Non Surgical Spine Treatment

This past spring I had the honor of presenting at the annual continuing medical education meeting of the American Association of Neurological Surgeons / CNS Section on Disorders of the Spine and Peripheral Nerves. The focus of this medical education meeting, held in Phoenix, was Evidence-Based Spine Surgery in the Real World.

At this medical education program I was a faculty member for a section on cervical myelopathy, and presented on Myelopathy at the CVJ. This course reviewed and discussed the evaluation and treatment algorithms of cervical myelopathy and discussed surgical approaches. Additionally, etiology, pathogenesis and diagnosis of cervical myelopathy were reviewed. A few of the continuing medical education objectives of this session are outlined below.


Participants will be able to:

•  Synthesize appropriate anatomy and biomechanics of the cervical spine.
•  Differentiate the methods for diagnosis of neck disorders.
•  Apply operative and non-operative treatment options for cervical spine       disorders. 
• Recognize and respond to complications of surgical treatment, and more.

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.

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.

I recently co-authored a few chapters in a continuing medical education book published by the American Academy of Orthopaedic Surgeons. This continuing education, instructional course lecture spine book focused on the Bryan disc and motion.

A few chapters of this book included:

• Emergency evaluation, imaging and classification of thoracolumbar injuries
• Nonsurgical treatment of thoracolumbar spinal fractures
• Surgical treatment of thoracolumbar fractures
• Update on cervical artificial disc replacement
   

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

I am chairman of a continuing medical education program for spine surgeons which will be held in Chicago during November. This program, sponsored by the American Academy of Orthopaedic Surgeons, is titled “Contemporary Techniques in Spine Surgery.”

This is an interactive continuing medical education program which will provide spine surgeons the opportunity to learn the latest surgical techniques for addressing spinal pathology. This program will provide a comprehensive overview of the diagnosis and treatment of spinal pathologies, as well as applicable surgical techniques of the cervical, thoracic and lumbar spine. Additionally, this course will provide a hands-on lab where spine surgeons will have the opportunity to perform these newer procedures under expert direction.

A few course objectives include: 

·        Evaluate patients with cervical, thoracic, and lumbar spinal pathologies and formulate a treatment plan.

·        Compare and contrast various surgical and nonsurgical treatment protocols for spinal pathologies.

·        Discuss alternative treatment and rehabilitation techniques for spinal disorders.

·        Compare and contrast techniques of different surgical approaches to specific spinal disorders.

 To learn more about this spine surgery continuing medical education program, click here.

A prior blog entry highlighted a research study that Dr. Renkens, a neurosurgical spine surgeon with Indiana Spine Group, was participating in for lumbar disectomy.  Dr. Renken’s is also participating in a clinical research study for the surgical treatment of spinal stenosis. 

Spinal stenosis is a degenerative spine disease where one or more areas of the spine narrows.  Usually affecting individuals in their 50’s and 60’s, spinal stenosis is most often caused by osteoarthritis-related bone damage.
 
Symtpoms include pain or numbness in the lower legs, back, neck, shoulders or arms, a loss of sensation in extremities, tingling or weakness.  Depending on the severity of the spinal stenosis – treatment may range from physical therapy to surgery.  

The study that Dr. Renkens is participating in is for more severe cases of spinal stenosis – where surgery is required.  The name of this study is A Prospective and Randomized Controlled Trial to Evaluate the Safety and Effectiveness of Total Facet Arthoplasty in the Treatment of Degenerative Spinal Stenosis.  In this study, Dr. Renkens will be using the Archus Total Facet Arthoplasty System (TFAS), which is a non-fusion spinal implant for the treatment of patients with moderate to severe spinal stenosis.  This TFAS, provides an alternative treatment for spinal stenosis as an alternative to spinal fusion – which is one spine surgical treatment for spinal stenosis. 

For more study information, click here. 

In some of my blog entries, I have discussed surgical procedures for a herniated cervical disc.  These surgical procedures include spinal fusion and artificial cervical disc replacement.  The good news is that very few individuals with a herniated cervical disc require surgery.  It is projected that only about 5-10% of patients with a herniated cervical disc need surgery.

Many times medical management is an effective treatment for herniated cervical discs.  To learn more about the non-operative spine treatment options for a herniated cervical disc, click here.  This is an article that I wrote for Spine Universe, which outlines the non-surgical treatments for herniated cervical discs. 

In some of my blog entries, I have discussed surgical procedures for herniated cervical disc.  These surgical procedures include spinal fusion and artificial cervical disc replacement.  The good news is that very few individuals with a herniated cervical disc require surgery.  It is projected that only about 5-10% of patients with herniated cervical disc need surgery.

Many times medical management is an effective treatment for herniated cervical discs.  To learn more about the non-spine surgical treatment options for herniated cervical disc, click here.  This is an article that I wrote for Spine Universe, which outlines the non-surgical treatments for herniated cervical discs. 

This blog entry will highlight more frequently asked questions about degenerative disc disease.

Q: How do you treat degenerative disc disease?

A:  The most common treatment for degenerative disc disease is non-operative treatment.  Usually, it gets better with rest - in a few days to a week. If necessary, people will get steroid injections to help eliminate the back pain.

Unfortunately, in some cases it does not resolve itself with non-operative treatments - especially if it's associated with weakness or tingling. Approximately, 200,000 people in the United States each year will undergo spine surgery for degenerative disc disease.  The goal of this spine surgery is to take the pressure off of a nerve in the neck.

Q: What does that operation consist of?

A: The standard spine surgery procedure for degenerative disc disease is a spinal fusion.  This is where we take the pressure off the nerve and then fuse that segment. The main disadvantage of the spinal fusion is that when we fuse a disc, there may be a quicker wearing out of those discs next to the fused disc.  Once a patient has a fusion, there is about a 30 percent chance, that in the next 10 years the patient will need a spinal fusion at a different disc level.

A:  Is there an alternative procedure to a spinal fusion for the treatment of degenerative disc disease?

Q:    Over the decades, medical researchers have been trying to develop artificial discs that would allow continued normal motion across that segment – a mobile disc.  Needless to say, it is s a lot harder than the development of an artificial hip or knee.

Fortunately, there has been great success in this development.  Just last summer, the Food and Drug Administration approved a surgical cervical disc replacement and recommended approval for another cervical disc.  (To see FDA announcement, click here.)  Additionally, there are many more similar devices under development.  
 

Spinal therapeutics is the term used to treat spinal pain and disorders that is non-surgical.  In approximately 80% of the time, non-surgical treatment is effective – depending upon the diagnosis.

Spinal therapeutics is divided into two categories and these are medical and minimally invasive treatments.  Types of medical treatments include physical therapy, bracing and medications.  Types of minimally invasive treatments include the spinal injections, IDET, radiofrequency rhizotomy and nuceloplasty. 

In upcoming blog entries – we will review some of the common treatments, and when they would be recommended by your physician.

The Back Talk agenda is in the process of being finalized. 

Conference topics will include information about the diagnosis of spinal pain including spinal imaging.  There will also be presentations about medical and minimally invasive spinal therapeutics including the non-operative management of spinal problems and minimally invasive treatments. 


The section on spine surgery will address the appropriate timing for patient referrals for spine surgery and when surgery is an option.  Additionally, the surgery section will discuss surgical options for lumbar surgery and surgical options for cervical degenerative disc disease – including updates on cervical artificial discs. 

Indiana Spine Group is a center of excellence for the treatment of spinal disorders and abnormalities.  Located in Indianapolis - with offices in Kokomo and Anderson, we provide comprehensive spine care – including interventional pain management treatments, nonsurgical spine treatments, minimally invasive spine procedures, minimally invasive spine surgery and spine surgery.  Treating both adults and children, some common diagnoses that we treat include degenerative disc disease, spinal stenosis, herniated cervical disc, failed back syndrome, osteoporosis and scoliosis. 

Physicians with Indiana Spine Group include:

§          Ken Renkens, MD (neurosurgical spine surgeon)

§           Rick Sasso, MD (spine surgeon)

§           Kevin Macadaeg, MD (minimally invasive spine specialist)

§           Thomas Reilly, MD (spine surgeon)

§          Jonathan Gentile, MD (minimally invasive spine specialist)

§          John Arbuckle, MD (minimally invasive spine specialist

All About Our Spine Symposium - Continuing Medical Education  

Welcome to Indiana Spine Group’s spine education blog.  The purpose of this blog is to provide information about continuing medical education opportunities sponsored by Indiana Spine Group.  In 2007, Indiana Spine Group hosted their first spine symposium for physicians and other health care practitioners.  Over 120 people attended this conference. 

At this conference, we kept hearing about the need for this type of conference – so Indiana Spine Group is going to host a spine symposium in 2008.  Entitled Back Talk – the second spine symposium will be held on August 22 and 23, 2008.  This continuing medical education conference for physicians and other health pracititioners will provide the latest information on interventional pain management - including non-surgical spine treatments, minimally invasive spine procedures and back surgery (cervical and lower back surgery) - helping practitioners treat their patients with back pain and spinal disorders.

To learn more about the conference call 317.228.7000 or click here.   

If you would like to receive a spine conference brochure, send us your contact information.  This can be faxed to 317.228.9029 or emailed to lkriech@indianaspinegroup.com.