Episode #21
Spine Surgery, Trauma Triage, and the Acute vs. Degenerative Debate with Dr. Timothy Roberts
From Brittle Bones to Board Certified Spine Surgeon A spine surgeon who overcame 50 childhood fractures and helped crack a genetic mystery goes inside the OR to explain what trauma really does to the spine and how you prove it. In this episode of Victim to Victory, Lawrence LeBrocq of Garces, Grabler & LeBrocq sits down with Dr. Timothy Roberts, board-certified orthopedic spine surgeon and attending at New York Spine Institute and New Jersey Spinal Associates. Dr. Roberts covers everything from emergency trauma triage and cauda equina syndrome to the medico-legal debate over acute versus degenerative disc injury. Together, they pull back the curtain on spinal trauma medicine and give every personal injury attorney, spine patient, and legal professional a clear, honest roadmap for what to do next. What You'll Learn: OI and the Surgeon Origin Story: Dr. Roberts was born with osteogenesis imperfecta, a genetic condition causing brittle bones, and suffered roughly 50 childhood fractures. That personal experience, and a surgery that straightened his legs, put him on the path to orthopedics and led him to help identify the genetic mutation behind the rarest subtype of the condition. Combined Orthopedic and Neurosurgical Training: The Cleveland Clinic fellowship exposed Dr. Roberts to both disciplines simultaneously, giving him fluency in bone and soft tissue work alongside fine neural dissection and nerve management, a combination most spine surgeons do not have. Cauda Equina Syndrome and the Surgical Clock: When a large herniated disc or blood clot compresses the nerve rootlets at the base of the spinal cord, bowel, bladder, and sexual function are all at risk. Dr. Roberts explains why decompression must happen as soon as safely possible and what irreversible loss looks like when it does not. Trauma Triage and Distracting Injury Syndrome: In high-energy trauma, one catastrophic injury can mask other fractures entirely. Dr. Roberts notes that up to 30 to 40 percent of patients with a lumbar fracture have an additional fracture elsewhere in the spine, making exhaustive examination, not just imaging of the obvious site, a non-negotiable step. Distinguishing Acute from Degenerative Injury on MRI: Specific MRI sequences, including STIR and T2, reveal fresh inflammation at the disc edge or nucleus. When a single level lights up in a 30-year-old whose remaining discs look pristine and the clinical history includes a motor vehicle accident, the traumatic cause is, in Dr. Roberts's words, "pretty clear." Arthroplasty, Adjacent Segment Disease, and the Future of Spine Surgery: Cervical disc replacement preserves motion at the operative level and reduces stress on adjacent segments, addressing a documented failure mode of traditional fusion. Dr. Roberts also discusses how robot-assisted surgery synchronized with preoperative imaging is making procedures smaller, more precise, and more reliably complete. Show Notes & Key Timestamps [00:00:00] Welcome and Introductions Lawrence LeBrocq, CEO and Managing Partner of Garces, Grabler & LeBrocq, welcomes Dr. Timothy Roberts, board-certified orthopedic spine surgeon and attending at New York Spine Institute and New Jersey Spinal Associates. LeBrocq notes that Dr. Roberts arrived directly from the OR, where he had performed a fusion and two microdiscectomies that morning. The conversation opens with a preview of the clinical and medico-legal ground the episode will cover. [00:01:23] Clinical Research Career and the OI Discovery Dr. Roberts describes his research focus on spinal injuries and outcomes, then introduces osteogenesis imperfecta, the genetic bone condition he was born with. He explains his role at Johns Hopkins Kennedy Krieger Institute as part of the team that confirmed the genetic mutation responsible for the rarest subtype, type 5 OI, which had gone unidentified for years. [00:02:08] Growing Up with Brittle Bones: 50 Fractures and a Life-Changing Surgery Dr. Roberts recounts roughly 50 to 60 childhood fractures, legs that grew at abnormal angles, and the rodding surgery at around age 10 that straightened his bones and allowed him to, as he describes it, get back on the soccer pitch with his friends. He explains how that experience made orthopedic surgery a personal calling rather than just a career choice. [00:05:55] Why a Combined Orthopedic and Neurosurgical Fellowship Matters Dr. Roberts details the Cleveland Clinic spine program, explaining that orthopedic surgeons are experts in bone and soft tissue but spend little time working around neural structures, while neurosurgeons have the opposite gap. Training under experts in both disciplines simultaneously gave him tools that a single specialty fellowship does not provide. [00:09:15] Trauma, Spinal Cord Injuries, and the 3 a.m. Call Drawing on his trauma call coverage at Jamaica Hospital in New York, Dr. Roberts explains what wakes a spine surgeon in the middle of the night: partial spinal cord injuries where rapid decompression can restore or substantially improve neurological function. He describes the urgency that drives emergency spine surgery for broken or dislocated vertebrae. [00:10:38] Cauda Equina Syndrome: The Surgical Emergency Most Patients Have Never Heard Of Dr. Roberts defines cauda equina syndrome, the compression of the nerve rootlets at the base of the spinal cord by a large disc herniation, hematoma, or infection. He explains the stakes clearly: bowel, bladder, and sexual function are all on the line, and the longer pressure remains, the less likely those nerves are to recover. [00:12:24] ER Triage for Spinal Trauma: History, Examination, and Distracting Injuries Dr. Roberts walks through how spine surgeons evaluate trauma patients, including those who are unconscious or intubated. He flags distracting injury syndrome, the phenomenon where the most painful injury obscures others, and notes the high rate of multilevel spinal fractures in patients who present with a single identified lumbar fracture. [00:14:28] Surgical Options: Discectomy, Laminectomy, and Fusion Explained Dr. Roberts explains the spectrum of spine surgery from the least to most invasive: trimming a herniated disc to relieve nerve pressure, removing a shelf of bone to give compressed nerves room, and full fusion where the disc is removed and two vertebrae are healed together with hardware. He addresses the common patient misconception that seeing a spine surgeon means surgery is inevitable. [00:17:31] Cervical Disc Arthroplasty and the Adjacent Segment Disease Problem Dr. Roberts describes cervical disc replacement as an alternative to fusion that preserves motion at the operative level and avoids overloading the segments above and below, which is the mechanism behind adjacent segment disease. He reviews 20- to-30-year outcome data now available on the procedure and explains the engineering evolution of the implants themselves, from early flanged designs to modern titanium ingrowth surfaces. [00:19:47] The Future of Spine Surgery: Arthroplasty, Minimally Invasive Techniques, and AI Dr. Roberts draws a parallel to the revolution in hip and knee replacement to frame where spine surgery is headed. He discusses robot-assisted procedures synchronized with preoperative CT and MRI as a tool that allows surgeons to work with greater confidence and smaller incisions, and acknowledges that AI will reshape radiology and ultimately every medical and legal profession. [00:23:15] Proving Trauma in Court: Acute vs. Degenerative Findings on MRI LeBrocq frames the medico-legal challenge directly: defense attorneys routinely argue that disc herniations are degenerative rather than traumatic. Dr. Roberts explains how STIR and T2 MRI sequences reveal acute edema, why a single inflamed level in an otherwise pristine young spine is diagnostically significant, and how EMG findings and physical examination add further evidence of acute nerve injury. [00:25:03] Pre-existing Herniations and Traumatic Aggravation Dr. Roberts confirms that asymptomatic herniations absolutely can be worsened by trauma and outlines the clinical and imaging tools that document aggravation, including acute edema on MRI, EMG nerve conduction studies, and new neurological deficits on physical examination that were absent before the accident. [00:26:12] Where to Reach Dr. Timothy Roberts Dr. Roberts provides contact information for New York Spine Institute, with New Jersey locations in West Orange and Marlton under the name New Jersey Spinal Associates. He notes the practice is continuing to expand and can be reached by searching New York Spine Institute online or by calling 516-357-8777. Notable Quote: "The longer they have pressure on them, the higher the chance that they may not regenerate or might not come back to life." Quote from Dr. Timothy Roberts, board-certified orthopedic spine surgeon, New York Spine Institute and New Jersey Spinal Associates Whether you are a personal injury attorney trying to understand the medical science behind your client's spinal injury claim, a spine patient navigating a decision between conservative care and surgery, or a legal or medical professional thinking seriously about what AI means for the future of your practice, this episode is required listening. Connect & Learn More Garces, Grabler & LeBrocq https://ggllawyers.com/contact-us/ Serving injured workers across all of New Jersey Victim to Victory is the authority in NJ personal injury. New episode every week.
