A. Additionally, the first patient to receive the Bryan Cervical Disc in the United States was interviewed. In a prior blog, the recent FDA-approval of the Bryan Cervical Disc ™ was announced. One of the advantages of this device and cervical arthroplasty, as a spine surgical treatment for degenerative disc disease, is that patients can return to work and their normal activities in a relatively short period of time. Generally, this time period is quicker when compared to a spinal fusion – which is the current standard spine surgical treatment to this newer procedure and technology. At this time, spinal fusion is the standard surgical treatment.
A study recently published in Neurosurgery, concluded that patients that underwent cervical arthroplasty returned to work on average about three months sooner than those patients that underwent a spinal fusion and cervical discectomy. The patients who received the cervical artificial disc returned to work in a median time frame of 101 days following their spine surgery (cervical arthroplasty) as compared to 222 days in the group that underwent the spinal fusion and cervical discectomy.
The second day of Back Talk, the continuing medical education symposium for physicians and health care practitioners, will provide a series of concurrent sessions where attendees will choose which topics they would like to attend. There are four series of sessions that will address specific diagnoses, overall spine wellness, discuss minimally invasive spine treatments including spinal cord stimulator and verteboplasty as well spine surgery treatments. Additionally, case studies will be reviewed. For a complete continuing medical education agenda, click here.
One treatment for ongoing back pain following spine surgery - sometimes referr
ed to as failed back syndrome, is a spinal cord stimulator. A spinal cord stimulator uses electrical impulses to help relieve chronic back pain. Previous blog entries have highlighted this procedure.
Dr. Jonathan Gentile, MD, a minimally invasive spine specialist with Indiana Spine Group, implants spinal cord stimulators - when indicated - in patients suffering from failed back syndrome. To watch him discuss this procedure, click here.
arthroplasty, is a newer spine surgery that is an alternative to traditional spinal fusion surgery. For patients that suffer from cervical degenerative disc disease, when medical management is ineffective, cervical arthroplasty may be indicated.In September, Indiana Spine Group is sponsoring a continuing medical education symposium entitled “BACK TALK: Comprehensive Concepts in the Diagnosis and Treatment of Spinal Disorders”. At this conference I will be providing a few talks – one is on spine surgery; specific to the cervical spine surgery patient. The other talk is on the future of spine care.
During the cervical spine surgery talk, I will be discussing the cervical pathology and diagnoses indicative for spine surgery – both degenerative and traumatic. Additionally, I will discuss common cervical spine surgical procedures, their indications and expected outcomes.
In the talk about the future of spine care – I will review the latest FDA-approved technologies and treatments. Additionally, I will discuss interventional and surgical innovations that are either in development or clinical trials. Additionally, this presentation will provide highlights about the cervical artificial discs; i.e. the Prestige™ artificial disc and the Bryan™ artificial disc.
We are excited to highlight another silver sponsor of Back Talk, Indiana Spine Group’s continuing medical education program – Globus Medical.
Globus Medical is dedicated to providing the most advanced, simple to use, highest quality spinal products. Their spinal products include the areas of fusion, minimally invasive surgery (MIS), biomaterials and motion preservation. Since its founding in 2003, Globus Medical continues to develop new technologies to improve patient outcomes.
The ultimate goal of Globus is to utilize superior engineering and technology to achieve pain free active lives for all patients.
Spine surgeons Drs. Rick Sasso and Kenneth Renkens, will be presenting a two part talk on The Surgical Patient at Back Talk. Back Talk is the continuing medical education symposium for primary care physicians and health care practitioners. These presentations will discuss the cervical spine surgical patient and the lumbar spine surgical patient. The goal of these continuing medical presentations is to help the practitioner understand who the ideal spine surgery candidate is, and the indications and expectations for spine surgery. Additionally, different surgical options will be discussed.
Dr. Rick Sasso, will discuss the cervical spine surgery patient. In this presentation he will review the cervical pathology and diagnoses for indicative of surgery – both degenerative and traumatic. Additionally, Dr. Sasso will discuss common cervical spine surgical procedures, their indications and expected outcomes.
For the lumbar spine presentation, Dr. Kenneth Renkens will discuss the indications and diagnoses when lumbar surgery is a treatment option. Dr. Renkens will also discuss common lumbar surgical procedures – their specific indications and the effectiveness of these lumbar spine surgery procedures.
Many times – conservative, non-operative therapies are an effective treatment for patients with back pain and spinal problems. This presentation at Back Talk, Indiana Spine Groups continuing medical education symposium for primary care physicians and health care practitioners, will highlight some of the conservative treatments including physical therapy, activity modification and medications. Additionally, the indications and expected outcomes of these non-operative treatments will be discussed.
This talk will be given by Jonathan Gentile, MD, and Jeff Hebert, DC, PhD(c), DACBSP. Dr. Gentile, is a minimally invasive spine specialist with Indiana Spine Group. Dr. Hebert is a chiropractic physician and is an assistant professor at the University of Utah; Department of Neurosurgery.
In February, Dr. Paul Kraemer attended and presented at the annual continuing medical education meeting of the American Associ
ation of Orthopaedic Surgeons in Las Vegas. Dr. Kraemer gave a presentation entitled, ““Infectious Pin Complications in Halo’s Utilizing Ceramic vs Metallic Pins”.
Dr. Kraemer a spine surgeon with Indiana Spine Group specializes in all aspects of spine surgery, including cervical, thoracic and lumbar. He also specializes in spine trauma and other emergencies, including infections, tumors and injuries
This blog entry will highlight Rapp Medical Systems Inc. | Medtronic Spinal & Biologics, a silver sponsor of Back Talk. Back Talk is the continuing medical education program that Indiana Spine Group is sponsoring for primary care physicians and practitioners.
Rapp Medical Systems Inc. is a local medical product distributorship representing Medtronic Spinal and Biologics. Working with physicians, their mission is to provide superior products and service which will enable our physician partners to provide the highest level of patient care possible.
Medtronic Spinal and Biologics, is a division of Medtronic which focuses on spinal and musculoskeletal therapies. Their key product areas include:
For more information, visit Medtronic Spinal and Biologics and for consumer education information visit their patient education site.
In March, I attended and presented at the annual continuing medical education meeting of the American Association of Neurological Surgeons in Phoenix. This meeting was entitled, 
The Backbone of Spinal Surgery: Evidence, Appraisal and Advocacy. At this meeting, I co-presented a special course entitled – New Developments in Arthroplasty.
The overall objective of this course was to review the indications for cervical and lumbar arthroplasty. (Arthroplasty is the procedure that utilizes a cervical artificial disc or lumbar artificial disc – and this artificial disc is used as an alternative to spinal fusion).
The overall course objectives were as follows:
· Have an understanding of the indications and contraindications for arthroplasty.
· Discuss the associated complications and management strategies for them.
· Gain a better understanding of the biology and biomechanics of the devices.
An article on Spine Universe entitled “Post-Operative Care: Activity, Incision Care, Rehab and Recovery,” discusses the importance of planning on post-operative care, prior to spine surgery. This article outlines the expectations immediately following spine surgery, and answers frequently asked questions by the patient and the family; i.e. recovery room, anesthesia and waking up and pain management.
Part two of this article addresses other key post-operative spine surgical care issues such as physical therapy and rehab, surgical incisions and hospital discharge.
This article was reviewed by Indiana Spine Group spine surgeon, Rick Sasso, MD. Dr. Sasso thought that this was a good resource for patients that are scheduled for spine surgery and that it is important for patients to be aware of the routine post-operative steps following spine surgery.
In this study, patients diagnosed with cervical radiculopathy or myelopathy that required surgical intervention were randomly selected. Patients either had cervical artificial disc (Bryan artificial disc) or anterior cervical discectomy and fusion. The study then followed the patients for two-years to determine their functional outcome and radiographic results.
In summary, this study concluded that the Bryan artificial disc replacement was a comparable surgical alternative to an anterior cervical discectomy and fusion for patients suffering with 1-level cervical disc disease. (1-level is where only one of the spinal discs is affected). Following surgery, both groups showed improvement in their functional outcomes. In respect to the patient’s range of motion, at two-years – those patients that underwent the Bryan artificial disc replacement had a greater range of motion than those that underwent the anterior cervical discectomy and fusion. This study did demonstrate that the artificial disc replacement is a comparable procedure to the spinal fusion. Further studies are underway, to determine longer term results of this investigational device.
Another study that I participated in has recently been completed, and the results published. This study compared the results of Bryan artificial disc replacement to anterior cervical fusion, two years following spine surgery. This study is entitled, Artificial Disc versus Fusion | A Prospective Randomized Study with 2-Year Follow-up on 99 Patients.
This study evaluated 99 patients for a two-year period. Patients were from three spine surgical centers that were involved in the US FDA Investigational Trial for the Bryan artificial cervical disc. One of the centers involved in this investigational trial was Indiana Spine Group. I was honored to implant the first Bryan cervical artificial disc in the US, in May 2002.
Orthopaedic Surgeons meeting. This meeting was held in February in Las Vegas. I was a co-presenter of an instructional course entitled, "The Degenerative Cervical Spine: What You Need to Know". During this lecture we reviewed the different treatment options for cervical degenerative disease - their indications and effectiveness. This discussion included a review of the spine surgery options and indications including the cervical artificial disc.
Recently an article that I co-wrote was published in the January issue of Spine. This article is entitled, “Comparison of Short-term SF-36 Results between Total Joint Arthroplasty and Cervical Spine Decompression and Fusion or Arthroplasty.”
The purpose of this research was to evaluate patient outcomes – comparing cervical spine surgery with hip and knee surgery. The measurement tool was a functional outcome score that measures a patient’s ability to perform activities of daily living. This is a patient derived score, based on results obtained from a questionnaire that the patient completes.
The surgical procedures were hip and knee arthroplasty compared to cervical spine surgical procedures. The spine surgical procedures evaluated were cervical arthroplasty, (cervical disc replacement), and cervical discectomy with cervical fusion.
In summary, all groups showed significant improvement in their scores post-surgery. Although, patients that underwent cervical spine surgery showed greater or equal improvement.
Recently, I had the honor of being the co-chairman of an annual spine meeting hosted by the
At this meeting I gave presentations on spinal decompression and reconstruction techniques, including; ACDF, corpectomies and struts. I also presented information that compared the cervical artificial replacement procedure with the spinal fusion. Additionally, I was a lab instructor – which provided hands-on training to orthopaedic surgeons. A few procedures reviewed included X-Stop – a procedure which utilizes a device in spine surgery for lumbar spinal stenosis; XLIF – this is a minimally invasive spine surgery procedure used to treat back pain that is caused by degenerative disc disease.
In an earlier blog, I talked about the AO Spine International meeting that I presented at in December. With this blog entry, I wanted to define a few of the terms that were used. These were spine surgery topics that I presented on.
One term is cervical myelopathy. In defining cervical myelopathy – first I will define myelopathy. When the word myelopathy is used it refers to any condition that affects the spinal cord. Therefore cervical myelopathy is a condition of the cervical (neck) area of the spinal cord. In respect to cervical myelopathy it means that there is compression on the spinal cord that is either a result of disc herniation or spinal stenosis. Cervical myelopathy is a degenerative spine disease that is more common in the elderly.
Another term used in the blog entry was cervical radiculopathy. The term radiculopathy refers to a disease of the spine nerve roots and spinal nerves. Cervical radiculopathy is when a spinal nerve root in the neck (cervical) is compressed and/or irritated. This can be caused by disc herniation, spinal stenosis or other degenerative spine disorders.
This blog entry will answer a few common questions asked about spinal cord stimulators.
What are spinal cord stimulators used for?
Generally spinal cord stimulators are used to treat chronic / ongoing lower back pain that continues following back / spine surgery. Back pain following spine surgery is a condition called post-laminectomy syndrome, also referred to as failed back syndrome.
When are spinal cord stimulators considered as a treatment option?
Spinal cord stimulators are a treatment option for lower back pain, when other medical management treatment options are ineffective; i.e. epidural injections and/or medications.
What is a spinal cord stimulator?
A spinal cord stimulator is also called a neurostimulator – and this is a device that is a programmable generator that is the size of a stop watch, which has electrical leads/electrodes. The electrodes are placed in the epidural space near the spinal cord.
How does a spinal cord stimulator work?
With spinal cord stimulation electrical impulses are generated to relieve the chronic pain. The electrical impulses that are created interfere with the transmission of pain signals to the brain, and eliminate the sensation of pain that the patient would normal feel. Rather than pain, the patient feels a tingling sensation - which is called paresthesia.
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