Physicians with Indiana Spine Group are actively involved in research.  The goals of the research that they participate in are to develop minimally invasive surgical techniques, and to identify and develop minimally invasive procedures that allow the patients to return to normal activities as quickly as possible.

A few research projects that Indiana Spine Group has participated in include:

Lumbar Disc Implant – Drs. Rick Sasso (a spine surgeon with Indiana Spine Group) and Kenneth Renkens (a neurosurgical spine surgeon with Indiana Spine Group) participated in the FlexiCore lumbar disc study.  Used to treat degenerative disc disease, the lumbar disc implant replaces the damaged disc. This procedure is an alternative to a spinal fusion.

Percutaneous Reference Frame (PRF) – Dr. Rick Sasso developed this devise that improves the capability for spine surgeons to perform minimally invasive spine surgery.  By the use of an infrared camera and the PRF - this allows spine surgeons exact placement of spine surgical instruments – with less of an incision. This technology has been referred to as “global positioning of instrumentation” – and it works similar to the GPS technology used in cars.

Cervical Artificial Disc – Drs. Rick Sasso and Kenneth Renkens also participated in the study for the Bryan Cervical Disc, and performed the first cervical artificial disc implant in North America in 2002.  This cervical artificial disc has received preliminary approval from the FDA last summer. 

Electrothermal Disc Decompression (EDD) and Intradiscal Elctrothermal Therapy (IDET) Studies – Dr. Kevin Macadaeg, a minimally invasive spine specialist with Indiana Spine Group, participated in this study that evaluated the effectiveness of EDD and IDET to treat lower back pain and sciatica.  These treatments use a heat coil, which is inserted via a catheter in the disc of the spine.

In previous blogs, I have referenced the exciting research that was summarized in a recent article on cervical artificial discs.  Again, this is an alternative spine surgery procedure to spinal fusion as a treatment for degenerative disc disease.  This information was also presented at the Back Talk physician symposium sponsored by Indiana Spine Group.

Spinal fusion, which is considered the “gold standard” spine surgical treatment for degenerative disc disease has a few disadvantages.  One key disadvantage is the degenerative of the adjacent cervical discs over time.  The other is the complications that are associated with the site of the bone graft used in the spinal fusion; the iliac crest bone (hip bone). 

It is projected, that as a result of motion preservation with the cervical artificial discs that this will prevent or delay adjacent disc degeneration.  These initial results are exciting, and as studies are completed and results reported, I will continue to provide updates on my blog. 

The advancements and preliminary research results for cervical artificial disc replacements as an alternative spine surgical treatment for degenerative disc disease are promising.  When spine surgery is required for degenerative disc disease, the traditional procedure has been a spinal fusion.  This has been considered the “gold standard” of treatment.  I predict that in the future, the “gold standard” of surgical treatment of certain types of cervical radiculopathy caused by a herniated disc will be a cervical artificial disc rather than a spinal fusion. 

A recent article that I co-wrote, provides an overview and summary of the different cervical artificial discs that are currently being used in FDA-trials.  The Prestige Disc was approved last summer (2007).  Also last summer, the BRYAN cervical artificial disc received preliminary FDA-approval and the Prodisc-C was approved earlier this year.

We have all heard that having a healthy lifestyle is good for our cardiovascular health – but did you know it is also good for your spine health?  At the recent medical education conference/ symposium Back Talk sponsored by Indiana Spine Group, Alta Skelton, RN, MSN, NP-C, discussed key factors for helping patients keep their spine healthy.

A few of the key things discussed were:

• Smoking – An earlier spine wellenss blog entry discussed smoking and the spine.  One of the key effects that smoking has on the spine is that it  speeds up disc degeneration.

• Nutrition – Proper nutrition helps maintain strong bones and connective tissue.  Additionally, nutrients are important for tissue repair.

• Obesity – Being overweight puts increased pressure / load on the spine. 

• Exercise – Aerobic activities help to increase not only the heart rate but also the blood flow.  This increased blood flow, can increase the   nutrients being diffused into the disc. 

In continuing my blog entries on the lumbar spine and degenerative disc disease, I will answer some frequently asked questions by my patients.

What is lumbar degenerative disc disease?
Generally speaking, degenerative disc disease is the result of the normal aging process.  This is where the disc becomes more brittle and less flexible.  When the discs of the lower back are affected, this is referred to lumbar degenerative disc disease.  Often this results in lower back pain. 

 Technically called invertebral discs, spinal discs are discs found between each vertebrae that act as a cushion..  The spinal discs are what helps maintain the position of your spine, as well as allows motion between each vertebrae.  Sometimes they are called the “shock absorbers” of the spine - in that they compress with weight, and spring back when weight is removed. 

Anatomically, the discs are flat and round – and less than an inch thick.  The outer shell is a tough tissue and this is called the annulus fibrosis.  This tissue is filled with a jelly like consistency fluid that is called the nucleus pulposus.  Cartilage then connects the spinal discs to the vertebrae. 

Even though degenerative disc disease is a part of the aging process, everyone ages differently and no - everyone does not get degenerative disc disease. 

In addition to aging, wear and tear can also cause degenerative disc disease.  There are many lifestyle factors that can affect the health of the spinal discs.  For example, for individuals who are over weight; this would increase the stress on the spine.  Additionally, someone who has a job that requires heavy lifting – this can increase their risk for degenerative disc disease.  In some instances, trauma can lead to degenerative disc disease – lumbar or cervical. 

This blog entry is in response to a reader comment where they wanted more information on the Prestige Cervical Artificial Disc that was approved by the FDA last summer.  Here is a link to an article that I wrote for Spine Universe.  This article discusses cervical artifical discs that are used as a spine surgical treatment for degenerative disc disease.  Additionally, here is a link that provides more specific information about the Prestige Cervical Artifical Disc by the manufacture. 

This blog entry is in response to a recent comment where I was asked if there was a clinical study for a lumbar artificial disc.  The answer to that question is yes.  Currently I am participating in a FDA-approved clinical trial for the Flexicore artificial lumbar disc.  This lumbar artificial disc is a metal on metal disc used as a spine surgery treatment option for lumbar degenerative disc disease.  Here is a link to an abstract of a recent article published an article in Spine. I co-authored this study entitled, Prospective, Randomized Trial of Metal-on-Metal Artificial Lumbar Disc Replacement: Initial Results for Treatment of Discogenic Pain.

To find out more about this study and participant criteria, my research nurse can answer your questions.  Please call our office at 317.228.7000 and ask to speak to Dr. Sasso's research nurse. 

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.  
 

Last year, I was interviewed for an article in The Indianapolis Star.  This interview was by health reporter Shari Rudavsky.  This interview was about degenerative disc disease. 

The following are a few of the common questions about degenerative disc disease, which were asked during this interview.

Q:  How common is degenerative disc disease?

A:  Degenerative disc disease is quite common, especially in people in their 30’s and 40’s.  It is one of the main reason’s that people see their family doctor.

Q:  What causes degenerative disc disease? 

A:  Usually this occurs from normal degenerative changes as a result of aging. The discs in the spine are specialized joints.  Just like a knee or hip that can get arthritic, the disc can also get arthritis.  A common analogy used for the spinal discs is a jelly doughnut.  The inside is soft and it is surrounded by a shell.  When this outer shell tears, the degenerated pieces can extrude through this shell (outer covering) and then sit on the nerves on the spinal cord.

Q: What are the symptoms of degenerative disc disease?

A: The most common symptoms are neck and arm pain that radiates down the arm, below the elbow, down to the hand, associated with weakness and tingling.

Spinal disorders such as spinal stenosis, excessive kyphosis, vertebral fractures, degenerative disc disease or other spinal disorders – can sometimes affect more than one vertebrae level of the spine.  In instances where surgery is necessary, this can provide a challenge to spine surgeons.

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”.   

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.

One spine surgical procedure that is an option to traditional spinal fusion is an artificial cervical disc replacement.  Today, there is one artificial cervical disc that has received FDA- approval and that is the Prestige Disc.  Additionally, there is the BRYAN cervical disc which has received preliminary FDA-approval. 

I have been involved in the clinical study of the BRYAN cervical disc – and have blogged about my involvement in this research.  Recently, I co-authored an article which summarized a 24-month follow-up study of patient’s that have received this BRYAN Cervical Disc. 

In this study, the outcomes of cervical arthoplasty (artificial BRYAN cervical disc) were compared to traditional spinal fusion surgery for the treatment of cervical radiculopathy and myelopathy. In a spinal fusion surgery, technically called ACDF (anterior cervical discectomy and fusion), the damaged cervical disc is removed and then bone is fused to the treated area to maintain stability.  With the artificial BRYAN cervical disc, the damaged disc is removed and the artificial cervical disc is inserted/implanted. 

This study concluded that cervical disc arthoplasty had similar results to the ACDF as defined by the standard outcome scores.  More long-term studies are needed, but preliminary results indicate that the BRYAN disc created less strain on adjacent discs than fusion and it is projected that cervical disc arthroplasty will result in minimizing adjacent disc degeneration. 

Traditional spinal fusion is an excellent surgical option for some patients.  Last year, Scott Swan, a reporter with WTHR, suffered from degenerative disc disease and underwent a spinal fusion. 

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).

When conservative management or minimally invasive spine procedures are not effective in treating lumbar radiulopathy (lumbar degenerative disc disease), the patient may require surgery.  A common spine surgery procedure is surgical decompression.  The goal of this surgery is to eliminate the compression of the spinal cord on the nerves to reduce the back pain.

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. 

People with back problems – may have more than just back pain.  Sometimes, if you suffer from leg pain – this can be related to your spine.  If a person has ongoing leg pain that is persistent and increases as you lift your knee to your chest or bend over – it could be related to your back.  One back problem – that causes a shooting pain down your leg referred to as “sciatica” is lumbar radiculopathy. 

This past summer, the Prestige Cervical Artificial disc received FDA approval. 

Now patients who suffer from degenerative disc disease, that need surgical treatment, have a second option.  Patients no longer have to be accepted to a research study to receive a cervical artificial disc.

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