Indiana Spine Surgery

For more information about Back Talk, call (317) 228-7000, or visit this link.

Back Talk | A Comprehensive Review and Practical

Approach to Spinal Diagnosis and Treatment

During this current session Paul Kraemer, MD, a spine surgeon with Indiana Spine Group, will address the many myths and insights of spine surgery. This includes the what, when and why. A few topics that will be reviewed include evidence-based research documenting the indicators for spine surgery. Dr. Kraemer will also review the criteria for patient selection for spine surgery. A few of the common misconceptions of spine surgery that will be discussed include age appropriateness, rest requirements, postoperative pain and bracing.

Back Talk | A Comprehensive Review and Practical

Approach to Spinal Diagnosis and Treatment

One challenge to physicians is ongoing back pain following spine surgery. This session will provide attendees a better understanding of failed back syndrome / post-laminectomy syndrome.

During this continuing medical education session during the Back Talk spine symposium, speakers will discuss the contributing factors and causes of failed back syndrome. Additionally, the medical and interventional treatments for failed back syndrome will be reviewed – their indications and expected outcomes. One treatment that will be discussed is spinal cord stimulators. Indications for salvageable spine surgery and the outcome predictors will be reviewed.

Faculty for this continuing medical education session includes minimally invasive spine specialist Jonathan Gentile, MD, and spine surgeon Thomas Reilly, MD, FACS.

Back Talk | A Comprehensive Review and Practical

Approach to Spinal Diagnosis and Treatment

Another series of talks during the spine symposium Back Talk, Indiana Spine Group’s fifth annual continuing medical education symposium will focus on treatment options for spine patients and highlight medical, minimally invasive and spine surgery options. This includes their clinical indicators and expected outcomes.

These sessions include:

• Nonoperative and Noninvasive Therapies, which will be presented by minimally invasive spine specialist Jonathan Gentile, MD.

• Minimally Invasive Therapies, presented by Kevin Macadaeg, MD,  minimally invasive spine specialist.

• Common Surgical Procedures, which will be presented by spine surgeon Thomas Reilly, MD, FACS.

 For a complete spine symposium brochure, visit this link.

Paul Kraemer, MD, a spine surgeon with Indiana Spine Group, is featured in a video produced by Community Hospital. In this video, Dr. Kraemer discusses his philosophy of care and working with Community.

A few highlights of this video include:

• Dr. Kraemer’s working relationship with other physicians within Indiana Spine Group, to provide a comprehensive continuum of care to spine patients. In this section, he discusses the advantages of working in the same office with Jonathan Gentile, MD - a minimally invasive spine specialist.
• With the resources provided by Community Hospital, Dr. Kraemer is able to perform complex spine surgery; i.e. operating rooms, surgical equipment, staff expertise, ICUs, etc.
• There is a continued trend towards more minimally invasive spine surgery. This includes smaller incisions and less muscle movement.

Back Talk | A Comprehensive Review and Practical

Approach to Spinal Diagnosis and Treatment

One series of sessions at Indiana Spine Group’s continuing medical education / continuing education spine symposium will focus on the diagnosis of spinal disorders.  In one series of talks, speakers will highlight key issues and steps critical to spinal diagnosis. Topics will include:

• Spinal Anatomy – differentiating between normal and abnormal spinal anatomy (Speaker: Jonathan Gentile, MD, minimally invasive spine specialist with Indiana Spine Group)

• Diagnostic Pearls – identification of the critical components of the physical exam, and essential elements of the diagnostic work-up (Speaker: John Arbuckle, MD, minimally invasive spine specialist with Indiana Spine Group)

• Common Spinal Disorders – diagnostic indicators for disorders such as herniated discs, degenerative disc disease, spinal stenosis, spondylosis and more (Speaker: Kevin Macadaeg, MD, minimally invasive spine specialist with Indiana Spine Group)

• Disorders of the Bones – a review of conditions such as osteomalacia, Paget’s disease, spinal arthritis and osteoporosis (Rashid Khairi, MD, FACP, FACE, an endocrinologist with Diabetes & Endocrinology Associates) 

• Uncommon and Benign Disorders – a discussion of disorders such as infections and vascular disorders. (Kenneth Renkens, MD, FACS, spine surgeon with Indiana Spine Group)

•  The Role of EMG – the role and indications of EMG in the diagnosis of cervical and lumbar radiculopathy. (Larry Lett, MD, Center for EMG and Neurology)

I recently blogged about a new genetic test that predicts the likelihood of curve progression of patients diagnosed with mild adolescent idiopathic scoliosis (AIS) – the ScoliScore AIS Prognostic Test. 

Previously I did a series of blogs, defining scoliosis, reviewing scoliosis screening recommendations and treatment options (addressing bracing, and spine surgery).

Here are the links to those prior blogs:

            Scoliosis defined and general information 
Scoliosis screening guidelines 
Scoliosis treatment options 

Staff from Indiana Spine Group attended the 4th Annual annual spine run, sponsored by and benefiting The Spinal Research Foundation. The Spinal Research Foundation is a non-profit organization, who's mission is to improve spinal health care through research and education. Funds raised from the event will go directly to spinal research. 

This foundation was established by spine surgeon Thomas Schuler, M.D., F.A.C.S. in 2002. 
Since its inception, The Spinal Research Foundation has produced significant scientific research resulting in enhanced spinal care.  New technologies, treatments and techniques are the results of the research conducted by The Spinal Research Foundation.

For more information about The Spinal Research Foundation, visit this link.

A recent blogger submitted a few questions about degenerative disc disease, and asked about treatment options for the lumbar spine. 

The blogger asked the following:

What about dynamic stabilization devices as an alternative to lumbar fusion? I have been doing some online research, hoping to get plugged into a 522 study, or otherwise explore whether insurance might cover something like this in my situation. (2 degenerating discs.)

Paul Kraemer, MD, a spine surgeon with Indiana Spine Group responded to these questions.

First, there is no perfect treatment for degenerative discs. The technology of motion stabilization is still very much in its early infancy, and at this point that is probably not the best solution.

There are two categories of implants that exist, disc replacement and motion stabilization, but trials have had problems and neither is currently being implanted.  One motion stabilization implant, sought to minimize motion of the disc to prevent pain and decrease revision surgery, but no definitive proof for either of those claims exists, and they have run into recent trouble with the FDA for their longer term data. Another motion stabilization concept, facet replacement devices are motion preservation devices aimed at facet joints, and at least one recent trial was ended early by the FDA.

Disc replacement in the lumbar spine has been done for over 20 years and works well in appropriately selected patients.  This procedure is FDA approved, but insurance companies frequently refuse to acknowledge convincing data. The results for this surgery seem very reproducible, but it’s only approved for single level disease with healthy facet joints.

All of this skips over the point that back surgery is usually not the first or best answer for back pain, and many people with degenerative discs have little or no pain. It's always recommended to talk to a spine surgeon to see what your specific treatment options are.

In respect to web sites that provide spine specific information – a few very popular sites are Spine Universe and Spine Health.  

Construction on the new Indiana Spine Group dedicated spine center is progressing. In August 2010, Indiana Spine Group broke ground on this new 60,174 square foot facility, and in September 2011 they are projected to move. This new facility will be unique to Indiana, in that it will provide comprehensive care dedicated to spinal disorders in one centralized location. 

• Dedicated patient and visitor areas, with 16 patient exam/treatment rooms, waiting areas and a visitors cafe;
• Ambulatory surgery center, designed specifically for spinal and orthopaedic procedures;
• Imaging suite with MRI and CT scan;
• Physical therapy suite, with a complete gym and treatment rooms;
• Medical Academic Center that will house a bio-skills training lab, 65-seat amphitheater and other meeting areas;
• And more. 

In addition to the talks previously highlighted in prior blogs, I also gave a few talks on the cervical spine at the annual American Academy of Orthopaedic Surgeons continuing medical education meeting. One Instructional Course lecture, where I served as faculty, focused on the degenerative cervical spine and was entitled, “The Degenerative Cervical Spine: What You Need to Know”.  This talk focused on the evaluation and treatment options for the degenerative spine and it addressed anterior and posterior spine surgery options, as well as non-operative treatment options.

The other talk was a Podium Presentation of the research results for the five-year study of the Bryan Cervical Artificial Disc. This continuing medical education presentation was entitled, “Cervical Disc Replacement: Five Year Follow-up from the U.S. Prospective Randomized Bryan Trial”.  This link provides an overview of the initial results of this study – which followed spine surgery patients post-operatively for five years. Patients evaluated either underwent spinal fusion or arthroplasty (cervical artificial disc).

Congratulations to Dr. Rick Sasso for his recent publication! (Dr. Sasso is a spine surgeon with Indiana Spine Group). Dr. Sasso recently co-authored an article published in the recent issue of the SAS Journal. This journal is a publication of the International Society for the Advancement of Spine Surgery and the Society for Minimally Invasive Spine Surgery.

This article entitled, Lumbar Extraforaminal Decompression: A Technical Note and Retrospective Study Looking at Potential Complications as an Outpatient Procedure, published the results of a recent spinal study. This spine study retroactively evaluated the medical records of 100 patients from the same spine surgeon, who underwent spine surgery for lumbar disc herniation or stenosis. The spine surgical procedure was a type of decompression. This study concluded that extraforaminal lumbar decompression can safely be done as an outpatient spine surgical procedure.

In addition to planning and coordinating the symposium on spinal trauma, previously addressed in a prior blog entry, at the annual American Academy of Orthopaedic Surgeons meeting I also served as faculty for Instructional Course lectures. One Instructional Course was entitled “Differentiating Cervical Spine and Shoulder Pathology: Common Disorders and Key Points of Evaluation and Treatment.” This continuing medical education talk focused on the overlap of cervical spine and shoulder pathology, and addressed the diagnostic methods for differentiation.  One of the co-presenters of this session was Paul Kraemer, MD. Dr. Kraemer is also a spine surgeon with Indiana Spine Group.

Keynote Speaker Announced

Back Talk | A Comprehensive Review and Practical Approach to Spinal Diagnosis and Treatment

November 11 and 12, 2011 | Carmel, IN

Indiana Spine Group is excited to announce that Josh Bleill is the keynote speaker for their fifth annual spine symposium / continuing medical education program Back Talk.

On October 15, 2006, Marine Corporal Josh Bleill's life was forever changed. While conducting combat patrols in Fallujah, the Humvee he was riding in was struck by an improvised explosive device (IED). Two fellow marines lost their lives, one lost a leg and Josh lost both of his legs. After extensive surgeries and rehabilitation, Josh is one of  the first persons to use blue-tooth technology in his prosthetic legs, and one of two members of the U.S. military to utilize this new technology.  Josh describes his legs as "the power knees" and "the latest and the greatest." With this technology, initially developed for unilateral prosthetics, blue-tooth transmitter/receivers are attached to his ankles. Josh uses muscle movement with his thighs to initiate walking, and once he starts to walk the legs mimic each other as he takes steps.

While recovering at Walter Reed Medical Center, Josh had the opportunity to meet Colts players and team owner Jim Irsay. The Colts stopped by to visit with war veterans on their way to the White House, after their 2007 Super Bowl victory.  Deeply impressed, Mr. Irsay told Josh to see him about a job when he returned home. Today, Josh is a community spokesperson for the Colts, an author and motivational speaker.

Conference attendees will hear his story, as he talks about his enlistment, experience in active duty, injuries, recovery and life today. Learn more about Josh Bleill at  CNN, or read his recently published book One Step At A Time: A Young Marines Story of Courage, Hope and a New Life in the NFL.

I recently had a chapter that I co-authored published in a text book. This chapter was on sacral fractures and was published in Spine and Spinal Cord Trauma: Evidence-based Management.

This book is a continuing medical education resource for orthopaedic surgeons, spine surgeons and other health care professionals that treat spinal cord injuries and trauma. The goal of this book is to provide multiple treatment options, and objective reviews of state-of the-art procedures. In addition to the book, it also provides a video component that provides narrated videos and overviews of the spine surgical procedures highlighted in the book. This book is written by a multinational, multidisciplinary panel of spine experts and it is an honor to be included in this publication. For more publication information,visit this link.

Medline Plus defines kinematics as a discipline of physics that deals with the aspects of motion, separate from the considerations of mass and force. As a physician, I don’t really think of myself as a physicist – but recently I had the opportunity to study kinematics.

Recently I participated in a study to evaluate “cervical kinematics”. The purpose of cervical kinematics is to understand the motion of the cervical spine. Cervical kinematics has evolved as a result of the spine surgery procedures that alter the pathological structure of the cervical spine. In looking at the cervical spine and motion – cervical kinematics evaluates how the anatomical alterations affects an individual’s motion.

The study that I participated in evaluated the affects of cervical disc arthroplasty. This spine surgery procedure, which is relatively new and just recently received FDA approval, is a spine surgical alternative to standard spinal fusion in the surgical treatment of degenerative disc disease. With cervical disc arthroplasty, the damaged cervical disc is removed and an artificial cervical disc is implanted. The purpose of this study was to determine how movement is affected by the artificial cervical disc. In this study radiographic films were used to measure movement (distance) in the flexion and extension of the cervical area (neck) and it also utilized a computer assisted model. The results of this study were published this past June in Techniques in Orthopaedics. 

Congratulations to Rick Sasso, MD, a spine surgeon with Indiana Spine Group. He recently had a chapter published in a new spine surgery textbook, and an article published in a medical journal.

Dr. Sasso co-authored a chapter on sacral fractures published in Spine and Spinal Cord Trauma: Evidence Based Management. This book is now available for purchase.

As I previously blogged, I attended and participated in the recent continuing medical education meeting sponsored by the Cervical Spine Research Society.

Here is some information about this organization. The Cervical Spine Research Society, as its name implies, focuses on the cervical spine. It provides a forum for spine surgeons and other medical personnel to share information that promotes cervical spine research. Their vision statement is “The Cervical Spine Research Society is the recognized authority on diseases of the cervical spine.”

This past December, I served as a faculty member at the 15^th Instructional Course meeting for the Cervical Spine Research Society held in Charlotte, North Carolina. For this continuing medical education meeting, I was a member of the course program committee as well as a moderator and speaker.

The overall continuing medical education objectives for this meeting included:

·                     Review appropriate anatomy and biomechanics of the cervical spine,

·                     Compare the methods for diagnosis of neck disorders,

·                     Evaluate operative and non-operative treatment options for cervical   spine disorders, and

·                     Recognize and respond to complications of surgical treatment, and exchange information on cervical spine research, diagnosis and treatment with both US and international spine surgeons.

At this meeting, in a section on techniques in spine surgery, I lectured on C1 lateral mass/C2 laminar screw fixation for posterior atlantoaxial fusion. In that this was a spine surgical technique section, I described how the procedure was done and then presented a video demonstration.

There was another educational section on cervical myelopathy for which I was a co-moderator. During this section I also presented a talk on myelopathy. A basic definition of myelopathy is a functional or pathological change in the spinal cord.

A prior study published, evaluated patients two years following spine surgery and their participation in the Bryan Cervical Disc Trial. In addition to this study, a more recent study I participated in evaluated Bryan Cervical Disc study patients five years following their spine surgery.

This study concluded that patients still continued to have excellent spine surgical outcomes five years postoperatively in both study groups – arthroplasty (artificial cervical disc) and ACDF (spinal fusion). Additionally, those patients that had arthroplasty and received the Bryan cervical disc show significant improvement and less neck pain than those in the control group (spinal fusion). In respect to complications and a second spine surgery – both groups had low adverse effects. 

To read the abstract of this cervical disc replacement study, visit this link.