In July 2009, an article that Dr. Kenneth Renkens co-authored was published in the Journal of the American College of Surgeons. This article was entitled “A Phase 3b, Open-Label, Single-Group Immunogenicity and Safety Study of Topical Recombinant Thrombin in Surgical Hemostatis”.

This study evaluated the affects of a topical hemostat during surgery. (Note:  a topic hemostat is used to control bleeding during spine surgery and other surgical procedures).   For an abstract of this study background and conclusions, link here. 

Dr. Kenneth Renkens is a neurosurgical spine surgeon with Indiana Spine Group. 

Often time’s patients that have idiopathic scoliosis may also have a visible rib deformity that may be present following corrective spine surgery.  The traditional spine surgical procedure to correct this has been open thoracoplasty.  A newer, minimally invasive procedure used is video- assisted thoracoplasty.  This procedure is less invasive than the traditional spine surgical procedure.

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.

Many times with scoliosis - no treatment is needed.  Once a patient is diagnosed with scoliosis it is important to observe and monitor the curve during the patient’s growing years.  Factors that affect what type of treatment is recommended include the age of the patient and how much growth they have left, the degree and pattern of the curve, and the type of scoliosis. 

Treatment options may range from observation to surgery.  If it is decided that the patient will be observed; they will be evaluated approximately every six months while the patient is still growing.  At this time, the degree of the curve will be assessed.

Bracing is a treatment option to prevent the curve from progressing.  This is recommended if the patient has an idiopathic curve, is still growing and:

• Has a curve greater than 25 degrees,
• Has two more years of potential growth remaining and the curve is between 20 and 29 degrees, (and if female has not had her first menstrual period) or
• Has a curve that is between 20 and 29 degrees and is progressing.   

This spine wellness blog entry will address more about the effects of smoking and your spine’s health.  In this Spine Universe article, it summarizes the negative effects of smoking and its impact on the spine surgery procedure of spinal fusions. 

A general definition of a spinal fusion is that it is a spine surgical procedure that joins bony segments of the spine (vertebrae) – this spine surgery can be performed at the lumbar, thoracic or cervical areas of the spine.  As a part of the healing / fusion process of this spine ssurgery there needs to be new bone growth.  Many factors can affect the success of a spinal fusion and can include the patient’s overall health, other medical conditions and smoking. Research has shown that habitual cigarette smoking results in less successful spinal fusions when compared to similar spine surgical procedures performed on nonsmokers.  Additionally, another study indicated that individuals that smoked had a higher post-operative infection rate than nonsmokers. 

Earlier this year, Dr. Rick Sasso and I were asked to write a spine continuing education chapter on “Controversies in Cervical Spine Surgery”, specifically about a newer spine surgical technology known as dynamic plating for cervical fusions.  Traditional plates, known as static plates, have a high success rate, but in reviewing the published reports of direct comparisons between the two plates, the dynamic plates have a slightly higher percentage which fuse.  It may be even more beneficial in longer fusions.

I have switched my practice to essentially using only the dynamic plates for cervical spinal fusions.  I have been very happy with the  results.  As with all new technology, it is important to carefully monitor results and compare them against established techniques.  I'm keeping an eye on continuing trials even as I incorporate this technology into my own practice.

(This blog entry was written by Paul Kraemer, MD; a spine surgeon with Indiana Spine Group). 
 

A prior spine wellness blog entry highlighted the Great American Smokeout, held on November 19.  This spine wellness blog entry will address smoking and your spine.  Usually when you think about the health effects of smoking – you think about cancer and heart disease.  But smoking also affects your spine wellness and as a recent study indicated, can contribute to lower back pain.

Study results published on Spine-Health.com indicated that there is a link between smoking and lower back pain.  The study concluded that the development of lower back pain was linked to smoking history and hypertension.  Additionally, the development of lumbar spondylosis was also associated with smoking history and hypertension.

In October, I was a faculty member at the 8^th Annual Symposium on “Innovative Techniques in Spine Surgery.” This continuing education meeting, hosted in Phoenix, addressed the innovative and emerging technologies of spinal surgery including; arthroplasty, minimally invasive procedures, motion sparring technologies and biologics.  At this meeting I gave a talk on Lumbar Artificial Disc Replacement, and presented the results of the FDA studies for the Cervical Artificial Disc.

This education program was sponsored by the Organization of Spinal Teaching and Research.  The purpose of this group is to facilitate education and discussion among spine care providers and industry and this organization includes leaders in the field of spine surgery and technology that utilize the most advanced and effective technology available for the treatment of spinal disorders.

Another condition of the lumbar spine is spondylolisthesis. Spondylolisthesis is the result of degenerative changes in the joints of the spine that cause a shifting of alignment. Generally the L4 (lumbar vertebrae) – will slip forward over the L5 (lumbar vertebrae). 

Learn more about spondylolisthesis, the symptoms and treatments with this educational video by Kenneth Renkens, M.D. Dr. Renkens is a spine surgeon with Indiana Spine Group. 

Spinal stenosis is a general term that refers to the narrowing of the spinal canal. Often this is a degenerative condition resulting from aging. More commonly found in the lumbar (lower back) spine, it also occurs in the cervical (neck) spine. 

Learn more about spinal stenosis, the diagnosis and treatment with this education video featuring Dr. Kenneth Renkens.   Dr. Renkens is a neurosurgical spine surgeon with Indiana Spine Group. Orthopaedic spine surgeons with Indiana Spine Group include Rick Sasso, M.D., Thomas Reilly, M.D., and Paul Kraemer, M.D.

In the movie Princess Dairies there is a scene where Mia, played by Anne Hathaway, is practicing good posture with a book on her head and walking across the room. 
Although books are not required, good posture is important in preventing lower back pain. 

This spine wellness tip will highlight how to evaluate your posture. 

1. Stand with your heels against the wall.
2. Your head, shoulders, calves and buttocks should be touching the wall. (Once you do this, you should be able to place your hand behind the small of your back).
3. Now, take a step forward – this is how your posture should be.

Previously, I blogged about the research results of a spine patient study – which evaluated the clinical outcomes of patients who received a Bryan Cervical Disc compared to those that had a standard spinal fusion at 24-months post-operatively. I recently completed a new study, which evaluated these patients 48-months post-operatively. This study will soon be published.

In this study – the functional outcomes of patients at 48-months (4 years) following their spine surgery was evaluated. This study had two groups of patients – one group received a spinal fusion (Anterior Cervical Discectomy and Fusion - ACDF) and the other group received the Bryan cervical artificial disc prosthesis. This spine surgery was for the treatment of radiculopathy and myelopathy, after minimally invasive spine procedures were determined ineffective.

There were 47 patients enrolled in this spine study. Of this group, 21 were enrolled in the Bryan cervical disc arm of the study and their mean age was 40.  In the group that received a spinal fusion (control group), there were 26 participants and their mean age was 43.

This study concluded that patients that received the Bryan Artificial Cervical Disc at 48-months, when compared to the control group:

•     Had less neck and arm pain,
•     Greater mobility,
•     Less adjacent segment degeneration, and
•     Lower secondary operation rate.

The St.Vincent Orthopedic Center and St.Vincent Spine Center recently earned the Joint Commission’s Disease-Specific Care Certification for joint replacement and spine surgery, respectively. The Joint Commission is the nation’s premier healthcare accreditation entity.  Read the complete story in the Indianapolis Star. 

Dr. Rick Sasso, co-medical director of the St.Vincent Spine Center spine surgeon with Indiana Spine Group was quoted in this article.

Another session at Back Talk, the continuing medical education symposium for physicians and health care practitioners will address the failed back. Sometimes called failed back syndrome, failed back surgery or post-laminectomy syndrome – these patients continue to have ongoing back pain following spine surgery. 

This session will be presented by minimally invasive spine specialists Jonathan Gentile, MD, and John Arbuckle, MD, and spine surgeon Paul Kraemer, MD. With Indiana Spine Group, these physicians treat patients at our offices located on the north side of Indianapolis. 

During this continuing medical education session, the tools for physicians and health care practitioners to perform a diagnostic assessment of patients with chronic back pain following spine surgery will be highlighted. This diagnostic assessment will help caregivers to understand the underlying causes of ongoing back pain, and the mechanism of failed back. Additionally, medical and interventional treatments for failed back will be discussed – their indications and expected outcomes.

Many times, when people have chronic lower back pain – they experience a greater level of depression than individuals without chronic back pain. This continuing medical education session at “Back Talk” will provide physicians and health care practitioners insight into learning to recognize and assess psychological risk factors of patients with acute and chronic back pain. 

During this session entitled "Psychological Barriers," Ricks Warren, PhD, ABPP, will identify psychological issues in patients with chronic back pain and malingering. Additionally, he will review the psychological barriers for effective treatment of acute and chronic spinal problems – and identify the warning signs and when referral to a metal health professional is indicated. 

Ricks Warren, PhD, ABPP joins the Back Talk continuing medical education  faculty from Michigan. Dr. Warren is a clinical lecturer and psychologist with the Department of Psychiatry at the University of Michigan Medical School in Ann Arbor. 

I recently went to Austria to attend the 16^th International Meeting on Advanced Spine Techniques (IMAST). For this spine continuing medical education conference, I was a faculty member and invited faculty speaker. This spine conference, sponsored by the Scoliosis Research Society, is an international forum where spine surgeons from around the world discussed the latest research and advanced spine technologies. The goal of this conference is to improve the quality of patient care.

While at this conference I participated in a few instructional lectures. I moderated a spine surgery education series on Options in Cervical Fixture and Motion and presented a talk on Current State of Cervical Motion Technology.  Additionally, I participated in a instructional lectures series on Cervical Trauma and presented a talk on C1 – 2 fractures. 

In addition to the instructional lectures, I participated in a round table discussion on Cervical Reconstruction. This discussion provided an opportunity for spine surgeons from around the world to discuss case studies presented. 

In July, Jonathan Gentile, MD, spoke during the luncheon at the annual Indiana Academy of Family Practitioners (IAFP) conference. This lunch was sponsored by St.Vincent Health, a strategic partner with IAFP. 

Dr. Gentiles talk entitled Understanding the Failed Back, addressed the following:

•  The assessment of patients following spine surgery who continue to suffer from  ongoing chronic back pain; and identification of failed back.
• The treatment options for failed back; their indications and effectiveness.