10 Tips for a Healthy Back

Here are 10 tips for keeping your back healthy from knowyourback.org:

1. Standing: Keeping one foot forward of the other, with knees slightly bent, takes the pressure off your low back. 
2. Sitting: Sitting with your knees slightly higher than your hips provides good low back support. 
3. Reaching: Stand on a stool to reach things that are above your shoulder level. 
4. Moving Heavy Items:  Pushing is easier on your back than pulling. Use your arms and legs to start the push. If you must lift a heavy item, get someone to help you. 
5. Lifting: Kneel down on one knee with the other foot flat on the floor as near as possible to the item you are lifting. Lift with your legs, not your back, keeping the object close to your body at all times. 
6. Carrying: Two small objects (one in either hand) may be easier to handle than one large one. If you must carry one large object, keep it close to your body. 
7. Sleeping: Sleeping on your back puts 55 lbs. of pressure on your spine. Putting a couple of pillows under your knees cuts the pressure in half. Lying on your side with a pillow between your knees also reduces the pressure. 
8. Control Your Weight:  Additional weight puts a strain on your back. Keep within 10 lbs. of your ideal weight for a healthier back.
9. Quit Smoking:  Smokers are more prone to back pain than nonsmokers because nicotine restricts the flow of blood to the discs that cushion your vertebrae. 
10. Minor Back Pain:  Treat minor back pain with anti-inflammatories and gentle stretching, followed by an ice pack.

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Definitive Back-Pain Study?

written by Biloine W. Young | Orthopedics This Week | Dec. 6, 2011


Can a single injection of stem cells repair and regenerate diseased lumbar discs? That question may soon be answered by the first of its kind nationwide study that will test the safety and efficacy of the use of mesenchymal precursor cells (MPCs) to replace bone, cartilage and muscle.

Headquartered at the University of California, Davis, the study will be directed by Dr. Kee Kim, associate professor and chief of spinal neurosurgery at UC Davis Health System. He will collaborate with Scott Fishman, professor and chief of pain medicine and co-principal investigator, to monitor the patients' progress.

An estimated 30 million people in the United States suffer from back pain. Degenerative disc disease is the most common cause of low-back pain, which develops with the gradual loss of a material called proteoglycan, which cushions the bones of the spine and enables normal motion.

"Many scientists and clinicians have injected all different kinds of material into the degenerated disc, hoping that something good will happen. Thus far, we have not been very successful, but we hope that a stem cell-based therapy will be the answer that we have been seeking for decades," Kim said. In pre-clinical studies on sheep with discs that were damaged or degenerated, a single injection of the stem cells was found to make the discs indistinguishable from healthy ones.

"If safety and efficacy are shown in the study, this would be revolutionary,” Kim noted. “It would imply that we can possibly turn back the clock on aging by not only stopping the progression of degenerative changes in the disc, but also reversing the degenerative process," he said. The researchers plan one single injection of adult stem cells directly into the diseased lumbar discs.

Researchers will enroll approximately 100 study participants, 10 at UC Davis and the rest at 11 other medical centers throughout the country. The participants will be individuals who have suffered from moderate low-back pain for a minimum of six months and whose condition has not responded to other, conventional treatments.

The patients will be divided into four groups. One group will receive a high dose of MPCs plus hyaluronic acid, a substance that facilitates the localization and retention of the stem cells. A second group will receive a lower dose of MPCs, plus the hyaluronic acid. A third group will receive the hyaluronic acid alone and a fourth group will receive only the saline solution.

"As an investigator, the design of this study is one of its most attractive features. This type of randomized study where the patients are blinded to the treatment is as good as it's going to get to eliminate any possible bias," Kim said.

The current study is sponsored by Mesoblast Ltd., of Melbourne, Australia, which is investigating stem cell technology to regenerate and repair bone and cartilage. The MPCs are derived from a single adult donor's bone marrow to ensure homogeneity, thus minimizing the risk of rejection by the recipient. Kim will not receive compensation from Mesoblast for his participation in the study.

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Stem Cell Shots into the Heart Could Stave Off Chest Pain

This story from ABC World News Tonight includes a video that helps demonstrate the healing power of adult stem cells. Instead of injecting a patient's own adult stem cells into the spine to enable healing as we are doing at The Spine Institute, in this story, the adult stem cells are being injected into the patient's heart to treat chest pain.

The video that immediately follows the story of treating a heart with adult stem cells tracks the progress of a young man with a spinal cord injury who was treated with embryonic stem cell therapy. This therapy is different from the work we are doing with adult stem cells, but it's a remarkable testament to the healing power of stem cells.

Go to the story and video

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5 Comments on Spine Surgeries in ASCs From Surgeons Who Perform Them

written by Laura Miller | Becker's Orthopedic, Spine, and Pain Management Review | November 21, 2011

Here are five spine surgeons performing cases in ambulatory surgery centers and why they urge other surgeons to transition into the outpatient setting.

1. Richard Hynes, MD, The Back Center (Melbourne, Fla.). Dr. Hynes says the advantages of performing cases in the ASC include the same or quicker recovery time, reduced length of stay in a medical facility and same-day recovery. He performs several procedures, including laminectomies, anterior cervical discectomies and fusions and other minimally invasive, percutaneous spine procedures in an outpatient ambulatory surgery center.

Improved technology for less invasive procedures has made it possible to bring spine cases into the outpatient setting, according to Dr. Hynes. Interbody fixation, bone morphogenic protein and percutaneous procedures are the way of the future, he says, and the methodology will continue to evolve for better outcomes.

2. James Lynch, MD, SpineNavada, Surgery Center of Reno. Dr. Lynch performs spine surgery in an ASC and says it's good business in today's cost- and quality-conscious healthcare environment to do so. Positive data for spine surgery and spine surgeons in the ASC setting will play a large role in the future, as comparative profiling of physicians using data points allows patients to "shop" for physicians and hospitals to benchmark providers against one another, he says.

He expects to see spine technology revolve around minimally invasive spine surgery, robotics, nuclear disc replacement and imaging in the future. An additional shift toward generic spinal implants could help administrators manage costs at ASCs and specialty spine facilities.

3. Robert Nucci, MD, Citrus Park Surgery Center (Tampa, Fla.). Dr. Nucci performs several cases in outpatient ASCs, including far lateral interbody fusions. To perform single or multi-level FLIFs, Dr. Nucci removes the disc through a small incision, inserts a mesh cage and inflates it with allograft bone. The average OR time for the procedure is 129 minutes, surgeon time is 118 minutes and recovery time is 180 minutes. The average blood loss is 141 cc and there is minimal muscle tissue disruption.

Dr. Nucci also performs cervical disc replacement in ASCs using an artificial disc. The average OR time is 92.4 minutes, surgeon time is 77.5 minutes and recovery is 140.8 minutes. Patients are under anesthesia for approximately two hours and experience average blood loss of 95 cc. He hasn't experienced any complications with that procedure. The reasons he cites for performing these cases in an ASC include:

•    The infection rate is lower than in hospitals
•    There is less overhead cost and increased efficiency in the OR
•    Shorter anesthesia time

4. Joan O'Shea, MD, The Spine Institute of Southern New Jersey. Dr. O'Shea predicts at least 80 of practicing spine and neurosurgeons are capable of performing their cases in the ASC, whether they are currently doing so or not. However, not every surgeon is suited for the switch; she notes that ASC surgeons must perform quick surgeries, be confident in their surgical ability and have a good support team.

For her cases in the ASC, Dr. O'Shea increases patient comfort and decreases the risk of complications by:
•    Taking patients off of medications during the preoperative
•    Using cottonoids to stop epidural bleeding
•    Using Decadron to relieve patients of post-operative nausea and vomiting
•    Using cervical traction five to 15 pounds
•    Encouraging early ambulation to avoid urinary issues

5. Ken Pettine, MD, The Spine Institute, Loveland (Colo.) Surgery Center. Spine surgeries performed at the hospital are a significant expense and surgeons stand to leave money on the table if they perform procedures there instead of an ASC, Dr. Pettine says. His experience shows outpatient spine surgery can be performed safely and effectively in ASCs; in the 284 outpatient spine cases Dr. Pettine has performed, he reports no complications (although his ASC has a 23-hour convalescence center). He recommends ASCs start slow with less complicated cases, such as decompressions, and then moving to the more complicated procedures.

To recruit spine surgeons, ASC administrators can present data about the safety and efficacy of spine in other ASCs and entice them through shared income. Insurance contracts for spine can be attractive to payors because implant carve-outs bill 10 percent over retail price while hospitals bill significantly higher. Surgery centers can gain an even higher return if they negotiate discounts with device companies.


Read the original article on Becker's Orthopedic, Spine, and Pain Management Review.

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Orthopedic Stem Cells: Using Adult Stem Cells to Treat Back Pain

When it comes to stem cells, there is often a lot of mystique surrounding them.  We hear from the media that we can create a human being out of a bundle of cells, which is not necessarily true.  We also tend to look at embryonic stem cells as being the only type of stem cell.  With these types of embryonic stem cells, one idea is to be able to create a liver or kidney in a Petri dish, which is not controllable or feasible at this point, and the work being done by the Orthopedic Stem Cell Institute isn’t about that.

When we look at stem cell types, we have embryonic stem cells on one hand and adult stem cells on the other.  The characteristics of each of these are not like other cells.  For instance, a liver cell can divide but it will only ever be a liver cell.  These stem cells, both embryonic and adult, can turn into different types of cells.  The embryonic stem cells can really turn into any cell type, but adult stem cells are limited as far as the cells they can turn into.  This depends upon environment or niche and what they are already programmed to become.  A lot of people think there is a lot of promise with embryonic stem cells and there is, although we are not quite there yet.

We are still at the forefront of stem cell technology and embryonic stem cells in particular. With those cells, we do not have the ability to control what types of tissue they turn into. For example, we could be trying to manipulate these cells to turn into kidneys, but they might start to develop as pancreatic cells, which is troublesome.  Another key with all stem cells is that they can proliferate quite a bit, usually at a higher rate than just a regular somatic cell.  Although this sounds good at first glance, the issue with this, particularly with embryonic stem cells, is we cannot control that division.  Hence, these cells can keep going and going without dying.  In the normal bodily process, cells are programmed to die after a certain time, but these embryonic stem cells can evade that action and continue dividing, which takes on the characteristic of cancer cells.  In some animal studies, an issue that keeps arising is development of tumors in some of these animals. It is difficult to predict if tumors are going to form when using some sort of embryonic stem cell treatment.  This is still a scary area through which we are still trying to navigate.

However, the focus of the Orthopedic Stem Cell Institute is on adult mesenchymal stem cells. On the whole, the media does not give a lot of attention to these kinds of stem cells, as using them avoids any kind of ethical or controversial issues. There is a great amount of research being done on adult mesenchymal stem cells, however, because they are very powerful.

First off, we can control what cell type they turn into much more easily.  For example, the treatment used by the Orthopedic Stem Cell Institute focuses on Mesenchymal precursor cells (MPC).  Mesenchymal means these cells are not going to turn into any kind of blood product such as a red blood cell or white blood cell, although they are derived from bone marrow.  The fact that they are precursor cells means these MPCs are only going to differentiate into one of a few cell types.  They are either going to become bone cells, i.e., osteoblasts, or chondrocytes, i.e., cartilaginous tissue such that we see in intervertebral discs and joints, etc.  All of that really depends on the environment in which we place these adult stem cells where it is well suited to do this.  For example, we can inject these MPCs into a bone fracture, and because the cells are surrounded by bone tissue, these cells will receive signals from the surrounding cells that tell them to turn into bone. However, the cells we use will be injected into a disc or joint, and the cells composing the disc and joint tissue will signal the stem cells to develop into similar tissue.  Again, there is no chance of any sort of pancreatic cell or nerve cell type spontaneously forming because we are using certain adult stem cell types, which are limited and cannot turn into anything like that.  In addition, as the tissue surrounding the disc and joint is relatively avascular, there is not really any worry of these cells migrating through the blood stream to somewhere else in the body and causing any sort of problem.  As far as the proliferation issue with embryonic stem cells, we have not seen this issue with adult stem cells in terms of dividing exponentially without ceasing.  There is almost a preset limit to how many times these adult stem cells will divide.

Through the Orthopedic Stem Cell Institute, the Spine Institute treats lumber and cervical spine conditions using Adult Stem Cells using an FDA-approved stem cell therapy and is also involved with an FDA clinical trial. Visit the stem cell page on our website for more information on both.

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Matthew D. Pouliot, DO, Joins Staff of The Spine Institute

Dr. Matthew D. Pouliot has joined the staff of Rocky Mountain Associates in Orthopedic Medicine and The Spine Institute in Loveland, CO. Dr. Pouliot will specialize in treating adult and pediatric patients with acute and chronic spinal and orthopedic pain.

A graduate of Kansas City University of Medicine and Bio Sciences, Dr. Pouliot completed his residency in physical medicine and rehabilitation at the State University of New York Upstate Medical University, where he served one year as chief resident. He completed his fellowship in pain medicine at SUNY Upstate Medical University in the department of anesthesia. He is board certified in physical medicine and rehabilitation, and board eligible in pain medicine.

Dr. Pouliot’s specialty at RMA Ortho and The Spine Institute will be in interventional pain medicine techniques for conditions including acute and chronic spinal and joint pain, complex regional pain syndrome, and other various pain syndromes using advanced interventional pain  techniques such as image guided spinal injections,  Botox® injections for myofascial pain and headaches, and implanted spinal cord stimulators for chronic spinal and nerve pain.  Dr Pouliot will also be participating in the stem cell therapy program.  In addition, Dr Pouliot is trained to perform EMG and nerve conduction studies to aid in diagnosing common neuropathies and spinal disorders, and he is buprenorphine certified for opioid detox and level II certified for worker’s compensation in Colorado.

Those looking for assistance in managing their pain are encouraged to contact RMA Ortho and The Spine Institute at 800-795-5487 or 970-669-8881.

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Dr. Kenneth Pettine Named to Becker's "150 Physician Leaders in the Ambulatory Surgery Center Industry"

Becker's ASC Review is pleased to announce the publication of its list, "150 Physician Leaders in the Ambulatory Surgery Center Industry," which recognizes outstanding physician leaders in surgery centers and ASC-focused companies across the country. Dr. Kenneth A. Pettine of The Spine Institute is included on this list.

The physician leaders named to this list support ASCs and surgery center companies by bringing their surgical cases to the outpatient setting, pioneering new clinical developments in surgery centers and advising ASC leaders on operational and clinical issues. The chosen physicians were selected for the list based on their leadership in surgery centers or ASC-focused companies and their experience advocating for surgery centers to other physicians, payors and governmental leaders.

Physicians do not pay and cannot pay to be included on this list. There are never fees involved in Becker's ASC Review lists. Recognized providers are free to note their inclusion through marketing materials, website promotion, press releases and other media materials without paying a fee.


The full-length version of this list can be found online here:
150 Physician Leaders in the Ambulatory Surgery Center Industry

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Colorado Doc Injects Stem Cells

Originally published in Orthopedics This Week by Biloine W. Young | Fri, Aug 26, 2011

Author with Dr. Kenneth Pettine/Source: RRY Publications LLC

Colorado spine surgeon Kenneth Pettine of the Spine Institute and Loveland Surgery Center, has just performed the first minimally-invasive lumbar disc procedure in the Phase 2 clinical trial of mesenchymal precursor cells (MPC) for the treatment of low back pain and degenerative disc disease. The developer of MPC is Mesoblast Limited, a regenerative medicine company based in Melbourne, Australia. Dr, Pettine is the co-inventor of Medtronic’s Maverick artificial lumbar disc device.

The outpatient procedure lasted less than 20 minutes. The patient was fully awake, under light sedation and was discharged by Pettine shortly after. There were no complications.

Commenting on the stem cell treatment, Pettine said, "This marks the third renaissance in spine care. The first was improved diagnosis using Magnetic Resonance Imaging (MRI), the second was end-stage replacement with artificial discs, and now there is the potential widespread use of adult stem cells for disc repair and regeneration."

This marks the third renaissance in spine care. The first was improved diagnosis using Magnetic Resonance Imaging (MRI), the second was end-stage replacementIn preclinical trials, the company claims that a single minimally invasive injection of Mesoblast's allogeneic MPCs into severely damaged intervertebral discs resulted in significant reversal of the degenerative process, regrowth of disc cartilage, and sustained normalization of disc pathology, anatomy and function for at least six months.

Building on these results, Mesoblast hopes to show through Phase 2 of its clinical trial that a single minimally invasive injection of its allogeneic or off-the-shelf disc repair MPC product can regenerate damaged discs, reduce pain, improve function, and avoid surgery for patients experiencing lower back pain. Mesoblast's Phase 2 trial, which the United States Food and Drug Administration (FDA) cleared in July, will enroll 100 patients with chronic low back pain due to lumbar disc degeneration in 15 centers across the United States and Australia. Researchers will compare outcomes at six months in 60 patients receiving MPC injections against 40 patients receiving control injections with artificial discs, and now there is the potential widespread use of adult stem cells for disc repair and regeneration.

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Northern Colorado Spine Surgeon Successfully Performs First Minimally Invasive Lumbar Disc Procedure Using Adult Stem Cells

First Procedure in Phase 2 Clinical Trial of Mesoblast’s Adult Mesenchymal Precursor Cell (MPC) Product

Dr. Kenneth Pettine of The Spine Institute in Loveland, CO successfully performed the first minimally invasive lumbar disc procedure in the Phase 2 clinical trial of Mesoblast’s investigational adult Mesenchymal Precursor Cell (MPC) product for low back pain and degenerative disc disease. The outpatient procedure lasted less than 20 minutes, with the patient fully awake and under light sedation. The patient was shortly discharged and there were no complications.

The procedure took place at The Spine Institute and Loveland Surgery Center in Colorado, a United States Spine Center of Excellence. Dr. Pettine is a founder of The Spine Institute, an international leader in non-fusion surgery of the spine, and the co-inventor of Medtronic’s Maverick artificial lumbar disc device.

“This marks the third renaissance in spine care,” Dr. Pettine said. “The first was improved diagnosis using Magnetic Resonance Imaging (MRI), the second was end-stage replacement with artificial discs, and now there is the potential widespread use of adult stem cells for disc repair and regeneration.”

Up to 15 percent of people in industrialized countries have chronic low back pain lasting more than six months.  For those with progressive, severe and debilitating pain due to ongoing progression of disc degeneration, the only option is major back surgery involving artificial disc replacement or spinal fusion.  Both types of surgery are associated with significant risks, and the avoidance of surgery is a major objective of new treatments for degenerative disease of the spine.

Building on these results, Mesoblast aims to show that a single minimally invasive injection of its allogeneic, or off-the-shelf, disc repair MPC product can regenerate damaged discs, thereby reducing pain, improving function, and avoiding surgery.  Mesoblast’s Phase 2 trial, which was cleared by the United States Food and Drug Administration (FDA) in July, will enroll 100 patients with chronic low back pain due to lumbar disc degeneration in 15 centers across the United States and Australia, comparing outcomes at six months in 60 patients receiving MPC injections against 40 patients receiving control injections.

“There is a significant need for a minimally invasive biological solution to repair the degenerating disc, reduce back pain, improve function, and eliminate the need for surgery. Mesoblast’s adult stem cell product could find broad use in the treatment of both early and late degenerative disc disease, and could additionally reduce spine surgery for this condition by as much as 80 percent,” Dr. Pettine added.

Those interested in becoming a candidate for the Phase 2 clinical trial are encouraged to contact The Spine Institute at 800-795-5487 or 970-669-8881.


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Orthopedic & Spine Industry Leader to Know: Dr. Ken Pettine

Originally published in Becker's Orthopedic, Spine & Pain Management Review by  Rachel Fields | June 16, 2010


Dr. Ken Pettine, co-founder of Colorado's Rocky Mountain Associates in Orthopedic Medicine and The Spine Institute, has one piece of advice for his patients: "Friends don't let friends get fused." This phrase, which he trademarked as the tagline for The Spine Institute, communicates his belief that disc and facet replacement devices provide better treatment for spinal injuries and degeneration than traditional spinal fusion.

Dr. Pettine is the chief investigator for 13 different FDA studies on nonfusion technology, as well as an active researcher. He has an extensive background in spinal surgery, research and rehabilitation and is a member of the American Academy of Orthopedic Surgeons, the North American Spine Society and the Spine Arthroplasty Society. In February he was named to Becker's ASC Review's list of "50 of the Best Spine Specialists in America".

Dr. Pettine completed his residency and master's degree in orthopedic surgery at Mayo Clinic and received his medical degree from the University of Colorado School of Medicine. After completing his spine fellowship training at the Institute for Low Back Care in Minneapolis, he partnered with E. Jeffrey Donner, MD, to found RMA Ortho in 1991 and The Spine Institute in 2004. Along with W. Carlton Reckling, MD, Drs. Donner and Pettine have completed hundreds of spine procedures, making them three of the most experienced spine surgeons in the country. They are also some of the only surgeons nationwide qualified to implant artificial discs and spine stabilization devices.

Dr. Pettine is the co-designer and co-inventor of the MaverickTM Artificial Disc, a patented disc replacement device for the neck and back. The disc is currently the subject of a clinical trial, but while they wait, Dr. Pettine and his co-workers are venturing into other research territory. The Spine Institute plans to explore the possibility of adult stem cell therapy for bone fractures and spine disease, as well as the regeneration of damaged cartilage and invertebral discs.

"It's about staying ahead of the curve and always looking for new and better ways to help patients," Dr. Pettine told Style Magazine. "This was the vision from the beginning. It's so exciting, I've lost sleep thinking about it."


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