How awake endoscopic spine surgery reinvigorated Dr. Raymond Gardocki's practice

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Raymond Gardocki, MD, is a spine surgeon specializing in endoscopic spine surgery at Memphis, Tenn.-based Campbell Clinic Orthopaedics.

Ten years ago, Dr. Gardocki tried his hand at endoscopic spine surgery before turning to focus on outpatient lumbar fusions. After continuously refining his approach to outpatient lumbar fusions with no new technology or variation to the procedure on the horizon, he recalled the early stages of burnout starting to set in.

Dr. Gardocki returned to endoscopic spine surgery, completed his training and began incorporating it into his practice in 2017. In February, he completed his 100th endoscopic spine surgery using Joimax technology.

Here, Dr. Gardocki discusses the evolution of patient education and avoiding burnout.

Question: How has the evolution of the internet and patient self-education affected your practice? Have you experienced patients requesting specific spine procedures they've researched?

Dr. Raymond Gardocki: Actually, yes. There's one gentleman had a transforaminal discectomy awake and he did a very good job of articulating what it was like. I think that's one of the most common questions patients ask me — 'what is it like to be awake when you're pulling stuff out of my spine?' I always send people to this video because he articulated it very well. That patient came to me in clinic, said he's got a problem with pain down his leg and saw I was doing this surgery. He said, 'I don't know if I'm a candidate, but I want you to do it anyway.' I told him it doesn't work that way, but he actually turned out to be an excellent candidate. There's a moment where I pull the herniation out and he explains how the pain relief came on and how he literally passed out from joy and relief of pain.

For a while I was getting burnt out, I didn't think I could do spine surgery much longer and now I look forward to going into the OR. When I had the difficulty with endoscopic surgery a decade ago, and kind of gave up on it, I really focused on outpatient lumbar fusions. I got pretty good at it and I felt like I had it refined about as much as I could. When you start doing a surgery like that it takes you four hours, and I got it down to 90 minutes. You don't knock 90 minutes off a surgery by finding one thing that saves you 90 minutes; you find 90 things that save you a minute each. You don't do it by rushing, you do it by doing things efficiently and only doing the essential steps. 

I was at the point where unless there was some sort of technological change, I didn't see myself being able to do this much differently or better than I am doing it now. Then the endoscope came along. It's very enjoyable to offer patients a procedure you think is best and there's nobody else offering it in your community. I truly believe I'm doing the best I can and the best that's possible with the technology that's available, which is very fulfilling.

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