Daniel Choi, MD, is often looking for new ways to innovate in endoscopic spine surgery.
He recently performed the first Barricaid annular closure implantation with Amplify Surgical’s dualPortal system approach.
Dr. Choi, of Spine Medicine & Surgery of Long Island in Ronkonkoma, N.Y., discussed the debut case and what he wants to do next with Becker’s.
Note: This conversation was lightly edited for clarity.
Question: With your endoscopic case, how was the learning curve with combining it with the Barricaid device?
Dr. Daniel Choi: I’m a recent incorporator of Barricaid. I had already been doing a lot of my discectomy laminated surgeries with dual portal endoscopy, so it was a natural fit to try to place the Barricaid with it. I didn’t actually realize this was the world’s first implantation, but that’s what Intrinsic Therapeutics told me.
I definitely wished I had a little more room putting the implant in. Endoscopic incisions are typically one centimeter or less, and the Barricade implant was seven millimeters. So we were trying to fit this thing through a decent amount of soft tissue, and had to get a little creative, but we were able to safely implant the Barricaid and make sure that the nerve root was protected.
Q: Can you paint a bigger picture on the creativity involved with navigating that hurdle?
DC: When you’re putting this implant in, you don’t want it to hit too many structures that can dislodge it from the implant holder. Soft tissue can potentially release the spring mechanism that’s holding the implant. I had to do a little bit more soft tissue dilation to make sure that my channel stayed patent to put the implant through. We used the X-ray to make sure I knew exactly where I was because I wasn’t looking right down into the laminotomy site. I had a camera on it, and I was putting this implant in through the dual portal.
Q: What do you think will be some next implants to be able to use endoscopic techniques with?
DC: The kind of big golden goose I’m shooting for in my endoscopic career is to eventually do an endoscopic fusion with the DualPortal technique. Other surgeons have been able to do what we call endoTLIF where you do the complete discectomy and you place an expandable spacer into the interbody space using endoscopic techniques.
I haven’t gotten to the point where I’m comfortable doing that yet, but that definitely would be the next iteration of endoscopic surgery, to also incorporate fusion techniques into their repertoire. Another company that’s doing endoscopic interbody fusions is using an allograft-based kind of planning and you actually don’t have to remove the facet joint to do this. If you’re not taking the facet down, it can be done through a very small incision and is also amenable for the ASC. That’s an interesting technique that I would like to also explore and learn about. But I think, in general in endoscopic spine surgery, doing more implantation of interbody spacers is going to be the next exciting thing we’re going to see.
