Avicenna Society

09/08/2026

Very interesting discussion today in Homburg at the Saar Global Spine Congress: sacral insufficiency fractures in the elderly.

These fractures can be easily overlooked, yet the consequences can be profound. Severe pain leads to immobility, and in frail elderly patients, prolonged bed rest can rapidly accelerate loss of muscle mass, functional decline, and medical complications.

The key message: a sacral insufficiency fracture is not just a painful fracture. In an elderly patient, prolonged immobility can become life-threatening.

Early recognition, adequate pain control, mobilization, and appropriate treatment are critical to breaking this cycle.

08/23/2026

This may generate some controversy, particularly among our interventional colleagues.

These nerves are there for a reason, and radiofrequency ablation intentionally destroys the targeted sensory nerve to interrupt pain transmission. Whether repeated denervation has meaningful long-term consequences is a question I do not think we discuss enough.

I do not have enough evidence or expertise in this specific area to take a firm position. I am sharing this because I would genuinely like to hear what our society members, pain specialists, and spine surgeons think.

Is the concern biologically meaningful, or is the clinical evidence reassuring enough that it should not influence our use of RFA?

A prior authorization rule written to stop low-value injections has been quietly selecting young back pain patients into a procedure that denervates a stabilizing muscle. Nobody designed that outcome, and nobody owns it. That is the shape a utilization management failure usually takes. The gate does...

08/23/2026

Today, August 23, we celebrate the birthday of Avicenna (Ibn Sina) and Doctor’s Day in Iran.

Medicine comes with sacrifices: missed birthdays, anniversaries, family moments, sleepless nights, and the constant weight of responsibility.

But this week, several patients looked me in the eye and simply said, “Thank you for what you do.”

Sometimes one genuine thank you makes every sacrifice worthwhile.

Because we change lives.

Happy Doctor’s Day to my colleagues in Iran and physicians everywhere.

08/22/2026

A colleague asked whether I would proceed with L4 to S1 OLLIF in a patient with a still-open wound after an infected lymph node resection.

For me, the key issue is not whether the wound is completely closed, but whether there is any active infection. If the wound is clean, well granulated, and there is no clinical or laboratory evidence of ongoing infection, I would consider proceeding after informed discussion with the patient. Specially if patient has severe symptoms related to spinal pathology.

OLLIF has a very low reported infection rate, approximately 0.24% for pure MIS OLLIF, with substantially greater risk when an open component is added.

In this specific situation, if proceeding, I would consider continuing an appropriate oral antibiotic for 3 to 5 days postoperatively, tailored to the patient’s prior infection, cultures, allergies, and local antimicrobial guidance.

Would you wait for complete wound closure, or proceed once active infection has been convincingly excluded?

08/20/2026

Just last week, we published our paper describing **Oblique Thoracic Interbody Fusion (OTIF), a true trans-Kambin minimally invasive thoracic fusion technique**.

Yesterday, we performed **two OTIF cases here in Minnesota**, putting the technique directly into clinical practice. Here is one of those cases, including the intraoperative image and operative details.

For colleagues interested in learning more about the technique, indications, surgical workflow, and instrumentation, please connect with me. We are planning a dedicated **educational session on OTIF within the next few months**.

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08/20/2026

Congratulations to Dr. H. S. Chhabra in India on successfully using the sacroiliac joint fusion system, and many thanks for sharing this beautiful image.

To the best of my knowledge, this is the first independent case performed in India, besides the case I performed on a patient in Bareilly for demonstration and training purposes.

As we often say in surgical training in the United States: “See one, do one, teach one.”

You have seen it and done it. The next step is to teach it and share the technique with the broader community of our colleagues.

Congratulations again, Dr. Chhabra, and thank you for bringing this treatment option to patients in India.

08/18/2026

Interesting case for the community.

This patient presents with significant axial low-back pain with a component suggestive of L4 radiculopathy. The lumbar MRI demonstrates an abnormal appearance that, to me, raises concern for an underlying pathologic process rather than routine degenerative disease.

I am currently obtaining a PET scan, as well as a dedicated MRI of the involved region with and without contrast for further characterization.

Have you seen a similar imaging appearance? What would be highest on your differential, and would you recommend any additional diagnostic workup before considering biopsy?

08/17/2026

I’m happy that we are finally having this discussion and working toward establishing clear standards for what truly constitutes minimally invasive surgery. As you can see at the top of the scale, operative time is a crucial factor and should be an integral part of any meaningful definition of MIS.

Based on this scoring system, approximately 95% of what we do with the Trans-Kambin OLLIF technique, including multilevel fusions, qualifies as MIS, with scores below 5. This provides a much more objective way to evaluate minimally invasive surgery rather than simply defining MIS by incision size or the name of a particular technique.

08/16/2026

What a fantastic meeting at CONISCECO in Baja California!

A vibrant spine community with colleagues from across Mexico, an excellent scientific program, and a wonderful opportunity to exchange ideas, learn from each other, and build new friendships.

Very grateful for the warm Mexican hospitality. We look forward to strengthening these collaborations and returning for future conferences and educational programs.

08/15/2026

It seems compared to United States, Mexican conferences are much more fun😁

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