This continuing medical education session will address caring for the patient with traumatic spine injuries.  These spine injuries can occur from motor vehicle accidents, work-related injuries, falls and even sports.  At this session, Dr. Paul Kraemer will discuss the caring for the patient with acute traumatic spine injuries and will also discuss when spine surgery is an option.  The latest research and updates for the treatment of spinal cord injuries will also be reviewed.

Dr. Paul Kraemer is an orthopaedic spine surgeon, who has recently joined Indiana Spine Group. 

For my next few blog entries I will talk about the lumbar spine and discuss a few spine surgery procedures for the lumbar spine.  But first – I will define what the lumbar spine is. 

The lumbar spine is what is commonly known as the lower back. The spine is made up of 24 vertebrae.  And the lower part of the spine – are the lumbar vertebrae – L1 – L5.  The neck region of the spine is the cervical spine and the chest area of the spine is the thoracic spine.  One of the reasons that the lumbar spine is the cause of back pain is that it carries a majority of the body weight and is subject to the forces and stresses of the spine. 

Often times, individuals w/ neck or back pain can be treated without surgery; by medical management or minimally invasive therapies.  It is estimated that approximately 10% of those with back problems require spine surgery.

If you have been told that you need spine surgery, this blog entry will provide a few guidelines of questions to ask your spine surgeon.  Prior to spine surgery, or any surgery, it is important to get all of the facts.

A Few Questions to Ask

1. Find out why you need the surgery.
2. Ask about the expected outcome of the surgery.
3. Get a detailed explanation of the procedure (and get the technical name of the procedure).
4. Find out if there is an alternative surgical procedure or alternative treatment to the surgery.
5. Find out the risks of the surgery.
6. Ask about the recovery time following the surgery, and the side effects of the surgery.
7. Ask about anesthesia; find out if you will receive a local, regional or general anesthetic. 
8. Find out how long you should be in the hospital.
9. Find out if you will need any special arrangements for home care after you are discharged.
10. Ask which hospital you will have the procedure in.
11. Find out what the risks are if you decide not to have the surgery.
12. Ask the spine surgeon what his/her qualifications are, and his/her experience with the specific procedure.

Remember, it is okay to get a second opinion and many times insurance companies will require it.  Also, it is good to talk to the spine surgeon’s billing department to review all of the costs associated with the procedure; and then to talk to your insurance regarding all of their pre-certification guidelines as well as projected reimbursement.

During this education session, Dr. Rick Sasso will discuss common spinal deformations which affect younger patients; including scoliosis.  This will include the latest diagnostic information and screening guidelines as well as treatment information.  Additionally, Dr. Sasso will discuss when spine surgery is a treatment option.

One of the breakout sessions will be presented by Alta Skelton, RN, MSN, NP, and Jennifer Turner, PA-C.  Alta is a nurse practitioner with Indiana Spine Group and Jennifer is a physician’s assistant – also with Indiana Spine Group. 

During their continuing medical education presentation, they will discuss the expected outcomes following spine surgery for a lumbar fusion.  Additionally, they will review patient care post-op for the spine surgery and how to identify complications following spine surgery.  Other discussion topics include expectations following discharge and patient recovery.

This blog entry will highlight more frequently asked questions about degenerative disc disease.

Q: How do you treat degenerative disc disease?

A:  The most common treatment for degenerative disc disease is non-operative treatment.  Usually, it gets better with rest - in a few days to a week. If necessary, people will get steroid injections to help eliminate the back pain.

Unfortunately, in some cases it does not resolve itself with non-operative treatments - especially if it's associated with weakness or tingling. Approximately, 200,000 people in the United States each year will undergo spine surgery for degenerative disc disease.  The goal of this spine surgery is to take the pressure off of a nerve in the neck.

Q: What does that operation consist of?

A: The standard spine surgery procedure for degenerative disc disease is a spinal fusion.  This is where we take the pressure off the nerve and then fuse that segment. The main disadvantage of the spinal fusion is that when we fuse a disc, there may be a quicker wearing out of those discs next to the fused disc.  Once a patient has a fusion, there is about a 30 percent chance, that in the next 10 years the patient will need a spinal fusion at a different disc level.

A:  Is there an alternative procedure to a spinal fusion for the treatment of degenerative disc disease?

Q:    Over the decades, medical researchers have been trying to develop artificial discs that would allow continued normal motion across that segment – a mobile disc.  Needless to say, it is s a lot harder than the development of an artificial hip or knee.

Fortunately, there has been great success in this development.  Just last summer, the Food and Drug Administration approved a surgical cervical disc replacement and recommended approval for another cervical disc.  (To see FDA announcement, click here.)  Additionally, there are many more similar devices under development.  
 

At this special interest session Drs. John Arbuckle and Jonathan Gentile will discuss what to do with patients that continue to have back pain despite spine surgery and/or ongoing treatments.  A diagnosis that remains a challenge to phyiscians, this session will define what a failed back is and what the warning signs are.  Additionally, treatment options will be discussed including pharmacological therapy and implantable therapies; i.e. spinal cord stimulator. 

This continuing medical education program will also provide in-depth information on spine surgery – areas focused on will be lumbar surgery and cervical spine surgery. 

This session will be presented by neurosurgical spine surgeon Kenneth Renkens, MD, and will provide an overview of spine surgery procedures for the lower back and indications. 

Topics discussed will include:

 §     Identify and discuss the indications for common lumbar surgical  procedures, including decompression, lumbar spinal fusion and disc replacement.

An experimental procedure for the treatment of degenerative disc disease is to replace the nucleus.  The goal of this procedure is to replicate the normal disc function and to maintain motion.  The procedure was first developed in 1988, and contiunes to be modfied and refined. 

To learn more about this spine surgery procedure, here is a link to a chapter that I co-authored, “Nucleus Replacements”.   

In this session, which focuses on evaluating a patient for spine surgery, spine surgeon Thomas Reilly, MD, will discuss when spine surgery is an option and timing for referral to a spine surgeon. 

In that only 10 -20% of patients with spine problems require spine surgery, this session will provide: 

§          Detailed indications and contraindications for spinal surgery.

§          When to refer to the spine surgeon; a review of case studies.

§          An overview of surgical options and expected outcomes.

For patient’s suffering from degenerative disc disease in the lumbar spine – surgical treatment options are either a lumbar spinal fusion or an artifical lumbar disc replacement.  The artifical lumbar disc has recently been approved by the FDA.

In March, I gave a presentation to the Scientech Club meeting held at the Children’s Museum. At this meeting, I discussed surgical navigation of the spine.  This is the “global positioning” system used in spine surgery that I have recently blogged about. 

This spine surgery navigation system allows the spine surgeon to see in 3-d, exactly where structures are located within the body (neural, skeletal and vascular) providing greater accuracy for spinal instrumentation during surgery.  Prior to the development of this technology, traditional X-rays were used.

When discussing this technology, many times I compare it to the GPS system used in cars.  In this instance, the “satellite” is the infrared camera in the operating room.  The “antenna” is a reference frame that is has been placed on the patient.  This “antenna” sees the spine surgeon’s instruments under the skin.

Computer-assisted spinal navigation provides an alternative to traditional imaging used during spine surgery.  With traditional imaging during spine/ back surgery – this exposes the patient and medical team to unnecessary radiation.  Additionally, the images are not in real-time. 

With the newer computer-assisted spinal navigation system now used – spine surgeons see images in real time and are able to see multi-level images.  Additionally, this reduces radiation exposure and allows for greater visualization for instrumentation.

With this newer technology, it had not been determined if the patient’s time in surgery was affected.  A study that I conducted with another spine surgeon concluded that computer-assisted spinal navigation did reduce the operating time.  For this research, a detailed review of the patient’s medical record was analyzed.  Patients included in the study had undergone spinal fusion surgery for isthmic spondylolisthesis.  

It is my prediction that computer-assisted spinal navigation will become standard practice for spine surgery.  It not only reduces surgical time, but also reduces the risk of radiation exposure to the patient and medical team and also provides a mechanism for greater accuracy for spinal instrumentation during spine surgery.

Here is a link to an abstract of the study.

At the Back Talk continuing medical education conference sponsored by Indiana Spine Group, on Friday there will be three key topic categories.  These include:  spinal diagnostics, medical and minimally invasive spinal therapeutics and spine surgery. 

On Saturday there will be special interest sessions.  These sessions will focus on specific diagnoses and treatment options for patients with neck and back pain.  A few topics include; osteoporosis, spinal manipulation, assessment and management of low-back pain in the primary care setting, spinal injuries of athletes and the weekend warrior, pediatric and adolescent spine problems and spinal arthritis. 

Last week, I attended and presented at the annual American Academy of Orthopedic Surgeons meeting in San Francisco.  This annual meeting is the largest continuing medical education program for orthopaedic surgeons in the world. 

At this continuing medical education meeting, I was honored to be a faculty member.  On Thursday, I presented the radiographic data from a Bryan Disc Study (a cervical artificial cervical disc).  On Friday as a moderator, I was joined by four world renowned experts in the field of spinal trauma.  For this instructional course, we discussed thoracic and lumbar spine fractures.  On Saturday, I participated in a special program devoted to spine surgery.  I joined other world renowned experts on a debate about the proper treatment for cervical radiculopathy.  (A general definition for cervical radiculopathy is disease of the spinal nerve roots or spinal nerves in the cervical (neck) spine.  Many times this is caused by degenerative disc disease).

Prior to talking more about cervical artificial discs – here is an overview of cervical herniated discs sometimes called bulging discs.  The cervical artificial disc is a surgical treatment option.  The cervical artificial spine surgery procedure provides a minimally invasive spine surgery treatment for herniated discs. 

Here is the definition - a herniated disc is where the soft center of the spinal disc “bulges” or breaks through the weakened part of the disc. This usually occurs in the lower part (lumbar area) of the spine, but can occur anywhere; i.e. in the cervical (neck) or thoracic (chest) areas of the spine.   This is also called a slipped, prolapsed or ruptured disc.