A prior blog entry highlighted a research study that Dr. Renkens, a neurosurgical spine surgeon with Indiana Spine Group, was participating in for lumbar disectomy.  Dr. Renken’s is also participating in a clinical research study for the surgical treatment of spinal stenosis. 

Spinal stenosis is a degenerative spine disease where one or more areas of the spine narrows.  Usually affecting individuals in their 50’s and 60’s, spinal stenosis is most often caused by osteoarthritis-related bone damage.
 
Symtpoms include pain or numbness in the lower legs, back, neck, shoulders or arms, a loss of sensation in extremities, tingling or weakness.  Depending on the severity of the spinal stenosis – treatment may range from physical therapy to surgery.  

The study that Dr. Renkens is participating in is for more severe cases of spinal stenosis – where surgery is required.  The name of this study is A Prospective and Randomized Controlled Trial to Evaluate the Safety and Effectiveness of Total Facet Arthoplasty in the Treatment of Degenerative Spinal Stenosis.  In this study, Dr. Renkens will be using the Archus Total Facet Arthoplasty System (TFAS), which is a non-fusion spinal implant for the treatment of patients with moderate to severe spinal stenosis.  This TFAS, provides an alternative treatment for spinal stenosis as an alternative to spinal fusion – which is one spine surgical treatment for spinal stenosis. 

For more study information, click here. 

We are excited to announce that Dr. Rick Sasso has been selected to be the chairman / course director for the annual spine meeting hosted by the American Association of Orthopaedic Surgeons.  This program that targets orthopaedic surgeons - will be held in November 2009.

At this program entitled, Contemporary Techniques in Spine Surgery, physicians will learn the latest surgical techniques for addressing spinal pathology.  Dr. Sasso will address basic and advanced techniques of various spine surgeries including cervical, thoracic and lumbar spine procedures. 

To learn more about this program, click here. 

Physicians with Indiana Spine Group presented at the fall conference of the Indiana State Chiropractic Association this past weekend, on November 1 and 2. 

On Saturday Dr. Kevin Macadaeg, a minimally invasive spine specialist, spoke on minimally invasive techniques used to help manage spinal pain.  Additionally, he addressed diagnostic and therapeutic spinal injections.  Spine surgeons - Dr. Thomas Reilly, Dr. Kenneth Renkens and Dr. Rick Sasso also spoke on Saturday.  Dr. Reilly discussed when spine surgery is a potential treatment option.  Dr. Renkens’ talk entitled “Understanding Lumbar Surgery”, focused on the lower back and reviewed spine surgery options and indications for the lumbar spine.  Additionally, he discussed the different types of lumbar fusions and their applications.  Dr. Rick Sasso focused on cervical surgery, and his talk was entitled “The ABC’s of Cervical Surgery”.  In this talk, he discussed common cervical surgical procedures; including spinal fusion and cervical artificial disc replacement. 

On Sunday, minimally invasive spine specialists Dr. Jonathan Gentile and Dr. John Arbuckle reviewed case studies of minimally invasive diagnostic and therapeutic techniques.  Spine surgeons Dr. Thomas Reilly and Dr. Paul Kraemer also reviewed case studies of surgery patients.

For more information about this conference, click here. 

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.

Physicians with Indiana Spine Group attended the 23^rd annual meeting of the North American Spine Society(NASS) in Toronto, Canada.  At this international meeting, all aspects of caring for the patient with spine problems were discussed.  This includes medical management, minimally invasive spine treatments and spine surgery. 

Additionally, Dr. Rick Sasso a spine surgeon with Indiana Spine Group gave numerous presentations.  A few of his presentations included:  A Comparison of the Dynamic Compliance Characteristics of Prosthetic Cervical Disc Materials and Total Disc Replacement for Treating Lumbar Discogenic Back Pain: A Prospective, Randomized, Multicenter Study of Flexicore® vs. 360 Spinal Fusion.  Additionally, he chaired a technique workshop on Interbody Fusion Technologies. 

Indiana Spine Group is excited to welcome our new spine surgeon, Dr. Paul Kraemer. Dr. Kraemer is an orthopaedic spine surgeon who specializes in all aspects of spine surgery, including cervical, thoracic and lumbar.  

Dr. Kraemer received his medical degree from the University of Iowa College of Medicine in Iowa City, Iowa.  He completed his residency at the University of Wisconsin in Madison, Wisconsin.  Dr. Kramer completed his fellowship in orthopaedic spine surgery at Harborview Medical Center, University of Washington in Seattle. For more information, here is a link to Dr. Kraemer's bio. 

His special medical interests include orthopaedic spinal trauma, adult spinal deformity, and the prevention and treatment of adjacent segment disease.  Involved in clinical research, Dr. Kraemer was the recipient of the OREF Resident Research Award in 2004 for his research study entitled, "The Correlation of Microdiscectomy Outcomes with Apolipoprotein E and Catechol-O-Methyltransferase Genotype." 

Dr. Kraemer is seeing patients at our office located at 8040 Clearvista Parkway, Suite 440.

For more information, or to schedule a patient consultation,
please call (317) 228-7000.

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. 

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.  
 

This special interest symposium, The Physical Exam, will be lead by Laurie Scott, RN, MSN, NP-C, and Jodi Hetterman, PA-C.  Laurie is a nurse practitioner with Indiana Spine Group, and she works with spine surgeon Thomas Reilly, MD.  Jodi is a physician assistant with Indiana Spine Group and she works with our neurosurgical spine surgeon Kenneth Renkens, MD. 

During this workshop, they will demonstrate using a live-model, the diagnostic steps in conducting a physical exam related to spine pain (back and neck).  In their presentation, they will include key points in evaluating both lumbar and cervical problems.  Additionally, with the lumbar exam – they will specifically discuss the identification of radicular pain from low-back pain, and the evaluation process to rule out hip abnormalities or knee problems. 

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.

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.