Pinpoint Precision

Scottsdale surgeon leads the way in minimally-invasive spine surgery

In 1995, Dr. Dilan Ellegala, Sonospine founder and surgeon-in-chief, was a medical student on a neurosurgery rotation at the University of Washington in Seattle, where he was surprised to see surgical instruments developed in the 1930s and ’40s still being used to perform spinal fusions.

“In many cases, in order to fully decompress the nerve, the surgeon has to take apart so much of the normal anatomy of the spine, that it becomes unstable,” he explains. “To restabilize it, we have to put in screws and rods, and fuse the spine together. Even as a medical student, I thought, ‘This is insane. How can we do this better?’ ”

Dr. Ellegala’s journey to find a less disruptive technique led him to the university’s Applied Physics Laboratory, where a team was developing ultrasonic technologies for the U.S. Department of Defense. “My ‘aha’ moment was thinking why can’t we use this in brain and spine surgery?” he says.

Compared to a rongeur (a surgical cutting plier) or high-speed drill, ultrasonic energy could deliver the pinpoint precision Dr. Ellegala desired. In today’s version of the tool, a 1-millimeter instrument tip vibrates at ultrasonic frequency, allowing the surgeon to pare away bone, discs or ligaments that are compressing a nerve, millimeter by millimeter, without destabilizing the spine.

Dr. Ellegala first started using ultrasonic surgery—which the FDA approved in 2001—for cranial surgery in 2002 and spine surgery in 2007. “Initially, I only used it for lumbar problems, but the range has dramatically increased into the mid back and neck,” he says. “We can now treat many spine issues without requiring a spinal fusion.”

Whereas spinal fusion requires a hospital stay and six to nine months of recovery, Sonospine surgeons perform minimally invasive surgeries on an outpatient basis in about 90 minutes, and patients are back to full activity in six to eight weeks.

Dr. Mohamed M. Abdulhamid, who joined the Sonospine team as president of neurosurgery at the beginning of 2018, found it made a perfect match with his approach.

“My general practice philosophy has always focused on three aspects,” he says. “First, it has to be patient centered, treating the patients, not just the images and X-rays. Second, it’s about a multidisciplinary approach, collaborating with physical therapists, chiropractors and pain management to establish a program for patients. Third is my belief that less is more. Sonospine’s technology and technique fit my desire for less-invasive alternatives to fusion operations whenever possible. The ultrasonic probe allows me to achieve a few extra millimeters of decompression that I couldn’t get before.”

Dr. Abdulhamid notes another distinction from many surgical practices. “In any given day, I’ll only see up to eight new patients for an hour each, instead of feeling like I had to rush through 20 or 40,” he explains. “A patient who leaves our clinic has far more information and understanding of the problem and treatment than they had coming in.”

Nearly 25 years after his “aha” moment, Dr. Ellegala remains on the leading edge of ultrasonic surgery, including a development partnership with Misonix, which manufactures Sonospine’s medical devices. The company’s next-generation ultrasonic tool, based on Dr. Ellegala’s pending patent, should hit the market in spring 2019. “Ultimately, I think we will do many or most spine surgeries percutaneously, through a large bore needle, so you don’t even need a surgical incision,” he says. “It’s going to be another 10 years before we’re there, but that will be a reality.”

Sonospine is covered by some commercial insurers and medical-sharing programs, and the company is in the process of pushing for wider acceptance. Self-insured employers have been a notable success. For example, Liberty University saved $500,000 in direct costs in its first quarter, and about $500,000 more in indirect costs by having employees return more quickly to work.

“I believe we’ll see a trend of more insurers covering it, but it’s a process,” says Dr. Ellegala.

Sonospine’s clinical practice and company were founded on the East Coast, but a national search led them to Scottsdale for its western U.S. headquarters. “It’s a wonderful place for our employees to live, and a great destination location for patients outside of the state and the country,” says Dr. Ellegala. “Above all, we wanted to be a part of a forward-thinking community that embraces advanced medical care and technology.”

 

Story: Jake Poinier

Photos: Mark Lipczynski

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