Back Surgery Procedure

During the early part of December, I had the privilege of being a visiting professor at NYU. I lectured for the New York University Hospital Joint Division of Spine Surgery on the following topics: “Intraoperative Spinal Navigation” and “Upper Cervical Spine Trauma.”

Intraoperative Spinal Navigation is basically the GPS system in the operating room that allows us to see anatomical structures in 3 dimension on a computer screen and navigate or see our instruments in relation to anatomical structures.

The information given during the Upper Cervical Spine Trauma presentation included the diagnostic evaluation and treatment of upper cervical injuries for the occiput to C2.

This November, a few chapters that I co-authored on spinal navigation were included in the Handbook of Spine Surgery published by Thieme Publishers. This book is a continuing medical education resource for spine surgeons. One chapter was on Spinal Navigation, which was included in the “Clinical Spine Surgery” section of the book. The other chapter in the “Surgical Techniques” section was on Facet Screw Fixation/Fusion.

This spine surgery educational book provides principles and techniques of spine surgery. Included in the book are sections on clinical spine anatomy, clinical spine surgery, spinal pathology and surgical techniques.

For more information or to order this spine surgical educational resource, visit this link.

This blog entry is part of a series of interview responses provided by Kevin Macadaeg, MD, a minimally invasive spine specialist with Indiana Spine Group. Dr. Macadaeg was recently interview about back pain and spinal treatments.

What are some of the different causes or reasons for chronic neck or back pain? What would you say is the most common cause of back or neck pain?

The most common causes of chronic neck or back pain are degenerative disc disease and degenerative spondylosis (degeneration of the spinal joints, development of bony spurs, disc degeneration and calcification of spinal ligaments).

Other causes include herniated disc, spinal stenosis (narrowing of the spinal canal) and spondylolisthesis (slipping of a vertebra).

What are the different options available to treat this type of pain?

Earlier this year, I was asked to present at the fourth annual meeting of the Lumbar Spine Research Society.

At this meeting, held in Chicago, I facilitated the discussions on the following papers: 

• the “Functional Outcomes and Height Restoration For Patients With Multiple Myeloma–Related Osteolytic Vertebral Compression Fractures Treated With Kyphoplasty”
• “The  The Effect of the Alpha‐2 Agonist Brimonidine on Intraocular Pressure During Prone Spine Surgery”

A recent reader submitted a billing question about spine surgery.To have specific insurance, self pay and billing questions answered to please call (317) 228 -7000 and ask to speak to the billing specialist.

In May, I had the honor of being an invited faculty member at the 4^th Annual Dubai Spine Masters continuing medical education program. This “Spine Trauma Masters Update” was held in Dubai, and included  spine surgeons from 70 different countries who are leaders in spinal trauma.

At this meeting, I lectured on the Rationale and Overview of Minimally Invasive Spine Surgery in Spinal Trauma, and Balloon Assisted Endplate Reconstruction (BAER) for TL Burst Fractures. I also moderated a case discussion on thoracolumbar spine trauma.

In this blog, I included a picture of the Health Minister of the United Arab Emirates. At this meeting, he gave the opening address and welcomed the attendees.

Congratulations to Rick Sasso, MD, a spine surgeon with Indiana Spine Group, on his recent patent assignment. This patent, filed in 2007 was approved in September 2011. US Patent number 8.016,831 is for” instruments and techniques for guiding instruments to a spinal column.”

This patent is related to spine surgery instrumentation and  techniques for anterior cervical discectomy and spinal fusion, as well as safely and accurately placing cervical artificial discs replacements into the intradiscal space. For more detail about this patent, visit this link.

Congratulations to Rick Sasso, M.D., Indiana Spine Group spine surgeon, for his recent publication of a chapter in Rothman Simeone The Spine – 6^th edition. Dr. Sasso co-authored a book chapter on “Cervical Disc Replacement”.

The Spine provides spine surgeons a continuing medical education resource to help them achieve optimal outcomes in the clinical practice of spine surgery for adults and pediatric patients. This resource includes chapters contributed by international experts on spine surgery, and highlights state-of the-art treatments and surgical techniques.

For more information about this resource, visit .

This past spring I had the honor of presenting at the annual continuing medical education meeting of the American Association of Neurological Surgeons / CNS Section on Disorders of the Spine and Peripheral Nerves. The focus of this medical education meeting, held in Phoenix, was Evidence-Based Spine Surgery in the Real World.

At this medical education program I was a faculty member for a section on cervical myelopathy, and presented on Myelopathy at the CVJ. This course reviewed and discussed the evaluation and treatment algorithms of cervical myelopathy and discussed surgical approaches. Additionally, etiology, pathogenesis and diagnosis of cervical myelopathy were reviewed. A few of the continuing medical education objectives of this session are outlined below.


Participants will be able to:

•  Synthesize appropriate anatomy and biomechanics of the cervical spine.
•  Differentiate the methods for diagnosis of neck disorders.
•  Apply operative and non-operative treatment options for cervical spine       disorders. 
• Recognize and respond to complications of surgical treatment, and more.

I co-authored a book chapter on “Cervical Disc Replacement”, that has been recently published in Rothman Simeone The Spine – 6^th Edition.

The Spine is a continuing medical educational resource for spine surgeons and highlights state-of-the-art spine treatments and spine surgery techniques. In addition to the text, there is also a video resource for physicians highlighting different surgical techniques and procedures.

Some sections of this book include: Basic Science, Spinal Diagnosis, Surgical Anatomy and Approaches, Thoracic and Lumbar Disc Disease, Minimally Invasive Surgery, Spinal Stenosis, Spinal Fusion and Instrumentation and more. For more information about The Spine and a table of contents, visit this link.

For more information about Back Talk, call (317) 228-7000, or visit this link.

Back Talk | A Comprehensive Review and Practical

Approach to Spinal Diagnosis and Treatment

During this current session Paul Kraemer, MD, a spine surgeon with Indiana Spine Group, will address the many myths and insights of spine surgery. This includes the what, when and why. A few topics that will be reviewed include evidence-based research documenting the indicators for spine surgery. Dr. Kraemer will also review the criteria for patient selection for spine surgery. A few of the common misconceptions of spine surgery that will be discussed include age appropriateness, rest requirements, postoperative pain and bracing.

Back Talk | A Comprehensive Review and Practical

Approach to Spinal Diagnosis and Treatment

One challenge to physicians is ongoing back pain following spine surgery. This session will provide attendees a better understanding of failed back syndrome / post-laminectomy syndrome.

During this continuing medical education session during the Back Talk spine symposium, speakers will discuss the contributing factors and causes of failed back syndrome. Additionally, the medical and interventional treatments for failed back syndrome will be reviewed – their indications and expected outcomes. One treatment that will be discussed is spinal cord stimulators. Indications for salvageable spine surgery and the outcome predictors will be reviewed.

Faculty for this continuing medical education session includes minimally invasive spine specialist Jonathan Gentile, MD, and spine surgeon Thomas Reilly, MD, FACS.

Back Talk | A Comprehensive Review and Practical

Approach to Spinal Diagnosis and Treatment

Another series of talks during the spine symposium Back Talk, Indiana Spine Group’s fifth annual continuing medical education symposium will focus on treatment options for spine patients and highlight medical, minimally invasive and spine surgery options. This includes their clinical indicators and expected outcomes.

These sessions include:

• Nonoperative and Noninvasive Therapies, which will be presented by minimally invasive spine specialist Jonathan Gentile, MD.

• Minimally Invasive Therapies, presented by Kevin Macadaeg, MD,  minimally invasive spine specialist.

• Common Surgical Procedures, which will be presented by spine surgeon Thomas Reilly, MD, FACS.

 For a complete spine symposium brochure, visit this link.

Paul Kraemer, MD, a spine surgeon with Indiana Spine Group, is featured in a video produced by Community Hospital. In this video, Dr. Kraemer discusses his philosophy of care and working with Community.

A few highlights of this video include:

• Dr. Kraemer’s working relationship with other physicians within Indiana Spine Group, to provide a comprehensive continuum of care to spine patients. In this section, he discusses the advantages of working in the same office with Jonathan Gentile, MD - a minimally invasive spine specialist.
• With the resources provided by Community Hospital, Dr. Kraemer is able to perform complex spine surgery; i.e. operating rooms, surgical equipment, staff expertise, ICUs, etc.
• There is a continued trend towards more minimally invasive spine surgery. This includes smaller incisions and less muscle movement.

I recently blogged about a new genetic test that predicts the likelihood of curve progression of patients diagnosed with mild adolescent idiopathic scoliosis (AIS) – the ScoliScore AIS Prognostic Test. 

Previously I did a series of blogs, defining scoliosis, reviewing scoliosis screening recommendations and treatment options (addressing bracing, and spine surgery).

Here are the links to those prior blogs:

            Scoliosis defined and general information 
Scoliosis screening guidelines 
Scoliosis treatment options 

A recent blogger submitted a few questions about degenerative disc disease, and asked about treatment options for the lumbar spine. 

The blogger asked the following:

What about dynamic stabilization devices as an alternative to lumbar fusion? I have been doing some online research, hoping to get plugged into a 522 study, or otherwise explore whether insurance might cover something like this in my situation. (2 degenerating discs.)

Paul Kraemer, MD, a spine surgeon with Indiana Spine Group responded to these questions.

First, there is no perfect treatment for degenerative discs. The technology of motion stabilization is still very much in its early infancy, and at this point that is probably not the best solution.

There are two categories of implants that exist, disc replacement and motion stabilization, but trials have had problems and neither is currently being implanted.  One motion stabilization implant, sought to minimize motion of the disc to prevent pain and decrease revision surgery, but no definitive proof for either of those claims exists, and they have run into recent trouble with the FDA for their longer term data. Another motion stabilization concept, facet replacement devices are motion preservation devices aimed at facet joints, and at least one recent trial was ended early by the FDA.

Disc replacement in the lumbar spine has been done for over 20 years and works well in appropriately selected patients.  This procedure is FDA approved, but insurance companies frequently refuse to acknowledge convincing data. The results for this surgery seem very reproducible, but it’s only approved for single level disease with healthy facet joints.

All of this skips over the point that back surgery is usually not the first or best answer for back pain, and many people with degenerative discs have little or no pain. It's always recommended to talk to a spine surgeon to see what your specific treatment options are.

In respect to web sites that provide spine specific information – a few very popular sites are Spine Universe and Spine Health.  

In addition to the talks previously highlighted in prior blogs, I also gave a few talks on the cervical spine at the annual American Academy of Orthopaedic Surgeons continuing medical education meeting. One Instructional Course lecture, where I served as faculty, focused on the degenerative cervical spine and was entitled, “The Degenerative Cervical Spine: What You Need to Know”.  This talk focused on the evaluation and treatment options for the degenerative spine and it addressed anterior and posterior spine surgery options, as well as non-operative treatment options.

The other talk was a Podium Presentation of the research results for the five-year study of the Bryan Cervical Artificial Disc. This continuing medical education presentation was entitled, “Cervical Disc Replacement: Five Year Follow-up from the U.S. Prospective Randomized Bryan Trial”.  This link provides an overview of the initial results of this study – which followed spine surgery patients post-operatively for five years. Patients evaluated either underwent spinal fusion or arthroplasty (cervical artificial disc).