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.

In my prior blog, I talked about some of the topics that I presented at the Spine Arthoplasty Society’s annual meeting.  I am sure some of you are wondering what exactly is the Spine Arthoplasty Society. 

The Spine Arthoplasty Society is a special interest group of physicians and medical specialists that are devoted to maintaining normal spinal joint movements in patients.  This focus is on the restoration and replacement of normal function for individuals that have degenerative spinal conditions that affect spinal joints.

In July, I presented at the 15^th annual International Meeting of Advanced Spinal Techniques.  I was honored to present two scientific papers at this medical education program.  One was about the US FDA IDE trial for the Bryan cervical disc replacement.  My second presentation was also about the Bryan cervical artificial disc replacement, and was a detailed motion analysis of the Bryan cervical disc. 

Here are links to the abstracts presented –“Radiographic Results from the BRYAN® Cervical Disc IDE Study,”and “Comparison of BRYAN Cervical Disc Arthroplasty with Anterior Cervical Decompression and Fusion: Clinical and Radiographic Results of a Randomized Controlled Clinical Trial.” 

In continuing my blog entries on the lumbar spine and degenerative disc disease, I will answer some frequently asked questions by my patients.

What is lumbar degenerative disc disease?
Generally speaking, degenerative disc disease is the result of the normal aging process.  This is where the disc becomes more brittle and less flexible.  When the discs of the lower back are affected, this is referred to lumbar degenerative disc disease.  Often this results in lower back pain. 

 Technically called invertebral discs, spinal discs are discs found between each vertebrae that act as a cushion..  The spinal discs are what helps maintain the position of your spine, as well as allows motion between each vertebrae.  Sometimes they are called the “shock absorbers” of the spine - in that they compress with weight, and spring back when weight is removed. 

Anatomically, the discs are flat and round – and less than an inch thick.  The outer shell is a tough tissue and this is called the annulus fibrosis.  This tissue is filled with a jelly like consistency fluid that is called the nucleus pulposus.  Cartilage then connects the spinal discs to the vertebrae. 

Even though degenerative disc disease is a part of the aging process, everyone ages differently and no - everyone does not get degenerative disc disease. 

In addition to aging, wear and tear can also cause degenerative disc disease.  There are many lifestyle factors that can affect the health of the spinal discs.  For example, for individuals who are over weight; this would increase the stress on the spine.  Additionally, someone who has a job that requires heavy lifting – this can increase their risk for degenerative disc disease.  In some instances, trauma can lead to degenerative disc disease – lumbar or cervical. 

This blog entry is in response to a reader comment where they wanted more information on the Prestige Cervical Artificial Disc that was approved by the FDA last summer.  Here is a link to an article that I wrote for Spine Universe.  This article discusses cervical artifical discs that are used as a spine surgical treatment for degenerative disc disease.  Additionally, here is a link that provides more specific information about the Prestige Cervical Artifical Disc by the manufacture. 

For my next few blog entries I will talk about the lumbar spine and discuss a few spine surgery procedures for the lumbar spine.  But first – I will define what the lumbar spine is. 

The lumbar spine is what is commonly known as the lower back. The spine is made up of 24 vertebrae.  And the lower part of the spine – are the lumbar vertebrae – L1 – L5.  The neck region of the spine is the cervical spine and the chest area of the spine is the thoracic spine.  One of the reasons that the lumbar spine is the cause of back pain is that it carries a majority of the body weight and is subject to the forces and stresses of the spine. 

This blog entry is in response to a recent comment where I was asked if there was a clinical study for a lumbar artificial disc.  The answer to that question is yes.  Currently I am participating in a FDA-approved clinical trial for the Flexicore artificial lumbar disc.  This lumbar artificial disc is a metal on metal disc used as a spine surgery treatment option for lumbar degenerative disc disease.  Here is a link to an abstract of a recent article published an article in Spine. I co-authored this study entitled, Prospective, Randomized Trial of Metal-on-Metal Artificial Lumbar Disc Replacement: Initial Results for Treatment of Discogenic Pain.

To find out more about this study and participant criteria, my research nurse can answer your questions.  Please call our office at 317.228.7000 and ask to speak to Dr. Sasso's research nurse. 

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. 

As you are probably aware – anytime you have a cut or wound, there is a risk for an infection.  But did you know that this infection can affect the bone?  When there is an infection of the bone, which is caused by bacteria, this is called osteomyelitis.             

When an individual has spinal osteomyelitis, generally they have severe back pain.  To learn more about osteomyelitis, here is a link to an article that I wrote for Spine Universe. 

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.  
 

Last year, I was interviewed for an article in The Indianapolis Star.  This interview was by health reporter Shari Rudavsky.  This interview was about degenerative disc disease. 

The following are a few of the common questions about degenerative disc disease, which were asked during this interview.

Q:  How common is degenerative disc disease?

A:  Degenerative disc disease is quite common, especially in people in their 30’s and 40’s.  It is one of the main reason’s that people see their family doctor.

Q:  What causes degenerative disc disease? 

A:  Usually this occurs from normal degenerative changes as a result of aging. The discs in the spine are specialized joints.  Just like a knee or hip that can get arthritic, the disc can also get arthritis.  A common analogy used for the spinal discs is a jelly doughnut.  The inside is soft and it is surrounded by a shell.  When this outer shell tears, the degenerated pieces can extrude through this shell (outer covering) and then sit on the nerves on the spinal cord.

Q: What are the symptoms of degenerative disc disease?

A: The most common symptoms are neck and arm pain that radiates down the arm, below the elbow, down to the hand, associated with weakness and tingling.

An experimental procedure for the treatment of degenerative disc disease is to replace the nucleus.  The goal of this procedure is to replicate the normal disc function and to maintain motion.  The procedure was first developed in 1988, and contiunes to be modfied and refined. 

To learn more about this spine surgery procedure, here is a link to a chapter that I co-authored, “Nucleus Replacements”.   

For patient’s suffering from degenerative disc disease in the lumbar spine – surgical treatment options are either a lumbar spinal fusion or an artifical lumbar disc replacement.  The artifical lumbar disc has recently been approved by the FDA.

When you hear about someone having cancer, you rarely hear about cancer of the spine – spinal tumors.  The good news is - that is because it is rare!  When cancer metastasizes to the skeletal system a common location for this is the spine. 

The most common cancer in women that metastasizes to the spine is breast cancer, and in men it is either prostate or lung cancer.

To learn more about spinal tumors, click here.

Recently, I co-authored a chapter in a textbook entitled, “Metastatic Spinal Tumors”.  This chapter outlines the diagnosis and treatment of these tumors.  To read more, link here. 

One spine surgical procedure that is an option to traditional spinal fusion is an artificial cervical disc replacement.  Today, there is one artificial cervical disc that has received FDA- approval and that is the Prestige Disc.  Additionally, there is the BRYAN cervical disc which has received preliminary FDA-approval. 

I have been involved in the clinical study of the BRYAN cervical disc – and have blogged about my involvement in this research.  Recently, I co-authored an article which summarized a 24-month follow-up study of patient’s that have received this BRYAN Cervical Disc. 

In this study, the outcomes of cervical arthoplasty (artificial BRYAN cervical disc) were compared to traditional spinal fusion surgery for the treatment of cervical radiculopathy and myelopathy. In a spinal fusion surgery, technically called ACDF (anterior cervical discectomy and fusion), the damaged cervical disc is removed and then bone is fused to the treated area to maintain stability.  With the artificial BRYAN cervical disc, the damaged disc is removed and the artificial cervical disc is inserted/implanted. 

This study concluded that cervical disc arthoplasty had similar results to the ACDF as defined by the standard outcome scores.  More long-term studies are needed, but preliminary results indicate that the BRYAN disc created less strain on adjacent discs than fusion and it is projected that cervical disc arthroplasty will result in minimizing adjacent disc degeneration. 

In March, I gave a presentation to the Scientech Club meeting held at the Children’s Museum. At this meeting, I discussed surgical navigation of the spine.  This is the “global positioning” system used in spine surgery that I have recently blogged about. 

This spine surgery navigation system allows the spine surgeon to see in 3-d, exactly where structures are located within the body (neural, skeletal and vascular) providing greater accuracy for spinal instrumentation during surgery.  Prior to the development of this technology, traditional X-rays were used.

When discussing this technology, many times I compare it to the GPS system used in cars.  In this instance, the “satellite” is the infrared camera in the operating room.  The “antenna” is a reference frame that is has been placed on the patient.  This “antenna” sees the spine surgeon’s instruments under the skin.

Recently, I co-authored a chapter in a medical textbook entitled, “Occipitocervical Vertex Fixation.”   The Vertex system is used to stabilize the occipitocervical junction.  The occipitocervical junction refers to where the base of the skull and the vertebra connect (this junction is where the occiput, atlas and axis all join).  More than 50% of the rotation and flexion/extension of the head and neck occurs in this area.