PercuDyn system, I feel we have a product that works with similar or better results than Interspinus stabilizers, with less tissue damage and in less invasive fashion. The PercuDyn system should also give the patient a longer term protection and function: an Interspinus stabilizer is subject to only about 200 Newton of force, while the PercuDyn facet is subject to 400 Newton each because they are closer to the axis rotation of the spine. After the surgery, normal motion is preserved - the only limit is what is painful. There are six sites in the United States that are doing an FDA approval study. We are teaching American surgeons at a workshop held six times per year in Irvine California.

At present, there is only one FDA approved dynamic stabilizer, with a failure rate of 27%. The FDA is about eight years behind Europe authorizing new products and new implants -- which is why the LDS surgery is available and perfectly safe in Europe and Mexico years ahead of the United States.

The implant is made in the United Sates, and both of the components and materials used are widely used in spine surgery, so should cause no reaction The LDS technology has been proven with more than three and a half years of usage and 400 patients worldwide and the number is growing rapidly.

What I tell my patients: the pros of the LDS procedure are many: it is minimally invasive, percutaneous, outpatient, done with patient awake, with only local anesthetic and mild sedation. It takes fifteen minutes per level to be treated. You will be discharged on your own two feet, walking under your own power, no braces or crutches or cane or brace four hours later. If your employment is office work, you can go back in four to seven days. If your job requires mild load bearing for your back, you can return to work in three weeks. For heavy laborers, return to work is five to six weeks.

LDS is not something we would try in a patient that already needs a fusion; LDS is for the younger patient, the patient who, if we don't help him now with LDS, will need a future fusion for sure. To me, this is an easy choice: small LDS surgery now, or big surgery a couple of years down the road. Degenerative disc disease that has not responded to conservative care, pain clinic or aggressive physical therapy will not stop on its own, pain doesn't work that way. You can do this now with low complications and low morbidity, and an easy surgery, instead of waiting. Waiting to see if the pain goes away is really just waiting for the time you will have so much pain you will need a fusion.

L5S1. With LDS we can treat from one to three levels. Another important advantage of the PercuDyn System over the Interspinus stabilizers is that PercuDyn is available for the L5 S1 space. The L5S1 is a very difficult segment to stabilize with an Interspinus stabilizer and the L5S1 is the most common level affected after L4L5. So you can see what sort of advancement the PercuDyn system represents for people who are suffering.