In July 2009, an article that Dr. Kenneth Renkens co-authored was published in the Journal of the American College of Surgeons. This article was entitled “A Phase 3b, Open-Label, Single-Group Immunogenicity and Safety Study of Topical Recombinant Thrombin in Surgical Hemostatis”.

This study evaluated the affects of a topical hemostat during surgery. (Note:  a topic hemostat is used to control bleeding during spine surgery and other surgical procedures).   For an abstract of this study background and conclusions, link here. 

Dr. Kenneth Renkens is a neurosurgical spine surgeon with Indiana Spine Group. 

Often time’s patients that have idiopathic scoliosis may also have a visible rib deformity that may be present following corrective spine surgery.  The traditional spine surgical procedure to correct this has been open thoracoplasty.  A newer, minimally invasive procedure used is video- assisted thoracoplasty.  This procedure is less invasive than the traditional spine surgical procedure.

The last few spine wellness blog entries have discussed the effects of smoking and the spine.  For example smoking can increase your risk for lower back pain, increasing healing time following spine surgery and increase your risk for osteoporosis. 

For a spine wellness fact sheet about smoking and your spine's wellness, click here.

Many times with scoliosis - no treatment is needed.  Once a patient is diagnosed with scoliosis it is important to observe and monitor the curve during the patient’s growing years.  Factors that affect what type of treatment is recommended include the age of the patient and how much growth they have left, the degree and pattern of the curve, and the type of scoliosis. 

Treatment options may range from observation to surgery.  If it is decided that the patient will be observed; they will be evaluated approximately every six months while the patient is still growing.  At this time, the degree of the curve will be assessed.

Bracing is a treatment option to prevent the curve from progressing.  This is recommended if the patient has an idiopathic curve, is still growing and:

• Has a curve greater than 25 degrees,
• Has two more years of potential growth remaining and the curve is between 20 and 29 degrees, (and if female has not had her first menstrual period) or
• Has a curve that is between 20 and 29 degrees and is progressing.   

This spine wellness blog entry will address more about the effects of smoking and your spine’s health.  In this Spine Universe article, it summarizes the negative effects of smoking and its impact on the spine surgery procedure of spinal fusions. 

A general definition of a spinal fusion is that it is a spine surgical procedure that joins bony segments of the spine (vertebrae) – this spine surgery can be performed at the lumbar, thoracic or cervical areas of the spine.  As a part of the healing / fusion process of this spine ssurgery there needs to be new bone growth.  Many factors can affect the success of a spinal fusion and can include the patient’s overall health, other medical conditions and smoking. Research has shown that habitual cigarette smoking results in less successful spinal fusions when compared to similar spine surgical procedures performed on nonsmokers.  Additionally, another study indicated that individuals that smoked had a higher post-operative infection rate than nonsmokers. 

Earlier this year, Dr. Rick Sasso and I were asked to write a spine continuing education chapter on “Controversies in Cervical Spine Surgery”, specifically about a newer spine surgical technology known as dynamic plating for cervical fusions.  Traditional plates, known as static plates, have a high success rate, but in reviewing the published reports of direct comparisons between the two plates, the dynamic plates have a slightly higher percentage which fuse.  It may be even more beneficial in longer fusions.

I have switched my practice to essentially using only the dynamic plates for cervical spinal fusions.  I have been very happy with the  results.  As with all new technology, it is important to carefully monitor results and compare them against established techniques.  I'm keeping an eye on continuing trials even as I incorporate this technology into my own practice.

(This blog entry was written by Paul Kraemer, MD; a spine surgeon with Indiana Spine Group). 
 

In October, I was a faculty member at the 8^th Annual Symposium on “Innovative Techniques in Spine Surgery.” This continuing education meeting, hosted in Phoenix, addressed the innovative and emerging technologies of spinal surgery including; arthroplasty, minimally invasive procedures, motion sparring technologies and biologics.  At this meeting I gave a talk on Lumbar Artificial Disc Replacement, and presented the results of the FDA studies for the Cervical Artificial Disc.

This education program was sponsored by the Organization of Spinal Teaching and Research.  The purpose of this group is to facilitate education and discussion among spine care providers and industry and this organization includes leaders in the field of spine surgery and technology that utilize the most advanced and effective technology available for the treatment of spinal disorders.

Previously, I blogged about the research results of a spine patient study – which evaluated the clinical outcomes of patients who received a Bryan Cervical Disc compared to those that had a standard spinal fusion at 24-months post-operatively. I recently completed a new study, which evaluated these patients 48-months post-operatively. This study will soon be published.

In this study – the functional outcomes of patients at 48-months (4 years) following their spine surgery was evaluated. This study had two groups of patients – one group received a spinal fusion (Anterior Cervical Discectomy and Fusion - ACDF) and the other group received the Bryan cervical artificial disc prosthesis. This spine surgery was for the treatment of radiculopathy and myelopathy, after minimally invasive spine procedures were determined ineffective.

There were 47 patients enrolled in this spine study. Of this group, 21 were enrolled in the Bryan cervical disc arm of the study and their mean age was 40.  In the group that received a spinal fusion (control group), there were 26 participants and their mean age was 43.

This study concluded that patients that received the Bryan Artificial Cervical Disc at 48-months, when compared to the control group:

•     Had less neck and arm pain,
•     Greater mobility,
•     Less adjacent segment degeneration, and
•     Lower secondary operation rate.

The St.Vincent Orthopedic Center and St.Vincent Spine Center recently earned the Joint Commission’s Disease-Specific Care Certification for joint replacement and spine surgery, respectively. The Joint Commission is the nation’s premier healthcare accreditation entity.  Read the complete story in the Indianapolis Star. 

Dr. Rick Sasso, co-medical director of the St.Vincent Spine Center spine surgeon with Indiana Spine Group was quoted in this article.

Another session at Back Talk, the continuing medical education symposium for physicians and health care practitioners will address the failed back. Sometimes called failed back syndrome, failed back surgery or post-laminectomy syndrome – these patients continue to have ongoing back pain following spine surgery. 

This session will be presented by minimally invasive spine specialists Jonathan Gentile, MD, and John Arbuckle, MD, and spine surgeon Paul Kraemer, MD. With Indiana Spine Group, these physicians treat patients at our offices located on the north side of Indianapolis. 

During this continuing medical education session, the tools for physicians and health care practitioners to perform a diagnostic assessment of patients with chronic back pain following spine surgery will be highlighted. This diagnostic assessment will help caregivers to understand the underlying causes of ongoing back pain, and the mechanism of failed back. Additionally, medical and interventional treatments for failed back will be discussed – their indications and expected outcomes.

I recently went to Austria to attend the 16^th International Meeting on Advanced Spine Techniques (IMAST). For this spine continuing medical education conference, I was a faculty member and invited faculty speaker. This spine conference, sponsored by the Scoliosis Research Society, is an international forum where spine surgeons from around the world discussed the latest research and advanced spine technologies. The goal of this conference is to improve the quality of patient care.

While at this conference I participated in a few instructional lectures. I moderated a spine surgery education series on Options in Cervical Fixture and Motion and presented a talk on Current State of Cervical Motion Technology.  Additionally, I participated in a instructional lectures series on Cervical Trauma and presented a talk on C1 – 2 fractures. 

In addition to the instructional lectures, I participated in a round table discussion on Cervical Reconstruction. This discussion provided an opportunity for spine surgeons from around the world to discuss case studies presented. 

In July, Jonathan Gentile, MD, spoke during the luncheon at the annual Indiana Academy of Family Practitioners (IAFP) conference. This lunch was sponsored by St.Vincent Health, a strategic partner with IAFP. 

Dr. Gentiles talk entitled Understanding the Failed Back, addressed the following:

•  The assessment of patients following spine surgery who continue to suffer from  ongoing chronic back pain; and identification of failed back.
• The treatment options for failed back; their indications and effectiveness.

Many times, patients spend a lot of time preparing for spine surgery – but what about after spine surgery? This Back Talk continuing medical education session will focus on the spine surgery patient, post-operatively; and provide health care practitioners in-depth guidelines to care for these patients; including warning signs, red flags, pharmacological management, and spinal rehabilitation guidelines and therapy.

This session will be presented by Jodi Hettermann Blume, PA-C, and Jennifer Turner, PA-C.  Both Jodi and Jennifer are physician assistants with Indiana Spine Group. 

For more information about this continuing medical education symposium,
call (317)228-7000, or click here. 

One unique session for “Back Talk”, the continuing medical education symposium sponsored by Indiana Spine Group, will feature a hands-on component. During this session, entitled Hands-On | Surgical Case Studies, attendees will have the opportunity to get a first-hand look at spinal instrumentation, cervical artificial disc implants and other surgical devices used during spine surgery. Spine surgeons Kenneth Renkens, MD, and Thomas Reilly, MD, will lead this discussion. As they review the technology, they will discuss spine surgery case studies including diagnoses, recommended surgical interventions and expected outcomes.

For more information about Back Talk, and a complete continuing medical education conference agenda, click here.

I am chairman of a continuing medical education program for spine surgeons which will be held in Chicago during November. This program, sponsored by the American Academy of Orthopaedic Surgeons, is titled “Contemporary Techniques in Spine Surgery.”

This is an interactive continuing medical education program which will provide spine surgeons the opportunity to learn the latest surgical techniques for addressing spinal pathology. This program will provide a comprehensive overview of the diagnosis and treatment of spinal pathologies, as well as applicable surgical techniques of the cervical, thoracic and lumbar spine. Additionally, this course will provide a hands-on lab where spine surgeons will have the opportunity to perform these newer procedures under expert direction.

A few course objectives include: 

·        Evaluate patients with cervical, thoracic, and lumbar spinal pathologies and formulate a treatment plan.

·        Compare and contrast various surgical and nonsurgical treatment protocols for spinal pathologies.

·        Discuss alternative treatment and rehabilitation techniques for spinal disorders.

·        Compare and contrast techniques of different surgical approaches to specific spinal disorders.

 To learn more about this spine surgery continuing medical education program, click here.

When spine surgery is recommended, it is important to have a complete understanding of the spine surgical procedure. Paul Kraemer, MD, a spine surgeon with Indiana Spine Group, states that he encourages his patients to ask questions prior to any spine surgery procedure. It is important for patients to have a clear understanding of their procedure and expected outcomes so that they have realistic expectations about their spine surgery, Kraemer adds.

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Physicians and staff at Indiana Spine Group, work closely with patients prior to surgery to help answer all of their questions.

The following are a few recommended questions:

1. What is the exact name of the procedure recommended?
2. What is a clear, layman friendly description of the procedure?
3. Why is the spine surgery recommended at this time?
4. What are the treatment options if this procedure is not done?
5. What are the risks of the procedure; and the incidence of these risks?
6. What is the anticipated outcome of the surgery?
7. What is the anticipated recovery period like, and what can be expected?

In a prior blog, the recent FDA-approval of the Bryan Cervical Disc ™ was announced. One of the advantages of this device and cervical arthroplasty, as a spine surgical treatment for degenerative disc disease, is that patients can return to work and their normal activities in a relatively short period of time. Generally, this time period is quicker when compared to a spinal fusion – which is the current standard spine surgical treatment to this newer procedure and technology. At this time, spinal fusion is the standard surgical treatment.

A study recently published in Neurosurgery, concluded that patients that underwent cervical arthroplasty returned to work on average about three months sooner than those patients that underwent a spinal fusion and cervical discectomy. The patients who received the cervical artificial disc returned to work in a median time frame of 101 days following their spine surgery (cervical arthroplasty) as compared to 222 days in the group that underwent the spinal fusion and cervical discectomy.