Ruwan Ratnayake MD

The OR is about many things but ultimately we are striving for craftsmanship. This is a life-long learning process. What matters is that you learn, grow, and advance with every opportunity.

@orthobullets @RothmanOrtho @atmghn @AmitJainSpine @KhoiThanMD @drericksonspine @MichaelYangMD @geofreyngetich @JohnHShinMD @AliBaajMD @JorgeLOC1960 Lateral interbody with revision of posterior instrumentation. A great option for this scenario.

Here are postop images of yesterday's case by Drs. Zachary Wilt and Alec Giakas from Rothman Orthopaedics (@RothmanOrtho). BUTTOCK AND LEG PAIN S/P L4-5 PSF IN 69F PROCEDURE: 1. 3-Month Preoperative Course of Tymlos (abaloparatide) 2. Prone L3-4 Lateral Interbody Fusion with Open Posterior L3-4 Posterolateral Fusion This case will be discussed at the Southernmost Spine Symposium in Key West, Florida, Apr 29 - May 2, 2026. Here is the link to the clinical presentation and the pre-op imaging: x.com/orthobullets/s… Do you agree with the treatment? Why or why not? Leave a comment and keep the great conversation going! #orthotwitter Vote on this case for CME: orthobullets.tiny.us/mwxw83sr

Often times regardless of surgical candidacy, patients are interested in learning about intradiscal therapies as options. I recently asked myself where do we stand with these treatments today? A recent narrative review by Min Cheol Chang and Seoyon Yang (Journal of Pain Research) Yeungnam University offers a balanced, evidence-based look at the landscape: 🔹 Promising but limited evidence: Platelet-rich plasma (PRP) and pulsed radiofrequency (PRF) show moderate support for pain relief and functional gains—yet most studies are small, short-term, and heterogeneous. 🔹 Limited or declining options: Intradiscal steroids provide only transient relief; methylene blue and thermal techniques (e.g., IDET, continuous RF) have weak/inconsistent evidence and higher risk profiles. 🔹 Key safety concern: Needle puncture itself may accelerate disc degeneration (supported by discography data). Recommendation: Use thin needles (e.g., 22-gauge), limit to 1–2 sessions, and reserve for severe, refractory cases.

@ananthe2 I’ve used grok 4 on complex case questions and I’ve loved it. No obvious false ideas and thorough literature reviews. Will have to check out Gemini

Every time a new AI model comes out I like to test it by asking difficult questions about spine surgery. So far the models have all given answers that would seem true to a layperson but are obviously false if you have real expertise. Until Gemini 3...

It’s always rewarding when you can do things a bit less invasively and still get a great result. This L4/5 intraforaminal disc herniation was perfect for an endoscopic approach. #SpineSurgery #EndoscopicSurgery #MinimallyInvasive #DiscHerniation #Neurosurgery

Prosper AI has raised $5 million in seed funding to expand its voice-first AI platform, which automates over 100,000 weekly patient calls for tasks like appointment scheduling, symptom triage, and prescription refills, slashing administrative burdens that cost U.S. healthcare $450 billion yearly. The platform's generative AI uses empathetic, multilingual interactions, has achieved 4x revenue growth in three months and integrates seamlessly with EHR systems to boost no-show rates by 25%. Could this address the $450 billion admin crisis in healthcare?

@spineopine Of course. What do you do for your bolts?

@ratnayakemd Can we see the lateral films?

I used to dislike on S2AI screws for pelvic fixation because the rods would look funky, but I've found that when placed thoughtfully can line up even better than traditional iliac bolts with less exposure, easier and faster insertion.

✨Featured✨ Researchers used TriNetX data to examine the effects of ketorolac admin for pain control ISO of ACDF. The results indicate that receiving ketorolac w/in 2d s/p #ACDF is not assoc w/⬆️ risk of pseudoarthrosis through 4y f/u #NSGY #orthospine journals.lww.com/spinejournal/f…

If you've ever seen a hematoma at imaging and wondered if it was a seroma after spinal surgery, this comprehensive postop spinal imaging review is just for you! bit.ly/4mrOUkN

@AJGrossbach @ViljoenMd @DavidSXu @SiriKhalsaMD @NeurosurgeryOSU @asadsakhter @OSUWexMed @OhioStateMed Agree that this one would not do well with a decompression alone! Although if possible that’s always the goal.

When to fuse a low grade spondy? “Instability” is hard to define. But when I see facet joints like this combined with vertical foraminal stenosis, an interbody fusion is needed. ALIF, XLIF, OLIF, TLIF, MIS TLIF is dealer’s choice.

@AJGrossbach @OhioState @OSUWexMed @OhioStateMed @NeurosurgeryOSU Looks like a great case for a lateral corpectomy followed by L3-5 screws with cement augmentation! Might do perc on the screws if you get good indirect decompression.

73 yo F with what started as an L4 compression fracture. Multiple procedures at outside hospital including a cement augmentation, lami, pedicle screw fixation, removal, and spinal cord stimulator. On Forteo 2 yrs. Back and leg pain, 4/5 in b/l dorsiflexion. What’s your plan?

@nedholmanmd Not the rads fault really since this should prompt an MRI (posted above). Fractures through ankylosed spine are sometimes impossible to spot.

A 77 year old female falls off a chair and has posterior neck pain. CT read as "no acute bony injury". Can you spot the fracture?

@ananthe2 Once you see the MRI it becomes clear. I know you used to see this all the time at UCD!

@ratnayakemd Discontinuity in anterior osteophyte at c5/6? Looks like interspinous widening posteriorly there too

@JahangirAsgha10 Always a good way to go. Can't really rule it out without an MRI.

@ratnayakemd Great image… Look for the subtle change in cortical bone And if I ever see that in the ER, I just assumed there’s a fracture until proven otherwise…

Key point with this case is non-displaced fractures through an ankylosed spine are sometimes impossible to spot on CT. Should prompt an MRI every time.

The recording of our recent session on Decompression and Fusion of the Cervical Spine is now on #YouTube! A must-watch for medical students, residents, and fellows interested in #spine #surgery. Share with colleagues who might find it helpful! 🔁🔁 youtube.com/watch?v=LDS1Sb…

@MeshalTurkiAl Great picture.

Anterior Cervical Spine