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. 

A small certain percentage of patients that undergo back surgery / spine surgery; may continue to have chronic back pain and/or lower extremity pain following surgery, that is referred to as failed back syndrome.   This is not an actual syndrome or medical diagnosis – but more a description of the symptoms.  The technical term for this is  post-laminectomy syndrome.

When medical management and other therapies are ineffective, one minimally invasive interventional pain management treatment for patients if they are suffering from both back pain and lower extremity pain is to implant a spinal cord stimulator.  A spinal cord stimulator, also called a neurostimulator uses a tiny programmable generator and electrical leads/ electrodes placed underneath the skin.  The electrodes are placed in the spinal canal, adjacent to the spinal cord.  (Photo courtesy of Medtronic, Inc.)

To learn more, read this recent press release.  This press release profiles a patient who had chronic back and lower extremity pain following back surgery.  Now she enjoys ballroom dancing!

Last summer, I was asked to testify at the FDA  hearing for the Bryan® Cervical Disc.  For the last five years, I had participated in the clinical trial for this cervical artificial disc.  This cervical artificial disc provides a surgical alternative to a traditional fusion in spine surgery.

Also testifying at this hearing, was one of my patients.  This patient was accepted into the trial and had the cervical artificial disc implanted in 2002.  Suffering from a herniated cervical disc – this procedure brought him much needed relief.  As an avid golfer – he was excited to be accepted into the trial.  Now, he can easily be found on area golf courses or sometimes water-skiing in area lakes. 

This cervical artificial disc did receive preliminary FDA approval at the hearing (July 2007).  Final FDA approval is expected sometime late in 2008.

Additionally, in July 2007 – the Prestige Cervical Disc did receive FDA approval.  Here is the link to the media release.

The Back Talk agenda is in the process of being finalized. 

Conference topics will include information about the diagnosis of spinal pain including spinal imaging.  There will also be presentations about medical and minimally invasive spinal therapeutics including the non-operative management of spinal problems and minimally invasive treatments. 


The section on spine surgery will address the appropriate timing for patient referrals for spine surgery and when surgery is an option.  Additionally, the surgery section will discuss surgical options for lumbar surgery and surgical options for cervical degenerative disc disease – including updates on cervical artificial discs. 

Indiana Spine Group is a center of excellence for the treatment of spinal disorders and abnormalities.  Located in Indianapolis - with offices in Kokomo and Anderson, we provide comprehensive spine care – including interventional pain management treatments, nonsurgical spine treatments, minimally invasive spine procedures, minimally invasive spine surgery and spine surgery.  Treating both adults and children, some common diagnoses that we treat include degenerative disc disease, spinal stenosis, herniated cervical disc, failed back syndrome, osteoporosis and scoliosis. 

Physicians with Indiana Spine Group include:

§          Ken Renkens, MD (neurosurgical spine surgeon)

§           Rick Sasso, MD (spine surgeon)

§           Kevin Macadaeg, MD (minimally invasive spine specialist)

§           Thomas Reilly, MD (spine surgeon)

§          Jonathan Gentile, MD (minimally invasive spine specialist)

§          John Arbuckle, MD (minimally invasive spine specialist

Stacia Matthews, health reporter with RTV6, just completed (January 2008) - a marathon in Phoenix.  Stacia has raised over $65,000 for the Leukemia and Lymphoma Society. 

Stacia has reported on many new spinal procedures and treatments, interviewing physicians with Indiana Spine Group.  She has interviewed us for stories about cervical disc replacement, as well as other spine surgery, spine wellness and interventional pain management topics.  You can see her health report on the RTV6's evening news at 5:00 pm.

Congratulations Stacia!

Many of you are familiar with the navigational systems found in cars.  It works great – you drive and this map with a little icon that is supposed to be your car – moves along the map following the exact route that you are driving.  This technology works great in cars – but did you know it also works well in spine surgery?

For the last decade, I have been involved in the design and development of a similar technology for spine surgery.  Technically called, Intraoperative Spinal Navigation, this is a GPS system used during back surgery.  During spine surgery, this navigation system allows the spine surgeon to operate more efficiently, effectively, safely and less invasively (minimally invasive spine surgery). 

As a spine surgeon, my days are varied.  The majority of my day – is in surgery, specifically spine surgery.  Types of surgery are varied – cervical spine surgery, lumbar surgery, minimally invasive spine surgery, etc.  But my days are also devoted to seeing patients in the hospital following surgery, seeing patients in the office and I am involved in research.

Last summer, I was contacted by a reporter from my alma mater - Wabash College (Jim Amidon).  Jim was doing a story about me for an upcoming issue of the Wabash Magazine.  For this article, he needed pictures of me in surgery.  Well, long story short – he attended a spine surgery.  Once all the proper permissions were gathered, and paper work was signed – his day begun at 6:00 am one summer morning. 

To learn more about Jim’s day in surgery, read his blog.

The surgery he watched was a laminectomy for spinal stenosis.  Spinal stenosis is a narrowing of the sine – and this narrowing puts pressure on the nerves resulting in pain.