Spinal Fusion Surgery

This November, a few chapters that I co-authored on spinal navigation were included in the Handbook of Spine Surgery published by Thieme Publishers. This book is a continuing medical education resource for spine surgeons. One chapter was on Spinal Navigation, which was included in the “Clinical Spine Surgery” section of the book. The other chapter in the “Surgical Techniques” section was on Facet Screw Fixation/Fusion.

This spine surgery educational book provides principles and techniques of spine surgery. Included in the book are sections on clinical spine anatomy, clinical spine surgery, spinal pathology and surgical techniques.

For more information or to order this spine surgical educational resource, visit this link.

Congratulations to Rick Sasso, MD, a spine surgeon with Indiana Spine Group, on his recent patent assignment. This patent, filed in 2007 was approved in September 2011. US Patent number 8.016,831 is for” instruments and techniques for guiding instruments to a spinal column.”

This patent is related to spine surgery instrumentation and  techniques for anterior cervical discectomy and spinal fusion, as well as safely and accurately placing cervical artificial discs replacements into the intradiscal space. For more detail about this patent, visit this link.

I co-authored a book chapter on “Cervical Disc Replacement”, that has been recently published in Rothman Simeone The Spine – 6^th Edition.

The Spine is a continuing medical educational resource for spine surgeons and highlights state-of-the-art spine treatments and spine surgery techniques. In addition to the text, there is also a video resource for physicians highlighting different surgical techniques and procedures.

Some sections of this book include: Basic Science, Spinal Diagnosis, Surgical Anatomy and Approaches, Thoracic and Lumbar Disc Disease, Minimally Invasive Surgery, Spinal Stenosis, Spinal Fusion and Instrumentation and more. For more information about The Spine and a table of contents, visit this link.

In addition to the talks previously highlighted in prior blogs, I also gave a few talks on the cervical spine at the annual American Academy of Orthopaedic Surgeons continuing medical education meeting. One Instructional Course lecture, where I served as faculty, focused on the degenerative cervical spine and was entitled, “The Degenerative Cervical Spine: What You Need to Know”.  This talk focused on the evaluation and treatment options for the degenerative spine and it addressed anterior and posterior spine surgery options, as well as non-operative treatment options.

The other talk was a Podium Presentation of the research results for the five-year study of the Bryan Cervical Artificial Disc. This continuing medical education presentation was entitled, “Cervical Disc Replacement: Five Year Follow-up from the U.S. Prospective Randomized Bryan Trial”.  This link provides an overview of the initial results of this study – which followed spine surgery patients post-operatively for five years. Patients evaluated either underwent spinal fusion or arthroplasty (cervical artificial disc).

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. 

Congratulations to Rick Sasso, MD, a spine surgeon with Indiana Spine Group. He recently had a chapter published in a new spine surgery textbook, and an article published in a medical journal.

Dr. Sasso co-authored a chapter on sacral fractures published in Spine and Spinal Cord Trauma: Evidence Based Management. This book is now available for purchase.

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.

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.

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.

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.

At Indiana Spine Group’s Back Talk continuing medical education symposium, as highlighted in a previous blog entry , there are two educational tracks that will be available for conference attendees on day one.  In addition to the general track discussed in the prior blog, there is a more in-depth track entitled, More Specifics | Spinal Diagnostics and Treatment. 

In this education track there will be a few sessions focusing on the diagnosis of spinal disorders and abnormalities.  One session titled Spinal Imaging | Technology and Diagnosis, will be presented by Stephen Pomeranz, MD. Dr. Pomerance is a radiologist. In this session, Dr. Pomeranz will provide an in-depth look at spinal imaging technologies and highlight the latest developments in spinal imaging technology and their applications in spinal diagnostics.  Additionally, using case studies, he will review radiological finds and diagnostic indicators. 

The second session of this educational track will focus on The Electrodiagnostic Evaluation, and will be presented by physical medicine and rehabilitation specialist Dr. Shashank Dave.  During his presentation, Dr.Dave will discuss the role and application of electromyography in the diagnosis of spinal disorders and diseases.  Additionally, he will review case studies which utilize electromyography and identify specific diagnoses. 

Another session presented for the in-depth track will focus on Diagnostic and Therapeutic Injections of the Spine.  This will be presented by minimally invasive spine specialist John Arbuckle, MD.  During this session Dr. Arbuckle will review and differentiate between the different type of therapeutic injections and will review the treatment efficacy of injections, the clinical protocols, indications and expected outcomes. 

The last session of this continuing education track will highlight spine surgery, and is entitled Surgical Perspectives | Fusion vs Arthroplasty, presented by spine surgeon Rick Sasso, MD.  During this session, Dr. Sasso will provide a detailed analysis of spinal fusion and arthroplasty and he will discuss motion preservation modalities for the treatment of generative disc disease.  He will highlight lumbar and cervical artificial discs as well as review research studies and discuss patient selection, indications and expected outcomes. 

Time and time again, we hear the dangers of smoking - cancer, stroke and  heart disease.  But did you know that smoking also affects the health of your spine?  This spine wellness blog tip will address your spine and smoking. 

To learn the best way to stop smoking, talk to your physician.  Additionally, resources are provided on the American Cancer Society’s web site. 
 

Spine Wellness Tip #2:  Put Out the Cigarettes

In May 2009, the Bryan Cervical Artificial Disc received FDA approval.  This approval was previously written about in Dr. Sasso’s blog.  The cervical artificial disc provides an alternative spine surgical treatment for cervical degenerative disc disease.

Dr. Rick Sasso, a spine surgeon with Indiana Spine Group, has been a principal investigator in the studies with this spine surgical device – the Bryan Cervical Disc.  A few of abstracts of his published research studies regarding the cervical disc are available on the U.S. National Library of Medicine / National Institutes of Health web site. 

These include:

• Cervical kinematics after spinal fusion and bryan disc arthroplasty 
  
• Motion analysis of bryan cervical disc arthroplasty versus anterior discectomy and spinal fusion: results from a prospective, randomized, multicenter, clinical trial