Cervical Artificial Disc

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

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 .

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.

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.  

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. 

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)

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 few chapters in a continuing medical education book published by the American Academy of Orthopaedic Surgeons. This continuing education, instructional course lecture spine book focused on the Bryan disc and motion.

A few chapters of this book included:

• Emergency evaluation, imaging and classification of thoracolumbar injuries
• Nonsurgical treatment of thoracolumbar spinal fractures
• Surgical treatment of thoracolumbar fractures
• Update on cervical artificial disc replacement
   

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.

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. 

I recently co-authored a book that is now available on Amazon or through the publisher.  The book, entitled Spinal Arthroplasty: The Preservation of Motion, provides detailed information about spinal arthroplasty.  This medical education book includes information about cervical artificial discs and lumbar artificial discs that are used in the spine surgical treatment of cervical and lumbar degenerative disc disease.

A few chapter titles include: 

• History of Spinal Fusion
• History of Motion-Sparing Surgery
• Spinal Anatomy
• Spinal Biomechanics
• The Effects of Fusion and Motion Sparing Procedures on the Biomechanics of the Spine
• Biomaterials in Spinal Arthroplasty
• Total Disc Arthroplasty: Clinical Indications and Surgical Approach
• Cervical Arthroplasty: Biomechanics, Design Considerations, Clinical Outcome
  

Congratulations to Rick Sasso, MD, who recently co-authored a book
on spinal arthroplasty! This book entitled, Spinal Arthroplasty: The Preservation of Motion, is an ideal medical education resource for orthopaedic surgeons, spine surgeons, residents/fellows and health science libraries.

The book provides state-of-the-art information on everything related to spinal arthroplasty; including relevant spinal surgical anatomy, biomechanics, clinical indications, spinal imaging, and a complete overview of artificial disc implants - both cervical and lumbar. The publisher describes this book as “Lavishly illustrated with high-quality surgical and anatomical art and images, this landmark text brings this exciting and innovative technology to the forefront of spinal surgery with authority and style!"
 
This book is now available on Amazon and from the publisher. Also, the publisher link provides a complete Table of Contents. 

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.

At Indiana Spine Group’s Back Talk continuing medical education symposium, as highlighted in a previous blog entry , there are two educational tracks that will be available for conference attendees on day one.  In addition to the general track discussed in the prior blog, there is a more in-depth track entitled, More Specifics | Spinal Diagnostics and Treatment. 

In this education track there will be a few sessions focusing on the diagnosis of spinal disorders and abnormalities.  One session titled Spinal Imaging | Technology and Diagnosis, will be presented by Stephen Pomeranz, MD. Dr. Pomerance is a radiologist. In this session, Dr. Pomeranz will provide an in-depth look at spinal imaging technologies and highlight the latest developments in spinal imaging technology and their applications in spinal diagnostics.  Additionally, using case studies, he will review radiological finds and diagnostic indicators. 

The second session of this educational track will focus on The Electrodiagnostic Evaluation, and will be presented by physical medicine and rehabilitation specialist Dr. Shashank Dave.  During his presentation, Dr.Dave will discuss the role and application of electromyography in the diagnosis of spinal disorders and diseases.  Additionally, he will review case studies which utilize electromyography and identify specific diagnoses. 

Another session presented for the in-depth track will focus on Diagnostic and Therapeutic Injections of the Spine.  This will be presented by minimally invasive spine specialist John Arbuckle, MD.  During this session Dr. Arbuckle will review and differentiate between the different type of therapeutic injections and will review the treatment efficacy of injections, the clinical protocols, indications and expected outcomes. 

The last session of this continuing education track will highlight spine surgery, and is entitled Surgical Perspectives | Fusion vs Arthroplasty, presented by spine surgeon Rick Sasso, MD.  During this session, Dr. Sasso will provide a detailed analysis of spinal fusion and arthroplasty and he will discuss motion preservation modalities for the treatment of generative disc disease.  He will highlight lumbar and cervical artificial discs as well as review research studies and discuss patient selection, indications and expected outcomes. 

While at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) in New Orleans, in addition to presiding as President of the Federation of Spine Societies spine specialty day, I also gave a few talks on cervical radiculopathy.

The first session that I moderated was on the current concepts in cervical radiculopathy.  The objective of this continuing medical education session was to provide the most up-to-date information on the pathophysiology, diagnosis and treatment of cervical disc disorders, including the role of selective nerve root sleeve injections and artificial disc replacement.

Another session that I served as a faculty member for was the spine instructional course lecture entitled, “The Degenerative Cervical Spine: What You Need to Know.”  This presentation provided an overview of cervical degenerative diseases and addressed the patient evaluation and treatment options, including anterior, posterior and non-operative options.