Cervical Arthroplasty

In the Fall 2011 Journal of the Spinal Research Foundation, three patients of mine, recipients of the Bryan Cervical Disc, were featured. The article describes their symptoms, diagnosis and participation in the clinical study. Being a part of the the clinical study and how the Bryan Cervical Disc changed their life, was also included. The importance of clinical studies and how they can improve the livelihood of our patients is the key component of the article. Please click the link and turn to page 56, to view the article.  www.spinerf.org/files/12.JSRFFall2011.pdf

The annual meeting of the Cervical Spine Research Society, was in early December and I had the opportunity to present on a number of clinical studies, they were as follows:

“The fate of a delayed union following an ACDF: A post-hoc analysis of data from a prospective, multicenter trial.” Cervical Spine Research Society 39^th Annual Meeting. Presented by Michael Kelly MD. December 9, 2011. Scottsdale, Arizona.

“Perioperative complication rates associated with surgical treatment based on a prospective multicenter study of 302 patients.” Cervical Spine Research Society 39^th Annual Meeting. Presented by Justin Smith MD. December 10, 2011. Scottsdale, Arizona.

“Impact of early and late complications on patient outcomes following surgical treatment of cervical spondylotic myelopathy based on a prospective multicenter study: The AO Spine North America CSM study.” Cervical Spine Research Society 39^th Annual Meeting. December 10, 2011. Scottsdale, Arizona.

“Long-term differences in dysphagia between cervical arthroplasty and anterior cervical fusion.” Cervical Spine Research Society 39^th Annual Meeting. Presented by Scott Bassuener MD. December 10, 2011. Scottsdale, Arizona.

Also during the meeting I served as a faculty member and took part in a debate forum wherein appropriate indications for anterior vs. posterior approaches for the surgical treatment of cervical radiculopathy were presented and discussed:

“Foraminotomy for spondylotic radiculopathy-Con.” Current controversies
in posterior cervical reconstruction.”

The Cervical Spine Research Society is a premier international society for the study of disorders of the cervical spine.

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.

Late this summer, I was a faculty member at a physician education meeting sponsored by the Scoliosis Research Society. This meeting was the 18^th International Meeting on Advanced Spine Techniques (IMAST), held in Copenhagen, Denmark. 

This IMAST meeting includes spine surgeons who are leaders in the field of research and advance spine technologies, for all areas of the all areas of spine (cervical, thoracic, and lumbar), most spinal conditions (degenerative, trauma, deformity, tumor), and a variety of treatment techniques. It is an honor to be asked to participate.

         The continuing medical education objectives of this meeting were to:

·         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.

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

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

I recently co-authored a chapter on Cervical Arthroplasty. This chapter was included in the book Advanced Reconstruction: Spine edited by Jeffrey Wang and published by the American Academy of Orthopaedic Surgeons and North American Spine Society.

This continuing medical education book highlights the way that spine surgeons handle complicated spine surgical cases. Chapters provide detailed step-by-step guidelines on spine surgical procedures. In addition to surgical guidelines for each procedure – this medical education resource also provides indications, contraindications, alternate treatment, results, surgical techniques and post operative information for the procedures.

In addition to the chapter on cervical arthroplasty, there are over 60 spine surgical procedures addressed. A few other spine surgical procedures in the book include Anterior Cervical Discectomy and Fusion, Cervical Laminectomy and Fusion and Posterior Lumbar Interbody Fusion. To review the complete table of contents, visit this link.

For more information or to purchase this book, 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 .

While at the American Association of Neurological Surgeon’s continuing medical education meeting in Phoenix, in addition to being a faculty member for a course on cervical myelopathy (previously blogged about), I was also a co-author for other research presentations.

These podium presentations included:

• Factors Associated with the Occurrence of Perioperative Complications in the Treatment of Cervical Spondylotic Myelopathy Based on 302 Patients from the AOSpine North America Cervical Spondylotic Myelopathy Study

• Cervical Disc Replacement: Interim Five-year Follow-up Results from the United States Prospective Randomized Bryan Clinical Trial

• Functional and Quality of Life Outcomes in Geriatric Patients with Type II Odontoid Fracture: One-Year Results from the AOSpine North America Multi-Center GOF Prospective Study

 For more information about this meeting, visit this link.

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.

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).

Blog Entry: Annual AAOS Meeting

In February, Drs. Rick Sasso, and Paul Kraemer presented at the annual continuing medical education meeting of the American Academy of Orthopaedic Surgeons in San Diego.

Drs. Kraemer and Sasso co-presented a talked entitled, “Differentiating Cervical Spine and Shoulder Pathology: Common Disorders and Key Points of Evaluation and Treatment.” Additionally, Dr. Sasso co-presented other talks, of which a couple were: "The Degenerative Cervical Spine: What You Need to Know," and "Cervical Disc Replacement: Five Year Follow-up from the U.S. Prospective Randomized Bryan Trial." For a complete, continuing medical education program, visit this link.  

In addition to planning and coordinating the symposium on spinal trauma, previously addressed in a prior blog entry, at the annual American Academy of Orthopaedic Surgeons meeting I also served as faculty for Instructional Course lectures. One Instructional Course was entitled “Differentiating Cervical Spine and Shoulder Pathology: Common Disorders and Key Points of Evaluation and Treatment.” This continuing medical education talk focused on the overlap of cervical spine and shoulder pathology, and addressed the diagnostic methods for differentiation.  One of the co-presenters of this session was Paul Kraemer, MD. Dr. Kraemer is also a spine surgeon with Indiana Spine Group.

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. 

As I previously blogged, I attended and participated in the recent continuing medical education meeting sponsored by the Cervical Spine Research Society.

Here is some information about this organization. The Cervical Spine Research Society, as its name implies, focuses on the cervical spine. It provides a forum for spine surgeons and other medical personnel to share information that promotes cervical spine research. Their vision statement is “The Cervical Spine Research Society is the recognized authority on diseases of the cervical spine.”

In a prior blog entry, I highlighted a few talks that I presented at the 15^th Instructional Course meeting for the Cervical Spine Research Society. In addition to speaking and moderating lectures at this continuing medical education event, I had three clinical papers presented.

These papers were:

1.                  Anterior vs. Posterior Surgical Approaches to Treat Cervical Spondylotic Myelopathy: Outcomes of the Prospective Multi-center AO Spine North American CSM Study in 280 Patients. (Presented by Michael Fehlings, MD)

2.                  The AO Spine North America Geriatric Odontoid Fracture Study: A retrospective review of mortality outcomes in surgical vs. conservative treatment in 158 patients with long term follow-up. (Presented by Jens Chapman, MD)

3.                  Adjacent level cervical ossification after Bryan cervical disc arthroplasty vs. ACDF. (Presented by Ben Garrido, MD)

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.

In a prior blog entry, I talked about study results for the Bryan cervical disc (artificial cervical disc used in arthroplasty).  This procedure is a spine surgical treatment option for degenerative disc disease.

Degenerative disc disease is a natural result of the aging process and is a condition where one or more of the vertebral discs weaken.  For a detailed definition and the symptoms of degenerative disc disease, visit this link.

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 a chapter on instrumentation that was published in a book entitled Cervical Spine Trauma. This chapter was entitled Cervicothoracic Junction Instrumentation. 

Additionally, I recently wrote a chapter for a Brazilian spine society book. The chapter was on degenerative disc disease, and was included in “Conceitos Avancados em Doenca Degenerativa Discal Lombar”.

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.