Rick Sasso, MD

Rick Sasso, MD, is spine surgeon and co-founder of Indiana Spine Group. Specializing in spine surgery, Dr. Sasso has dedicated his medical career to the comprehensive treatment and surgery of spinal disorders and abnormalities. Actively involved in spinal research, Dr. Sasso is a pioneer in the development of minimally invasive spine surgery techniques.  He is actively involved in many research studies, as well as the development of instrumentation technology used to treat spinal disorders.  Additionally, Dr. Sasso performed the first cervical artificial disc replacement surgery in the U.S.

Indiana Spine Group, is a Center of Excellence for comprehensive spine care.  Providing comprehensive diagnosis and treatment for all spinal disorders, our spine specialists are experts in using the most advanced diagnostic and treatment tools, with a focus on minimally invasive spine procedures.  Our comprehensive patient care team includes board-certified minimally invasive spine specialists and spine surgeons.

For more information,visit our website.

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.

While at the American Academy of Orthopaedic Surgeon’s annual continuing medical education meeting, I also gave a few other talks/podium presentations.  These presentations were:

"Does smoking have an impact on fusion rate in single level ACDF with allograft and plate fixation?"

“Does early return to work following arthroplasty and ACDF

result in adverse outcomes?"

While at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) in New Orleans, in addition to presiding as President of the Federation of Spine Societies spine specialty day, I also gave a few talks on cervical radiculopathy.

The first session that I moderated was on the current concepts in cervical radiculopathy.  The objective of this continuing medical education session was to provide the most up-to-date information on the pathophysiology, diagnosis and treatment of cervical disc disorders, including the role of selective nerve root sleeve injections and artificial disc replacement.

Another session that I served as a faculty member for was the spine instructional course lecture entitled, “The Degenerative Cervical Spine: What You Need to Know.”  This presentation provided an overview of cervical degenerative diseases and addressed the patient evaluation and treatment options, including anterior, posterior and non-operative options.

The American Academy of Orthopaedic Surgeons (AAOS) held their annual continuing medical education meeting in New Orleans, in early March.  In addition to attending the annual continuing medical education meeting, I also had the honor of coordinating and hosting the spine specialty day. The spine specialty day presented a common forum by the Federation Societies, of which I am the president.  The Federation Societies is comprised of four spine-focused organizations, and includes the Cervical Spine Research Society, North American Spine Society, Scoliosis Research Society and the American Spinal Injury Association.  

A few of the educational objectives for the day included discussing the current concepts in the diagnosis and management of spinal disorders, and to review and update the clinical results and complications of the new technologies and concepts.  The information was presented in the form of instructional presentations, discussions, papers and debates. 

Highlighted topics were presented by each society within the Federation.  During the day in the North American Spine Societies section, I presented a talk on cervical disc replacement, and for the American Spinal Injury Association I discussed spinal cord injury and the appropriate time for decompression. 

In my last few blog entries, I discussed scoliosis. In this blog entry, I am including a few scoliosis resources for more in-depth information about scoliosis.  

Scoliosis Research Society

National Scoliosis Foundation

iScoliosis
National Institute of Arthritis and Musculoskeletal and Skin Diseases
 

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.

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 blog entry is part of a series on scoliosis, and will address commonly asked questions about screenings.

At what age should I have my children screened for scoliosis and how frequently should this be done?

In that scoliosis is typically diagnosed between the ages of 10 and 16, I generally recommend that parents have their children screened for scoliosis as a part of their annual physical.  Depending on the school system, the school nurse may do scoliosis screenings as part of their wellness / health initiatives. 

Are there any visible symptoms of scoliosis that I can look for in my child? 

There are a few visible symptoms that as a parent you may notice in your child.  Some of these visible signs may be uneven shoulders, or a protrusion of one or both of the shoulder blades, an elevated hip, or uneven waist.  Sometimes, you may notice clothes do not fit properly – that pant legs may appear longer on one side than the other.  If you notice any of these symptoms in your child, it is recommended to talk to your family doctor.    

What is the screening test called that is commonly performed – when you are bending forward?

This is one of the most common initial screening tests for scoliosis and is called the Adam’s Forward Bending Test.  For this test, the individual puts his or her feet together,  leans forward and bends at the waist 90 degrees.  Often times, they are asked to put their hands together like they are diving.  The screener will then look at the spine for any abnormal curvatures and asymmetry of the trunk.  This screening can tell if there is a curve – but not the degree of the curve.

How do you determine the degree of spinal curvature?

If an initial screening such as the Adam’s Forward Bending Test indicated that they was a curvature – further testing then measures the degree of the spinal curvature.  To determine this – an X-ray of the spine is taken.  A process called the Cobb Method is then used to measure the amount of spinal curvature. 

With the Cobb method of measuring spinal curvature, lines are drawn on the X-ray parallel to the end plates of the vertebral bodies at the beginning and end of the curve.  A perpendicular line is then drawn – and the angle between these two lines equals the degree of curvature – called the Cobb measurement.  It is important to note, that the actual measurement can vary 3 to 5 degrees, depending upon the exact positioning of the patient for the X-ray.  That is why major treatment decisions are not made on one single X-ray.

In these next series of blog entries – I will answer common questions about scoliosis – including the diagnosis, and provide an overview of the treatment options both medical and surgical treatments.

The Scoliosis Research Society defines scoliosis as a lateral deviation of the normal vertical line of the spine, which is greater than ten degrees when measured by an X-ray.  Scoliosis is often referred to as “curvature of the spine.”

According to the National Scoliosis Foundation (NSF), scoliosis affects 2-3% of the population.  The common age for onset is 10-15 years, old and it affects both genders equally although females are eight times more likely to have a greater degree of curvature that requires treatment the NSF indicates.  Although scoliosis is not heredity, there is an increased likelihood of an individual being diagnosed with scoliosis if a family member has had it. 

The different types of scoliosis include:

§         Idiopathic Scoliosis – This is where scoliosis occurs without a known cause.  This is the most common type of scoliosis.

§         Congenital Scoliosis – This is when an individual is born with scoliosis as a result of the vertebrae not being properly formed during pregnancy.  This malformation occurs within the first six weeks of embryonic formation.

§          Neuromuscular Scoliosis – This is caused as a result of a neurological disorder such as muscular dystrophy that results in a weak trunk and the individual can not support the weight of their body.

§         Adult Scoliosis – This is when scoliosis is diagnosed in an individual as an adult.  It can either be undiagnosed scoliosis when the individual was younger or the result of age-related degeneration.  An example of age-related scoliosis is osteoporosis. 

If you have a question on scoliosis that you would like answered in this series of blog entries, please send your question to info@indianaspinegroup.com. 

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.

A lot of patients ask me about the differences with arthroplasty (cervical artificial disc) and spinal fusion; as well as how does the cervical artificial disc work. A few years ago, I was interviewed by Barbara Lewis on Sound Medicine. This segment titled, “New Artificial Cervical Discs”, can be heard by visiting this link. 

A few topics discussed during this interview included:

• Comparison of a spinal fusion to cervical artificial disc,
• More detailed information about the cervical artificial disc,
• Comparison of cervical artificial disc to artificial hip and knee,
•  The future of cervical artificial disc.

In my prior blog entry, I talked about the Bryan Cervical Artificial Disc study that has recently concluded.  To evaluate patient outcomes and functionality for this spine study, one measurement used was the neck disability index (NDI).  With this assessment, patients provide a self-evaluation and answer a series of questions of how their neck pain affects their ability to manage everyday life. 

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 Scoliosis Research Society is an excellent resource for individuals searching for information on spine wellness and education information on scoliosis. This web site provides detailed explanations of the types of scoliosis – as well as addresses the different life stages that one may have scoliosis; i.e. infants, juveniles, adolescents and adults. 

As a physician it is always rewarding to work with spine surgeon fellows. I recently had the honor of being a visiting professor at the Texas Back Institute in Dallas, Texas. While at the Texas Back Institute, I presented at their grand rounds and did an invited lecture on Interoperative Spinal Navigation. After my talk, I had the opportunity to meet with the spine fellows and staff to discuss cases and the latest spine surgical treatments for spinal disorders.  I enjoyed my visit to the Lone Star state! 

At the 16^th International Meeting on Advance Spine Techniques physician continuing medical education conference in July, in addition to participating in various continuing education lectures (discussed in prior blog entry) I also presented an abstract that I co-authored. This abstract summarized a spine research study recently completed and is entitled, Blood Metal Ion Levels Following Implantation of an All-Metal Lumbar Intervertebral Disc Replacement.

The purpose of this study was to measure the level of metal ions in an individuals blood stream following the implantation of a metal device; the all-metal lumbar intervertebral disc. This study concluded, that after six months and one year following surgery, that most patients that participated in the study did not have measurable levels of metal ions (cobalt and molybdenum ions) in their blood streams following total disc arthroplasty with the lumbar intervertebral disc replacement.

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. 

An article in Science Daily entitled “Artificial Disc Replacement As Good or Better Than Spinal Fusion, Study Suggests”, highlights a published study that I co-wrote. 
 

In this article in Science Daily, co-author K. Daniel Riew, MD – a cervical spine surgeon at Washington University Orthopaedics and Barnes-Jewish Hospital, stated that one of the most important findings of the study was that people who received the Bryan Cervical Disc were able to preserve all of their motion.