We have the presenters come up from the first half of this. Does anybody have questions? Feel free. Sure, go ahead. Question about Dr. Lal. He had a case that had AJA had a burst fracture. And so the surgery I thought they did was corpectomy with posterior short instrumentation fusion. What's the role of corpectomy on AJA patients? Or what's the role of corpectomy on most of the burst fractures? Is it necessary? Most of these fractures happen in young people. Most of, from my experience, they've done a lot of trauma as well. You reduce them on an operating table. And so is there any role? Because it's quite morbid procedure. So that's question one. Question number two is the presenters for a monotony. Now, do you do the same operation for a monotony as you do for artificial disc? I think these are two completely different populations. So I don't think that actually you can compare, personally. That's one. Second, if money was not an issue at all, a surgeon gets paid all of them the same. I think the ultimate question would be, which procedure would you do if you're good at both? So? I think I tried to make that point, I think. I saw it, but still, money is changing hands, though. Is that right? I think there are indications for proximal parietal stenosis and soft disc, post-lateral soft disc, where they can't be in both procedures. And I think that the answers are the same. In your hands, which procedure do you believe will give the patient the longest-term outcome? Remember, if you have an inflated reoperation rate, are you saving the money? Well, we know what the long-term economic impacts are for cervical disc arthroplasty. We're learning, and insurance companies are proving them out. And they wouldn't do that if there wasn't some economic advantage. And so I think that what we know about arthroplasty is that, in properly selected patients, they are at least equivalent, if not, as data matures, probably, there's probably some real improvement in adjacent second degeneration, if not reoperation. Fully agreed. In a very selective group. And so I think, when you look at those data, you have to say, am I properly selecting patients? Because if you think you're going to restore motion in a degenerative spine that needs to be used or decompress posteriorly, or if you're shoving up an implant and it flaps this space, but we're distracting it, you're going to get poor results. So I think it's exactly what you said. In properly selected patients, it's a great option. It tends to be younger patients. It tends to be ones that you're not worried about. Why preserve motion in a spondylotic, narrowed frame? And this isn't a Smith-Robinson, where you're jamming in a bone graft and getting indirect decompression. You want to place these devices in there, and you want them to be appropriately sized. So I completely agree with your comments. And I'll let Tim comment as well. I think, as Dr. Schaffer pointed out early on, these really are significant patient populations. And selecting the right surgery for the right patients is very important. There are superb procedures for those that are candidates for, I think, both of them. That's probably true. One of the interesting things, I get a fair number of out-of-state physicians that they kind of find because they want to have the right model. Yet, the most common population of physicians that I get out-of-state to operate on are orthopedic sciences that don't know how to do the right model. Yet, every one of them, I'll ask them to come back. We can spend some time after the deal, and we can learn how to do it. They don't want to have anything else done. It's a simple procedure. There was a comment about the procedure. There was a study that it's basically saying that, well, all you're doing, you're just taking some bone. Well, it's a simple procedure in hands that know how to do it. It can be devastating on somebody who is not confident. Absolutely. Thank you. So I think you were asking about the birth fracture. Correct, the birth fracture you showed there. AJA, yeah, correctly. Yeah, this is a neurologic thing. In fact, you pointed out a couple of points to clarify. That was actually an older patient. I think that patient was in his 60s. And it was also, at that point, a chronic injury. It was somebody who had failed conservative medicine. So it's a little bit different from the young person who was in their 40s. Correct, but nonetheless, it's right. An old patient who had failed conservative treatment, completely paralyzed. Oh, sorry. OK. So what I was driving at with showing that case was more about saying, this is the right way to do it, and more about saying, this is an example where I think minimally invasive techniques are essentially helpful. In the case of a guy, somebody with a malaric, chronic post-traumatic deformity with a tractable pain, you now have to fix the deformity. Unlike the acute fracture, where you're absolutely right, you'll reduce his loss of capacity, the chronic fracture is going to do that. And certainly, I think there are enough people who were raised for thoracolumbar burst fractures and basically healed themselves in a hypotic condition. And then, at that point, you're going to do a porpectomy. But certainly, I do agree. Early on in my career, in my training, every single thoracolumbar burst fracture got a lot of porpectomy. And then, you just evolved over time. I can't remember the last time I did it in an acute setting. Even if they had a spinal cord injury, I don't think they would answer a porpectomy anymore. And that's the other point, does really acute spinal cord injury, does doing a corpectomy helps whatsoever? I mean, there's cases. But I'm saying that we don't. I think it's one of those solutions. You guys are going to get an H.A. And the person is from a burst fracture. I want to do everything I possibly can to prevent this. I see that. Fortunately, I think our techniques and our skills have all evolved to the point where you can do a porpectomy for a post-therapeutic approach and simultaneously give them that multi-level post-therapeutic station that they all need. And so, post-therapy is still my approach of whether they have a spinal cord injury or not. OK, thank you so much. Thanks. Anybody else? I had a question for Dr. Wing. I don't know if he's still here. But he's such an advocate of the robot. And maybe someone else can answer this. Is he at the point where if the robot is broken or unavailable, then does he cancel the case or tell the patient and give the patient to reschedule? Is he that much of an advocate? I don't know. If anybody else has a robot in their institution, and let's say you're doing a single-level TLIF and the software is not working or for some reason it's not available, then do you tell that patient, we believe in it so much we have to cancel it because of outcome? I mean, in my case, when I go and tell the patient, I tell him, we might use the robot. We might use it 100%. And I also tell them, the robot should not make a difference in your life. Because I have to set up your regards money account. No, you know that it's not for the doctor. So they know you have to change the plan to reschedule. And Dr. Uribe, we got the Globus robot in December. And I agree with you 100%. We've had software problems. We have a variability in case time. You can do one case that goes very smoothly and you think, this is the next great technology. And another case, the software crashes and your workflow is off. So I agree with you 100%. Thank you. All right, unless we have more questions, we'll go ahead and continue with the program.

corpectomy

AJA patients

cervical artificial disc

monotomy

robot use