Rick Sasso, MD

I recently had a chapter that I co-authored published in a text book. This chapter was on sacral fractures and was published in Spine and Spinal Cord Trauma: Evidence-based Management.

This book is a continuing medical education resource for orthopaedic surgeons, spine surgeons and other health care professionals that treat spinal cord injuries and trauma. The goal of this book is to provide multiple treatment options, and objective reviews of state-of the-art procedures. In addition to the book, it also provides a video component that provides narrated videos and overviews of the spine surgical procedures highlighted in the book. This book is written by a multinational, multidisciplinary panel of spine experts and it is an honor to be included in this publication. For more publication information,visit this link.

Medline Plus defines kinematics as a discipline of physics that deals with the aspects of motion, separate from the considerations of mass and force. As a physician, I don’t really think of myself as a physicist – but recently I had the opportunity to study kinematics.

Recently I participated in a study to evaluate “cervical kinematics”. The purpose of cervical kinematics is to understand the motion of the cervical spine. Cervical kinematics has evolved as a result of the spine surgery procedures that alter the pathological structure of the cervical spine. In looking at the cervical spine and motion – cervical kinematics evaluates how the anatomical alterations affects an individual’s motion.

The study that I participated in evaluated the affects of cervical disc arthroplasty. This spine surgery procedure, which is relatively new and just recently received FDA approval, is a spine surgical alternative to standard spinal fusion in the surgical treatment of degenerative disc disease. With cervical disc arthroplasty, the damaged cervical disc is removed and an artificial cervical disc is implanted. The purpose of this study was to determine how movement is affected by the artificial cervical disc. In this study radiographic films were used to measure movement (distance) in the flexion and extension of the cervical area (neck) and it also utilized a computer assisted model. The results of this study were published this past June in Techniques in Orthopaedics. 

As I previously blogged, I attended and participated in the recent continuing medical education meeting sponsored by the Cervical Spine Research Society.

Here is some information about this organization. The Cervical Spine Research Society, as its name implies, focuses on the cervical spine. It provides a forum for spine surgeons and other medical personnel to share information that promotes cervical spine research. Their vision statement is “The Cervical Spine Research Society is the recognized authority on diseases of the cervical spine.”

In a prior blog entry, I highlighted a few talks that I presented at the 15^th Instructional Course meeting for the Cervical Spine Research Society. In addition to speaking and moderating lectures at this continuing medical education event, I had three clinical papers presented.

These papers were:

1.                  Anterior vs. Posterior Surgical Approaches to Treat Cervical Spondylotic Myelopathy: Outcomes of the Prospective Multi-center AO Spine North American CSM Study in 280 Patients. (Presented by Michael Fehlings, MD)

2.                  The AO Spine North America Geriatric Odontoid Fracture Study: A retrospective review of mortality outcomes in surgical vs. conservative treatment in 158 patients with long term follow-up. (Presented by Jens Chapman, MD)

3.                  Adjacent level cervical ossification after Bryan cervical disc arthroplasty vs. ACDF. (Presented by Ben Garrido, MD)

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.

In a prior blog entry, I talked about study results for the Bryan cervical disc (artificial cervical disc used in arthroplasty).  This procedure is a spine surgical treatment option for degenerative disc disease.

Degenerative disc disease is a natural result of the aging process and is a condition where one or more of the vertebral discs weaken.  For a detailed definition and the symptoms of degenerative disc disease, visit this link.

A prior study published, evaluated patients two years following spine surgery and their participation in the Bryan Cervical Disc Trial. In addition to this study, a more recent study I participated in evaluated Bryan Cervical Disc study patients five years following their spine surgery.

This study concluded that patients still continued to have excellent spine surgical outcomes five years postoperatively in both study groups – arthroplasty (artificial cervical disc) and ACDF (spinal fusion). Additionally, those patients that had arthroplasty and received the Bryan cervical disc show significant improvement and less neck pain than those in the control group (spinal fusion). In respect to complications and a second spine surgery – both groups had low adverse effects. 

To read the abstract of this cervical disc replacement study, visit this link.

I recently co-authored a chapter on instrumentation that was published in a book entitled Cervical Spine Trauma. This chapter was entitled Cervicothoracic Junction Instrumentation. 

Additionally, I recently wrote a chapter for a Brazilian spine society book. The chapter was on degenerative disc disease, and was included in “Conceitos Avancados em Doenca Degenerativa Discal Lombar”.

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
   

I recently co-authored an issue of Seminars in Spine Surgery on the “Complications of Occipitocervical Fixation”.

Seminars in Spine Surgery is a publication that provides practicing spine surgeons continuing medical education on current clinical topics on spine surgery. Each issue addresses a single "spine" topic and provides information related to management and patient care. A few issues addressed for each topic include anatomy, pathophysiology, clinical presentation/diagnosis, and treatment/management options. 

In mid-October, I was a faculty member at a continuing education meeting held at the Orthopaedic Learning Center outside of Chicago. This meeting was sponsored by The American Academy of Orthopaedic Surgeons and theLumbar Spine Research Society. The focus of this continuing medical education meeting was “Contemporary Techniques in Spinal Surgery”.  I was a lecturer and lab instructor at this spine surgery education meeting. 

One topic that I lectured on was related to the surgical technique for a spinal fusion (C1 lateral mass screw, C2 laminar screw technique for posterior C1-C2 spinal fusion). Additionally, I participated in a debate about cervical disc replacement (arthroplasty) versus fusion. In this debate, I was pro cervical disc replacement. A few of the continuing medical education spine surgery labs that I instructed included: anterior cervical discectomy, laminoplasty, high cervical and upper thoracic dissection and laminoplasty.

When most people think of spine surgery – they may typically think that this requires a few nights in the hospital. But just as other types of surgery have become less invasive and surgical techniques and post-operative care have become increasingly sophisticated, more spine surgeries may be performed on an outpatient basis. Typically, outpatient surgery is defined as a surgical procedure where the patient is discharged to go home within a few hours of the procedure.

A recent study that I participated in evaluated the postoperative data of 645 spine surgery patients who underwent an anterior cervical discectomy and spinal fusion (ACDF). Information was gathered following the patient’s spine surgery procedure, to determine the safety of performing ACDF on an outpatient basis. Of the data reviewed for the 645 patients, only two developed acute complications. These complications were present/symptomatic within four hours of post spine surgery, within the mandatory procedure protocol for postoperative observation. For those patients that were readmitted following discharge, 80% were a result of pain or nausea. 

The study did conclude that a single level cervical discectomy and spinal fusion (ACDF) can be safely performed on an outpatient basis. This is more so, if the patient has an allograft donation (bone graft from a bone bank donation) rather than grafting bone from their iliac crest (hip). 

The result of this study was published in the Journal of Spinal Disorders & Techniques. 

In a recent blog entry, I highlighted information from a study that I participated in and an article I co-authored, “Quality of Spinal Motion with Cervical Disc Arthroplasty.” This blog entry will define a few key terms used in that abstract/study.

Kinematic Study – This is the study of the motion of the body, not taking into consideration the effects of mass or force on the motion.

Cervical Arthroplasty – Refers to the spine surgery procedure where a damaged cervical disc is removed and replaced by an artificial cervical disc. 

Spinal Fusion – Often this procedure is referred to as ACDF, standing for anterior cervical discectomy and fusion. This is the spine surgical procedure where a damaged cervical disc is removed. To preserve the space within the vertebral bodies a bone graft is then placed where the damaged disc was removed. This bone graft is either from the patient’s hip bone (iliac crest) referred to as an autograft donation or from a bone bank (allograft). Then a spinal plate and screws are attached to the vertebral bodies immediately above and below the graft. 

An article that I co-authored, published in the Journal of Spinal Disorders & Techniques, summarized a study on cervical spinal motion at the adjacent discs (adjacent segment motion) following spinal arthroplasty with a Bryan Cervical Disc as compared to a spinal fusion.  Radiographic analysis was used to measure this motion prior to surgery, and at designated intervals post-surgery. 

For an abstract of this study, visit this link. 

I recently co-authored a book that is now available on Amazon or through the publisher.  The book, entitled Spinal Arthroplasty: The Preservation of Motion, provides detailed information about spinal arthroplasty.  This medical education book includes information about cervical artificial discs and lumbar artificial discs that are used in the spine surgical treatment of cervical and lumbar degenerative disc disease.

A few chapter titles include: 

• History of Spinal Fusion
• History of Motion-Sparing Surgery
• Spinal Anatomy
• Spinal Biomechanics
• The Effects of Fusion and Motion Sparing Procedures on the Biomechanics of the Spine
• Biomaterials in Spinal Arthroplasty
• Total Disc Arthroplasty: Clinical Indications and Surgical Approach
• Cervical Arthroplasty: Biomechanics, Design Considerations, Clinical Outcome
  

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.

At a recent annual continuing medical education meeting sponsored by The Scoliosis Research Society, I was an invited instructor. This conference was the 17^th International Meeting on Advanced Spine Techniques and was held in Toronto. This educational meeting is considered one of the premier international spine meetings held annually for spine surgeons, and it is an honor to be asked to be one of the limited faculty members.

At this meeting, I presented the results of a spine research study for an investigational device that I am participating in. This study is related to the cervical spine and deals with cervical motion technology. A few other continuing medical education activities that I participated in included:

·         Gave a presentation on occipitocervical fixation and biomechanics.

·         Moderated a round table discussion on cervical reconstruction.

·         Participated in a fundamentals session on the cervical spine and discussed posterior cervical decompression and fusion.

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.