SPMLs & EtOH

2. Why do it “ that way?” We don’t do the surgery that others do ‘ this way’ or ‘that way’ through a smaller hole. We are doing something else . It turns out, as luck would have it, that we CAN use this as a less invasive way as we are being very selective as to how much & where and note overall change as we proceed. In our original tracked series of 500 cases, close to half also had additional open surgery. Most of the open surgery could have been prevented had we known what we now know years before we first started doing this (1980s). Patients treated as babies to 2 years old very seldom need that big open bone surgery. We do, sadly, a lot of really big repair joint surgery. Why? It is referred from places without a clue about prevention. Also fear is a cause. Parents who dread intervention and resist EVERYTHING are a huge source of bad outcomes. Academic or decision paralysis and neglect look a lot alike. “Percs”? We referred to ‘percs’, not as a name but as a check box for the operating room who has to set up our surgical tables with an array of many tools all sterilized and ‘spore tested’. It is expensive to do that. With SPMLs, we don’t need all that equipment as we are only doing percutaneous things (tiny poke holes) – percs with a few advancements are now called SPMLs. Operating Room “Case Card” = Dr. Name______________ [ ] C-arm & radiology table [ ] #10 surgical blades & handles [ ] oscillating drill + 2 battery cartridges [ ] Midas Rex air drill with M10 side cutter, other________ [ ] … many more things [x] only percs w optical blade [ ] cast cutter

The surgical card for SPMLs is very minimal for tools needed.