Kyphoplasty

Earlier this year, I was asked to present at the fourth annual meeting of the Lumbar Spine Research Society.

At this meeting, held in Chicago, I facilitated the discussions on the following papers: 

• the “Functional Outcomes and Height Restoration For Patients With Multiple Myeloma–Related Osteolytic Vertebral Compression Fractures Treated With Kyphoplasty”
• “The  The Effect of the Alpha‐2 Agonist Brimonidine on Intraocular Pressure During Prone Spine Surgery”

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)

Expanded Physical Therapy Services

The physical therapy center at the new Indiana Spine Group facility will be over 2,000 square feet. As you can see in the construction picture, it is a work in progress. This center will focus on physical therapy of patients with spine-related problems, as well as fitness models to improve an individual’s overall spine health. 

This physical therapy center is unique in that it will focus on the spine. According to Adam Ebbert, physical therapy coordinator at Indiana Spine Group, “we are excited about our expanded location in that we will be able to provide more comprehensive physical therapy services in one location.” In addition to physical therapy rehabilitation, therapists will also provide therapeutic exercise support. This program will provide patients with spinal problems, such as arthritis or osteoporosis, specific exercises to help them manage their spinal issues.

Patients are referred to physical therapy services by Indiana Spine Group physicians or their own physician.

For more information, or to schedule an appointment call (317) 228-7000.

At the annual American Academy of Orthopaedic Surgeons continuing education meeting this past spring, one research study presented evaluated the effectiveness of kyphoplasty.

Kyphoplasty is a minimally invasive spine treatment used to treat vertebral compression fractures as a result of osteoporosis. In this procedure, a balloon tamp is inserted in the affected spinal area. Once inserted, it is inflated to return the spine to the normal height and shape. The balloon is then removed, and bone cement is placed in the cavity/space created by the balloon.

This study included patients who had no more than three non-traumatic vertebral compression fractures. There were 149 patients in the kyphoplasty group, and 151 patients who received non-surgical treatment. Patients were evaluated over a two-year period.

This study concluded that those patients who underwent kyphoplasty faired better than those who had nonsurgical treatments. The kyphoplasty group had improved quality of life, reduced back pain and disability. The study also concluded that both groups had similar adverse affects. To ready a summary of this study, visit this link.

Most likely when you think of osteoporosis, you think of a disease that affects older individuals. But did you know that the health habits of teens can affect their risk for osteoporosis? This spine wellness blog will provide resources for you and your teen(s).

This fall the Health and Human Services launched a new program to influence girls aged 9 – 15 to eat healthy now! This campaign encourages spine wellness and is called The Best Bones Forever!™ Campaign. This program encourages girls to get active and eat more foods with calcium and vitamin.
 

“It is important for teens to pay attention to the amount of calcium and Vitamin D in their diet, as well as develop spine wellness health habits. When you are young, bone is replaced at a more rapid rate. So essentially, when you are a teenager you are building your “bone bank” for later years,” says Kevin Macadaeg, MD, a minimally invasive spine specialist with Indiana Spine Group. “And by 18, an individual has built most of their bone mass,” Macadaeg continues.

The new osteoporosis program for teens and their parents, Best Bones Forever, has a web site with resources and information to get started on bone healthy future. Click here, to visit the web site and resource center.

One essential ingredient to overall spine health and a tool in the fight against osteoporosis is Vitamin D. Vitamin D is essential to the absorption of calcium by your body. This spine wellness tip will provide the latest recommendations.

On November 30, 2010, the Institute of Medicine (ICM) released updated recommendations for Vitamin D and calcium for the prevention of osteoporosis.

The following is now recommended:

• Healthy adults under 71 – 600 IU (international units) of Vitamin D per day
• Healthy adults 71 and older – 800 IU of Vitamin D per day

Additionally, it is recommended that individuals with very little sun exposure, osteoporosis and other conditions/circumstances to intake more Vitamin D per day. Talk to your physician for your specific recommendations. To read the new recommendation, visit this link.

As you plan your menus for the upcoming holiday season and New Year – think of a spine healthy menu. Healthy menus are not only beneficial to maintaining your weight, lowering your cholesterol to just name a few of health benefits - but also for your overall spine wellness and health.

The National Osteoporosis Foundation provides a wealth of spine wellness and health resources to aid in the prevention of osteoporosis. Visit this link, to learn more about healthy eating tips and your spine.

It is estimated that 10 million Americans have osteoporosis. Sometimes called the “silent disease”, osteoporosis is a leading cause of fractures in older adults. According to the National Osteoporosis Foundation, approximately 50 percent of women with osteoporosis will break a bone in their life time, and one of four men with osteoporosis will experience a fracture.

Fractures as a result of osteoporosis are most likely to occur in the hip, spine or wrist. It is estimated that there are more than 700,000 vertebral compression fractures each year as a result of osteoporosis.

For more information about osteoporosis tips for prevention, treatment options, visit the National Osteoporosis Foundation’s web site.

Watch for upcoming spine wellness blog entries addressing osteoporosis and your spine’s health.

We are all aware of the dangers of smoking. Cancer, increased risk of stroke, coronary heart disease, are only a few of the risks. 

This spine wellness blog entry – will focus on smoking and your spine.

When you think of smoking and your overall spine health:
 

• Smoking contributes to early and more severe degenerative disc disease as a result of the nicotine blocking the transportation of oxygen and other important nutrients to the spinal discs. (This is true for nicotine in any form). When spinal discs are deprived of oxygen, the discs are less able to repair themselves which leads to earlier collapse than what is seen in non-smokers.

• Smoking results in slower healing times for individuals that undergo spine surgery (back surgery).

• Female smokers who are postmenopausal, have lower bone density than women who have never smoked. This lower bone density can increase the risk for osteoporosis and fractures (e.g. hip fractures).

The good news is when you stop smoking, this helps to reduce your health risks. Additionally, there are many resources to help individuals stop smoking and the American Lung Association provides a lot of programs for both adults and teens. For more information about how to stop smoking, visit this link and talk to your physician.

• 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. 

Back Talk, Indiana Spine Groups continuing medical education symposium, will provide concurrent sessions in addition to the two educational tracks (general and in-depth) and general sessions. These concurrent educational sessions will provide conference attendees a wide array of topics related to spinal conditions and treatments. A few of the concurrent sessions include:

Myths and Realities | Treatment of Vertebral Compression Fractures – This session, which will be presented by Indiana Spine Group minimally invasive spine specialist Kevin Macadaeg, MD, will highlight the symptoms, diagnosis and treatment indicators for vertebral compression fractures. Vertebral compression fractures have been identified as one of the most common fragility fractures in the U.S. During this educational session, two common treatment procedures for vertebral compression fractures will be discussed – this includes kyphoplasty and vertebroplasty.    

The Wellness Paradigm – Presented by chiropractic physician Nate Blume, DC, this continuing medical education session will apply the concept of functional medicine to spine health. The role of functional medicine in spinal health looks at contributing factors such as genetics and lifestyle. In this session, how to apply a wellness model to patient care and the role of functional medicine to improve the quality of a patient’s back health will be discussed. 

(Nate Blume, DC, is a chiropractic physician with Lakeside Chiropractic.)

Osteoporosis, also called the silent disease, has been estimated to affect 10 million Americans.  Another 34 million are projected to have low bone mass, according the National Osteoporosis Foundation. Needless to say, this critical topic will be discussed at Indiana Spine Group’s annual continuing medical education symposium Back Talk. This talk entitled The Silent Disease | Osteoporosis Updates will be presented by William Schmalz, MD, an internist from Bloomington, Ind.

During this talk, Dr. Schmalz will discuss the latest screening, diagnostic and treatment algorithms for osteopenia and osteoporosis, including the recommendations for various demographic groups, e.g. teenagers and young adults. Additionally, Dr. Schmalz will review the indications and contra-indications of medications and hormone replacement therapy in the prevention and treatment of osteoporosis – and will address the menopausal and post-menopausal life stages. 

The next series of blog entries will focus on a few spine wellness tips.  Simple solutions that provide health benefits to your spine. 

One popular New Year’s resolution is to go on a diet and lose weight.  Losing weight provides many health and wellness benefits, including spine wellness.  Did you know that obesity is one contributing factor to back pain? 

Spine Wellness Tip #1: Drop Some Pounds 

According to the National Osteoporosis Foundation one in two women and one in four men will sustain an osteoporotic fracture sometime in their lives.  One of the most common fractures as a result of osteoporosis is a spinal fracture. 

In this spine wellness educational video, Dr. Kevin Macadaeg discusses osteoporosis and vertebral compression fractures.  Dr. Macadaeg is a minimally invasive spine specialist with Indiana Spine Group. 

One procedure performed by the minimally invasive spine specialists at Indiana Spine Group is vertebroplasty.  Vertebroplasty is one of the treatment options for vertebral compression fractures. 

During vertebrplasty,a very specialized orthopaedic cement is injected into the vertebral body.  The advantages of vertebroplasty include:  immediate fix of the fractured area of the spine, that area of the bone is stronger as a result of the cement and the patient has pain relief in 1-2 days. 

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.

In these next series of blog entries – I will answer common questions about scoliosis – including the diagnosis, and provide an overview of the treatment options both medical and surgical treatments.

The Scoliosis Research Society defines scoliosis as a lateral deviation of the normal vertical line of the spine, which is greater than ten degrees when measured by an X-ray.  Scoliosis is often referred to as “curvature of the spine.”

According to the National Scoliosis Foundation (NSF), scoliosis affects 2-3% of the population.  The common age for onset is 10-15 years, old and it affects both genders equally although females are eight times more likely to have a greater degree of curvature that requires treatment the NSF indicates.  Although scoliosis is not heredity, there is an increased likelihood of an individual being diagnosed with scoliosis if a family member has had it. 

The different types of scoliosis include:

§         Idiopathic Scoliosis – This is where scoliosis occurs without a known cause.  This is the most common type of scoliosis.

§         Congenital Scoliosis – This is when an individual is born with scoliosis as a result of the vertebrae not being properly formed during pregnancy.  This malformation occurs within the first six weeks of embryonic formation.

§          Neuromuscular Scoliosis – This is caused as a result of a neurological disorder such as muscular dystrophy that results in a weak trunk and the individual can not support the weight of their body.

§         Adult Scoliosis – This is when scoliosis is diagnosed in an individual as an adult.  It can either be undiagnosed scoliosis when the individual was younger or the result of age-related degeneration.  An example of age-related scoliosis is osteoporosis. 

If you have a question on scoliosis that you would like answered in this series of blog entries, please send your question to info@indianaspinegroup.com. 

A recent blog entry referenced the International Osteoporosis Foundation (IOF).  The IOF is an international non-profit organization headquartered in Switzerland, whose mission is to increase awareness and understanding of osteoporosis.  Their goals are to:

·                     Increase awareness and understanding of osteoporosis.

·                     Motivate people to take action to prevent, diagnose and treat osteoporosis.

·                     Support national osteoporosis societies in order to maximize their effectiveness.

According to the IOF:

• Osteoporosis affects 75 million people in Europe, USA and Japan.
• In 2000, 9 million individuals suffered an osteoporotic fracture.
• I out of 3 women and 1 out 5 men will suffer an osteoporotic fracture. 
• Of these fractures, approximately 58% will be spinal fractures. 

The World Health Organization (WHO) introduced a new diagnostic tool in the fight against fractures resulting from osteoporosis.  This new risk assessment tool – call FRAX (fracture risk assessment tool), was created to provide a way to assess the risk for osteoporotic fractures more accurately.   FRAX provides the 10-year probability that an individual may have a major osteoporotic fracture; including hip, clinical spine, forearm, hip or shoulder.  FRAX takes into consideration the results of the FRAX questionnaire and bone mineral density (BMD) at the femoral neck (part of the thigh bone that connects to the hip joint).