Back Surgery Procedure

Congratulations to Dr. Rick Sasso for his recent publication! (Dr. Sasso is a spine surgeon with Indiana Spine Group). Dr. Sasso recently co-authored an article published in the recent issue of the SAS Journal. This journal is a publication of the International Society for the Advancement of Spine Surgery and the Society for Minimally Invasive Spine Surgery.

This article entitled, Lumbar Extraforaminal Decompression: A Technical Note and Retrospective Study Looking at Potential Complications as an Outpatient Procedure, published the results of a recent spinal study. This spine study retroactively evaluated the medical records of 100 patients from the same spine surgeon, who underwent spine surgery for lumbar disc herniation or stenosis. The spine surgical procedure was a type of decompression. This study concluded that extraforaminal lumbar decompression can safely be done as an outpatient spine surgical procedure.

Medline Plus defines kinematics as a discipline of physics that deals with the aspects of motion, separate from the considerations of mass and force. As a physician, I don’t really think of myself as a physicist – but recently I had the opportunity to study kinematics.

Recently I participated in a study to evaluate “cervical kinematics”. The purpose of cervical kinematics is to understand the motion of the cervical spine. Cervical kinematics has evolved as a result of the spine surgery procedures that alter the pathological structure of the cervical spine. In looking at the cervical spine and motion – cervical kinematics evaluates how the anatomical alterations affects an individual’s motion.

The study that I participated in evaluated the affects of cervical disc arthroplasty. This spine surgery procedure, which is relatively new and just recently received FDA approval, is a spine surgical alternative to standard spinal fusion in the surgical treatment of degenerative disc disease. With cervical disc arthroplasty, the damaged cervical disc is removed and an artificial cervical disc is implanted. The purpose of this study was to determine how movement is affected by the artificial cervical disc. In this study radiographic films were used to measure movement (distance) in the flexion and extension of the cervical area (neck) and it also utilized a computer assisted model. The results of this study were published this past June in Techniques in Orthopaedics. 

Congratulations to Rick Sasso, MD, a spine surgeon with Indiana Spine Group. He recently had a chapter published in a new spine surgery textbook, and an article published in a medical journal.

Dr. Sasso co-authored a chapter on sacral fractures published in Spine and Spinal Cord Trauma: Evidence Based Management. This book is now available for purchase.

This past December, I served as a faculty member at the 15^th Instructional Course meeting for the Cervical Spine Research Society held in Charlotte, North Carolina. For this continuing medical education meeting, I was a member of the course program committee as well as a moderator and speaker.

The overall continuing medical education objectives for this meeting included:

·                     Review appropriate anatomy and biomechanics of the cervical spine,

·                     Compare the methods for diagnosis of neck disorders,

·                     Evaluate operative and non-operative treatment options for cervical   spine disorders, and

·                     Recognize and respond to complications of surgical treatment, and exchange information on cervical spine research, diagnosis and treatment with both US and international spine surgeons.

At this meeting, in a section on techniques in spine surgery, I lectured on C1 lateral mass/C2 laminar screw fixation for posterior atlantoaxial fusion. In that this was a spine surgical technique section, I described how the procedure was done and then presented a video demonstration.

There was another educational section on cervical myelopathy for which I was a co-moderator. During this section I also presented a talk on myelopathy. A basic definition of myelopathy is a functional or pathological change in the spinal cord.

A prior study published, evaluated patients two years following spine surgery and their participation in the Bryan Cervical Disc Trial. In addition to this study, a more recent study I participated in evaluated Bryan Cervical Disc study patients five years following their spine surgery.

This study concluded that patients still continued to have excellent spine surgical outcomes five years postoperatively in both study groups – arthroplasty (artificial cervical disc) and ACDF (spinal fusion). Additionally, those patients that had arthroplasty and received the Bryan cervical disc show significant improvement and less neck pain than those in the control group (spinal fusion). In respect to complications and a second spine surgery – both groups had low adverse effects. 

To read the abstract of this cervical disc replacement study, visit this link.

I recently co-authored an issue of Seminars in Spine Surgery on the “Complications of Occipitocervical Fixation”.

Seminars in Spine Surgery is a publication that provides practicing spine surgeons continuing medical education on current clinical topics on spine surgery. Each issue addresses a single "spine" topic and provides information related to management and patient care. A few issues addressed for each topic include anatomy, pathophysiology, clinical presentation/diagnosis, and treatment/management options. 

In addition to patient care and research, physicians with Indiana Spine Group lecture nationally and internationally as well as publish.  A few recent publications include the following:

• A book chapter co-authored by Kevin Macadaeg, MD, and Rick Sasso, MD, et.al. This chapter was on neck pain and was entitled, “Treatment of Axial Neck Pain”. This was published in Arthritis and Arthroplasty: The Spine, edited by Shen and Shaffrey.  To purchase this book, visit this link.  

• A chapter co-written by spine surgeons Rick Sasso, MD, and Paul Kraemer, MD, entitled “Rigid versus Dynamic Cervical Plates: Indications and Efficacy”. This chapter was published in a book entitled Controversies in Spine Surgery: Best Evidence Recommendations, edited by Vaccaro and Eck. This book is available online.

We are all aware of the dangers of smoking. Cancer, increased risk of stroke, coronary heart disease, are only a few of the risks. 

This spine wellness blog entry – will focus on smoking and your spine.

When you think of smoking and your overall spine health:
 

• Smoking contributes to early and more severe degenerative disc disease as a result of the nicotine blocking the transportation of oxygen and other important nutrients to the spinal discs. (This is true for nicotine in any form). When spinal discs are deprived of oxygen, the discs are less able to repair themselves which leads to earlier collapse than what is seen in non-smokers.

• Smoking results in slower healing times for individuals that undergo spine surgery (back surgery).

• Female smokers who are postmenopausal, have lower bone density than women who have never smoked. This lower bone density can increase the risk for osteoporosis and fractures (e.g. hip fractures).

The good news is when you stop smoking, this helps to reduce your health risks. Additionally, there are many resources to help individuals stop smoking and the American Lung Association provides a lot of programs for both adults and teens. For more information about how to stop smoking, visit this link and talk to your physician.

In mid-October, I was a faculty member at a continuing education meeting held at the Orthopaedic Learning Center outside of Chicago. This meeting was sponsored by The American Academy of Orthopaedic Surgeons and theLumbar Spine Research Society. The focus of this continuing medical education meeting was “Contemporary Techniques in Spinal Surgery”.  I was a lecturer and lab instructor at this spine surgery education meeting. 

One topic that I lectured on was related to the surgical technique for a spinal fusion (C1 lateral mass screw, C2 laminar screw technique for posterior C1-C2 spinal fusion). Additionally, I participated in a debate about cervical disc replacement (arthroplasty) versus fusion. In this debate, I was pro cervical disc replacement. A few of the continuing medical education spine surgery labs that I instructed included: anterior cervical discectomy, laminoplasty, high cervical and upper thoracic dissection and laminoplasty.

When most people think of spine surgery – they may typically think that this requires a few nights in the hospital. But just as other types of surgery have become less invasive and surgical techniques and post-operative care have become increasingly sophisticated, more spine surgeries may be performed on an outpatient basis. Typically, outpatient surgery is defined as a surgical procedure where the patient is discharged to go home within a few hours of the procedure.

A recent study that I participated in evaluated the postoperative data of 645 spine surgery patients who underwent an anterior cervical discectomy and spinal fusion (ACDF). Information was gathered following the patient’s spine surgery procedure, to determine the safety of performing ACDF on an outpatient basis. Of the data reviewed for the 645 patients, only two developed acute complications. These complications were present/symptomatic within four hours of post spine surgery, within the mandatory procedure protocol for postoperative observation. For those patients that were readmitted following discharge, 80% were a result of pain or nausea. 

The study did conclude that a single level cervical discectomy and spinal fusion (ACDF) can be safely performed on an outpatient basis. This is more so, if the patient has an allograft donation (bone graft from a bone bank donation) rather than grafting bone from their iliac crest (hip). 

The result of this study was published in the Journal of Spinal Disorders & Techniques. 

In a recent blog entry, I highlighted information from a study that I participated in and an article I co-authored, “Quality of Spinal Motion with Cervical Disc Arthroplasty.” This blog entry will define a few key terms used in that abstract/study.

Kinematic Study – This is the study of the motion of the body, not taking into consideration the effects of mass or force on the motion.

Cervical Arthroplasty – Refers to the spine surgery procedure where a damaged cervical disc is removed and replaced by an artificial cervical disc. 

Spinal Fusion – Often this procedure is referred to as ACDF, standing for anterior cervical discectomy and fusion. This is the spine surgical procedure where a damaged cervical disc is removed. To preserve the space within the vertebral bodies a bone graft is then placed where the damaged disc was removed. This bone graft is either from the patient’s hip bone (iliac crest) referred to as an autograft donation or from a bone bank (allograft). Then a spinal plate and screws are attached to the vertebral bodies immediately above and below the graft. 

An article that I co-authored, published in the Journal of Spinal Disorders & Techniques, summarized a study on cervical spinal motion at the adjacent discs (adjacent segment motion) following spinal arthroplasty with a Bryan Cervical Disc as compared to a spinal fusion.  Radiographic analysis was used to measure this motion prior to surgery, and at designated intervals post-surgery. 

For an abstract of this study, visit this link. 

On September 10 and 11, Indiana Spine Group hosted their fourth annual spine symposium, Back Talk | Comprehensive Concepts in Spinal Disorders and Abnormalities.  This conference addressed an ongoing major medical issue – back pain.  Recent studies conducted indicates that one out of three Americans suffer from back pain nearly every day, and back pain continues to be one of the main reasons patients seek medical care.

This continuing medical education conference brought together experts in spine care, including interventional spine, spine surgery, physical medicine and rehabilitation, rheumatology, chiropractic and more.  Attendees learned the latest on spinal diagnosis, and the treatment of spinal disorders and abnormalities.

If you did not receive information about the 2010 Back Talk symposium, and would like to be added to our mailing list for future continuing medical education conferences, please send your contact information to info@indianaspinegroup.com. 

In a prior blog entry, I highlighted a few of the talks I participated in at the annual Scoliosis Research Society meeting. The acronym for this annual continuing medical education meeting is IMAST, and stands for International Meeting on Advanced Spine Techniques.

This international meeting brings experts on spine surgery from all over the world to discuss the latest surgical techniques, devices as well as it provides a forum to provide the latest on research in progress.

The overall educational objectives of this meeting are listed below.

At the completion of this program, participants should be able to:

1. Assess the most recent advances in surgical techniques for the treatment of spinal disorders and when to use them, in the interest of providing optimal patient care.

2. Analyze the indications and potential complications for various spine fixation systems including spinal arthroplasty.

3. Recognize emerging technology that has the potential to improve patient outcomes for specific indications and populations.

4. Understand when it may be appropriate to use biologic options to enhance spinal fusion.

• Dedicated patient and visitor areas, with a visitor's cafe.
• Ambulatory spine surgery center
• Imaging suite
• Osteoporosis treatment center
• Physical therapy suite
• Medical academic learning center with a bio-skills cadaver training lab and 65-seat amphitheater. 

Congratulations to Rick Sasso, MD, a spine surgeon with Indiana Spine Group, who was just awarded his eighth patent!  This is patent number 7,727,266 for a method and apparatus for retaining screws in a plate.  
 

This patent is for an anterior cervical plate, now called Venture.  This plate is used in spine surgery for patients suffering from a herniated disc or stenosis (disc degeneration), or after trauma, tumors or other conditions causing neck instability.  The plate is used to stabilize the cervical spine after removing the disc. 

Below is an abstract of this patent:

A retention system for maintaining a screw to a vertebral plate. One or more screws extend through apertures within the vertebral plate. A cavity is positioned adjacent to and overlaps into the aperture. A ring is positioned within the cavity and held in position by a cap. The cap attaches to the plate to prevent removal of the ring. The ring is deflectable between a first shape to allow the screw to be inserted and removed from the aperture, and a second shape to prevent screw back-out from the aperture. A method of using the system is also included and comprises positioning the ring within a cavity in the plate, maintaining the position of the ring to the plate by attaching a cap, inserting a screw through the aperture and attaching the plate to a vertebral member, and positioning the ring over the screw head and preventing the screw from backing-out.

The Nutritionally Healthy Spine – This continuing medical education session, presented by Lori Petrie, RD, will continue to focus on a healthy spine and the importance of nutrition in achieving and maintaining a healthy spine. This session will provide important nutritional recommendations for a healthy spine.  In addition to diet and lifestyle other factors that will be addressed for a healthy spine will include popular over-the-count medications, and a review of herbal, vitamin and nutritional supplements. Ms. Petrie is an outpatient nutritional counselor with St.Vincent Hospital.

Back Pain | Chronic and Failed – It is estimated that approximately 40% of individuals that undergo back surgery continue to have back pain.  Jonathan Gentile, MD, a minimally invasive spine specialist with Indiana Spine Group will address this ongoing issue.  In this educational session he will address both chronic back pain and failed back syndrome and will discuss the differentiation factors, and the diagnostic perils.  Additionally, Dr. Gentile will discuss the treatment options, indications and patient selection for various treatment options.  One treatment option that will be highlighted will included the spinal cord stimulator, used as an option for failed back syndrome. 

For more information about Back Talk, visit our web site, or call (317) 228-7000.

Recently Rick Sasso, M.D., a spine surgeon with Indiana Spine Group,
co-authored a book chapter for a medical textbook. This chapter was titled “Anterior Lumbar Interbody Fusion.”  Anterior lumbar interbody fusion, usually referred to as ALIF, is a spine surgical procedure commonly used to treat discogenic low back pain - when non-operative measures are ineffective.

In this chapter, the historical background of anterior lumbar interbody fusion was reviewed. This spine surgery procedure was used as early as 1932 for the treatment of spondylolisthesis. Additionally, this chapter reviewed the biomechanics, patient selection, clinical studies, and imaging. To read this chapter, click here

One spine surgery research study that I participated in - compared the post-operative results of cervical arthroplasty and arthrodesis on approximately 500 patients. The objective of this study was to compare any side effects of patients undergoing a cervical arthroplasty with the implantation of a Bryan Cervical Artificial Disc to those patients that underwent a spinal fusion.

In this study, of which there were 31 institutions where patients underwent spine surgery, there were 242 patients who received the Bryan Cervical Artificial Disc and 221 patients that underwent cervical discectomy and spinal fusion. Patients that participated in this study were over 21 years of age, had single level cervical degenerative disc disease causing radiculopathy or myelopathy as well as a few other clinical indicators. Once identified, these patients were evaluated before spine surgery and post-operatively at regular intervals beginning one and one half months following spine surgery up to 2 years. 

This study concluded that both procedures are safe, and that there is not a significant difference in adverse effects with the newer arthroplasty procedure utilizing the Bryan Cervical Artificial Disc when compared to the traditional surgical option of spinal fusion.

 To read the complete study,link here.