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.
Indiana Spine Group's new building project was highlighted in
an article in the enewsletter produced by
Inside Indiana Business on July 21. This article highlighted the new Indiana Spine Group building that will break ground on August 2. This new facility will provide a full continuum spine services in one centralized location - spinal diagnosis, education, treatment and outpatient surgery.
This new spine center, scheduled to be completed in the Fall of 2011, will include:
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.
Indiana Spine Group is excited to announce that they will be breaking ground on a new dedicated spine facility on August 2. This new state-of-the-art , 60,174-square-foot facility will provide comprehensiv
e spine care in one centralized location, including spinal diagnosis, education, treatment and outpatient spine surgery. Additionally, it will have a state-of-the-art bios-skills cadaver training lab for physicians and health care professionals that will allow for hands-on medical procedure - continuing medical education. For more information,
click here.
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.
For complete patent information, visit the U.S. Patent and Trademark Office website.
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.
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.
Planning continues for Back Talk | Comprehensive Concepts in Spinal Diagnosis and Abnormalities, Indiana Spine Group’s 4th annual spine symposium. For this year’s 
conference there will be two educational tracks. One track will provide more general information and one in-depth. These tracks will be held the morning of day one.
The general track is entitled: Spinal Care Boot Camp | Diagnostics and Treatment. There will be a session on spinal anatomy, entitled Spinal Anatomy 101, presented by minimally invasive spine specialist Kevin Macadaeg, MD. During this session, Dr. Macadaeg will discuss the functional anatomy of the spine, normal aging process, the spine’s degenerative cascading process and normal and abnormal spinal anatomy.
Another general session which will be presented by minimally invasive spine specialist John Arbuckle, MD, The ABCs of Spinal Diagnostics. In this session, the etiology of spinal pain and common spinal disorders that cause back pain will be reviewed. Additionally, Dr. Arbuckle will discuss the indications and applications of spinal testing, evidence-based guidelines for the diagnosis of lower back and neck pain, and he will highlight the red flags of spinal pain.
Two other sessions in this track include Understanding Spinal Therapeutics and The Spine Surgery Patient. In the spinal therapeutics session, presented by minimally invasive spine specialist Jonathan Gentile, MD, he will discuss the pharmacological management of acute and chronic back pain, review common noninvasive and minimally invasive spinal therapies and their indications. Spine surgeon Paul Kraemer, MD, will discuss the spine surgery patient and will provide an overview of common spine surgery procedures, their indications and expected outcomes. Additionally, Dr. Kraemer will discuss the applications and limitations of spine surgery, and when referral to a spine surgeon is indicated.
For a complete Back Talk agenda, link here.
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.
This abstract that I co-authored summarizes this procedure and the clinical results
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.
When patients have a curve that is greater than 45 degrees, they are still growing and the curve is getting worse they may be a candidate for spine surgery. In this case, a spinal fusion may be performed to straighten and stabilize the spine
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 educa
tion 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 8th 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.
In my prior blog entry, I talked about the Bryan Cervical Artificial Disc study that has recently concluded. To evaluate patient outcomes and functionality for this spine study, one measurement used was the neck disability index (NDI). With this assessment, patients provide a self-evaluation and answer a series of questions of how their neck pain affects their ability to manage everyday life.
Prior to surgery the average NDI score for patients in both the Bryan Cervical Artificial Disc group and the control group was 51. The average post-operative score in the Bryan group was 10, and for the control group it was 16.7Here is the
link to a NDI questionnaire.
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.
Once this study is published, I will provide the link to the results.
Last week Indiana Spine Group hosted their
third annual spine symposiu
m, continuing medical education program for physicians and health care practitioners. This conference provided the latest information on spine treatment - diagnostics, therapeutics and spinal surgery.
The keynote speaker for ths conference was Cheryl Angelelli. Cheryl is a paralympic swimmer and American record holder. At the 2008 Paralympic Games in Beijing in 2008, Cheryl won a pair of silver medals. Cheryl suffered a spinal cord injury when she was a teenager.
To learn more about her story, visit her web site -
www.untolddreams.net. On Friday prior to her keynote address, Cheryl was interviewed by Anne Marie Tiernon from WTHR. Additionally,
Kevin Macadaeg, MD, a minimally invasive spine specialist with Indiana Spine Group was interviewed. To watch the story,
click here.
On August 28, I was interviewed by Barbara Lewis for a segment in the Business of Health. I was interviewed about the impact of back pain and back injuries in the workplace. Additionally, in this segment the advantages of newer spine surgery technology was discussed. Specifically, the recently FDA-approved Bryan Cervical Artificial Disc was discussed. A recent research study indicated that patients who underwent a Bryan Cervical Disc procedure - as compared to a spinal fusion, returned to work sooner. To read this complete study,
visit this link.
To see the Business of Health segment, visit
this link.
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.
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