Minimally Invasive Spine Surgery

In a prior blog entry, I highlighted a few of the talks I participated in at the annual Scoliosis Research Society meeting. The acronym for this annual continuing medical education meeting is IMAST, and stands for International Meeting on Advanced Spine Techniques.

This international meeting brings experts on spine surgery from all over the world to discuss the latest surgical techniques, devices as well as it provides a forum to provide the latest on research in progress.

The overall educational objectives of this meeting are listed below.

At the completion of this program, participants should be able to:

1. Assess the most recent advances in surgical techniques for the treatment of spinal disorders and when to use them, in the interest of providing optimal patient care.

2. Analyze the indications and potential complications for various spine fixation systems including spinal arthroplasty.

3. Recognize emerging technology that has the potential to improve patient outcomes for specific indications and populations.

4. Understand when it may be appropriate to use biologic options to enhance spinal fusion.

• 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. 

Congratulations to Rick Sasso, MD, a spine surgeon with Indiana Spine Group, who was just awarded his eighth patent!  This is patent number 7,727,266 for a method and apparatus for retaining screws in a plate.  
 

This patent is for an anterior cervical plate, now called Venture.  This plate is used in spine surgery for patients suffering from a herniated disc or stenosis (disc degeneration), or after trauma, tumors or other conditions causing neck instability.  The plate is used to stabilize the cervical spine after removing the disc. 

Below is an abstract of this patent:

A retention system for maintaining a screw to a vertebral plate. One or more screws extend through apertures within the vertebral plate. A cavity is positioned adjacent to and overlaps into the aperture. A ring is positioned within the cavity and held in position by a cap. The cap attaches to the plate to prevent removal of the ring. The ring is deflectable between a first shape to allow the screw to be inserted and removed from the aperture, and a second shape to prevent screw back-out from the aperture. A method of using the system is also included and comprises positioning the ring within a cavity in the plate, maintaining the position of the ring to the plate by attaching a cap, inserting a screw through the aperture and attaching the plate to a vertebral member, and positioning the ring over the screw head and preventing the screw from backing-out.

Saturday’s continuing medical education sessions will include three concurrent sessions with nine different topics for conference attendees to choose from.  This blog entry will highlight those sessions available in “Concurrent Sessions Three” that will be on Saturday morning (9/11/10). 

These sessions will include:

The Anatomy of the Exam - This is a clinical workshop that will be co-presented by minimally invasive spine specialist Kevin Macadaeg, MD, and nurse practitioner Alta Skelton, RN, MSN, NP-C.  This workshop will provide an in-depth look at the patient exam and will utilize a live-model to demonstrate the critical components of the physical exam.  What is normal and abnormal during the cervical and lumbar exam will be discussed, as well as a review of the neurological exam.  Additionally, this session will also discuss multiple problems that present as back or should/neck pain and will review clinical algorithms. 

Active and Injured | A Look at Sports Injuries – This session, presented by chiropractic physician Tony Origer, DC, ATC, will highlight common sports injuries related to popular recreational activities of adults, e.g. golf, tennis, weights/fitness training and running.  This continuing medical education session will review the anatomical and physiologic functional changes of the spine that result with aging, and the effects of sports on the spine.  Additionally, the patient assessment of patients that present with spinal pain and injuries from sports-related activities will be discussed, as well as appropriate levels of care and red-flags. 

(Tony Origer, DC, ATC, is a chiropractic physician with Performance Chiropractic and Sports Rehabilitation.)
 

The Workplace | Back Pain and Injuries |  This continuing medical education concurrent session will be presented by Marc Duerden, MD, FAAPM&R, CIME.  Dr. Duerden is a physical medicine and rehabilitation physician with Rehabilitation Associates of Indiana. 

According to the Bureau of Labor Statistics, it is projected that annually more than one million workers injure their back representing one out of five work place injuries.  During this session Dr. Duerden will review common workplace spinal injuries and their contributing factors to back pain.  Additionally, the short- and long-term effects on the worker’s status will be reviewed.  Spinal conditions and physical attributes that predispose an individual to back injuries will be discussed as well as the indications and treatment options for low back pain.  

For more information about Back Talk, or to register click here, or call (317) 228-7000.

The Nutritionally Healthy Spine – This continuing medical education session, presented by Lori Petrie, RD, will continue to focus on a healthy spine and the importance of nutrition in achieving and maintaining a healthy spine. This session will provide important nutritional recommendations for a healthy spine.  In addition to diet and lifestyle other factors that will be addressed for a healthy spine will include popular over-the-count medications, and a review of herbal, vitamin and nutritional supplements. Ms. Petrie is an outpatient nutritional counselor with St.Vincent Hospital.

Back Pain | Chronic and Failed – It is estimated that approximately 40% of individuals that undergo back surgery continue to have back pain.  Jonathan Gentile, MD, a minimally invasive spine specialist with Indiana Spine Group will address this ongoing issue.  In this educational session he will address both chronic back pain and failed back syndrome and will discuss the differentiation factors, and the diagnostic perils.  Additionally, Dr. Gentile will discuss the treatment options, indications and patient selection for various treatment options.  One treatment option that will be highlighted will included the spinal cord stimulator, used as an option for failed back syndrome. 

For more information about Back Talk, visit our web site, or call (317) 228-7000.

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.)

Recently Rick Sasso, M.D., a spine surgeon with Indiana Spine Group,
co-authored a book chapter for a medical textbook. This chapter was titled “Anterior Lumbar Interbody Fusion.”  Anterior lumbar interbody fusion, usually referred to as ALIF, is a spine surgical procedure commonly used to treat discogenic low back pain - when non-operative measures are ineffective.

In this chapter, the historical background of anterior lumbar interbody fusion was reviewed. This spine surgery procedure was used as early as 1932 for the treatment of spondylolisthesis. Additionally, this chapter reviewed the biomechanics, patient selection, clinical studies, and imaging. To read this chapter, click here

Indiana Spine Group is hosting a fund raiser for The Leukemia and Lymphoma Society on September 11, 2010. This fund raiser is in honor of Kevin Macadaeg, MD, a minimally invasive spine specialist with Indiana Spine Group. Dr. Macadaeg was diagnosed with Grade 3A lymphoma in November 2009. All proceeds benefit The Leukemia and Lymphoma Society. 

 You and your guests are invited to attend! 

 Date:              September 11, 2010

Time:               7:00 p.m. – 11:00 p.m.

Place:               The Westin Indianapolis | 50 S. Capitol Avenue

Guests will enjoy live music, dancing and a silent auction. Hors d’ oeuvres will be served, and a cash bar available. 
Click here for more information, and to make your reservation or call (317) 228-7000.

One spine surgery research study that I participated in - compared the post-operative results of cervical arthroplasty and arthrodesis on approximately 500 patients. The objective of this study was to compare any side effects of patients undergoing a cervical arthroplasty with the implantation of a Bryan Cervical Artificial Disc to those patients that underwent a spinal fusion.

In this study, of which there were 31 institutions where patients underwent spine surgery, there were 242 patients who received the Bryan Cervical Artificial Disc and 221 patients that underwent cervical discectomy and spinal fusion. Patients that participated in this study were over 21 years of age, had single level cervical degenerative disc disease causing radiculopathy or myelopathy as well as a few other clinical indicators. Once identified, these patients were evaluated before spine surgery and post-operatively at regular intervals beginning one and one half months following spine surgery up to 2 years. 

This study concluded that both procedures are safe, and that there is not a significant difference in adverse effects with the newer arthroplasty procedure utilizing the Bryan Cervical Artificial Disc when compared to the traditional surgical option of spinal fusion.

 To read the complete study,link here.

At Indiana Spine Group’s Back Talk continuing medical education symposium, as highlighted in a previous blog entry , there are two educational tracks that will be available for conference attendees on day one.  In addition to the general track discussed in the prior blog, there is a more in-depth track entitled, More Specifics | Spinal Diagnostics and Treatment. 

In this education track there will be a few sessions focusing on the diagnosis of spinal disorders and abnormalities.  One session titled Spinal Imaging | Technology and Diagnosis, will be presented by Stephen Pomeranz, MD. Dr. Pomerance is a radiologist. In this session, Dr. Pomeranz will provide an in-depth look at spinal imaging technologies and highlight the latest developments in spinal imaging technology and their applications in spinal diagnostics.  Additionally, using case studies, he will review radiological finds and diagnostic indicators. 

The second session of this educational track will focus on The Electrodiagnostic Evaluation, and will be presented by physical medicine and rehabilitation specialist Dr. Shashank Dave.  During his presentation, Dr.Dave will discuss the role and application of electromyography in the diagnosis of spinal disorders and diseases.  Additionally, he will review case studies which utilize electromyography and identify specific diagnoses. 

Another session presented for the in-depth track will focus on Diagnostic and Therapeutic Injections of the Spine.  This will be presented by minimally invasive spine specialist John Arbuckle, MD.  During this session Dr. Arbuckle will review and differentiate between the different type of therapeutic injections and will review the treatment efficacy of injections, the clinical protocols, indications and expected outcomes. 

The last session of this continuing education track will highlight spine surgery, and is entitled Surgical Perspectives | Fusion vs Arthroplasty, presented by spine surgeon Rick Sasso, MD.  During this session, Dr. Sasso will provide a detailed analysis of spinal fusion and arthroplasty and he will discuss motion preservation modalities for the treatment of generative disc disease.  He will highlight lumbar and cervical artificial discs as well as review research studies and discuss patient selection, indications and expected outcomes. 

Planning continues for Back Talk | Comprehensive Concepts in Spinal Diagnosis and Abnormalities, Indiana Spine Group’s 4^th annual spine symposium. For this year’s conference there will be two educational tracks. One track will provide more general information and one in-depth. These tracks will be held the morning of day one. 

The general track is entitled: Spinal Care Boot Camp | Diagnostics and Treatment. There will be a session on spinal anatomy, entitled Spinal Anatomy 101, presented by minimally invasive spine specialist Kevin Macadaeg, MD.  During this session, Dr. Macadaeg will discuss the functional anatomy of the spine, normal aging process, the spine’s degenerative cascading process and normal and abnormal spinal anatomy.

Another general session which will be presented by minimally invasive spine specialist John Arbuckle, MD, The ABCs of Spinal Diagnostics. In this session, the etiology of spinal pain and common spinal disorders that cause back pain will be reviewed. Additionally, Dr. Arbuckle will discuss the indications and applications of spinal testing, evidence-based guidelines for the diagnosis of lower back and neck pain, and he will highlight the red flags of spinal pain. 

Two other sessions in this track include Understanding Spinal Therapeutics and The Spine Surgery Patient. In the spinal therapeutics session, presented by minimally invasive spine specialist Jonathan Gentile, MD, he will discuss the pharmacological management of acute and chronic back pain, review common noninvasive and minimally invasive spinal therapies and their indications. Spine surgeon Paul Kraemer, MD, will discuss the spine surgery patient and will provide an overview of common spine surgery procedures, their indications and expected outcomes. Additionally, Dr. Kraemer will discuss the applications and limitations of spine surgery, and when referral to a spine surgeon is indicated. 

For a complete Back Talk agenda, link here. 

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.