Written by Taryn Tawoda | March 29, 2012 | Becker's ASC Review
Kenneth Pettine, MD, is a spine surgeon and the founder of the Spine Institute and Loveland (Colo.) Surgery Center and Rocky Mountain Associates in Orthopedic Medicine.
When considering surgery center trends for 2012, Dr. Pettine told Becker’s ASC Review, "I think there's going to be a very renewed interest in ASCs. It is profitable to do spine surgery at an ASC for both the spine surgeon and other owners, and implant costs can be a source of additional passive income. Include 12-minute turnaround times and overall efficiency, patient satisfaction and this situation is too good for a spine surgeon not to desire. I have no intention of changing my ownership structure. In fact, I just want to own more."
Dr. Pettine is board certified and a member of the American Academy of Orthopedic Surgeons, the North American Spine Society and the Arthroscopy Association of North America. He received his fellowship training at the Institute for Low Back Care in Minneapolis, completed his residency and his master's degree in orthopedic surgery at the Mayo Clinic in Rochester, Minn., and was awarded his MD from the University of Colorado School of Medicine.
Dr. Pettine previously served as a staff orthopedic surgeon and chief of the sports medicine clinic at Eisenhower Army Medical Center in Fort Gordon, Ga.; associate clinical professor at the Medical College of Georgia; and visiting consultant at the Veteran's Administration Hospital in Augusta, Ga.
Friday, March 30, 2012
Wednesday, March 28, 2012
Positive Signs for Gene Therapy in Slowing the Course of Disc Degeneration
Spinal News International - Issue 22, March 2012 -- view as PDF
A new study, which was presented at the annual meeting of the North American Spine Society (NASS; 2–5 November 2011, Chicago, USA) and subsequently published online in The Spine Journal, has found that gene therapy has the potential to delay disc degeneration.
Lead author Steven Leckie, Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA, and co-investigators reviewed the use of the adeno-associated virus sero-type 2 (AAV2) vector carrying genes for either bone morphogenetic protein 2 (BMP2) or tissue inhibitor of metalloproteinase 1 (TIMP1) to manage degenerative disc disease in New Zealand white rabbits. Explaining the purpose of the study, Leckie, who presented the data at NASS, said: “BMP2 is known to induce proteoglycan production in the intervertebral disc and TIMP1 is anti-anabolic in that it prevents the breakdown of proteoglycan. The problem with growth factors is that they are transient, so the philosophy of gene therapy is that we might be able to induce a sustained response from the host.” He added that, in their study, which won the 2011 outstanding Paper: Basic Science award at NASS, they used AAV2 because it has been shown to be safer than other vectors used in previous studies.
The 34 skeletally mature rabbits used in the study were divided into five groups: non-surgical (negative controls; six), sham procedure (negative controls; four), puncture surgery (underwent puncture surgery but did not receive any subsequent therapy, positive controls; eight), puncture surgery followed by treatment with AAV2-BMP2 (eight), and puncture surgery followed by treatment with AAV2- TIMP1 (eight). Puncture surgery was performed with a 16-gauge needle, which has been reliably shown to induce degeneration, in L2-L3, L3-L4, and L4-L5 discs. Leckie said: “The outcomes that we measured included MRI, histology, biomechanics, and biochemistry.”
After 12 weeks, rabbits in the non-surgical and the sham procedure groups did not show any evidence of disc degeneration on MRI but all rabbits in the puncture surgery group did have evidence of disc degeneration (on MRI, images of nucleus pulpous in the affected area darkened and decreased over the 12 weeks of the study). About the treatment groups, Leckie said: “Although they did have some degree of
disc degeneration, they appeared to have less degeneration than the puncture group.” In The Spine Journal paper, Leckie et al reported that the nucleus pulpous of the treated groups “retained their size and did not darken as much as the punctured discs.”
Leckie said that he and his fellow investigators also collected serum biomarkers for C-telopeptide II, which he explained is the breakdown product of C-terminus of collagen II and could be measured in the serum. He added: “At 12 weeks, the control rabbits had a slight increase [the rabbits in the non-surgical group], the
puncture rabbits had significantly higher serum values, and the treatment groups had values that fell well below those of the puncture group.”
As well as the MRI data and the biomarker data, there was also histological data. Leckie said: “The discs of the control and sham rabbits appeared to be normal. The punctured discs appeared relatively acellular and more fibrotic, and the discs that were treated with AAV2-BMP2 or AAV2-TIMP1 gene therapy had a relative maintenance of cellularity and relative preservation of their architecture.”
Leckie concluded by saying: “We have MRI evidence, serum biomarker evidence, biomechanics evidence, and histology evidence that gene therapy treatment with AAV2-BMP2 or AAV2-TIMP1 might help slow the course of disc degeneration in a rabbit model.”
A new study, which was presented at the annual meeting of the North American Spine Society (NASS; 2–5 November 2011, Chicago, USA) and subsequently published online in The Spine Journal, has found that gene therapy has the potential to delay disc degeneration.
Lead author Steven Leckie, Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA, and co-investigators reviewed the use of the adeno-associated virus sero-type 2 (AAV2) vector carrying genes for either bone morphogenetic protein 2 (BMP2) or tissue inhibitor of metalloproteinase 1 (TIMP1) to manage degenerative disc disease in New Zealand white rabbits. Explaining the purpose of the study, Leckie, who presented the data at NASS, said: “BMP2 is known to induce proteoglycan production in the intervertebral disc and TIMP1 is anti-anabolic in that it prevents the breakdown of proteoglycan. The problem with growth factors is that they are transient, so the philosophy of gene therapy is that we might be able to induce a sustained response from the host.” He added that, in their study, which won the 2011 outstanding Paper: Basic Science award at NASS, they used AAV2 because it has been shown to be safer than other vectors used in previous studies.
The 34 skeletally mature rabbits used in the study were divided into five groups: non-surgical (negative controls; six), sham procedure (negative controls; four), puncture surgery (underwent puncture surgery but did not receive any subsequent therapy, positive controls; eight), puncture surgery followed by treatment with AAV2-BMP2 (eight), and puncture surgery followed by treatment with AAV2- TIMP1 (eight). Puncture surgery was performed with a 16-gauge needle, which has been reliably shown to induce degeneration, in L2-L3, L3-L4, and L4-L5 discs. Leckie said: “The outcomes that we measured included MRI, histology, biomechanics, and biochemistry.”
After 12 weeks, rabbits in the non-surgical and the sham procedure groups did not show any evidence of disc degeneration on MRI but all rabbits in the puncture surgery group did have evidence of disc degeneration (on MRI, images of nucleus pulpous in the affected area darkened and decreased over the 12 weeks of the study). About the treatment groups, Leckie said: “Although they did have some degree of
disc degeneration, they appeared to have less degeneration than the puncture group.” In The Spine Journal paper, Leckie et al reported that the nucleus pulpous of the treated groups “retained their size and did not darken as much as the punctured discs.”
Leckie said that he and his fellow investigators also collected serum biomarkers for C-telopeptide II, which he explained is the breakdown product of C-terminus of collagen II and could be measured in the serum. He added: “At 12 weeks, the control rabbits had a slight increase [the rabbits in the non-surgical group], the
puncture rabbits had significantly higher serum values, and the treatment groups had values that fell well below those of the puncture group.”
As well as the MRI data and the biomarker data, there was also histological data. Leckie said: “The discs of the control and sham rabbits appeared to be normal. The punctured discs appeared relatively acellular and more fibrotic, and the discs that were treated with AAV2-BMP2 or AAV2-TIMP1 gene therapy had a relative maintenance of cellularity and relative preservation of their architecture.”
Leckie concluded by saying: “We have MRI evidence, serum biomarker evidence, biomechanics evidence, and histology evidence that gene therapy treatment with AAV2-BMP2 or AAV2-TIMP1 might help slow the course of disc degeneration in a rabbit model.”
For Back, Neck Pain, Artificial Disc Replacement Has Cost, Outcome Advantages Over Fusion Surgery
ScienceDaily (Mar. 22, 2011) —
When physical therapy and drugs fail to relieve back or neck pain, patients often turn to spinal fusion surgery as a last resort, but two new studies show that in certain situations, especially when several discs are involved, artificial disc replacement may give better long-term results at lower cost.
Hospital costs for artificial disc replacement were 49 percent lower, and four years out from surgery, artificial disc patients were four times less likely to need additional surgery than those who had fusion operations, according to two recently published studies.
"Back pain is the fifth leading cause of hospital admission and the third most common reason for surgery," said orthopaedic surgeon Rick B. Delamarter, M.D., co-director of the Cedars-Sinai Spine Center. "Estimates vary and are probably understated, but health care expenditures for back pain top $91 billion a year, not including indirect and societal costs such as time lost from work and worker's compensation.It is crucial that we develop surgical procedures that are cost effective without sacrificing high-quality results."
Delamarter is a lead author of the two studies, which were published recently in the SAS Journal of the International Society for the Advancement of Spine Surgery and the Society for Minimally Invasive Spine Surgery.
Both studies compared disc replacement surgery with the more common fusion operation to treat degenerative disc disease -- deterioration caused by aging and wear and tear. One study looked at 209 patients with damaged neck discs who received either minimally invasive disc replacement or the more complex spinal fusion surgery. These patients were followed at regular intervals for four years. A separate group of 136 who received an artificial disc two years after the first group also were part of the study. All patients were assessed on their satisfaction with the results of the procedure. The other study focused on 53 patients suffering from three-level, lower back disc disease and looked at cost comparisons for length of hospital stay, resources used and other factors
Discs act as cushions between the bones (vertebrae) of the spine. When healthy, the discs have enough "give" to allow the back to be flexible but are firm enough to provide stability. With age or injury, they lose their pliability and density. Nerves may become pinched between the bones, causing pain not just in the spine but in other parts of the body.
Fusion surgery seeks to relieve symptoms of the degenerative disease by removing the damaged disc and replacing it with bone. Studies show this procedure often can be effective but there can be drawbacks: in some cases, fused spinal sections can lose flexibility, impeding normal movement and stressing adjacent discs, often leading later to more fusion surgery. Artificial disc replacement, which has been performed in the United States since 2000, tends to cause less tissue injury than fusion surgery, and the discs are designed to maintain natural spine movement and reduce need for follow-up surgery.
In their study of patients suffering neck (cervical) disc disease, Delamarter and his colleagues found both disc replacement and fusion surgery acceptable options providing good long-term outcomes. But four years out from surgery, fusion patients were four times more likely to need more surgery. Half of these secondary operations were needed to treat new disc problems occurring adjacent to fused sections.
Patients in the study had imaging scans to measure before-and-after flexibility and range of motion; were evaluated for physical and neurological improvement; and completed self-assessment questionnaires on neck disability, neck and arm pain intensity. Improvements were seen in all categories, regardless of the surgical procedure, but results tended to be at least slightly better in patients with disc replacements.
An important area, according to Delamarter, was patient satisfaction with the procedure. Four years after surgery, nearly 88 percent of disc replacement patients reported that they were very to completely satisfied, compared with 76 percent of fusion patients. When asked if they would undergo the same surgery again, 89 percent of disc replacement patients and 81 percent of fusion patients said yes.
"While the results of this 13-center study are preliminary, it appears that artificial disc replacement surgery compares favorably as an effective procedure, is preferred by patients and slows the rate of adjacent-level disease," Delamarter said.
Spinal fusion has been recognized as one of the more expensive surgical procedures. The second study looked at costs and is believed to be the first to compare those of three-level disc replacement with three-level fusion. It evaluated itemized billing records of 53 patients undergoing surgery for three consecutive discs of the low back (lumbar spine) at St. John's Health Center in Santa Monica, Calif., where Delamarter practiced before joining Cedars-Sinai.
Total hospital costs for patients undergoing disc replacement surgery averaged 49 percent lower than those for fusion patients.
The number of fusions for low back pain is rising rapidly, but Delamarter urges hospitals, insurers and surgeons to consider alternatives, including total disc replacement.
"After safety and effectiveness of a procedure have been documented, cost is an important consideration," he said. "Artificial disc replacement technology appears to offer a promising, cost-saving alternative to fusion, especially for patients with disease at three levels."
The artificial discs implanted in these studies -- the ProDisc-C and ProDisc-L -- were manufactured by Synthes USA Products. Delamarter and his colleagues have evaluated outcomes and written about the devices since the FDA approved them for research and limited use in the United States. Delamarter is a consultant for Synthes and receives royalties on the ProDisc devices. However, he does not receive royalties on devices used for his patients or any other patients at Cedars-Sinai Medical Center.
read this story online
Monday, March 26, 2012
Becker's ASC Review June Meeting to Gather 700 Industry Leaders to Discuss Orthopedics, Spine, ASC Profitability
Becker's ASC Review will host more than 700 surgery center industry leaders at its annual meeting June 14-16, 2012, at the Westin on Michigan Avenue in Chicago.
Chicago, Illinois (PRWEB) March 25, 2012
Becker's ASC Review will host more than 700 surgery center industry leaders at its annual meeting June 14-16, 2012, at the Westin on Michigan Avenue in Chicago.
The orthopedic, spine and pain-focused ASC conference brings together surgeons, physician leaders, administrators and ASC business and clinical leaders to discuss how to improve your ASC and its bottom line and how to manage challenging clinical, business and financial issues.
The conference will feature 30 presentations from physician leaders, including:
- Everything You Need to Know to Successfully Perform Spine Surgery in an ASC – Ken Pettine, MD, Founder of The Spine Institute and Loveland Surgery Center
- Evolving Clinical Developments in Interventional Pain Management – Mark Coleman, MD, CEO, National Spine and Pain Centers, LLC
- Hand Surgery – Key Business Issues for ASCs and Physician-Owned Hospitals – R. Blake Curd, MD, Board Chairman, Surgical Management Professionals
- Emerging Orthopedic Procedures in ASCs – Business and Clinical Issues – Michael Redler, MD, The OSM Center
Attendees will also have the chance to see a variety of presentations on improving profitability, featuring speakers such as Nancy Boyd of Crane Creek Surgery Center; Luke Lambert, of Ambulatory Surgical Centers of America; Jeff Leland of Blue Chip Surgical Center Partners; Tom Mallon of Regent Surgical Health; Kenny Hancock of Meridian Surgical Partners; Andrew Hayek of Surgical Care Affiliates; Robert Zasa of ASD Management; Charles Peck of Health Inventures; Steve Arnold, MD, of Access MediQuip; and Larry Taylor of Practice Partners.
Keynote speakers for the conference include Lou Holtz, legendary football coach and analyst for ESPN; Tucker Carlson, contributor to FOX News and editor-in-chief of The Daily Caller; and Sam Donaldson, ABC News veteran.
To register, visit: 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference
For information on sponsorship opportunities, contact Jessica Cole at Jessica(at)beckershealthcare(dot)com or call (312) 929-3621.
About Becker’s ASC Review
Becker's ASC Review features general business, legal and clinical guidance for surgery center administrators, physicians and industry leaders. Each of the magazine’s nine annual print issues reaches a qualified audience of more than 25,000 key business leaders and focuses on topics such as joint ventures, development and expansion, regulatory and compliance issues and methods to increase surgery center profitability. Every surgery center in the nation receives Becker’s ASC Review.
Becker's ASC Review features general business, legal and clinical guidance for surgery center administrators, physicians and industry leaders. Each of the magazine’s nine annual print issues reaches a qualified audience of more than 25,000 key business leaders and focuses on topics such as joint ventures, development and expansion, regulatory and compliance issues and methods to increase surgery center profitability. Every surgery center in the nation receives Becker’s ASC Review.
Friday, March 23, 2012
The Most Interesting 2.5 Days in the ASC & Spine Business Are Coming — The 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference
by the Staff at Becker's ASC Review
This conference includes great spine, orthopedic and pain management physician leaders as speakers. These include speakers such as Charles Gordon, MD, of Texas Spine and Joint Hospital; David Rothbart, MD, of Spine Team Texas; Richard Wohns, MD, of South Sound Neurosurgery; Scott Glaser, MD, of Pain Specialists of Greater Chicago; Kenneth Pettine, MD, of The Spine Institute and Loveland Surgery Center; Brian Cole, MD, of Rush University Medical Center; Laxmaiah Manchikanti, MD, of the American Society for Interventional Pain Management Physicians; John Caruso, MD, of Parkway Surgery Center; John Peloza, MD, of the Center for Spine Care; and James T. Caillouette, MD, of Hoag Orthopaedic Institute will all lead informative sessions about the biggest ideas, challenges and trends in spine, orthopedics and pain management.
The conference also includes incredible speakers on improving profitability in ASCs such as Nancy Boyd of Crane Creek Surgery Center; Luke Lambert, of Ambulatory Surgical Centers of America; Jeff Leland of Blue Chip Surgical Center Partners; Tom Mallon of Regent Surgical Health; Kenny Hancock of Meridian Surgical Partners; Andrew Hayek of Surgical Care Affiliates; Robert Zasa of ASD Management; Charles Peck of Health Inventures; Steve Arnold, MD, of Access MediQuip; Larry Taylor of Practice Partners in Healthcare; Larry Teuber, MD, of Medical Facilities Crop.; Michael J. Lipomi of Surgical Management Professionals; Gregory DiConciliis of Boston Out-Patient Surgical Suites; John Seitz of Ambulatory Surgical Group; and Edward Hetrick of Facility Development & Management.
The conference will be held in Chicago, June 14 through June 16, at the Westin Hotel on Michigan Avenue. Key note speakers are legendary football coach Lou Holtz, editor-in-chief of The Daily Caller and Fox News contributor Tucker Carlson and ABC News veteran Sam Donaldson.
To learn more and register, click here.
view the article online here
This conference includes great spine, orthopedic and pain management physician leaders as speakers. These include speakers such as Charles Gordon, MD, of Texas Spine and Joint Hospital; David Rothbart, MD, of Spine Team Texas; Richard Wohns, MD, of South Sound Neurosurgery; Scott Glaser, MD, of Pain Specialists of Greater Chicago; Kenneth Pettine, MD, of The Spine Institute and Loveland Surgery Center; Brian Cole, MD, of Rush University Medical Center; Laxmaiah Manchikanti, MD, of the American Society for Interventional Pain Management Physicians; John Caruso, MD, of Parkway Surgery Center; John Peloza, MD, of the Center for Spine Care; and James T. Caillouette, MD, of Hoag Orthopaedic Institute will all lead informative sessions about the biggest ideas, challenges and trends in spine, orthopedics and pain management.
The conference also includes incredible speakers on improving profitability in ASCs such as Nancy Boyd of Crane Creek Surgery Center; Luke Lambert, of Ambulatory Surgical Centers of America; Jeff Leland of Blue Chip Surgical Center Partners; Tom Mallon of Regent Surgical Health; Kenny Hancock of Meridian Surgical Partners; Andrew Hayek of Surgical Care Affiliates; Robert Zasa of ASD Management; Charles Peck of Health Inventures; Steve Arnold, MD, of Access MediQuip; Larry Taylor of Practice Partners in Healthcare; Larry Teuber, MD, of Medical Facilities Crop.; Michael J. Lipomi of Surgical Management Professionals; Gregory DiConciliis of Boston Out-Patient Surgical Suites; John Seitz of Ambulatory Surgical Group; and Edward Hetrick of Facility Development & Management.
The conference will be held in Chicago, June 14 through June 16, at the Westin Hotel on Michigan Avenue. Key note speakers are legendary football coach Lou Holtz, editor-in-chief of The Daily Caller and Fox News contributor Tucker Carlson and ABC News veteran Sam Donaldson.
To learn more and register, click here.
view the article online here
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