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. 

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. 

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). 
 

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.

When an individual continues to have chronic back pain and/or leg pain following back surgery; it is referred to as failed back syndrome. A few treatments for this can include physical therapy or non-steroidal anti-inflammatory medications (NSAID). If medical management is ineffective another treatment option available is a spinal cord stimulator.

A spinal cord stimulator is an implantable device that uses an electrical current to provide a tingling sensation that helps to mask the chronic pain. Dr. Gentile describes it as “a kind of pacemaker for pain.”

In this video, Dr. Gentile describes the procedure for implanting a spinal cord stimulator. Dr. Jonathan Gentile is a minimally invasive spine specialist with Indiana Spine Group.

This procedure is available at Indiana Spine Group. For more information, call 317.228.7000 or toll-free 866.947.7463.

Learn more about spinal / back pain with this education video. This video features Dr. John Arbuckle as he discusses back pain; including the definition, diagnosis and early treatment.  Dr. Arbuckle is a minimally invasive spine specialist with Indiana Spine Group. 

Generally when a patient’s spinal pain is longer than four to six weeks, and the pain is not relieved with the passage of time, anti-inflammatory medications or even physical therapy – a minimally invasive spine specialist will see the individual to evaluate the cause of this pain. 

Minimally invasive spine specialists with Indiana Spine Group include John Arbuckle, M.D., Jonathan Gentile, M.D., and Kevin Macadaeg, M.D. 

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.

If you were not able to attend Indiana Spine Group’s continuing medical education conference, Back Talk | Comprehensive Concepts in the Diagnosis and Treatment of Spinal Disorders -  educational sessions are now available on-line.

Educational Sessions include:

• The Fundamentals of Spinal Diagnostics | Kevin Macadaeg, MD
• Common Spinal Disorders | Paul Kraemer, MD
• The Uncommon and Difficult | Part One: Benign | Michael Stack, MD, PhD
• The Uncommon and Difficult | Part Two: Urgent | Kenneth Renkens, MD
• The Basics | Spinal Imaging | Thomas Reilly, MD
• Non-Operative Care: An Evidence-Based Overview | Jonathan Gentile, MD, and Jeff Hebert, DC, PhD (c)
• Minimally Invasive Spine Treatments | John Arbuckle, MD
• The Surgical Patient | Part One: Cervical | Rick Sasso, MD
• The Surgical Patient | Part Two: Lumbar | Kenneth Renkens, MD

To view these continuing education sessions, click here.  Additionally, if you would like to receive continuing medical education credits for viewing theses sessions, visit the St.Vincent Distance Education Site and view from there. Registration is free.

 
(A very special thank you to St.Vincent Spine Center for making these videos possible.) 

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.

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.