The Spine Institute in the News

Dr. Kenneth Pettine Named to Becker's list of Spine and Neurosurgeon Inventors to Know

2012-02-09T12:36:00.000-08:00

20 Spine and Neurosurgeon Inventors to Know

Written by Laura Miller | February 08, 2012 | Becker's Orthopedic, Spine, and Pain Management Review

Here are 20 spine and neurosurgeons currently in practice who invented spinal devices, techniques and systems.

Edward Benzel, MD (Cleveland Clinic, Cleveland). Dr. Benzel holds at least nine patents for devices, including a cervical spine stabilization method and system and a spinal column retaining apparatus. He is chairman of the Cleveland Clinic's department of neurosurgery. His clinical interests focus on spinal disorders, complex spine instrumentation and spine tumors. He is one of the founding members of the Lumbar Spine Research Society, which formed in 2007. He is chairman of the review board for the Journal of Neurosurgery: Spine and has reviewed for Spine, The Spine Journal and other publications. Dr. Benzel is medical co-director of the Cleveland Clinic Foundation Spine Research Laboratory. Dr. Benzel earned his medical degree from the Medical College of Wisconsin in Milwaukee, where he also completed his residency in neurosurgery. He received fellowship training in spine surgery and spinal cord injury at VA Medical Center in Albuquerque.

Scott Boden, MD (Emory Healthcare, Atlanta). Dr. Boden holds at least six different patents for medical devices and his research focuses on spine fusion, spinal disorders and bone regeneration. He is the director of Emory Healthcare's orthopedics and spine center as well as chairman and founder of the National Spine Network. More than 150 of Dr. Boden's journal articles have been published, and he has authored or edited more than 42 book chapters and nine books on spine topics. His research on the fundamental mechanisms of bone growth and regeneration has been awarded by the American Academy of Orthopaedic Surgeons, North American Spine Society, International Society for Study of the Lumbar Spine and other professional organizations. He earned his medical degree at University of Pennsylvania School of Medicine in Philadelphia, completed an internship at George Washington University Medical Center in Washington, DC, and received fellowship training at Case Western Reserve University Hospital in Cleveland.

Robert S. Bray, Jr., MD (Diagnostic and Interventional Spinal Care, Marina del Rey, Calif.). Dr. Bray has contributed to more than 20 patents, including a cervical dynamic stabilization system, SmartPlate spinal implant and a slidable bone plate system. He is the founding director and CEO of his practice, Diagnostic and Interventional Spine Care. He was chief of neurosurgery for the U.S. Air Force at David Grant Medical Center in 1989 and the founding director of the Institute for Spinal Disorders at Cedars-Sinai Medical Center in Los Angeles. Dr. Bray has served as spine consultant for the U.S. Men's volleyball team and the Oakland Raiders, among other professional athletic organizations. After he received his medical degree from Baylor College of Medicine in Houston, Dr. Bray completed his residency at Baylor Affiliated Hospitals, also in Houston.

James Lloyd Chappuis, MD (Spine Center Atlanta). Dr. Chappuis is in private practice at Atlanta Spine Center and holds patents for several spine devices, including an internal pedicle screw insulator apparatus and facet fusion system. Additional patents are pending for devices such as the Doppler retractor and a modular lumbar interbody fixation system. Dr. Chappuis is a member of several professional societies, including North American Spine Society and American Academy of Orthopaedic Surgeons. In addition to his clinical work, Dr. Chappuis has authored several papers on spinal surgery and served as a clinical instructor at The Medical College of Georgia in Augusta. Dr. Chappuis earned his medical degree at The Medical College of Ohio in Toledo and completed his residency in orthopedic surgery at Campbell Clinic/University of Tennessee. His additional training includes the AO Spine Fellowship where he studied in Karlsbad, Germany.

Kingsley R. Chin, MD (Institute for Modern & Innovative Spine Surgery, Ft. Lauderdale, Fla.). Dr. Kingsley is the founding spine surgeon at the Institute for Modern & Innovative Spine Surgery and inventor of the FacetFuse Minimally Invasive Screw System and MANTIS minimally invasive pedicle screw system for spinal fusion. During his career, Dr. Chin served as the chief of spine surgery at the University of Pennsylvania in Philadelphia and has published several articles in professional journals. He is a diplomat of the National Board of Medical Examiners and American Board of Orthopaedic Surgeons. He earned his medical degree at Harvard University in Boston and completed the Harvard Combined Orthopaedic Residency with Massachusetts General Hospital in Boston. His additional training includes a fellowship in adult reconstructive surgery at Harvard and a fellowship in spine surgery at Case Western Reserve University in Cleveland.

Charles R. Gordon, MD (Texas Spine and Joint Hospital, Tyler). Dr. Gordon has contributed to the development of several patented devices, including an artificial functional spinal unit system and an expandable articulating intervertebral implant. He founded the device company Flexuspine along with his practice, Gordon Spine Associates, based in Tyler, Texas. He is a co-founder of Texas Spine and Joint Hospital and a member of the North American Spine Society and American Association of Neurological Surgeons, among other professional organizations. He received his medical degree from Baylor College of Medicine in Houston and completed his residency and fellowship at The Medical College of Virginia.

Regis W. Haid, Jr., MD (Atlanta Brain and Spine Care, Atlanta). Dr. Haid holds multiple patents for implants used during cervical lateral mass plating, anterior cervical plating, posterior and transforaminal lumbar interbody fusion and cervical arthroplasty. He is a founding partner of Atlanta Brain and Spine Care and medical director of the Piedmont Spine Center and neuroscience service line at Piedmont Hospital in Atlanta. Dr. Haid has traveled internationally to present at spine conferences, including visits to Italy, Russia and Switzerland. He was previously the staff neurosurgeon for the U.S. Air Force at Wilford Hall Medical Center in San Antonio. Dr. Haid earned his medical degree from West Virginia University in Morgantown, where he also completed his neurosurgical residency. He received fellowship training in spinal disorders at the University of Florida College of Medicine.

Ken Y. Hsu, MD (St. Mary's Spine Center, San Francisco). Dr. Hsu is co-inventor – with James F. Zucherman, MD, also at St. Mary's — of the X Stop Interspinous Process Decompression System, which alleviates the symptoms of lumbar spinal stenosis. The process, FDA-approved in 2005, was first in the category of interspinous process devices. Dr. Hsu, who holds 43 patents, has been the director of spine surgery at St. Mary's Medical Center since 1988 and is a member of the clinical faculty at Stanford University. He received his medical degree from State University of New York, completed a residency in general surgery at Mt. Zion Hospital in San Francisco and an orthopedic surgery residency at St. Mary's. He completed a fellowship in spine and pediatric orthopedic surgery at the University of Hong Kong.

A. Jay Khanna, MD (Johns Hopkins Medical Center, Baltimore). Dr. Khanna is an associate professor of orthopaedic surgery and biomedical engineering at the Johns Hopkins University and holds patents for an orthopedic screw system and universally deployable and expandable bone and screw anchor assembly. He currently serves on the clinical teams of BOSS Medical and Cortical Concepts, two companies that he co-founded with his colleagues and biomedical engineering students from Johns Hopkins to foster the development of new orthopedic technologies. Dr. Khanna previously served as the Clinical Director of the Johns Hopkins Center for Bioengineering, Innovation and Design (CBID) which prepares graduate and undergraduate biomedical engineering students to become leaders in the medical device industry and creates collaborations between clinicians and engineers at Hopkins to develop new technologies and companies. Dr. Khanna has a special interest in treating patients with cervical spinal disorders and the use of minimally invasive techniques for the treatment of lumbar spinal disorders. He is a member of North American Spine Society and American Academy of Orthopaedic Surgeons. In addition to his clinical practice, Dr. Khanna has research interests in minimally invasive spine surgery and spinal biomechanics. He earned his medical degree at the Georgetown University in Washington, D.C., and completed his residency at Johns Hopkins. His additional training includes a fellowship spine surgery in the departments of in orthopedic and neurosurgery at the Cleveland Clinic.

Jeffrey A. Kozak, MD (Foundren Orthopedic Group, Houston). Dr. Kozak is a spine surgeon with Foundren Orthopedic Group and has a special interest in performing anterior procedures. He helped design several spinal implants and holds a patent for a spinal fixation device he invented. During his career, Dr. Kozak served on the Texas Workers' Compensation Task Force and authored several professional articles on spine surgery. He is a founding member and past president of the Texas Spine Society and member of the North American Spine Society. Dr. Kozak earned his medical degree from Baylor College of Medicine in Houston, where he also completed his residency in orthopedic surgery. His additional training includes spinal fellowships in England, France and Germany.

Casey K. Lee, MD (Spine Care and Rehabilitation, Roseland, N.J.). Dr. Lee is a spine surgeon with Spine Care and Rehabilitation and founder of Nexgen Spine, which developed the Physio-L Artificial Disc. He serves as chairman and chief medical officer of Nexgen Spine and continues his interest in the development of artificial disc prostheses. During his career, Dr. Lee has served as president of the North American Spine Society and New Jersey Orthopaedic Society as well as co-founder of the Korean American Spine Society. He has authored several papers published in spine text books and peer-reviewed journals. Dr. Lee earned his medical degree from Kyungpook National University Medical School in Korea and completed his orthopedic surgery residency at Carney Hospital/Boston City Hospital in Boston. In addition to his clinical work, Dr. Lee spent time as a professor of surgery at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School in Newark.

Isador Lieberman, MD (Texas Back Institute, Plano). Dr. Lieberman holds multiple patents for his technological innovations, including SpineAssist, a robotic tool he recently co-developed for use during minimally invasive spine surgery. He has held appointments with Cleveland Clinic as staff surgeon and professor of surgery at Cleveland Clinic Lerner College of Medicine. His developments have been recognized with awards from Cleveland Clinic and the Spine Society of Europe. He recently co-founded the Uganda Charitable Spine Surgeon Mission, with which he accompanies a team of surgeons to visit Uganda each year to treat the underprivileged with spine conditions. He earned his medical degree from the University of Toronto in Ontario, Canada, and completed his residency at Mount Sinai Hospital in Toronto. He also completed residency programs in orthopedic surgery at two Toronto hospitals along with a clinical fellowship in spine and trauma surgery at The Toronto Hospital.

David W. Lowry, MD (The Brain+Spine Center, Holland, Mich.). Dr. Lowry is a neurological spine surgeon with The Brain+Spine Center and co-founder of TransCorp Spine. He continues to serve as a board member of the company. During his career, Dr. Lowry invented a new spine surgery technique, the TransCorporal Micro Discectomy, for patients suffering from spinal stenosis. He holds two patents for his work and continues his efforts in research and development in areas such as the cervical spine. Dr. Lowry is a member of North American Spine Society and Congress of Neurological Surgeons. He also serves on the board of trustees for Hope College, his alma mater. Dr. Lowry earned his medical degree at Johns Hopkins Medical School in Baltimore and completed additional training at the University of Pittsburgh.

Robert Masson, MD (NeuroSpine Institute, Orlando). Dr. Masson is the founder and president of NeuroSpine Institute and a retired Lieutenant Commander of the United States Naval Reserve. He has a professional interest in minimally invasive spine surgery and developer of the iMAS surgical principles, techniques and products for Synthes Spine. The iMAS is an interpedicular minimal access surgery of the lumbar spine. During his career, Dr. Masson has treated several professional athletes, including football and basketball players. In addition to his clinical practice, Dr. Masson is a member of the Society for Minimally Invasive Spine Surgery. He was also featured on a Discovery Health documentary as a neurological surgery expert. Dr. Masson earned his medical degree at the University of Florida and completed his neurological surgery residency in Gainesville, Fla. His additional training includes a fellowship in skull base surgery and neurotology at the House Ear Clinic in Los Angeles.

Seth Neubardt, MD (Seth Neubardt, M.D. & Jack Stern, M.D., Ph.D., White Plains, N.Y.). Dr. Neubardt is the sole inventor of several medical patents, including one for a spinal procedure to safely insert screws which is now used at more than 25 hospitals in 15-plus countries. He has a professional interest in developing technology for minimally invasive spine surgery, such as an electrically insulated surgical probing tool and an apparatus and method for locating defects in bone tissue. He is a fellow with the American Academy of Orthopaedic Surgeons and member of the North American Spine Society. Dr. Neubardt earned his medical degree from the University of Texas Medical School at Houston and completed his residency in orthopedic surgery at Montefiore medical Center and Albert Einstein College of Medicine in New York City. His additional training includes an orthopedic and neurological spine fellowship at New York University Medical Center in New York City.

Kenneth A. Pettine, MD (Rocky Mountain Associates, Loveland, Colo.). Dr. Pettine is co-inventor and co-designer of the Maverick Artificial Disc, a disc replacement device for the neck and back. He is a co-founder of Rocky Mountain Associates and a surgeon at Loveland (Colo.) Surgery Center. During his career, Dr. Pettine has been chief investigator for eight FDA studies involving non-fusion spine technology. He is a distinguished speaker at national and international symposiums and the author of nearly 20 research publications. He received his medical degree from the University of Colorado School of Medicine in Denver. He completed his residency and his master's degree in orthopedic surgery at the Mayo Clinic in Rochester, Minn., and completed a fellowship at the Institute for Low Back Care in Minneapolis.

David G. Schwartz, MD (OrthoIndy Northwest, Indianapolis). Dr. Schwartz is the inventor of the Anteres Spinal Instrumentation System, which is used for the treatment of spinal fractures, scoliosis and tumors. During his career, Dr. Schwartz's clinical interests include spinal deformities, kyphosis, scoliosis and low back pain. He is the director of OrthoIndy's Spine Fellowship and an assistant clinical professor in the department of orthopedic surgery at Indiana University in Bloomington. He earned his medical degree from Loyola University in Chicago, completed a residency in orthopedic surgery at Northwestern University in Chicago and received fellowship training in spine surgery at the Leatherman Spine Center, Kosair Childrens Hospital and the University of Louisville, all located in Louisville, Ky.

Jeffrey Wang, MD (UCLA Comprehensive Spine Center, Los Angeles). Dr. Wang practices with the UCLA Comprehensive Spine Center and is the director of the UCLA Spine Surgery Fellowship. He is the inventor of an artificial disc, which he used in a spine surgery for Governor Benigno R. Fitial, who was suffering from spinal stenosis. During his career, Dr. Wang has served on the editorial boards for several professional journals, including editor-in-chief for Global Spine Journal and deputy editor for The Spine Journal. He has served on the board of directors for the Cervical Spine Research Society and North American Spine Society as well as held leadership positions with the American Academy of Orthopaedic Surgeons. In addition to his clinical work, Dr. Wang runs a basic science laboratory. His research interests include gene therapy for spinal disorders, minimally invasive spine surgery and bone growth biological proteins. He earned his medical degree at the University of Pittsburgh School of Medicine and completed his residency in orthopedic surgery at UCLA School of Medicine. Dr. Wang's additional training includes a spine and spinal cord injury fellowship at University Hospitals of Cleveland.

Anthony T. Yeung, MD (Desert Institute for Spine Care, Phoenix). Dr. Yeung developed the FDA-approved Yeung Endoscopic Spine System, and was one of the first spine surgeons to utilize endoscopically-guided laser for degenerative conditions of the lumbar spine. During his career, Dr. Yeung has authored more than 70 scientific publications on his technique. He is currently the president of the World Congress of Minimally Invasive Spine Surgeons and has held leadership positions within numerous other national and international spine organizations. Dr. Yeung received his medical degree from University of New Mexico School of Medicine in Albuquerque, completed his residency at Maricopa County General Hospital in Phoenix and served in the U.S. Navy Medical Corp in Subic Bay, Philippines.

Jim Zucherman, MD (San Francisco Orthopaedic Surgeons). Dr. Zucherman is a senior spine partner at San Francisco Orthopaedic Surgeons Medical Group and inventor and co-developer of the X-Stop, an interspinous process device for treating lumbar spinal stenosis. He is also in the process of developing the Starflex motion preservation minimally invasive spine stabilization device through Spartek. During his career, Dr. Zucherman has pioneered several surgical techniques and developed one of the first laparoscopic lumbar spinal fusions and percutaneous cervical discectomy procedures in the United States. He has been a principle investigator for the Prodisc and Flexicore FDA lumbar disc replacement trials as well as the Prestige and Cervicore cervical disc replacement trials. Dr. Zucherman earned his medical degree at Baylor College of Medicine in Houston and completed his residency in orthopedic surgery through the San Francisco Orthopaedic Residency Program. His additional training includes a pediatric and orthopedic spine surgery fellowship at the Duchess of Kent Children's Orthopaedic Hospital of the University of Hong Kong.

Spinal fusion surgery: The science behind Manning's life changing operation

2012-02-03T06:44:00.000-08:00

By Christi Sodano | Feb 02, 2012 | Medill Reports Chicago

With his home turf the epicenter of the Super Bowl buzz this season, his younger brother in contention for the NFL championship and a potentially life-changing contract decision only one month away, it is little wonder why Peyton Manning’s recovery is at the forefront of Indianapolis conversation.

Last September, Manning underwent his third neck surgery in two years. The controversial spinal-fusion surgery aimed to correct a cervical disc herniation in his neck has been associated with declines in his on-field performance.

Cervical disc herniation occurs when the cushioned discs, which act as shock absorbers between the vertebrae, bulge and pinch the spinal cord or nerve root that are encased in the spine.

This is generally caused by repeated neck motion or trauma and can result in loss of motor function and numbness or sharp pain, said Dr. Selene Parekh, associate professor of orthopedic surgery at Duke University.

Typically surgery is considered only after the patient has endured prolonged pain of up to six weeks, said Dr. Wellington Hsu, assistant professor of orthopedic surgery at the Feinberg School of Medicine at Northwestern University.

In Manning’s case, disc fragments pinching the nerve root in his cervical spine likely caused acute pain and decreased arm strength.

During the September operation, doctors removed a single disc through a small incision in the front of the neck, alleviating pressure on the nerve root and replacing the disc with bone grafts or a plastic implant. Once the new disc is set into place, the surrounding vertebrae are fused using a titanium plate and screws in the upper and lower vertebrae.

Prior to Manning’s spinal-fusion surgery, he underwent two microdiscectomies in an attempt to correct the problem. After a series of diagnostic tests in September showed his recovery was not on track, spinal-fusion surgery became the next step.

Although the surgery is touted by many industry professionals as more than 95 percent successful, Dr. Kenneth Pettine, an American Academy of Orthopedic Surgeons member, said in a 2010 report, “The perception is that this is a great operation. I’m not saying it’s an awful operation. We’re just presenting the data that it’s certainly not 95 percent.”

“When you get one level fused, the next level up and down has to take all the motion. This very often accelerates into adjacent level dysfunction. That can happen two years later, that can happen 10 years later,” said Shaeffer Bannigan, development engineer at NuVasive, Inc., a spinal surgery technology company.

Hsu, who published a study in 2010 about the likelihood of athletes to return to the NFL after spinal- fusion surgery said, “For a player like Manning, the time frame to play football is closing in and when his arm strength was not improving fast enough, he elected to have the fusion.”

In his study, Hsu analyzed 99 players, some of whom are still on the field, and found on average players treated surgically had a higher return-to-play rate and longer career than players who are treated nonsurgically and position was a key factor in success after surgery.

Performance after surgery largely depends on the player's position and is particularly relevant for quarterbacks, Parekh said.

“Loss of function, even if only by a few degrees, is significant because if neck rotation is inhibited, that can affect your ability to assess what is happening on the field,” he said.

Recovery plans after surgery vary depending on the patient.

According to Parekh’s medical-information blog, the bone usually takes 12 weeks to fuse and after fusion, “a prolonged course of therapy will be needed to regain some of the loss of function, mobility and strength.”

Despite a lengthy recovery process, Hsu speculated that, “Manning will be able to come back to the NFL next year. What his level of play will be after he returns is still yet to be determined.”

However, Hsu’s opinion is not shared by all.

“My personal opinion was that there wasn’t an entirely honest view of what was happening him, there is a real chance that he may never return to play in the NFL,” Parekh said.

View this article in its original publication.

Now Enrolling: ACADIA Facet Replacement System Study for Lumbar Spinal Stenosis

2012-01-17T13:48:00.000-08:00

The ACADIA™ Facet Replacement System (AFRS) study is designed to compare two treatment options for lumbar spinal stenosis and is one of many clinical trials in which The Spine Institute is participating. This page is designed to provide more information as to what the study involves and who is eligible to participate. After learning about the study here, if you are interested in participating or would like to receive more information, please contact our research coordinator, Nic Rittenhouse, at 970.669.8881, ext. 229 or complete our contact form.

Pre-Procedure Evaluation

To be eligible for the ACADIA™ study, you must meet specific study criteria that are designed to find the best possible candidates for the study. During your pre-procedure evaluation, your doctor will review your medical history, perform a neurological exam, and take images of your lower spine called radiographs to determine the extent of your stenosis. You will also be asked to complete several questionnaires to help us determine the level of pain or discomfort your stenosis is causing you and how it’s affecting your quality of life.

The Procedure

If you qualify for the study and choose to participate, your doctor will treat your stenosis with one of two procedures: surgical decompression with facet replacement using the ACADIA™ Facet Replacement System or surgical decompression with spinal fusion, which is a current standard of care for treating lumbar spinal stenosis. The decision as to which treatment you will receive is decided at random. As part of the study, two out of every three patients will receive the ACADIA™ Facet Replacement System and one out of every three patients will receive spinal fusion.

Post-Procedure Follow-Up

After your procedure, you will need to attend follow-up visits at six weeks, three months, six months, twelve months, and twenty-four months so your doctor can document your progress.

Frequently Asked Questions

What is the purpose of a clinical study?

A clinical study (also called a clinical trial or a research trial) is to examine treatment options for specific health conditions. Although there are many types of clinical trials, all must follow the strict rules set by the U.S. Food and Drug Administration (FDA). These rules help protect the rights and safety of those who volunteer to take part in clinical research studies.

Can I receive the ACADIA™ Facet Replacement System without joining the study?

No, the ACADIA™ Facet Replacement System is currently only available to patients through a clinical study.

Are there any costs involved with taking part in the ACADIA™ Clinical Study?

Any study-related tests, procedures, physician fees, or services that are not covered by your insurance will be provided to you at no cost. However, you will be responsible for your insurance co-pays.

How do I know if I’m right for the ACADIA™ study?

In addition to the medical information that your doctor will collect at your pre-procedure evaluation, there are criteria that will make you right for the study (inclusion criteria), and criteria that will automatically exclude you (exclusion criteria). Here is a brief list – the complete list may be found on the ACADIA™ study protocol summary on The Spine Institute website.

Inclusion criteria include:

21-85 years of age and skeletally mature
Undergone at least six cumulative months of conservative treatment prior to surgery including any of the following:

- Medications
- NSAIDs
- Physical therapy
- Bracing
- Chiropractic manipulation
- Modified activities of daily living
- Epidural injections
- Facet block injections

Persistent leg, thigh, and/or buttock symptoms, including pain, numbness, burning or tingling
Willing and able to comply with post-operative and routinely scheduled clinical and radiographic evaluations
Live in the immediate area of The Spine Institute (Loveland, Colorado) and have no plans to relocate to another geographic area before the completion of the study, or live outside the immediate area and are willing to comply with scheduled postoperative visits with a Spine Institute physician.

Exclusion criteria include:

Previous surgical procedure at the operative or adjacent level, except for micro-discectomy, laminectomy, lamino/foraminotomy, rhizotomy, IDET, and/or interspinous spacer
Previous lumbar fusion or disc replacement procedure
Osteoporosis
Certain levels of spondylolisthesis or retrolithesis
Scoliosis of the lumbar spine
Discogenic back pain because of torn, herniated, inflamed or irritated disc or other cause that give you axial back pain from degenerative disc disease
Spinal stenosis at more than three lumbar segments
Acute trauma to the lumbar spine has occurred within the last 24 months
Type I Diabetes
Known allergy to cobalt chromium or titanium
Pending litigation related to back pain or injury, or are currently receive Worker’s Compensation

These criteria will not automatically include you in or exclude you from in the ACADIA™ Clinical Study, they are merely to give you an idea of what’s involved. The complete list is available on the clinicaltrials.gov website.

For further questions on the study or to schedule a pre-procedure evaluation, please contact The Spine Institute Research Coordinator, Nic Rittenhouse, at 970.669.8881 ext. 229 or complete our contact form.

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Are You a Candidate for Lumbar Artificial Disc Replacement?

2012-01-03T15:04:00.000-08:00

At the Spine Institute, we advocate for artificial disc replacement over fusion for a number of reasons. While everyone's condition is unique and you must always discuss your options for artificial disc replacement with your physician, here are the criteria for a candidate for a ProDisc-L implant made by Synthes:

You must be suffering from Degenerative Disc Disease (DDD) at only one level between L3 and S1. DDD is defined as a disc that is worn out or has become injured and is causing pain. This determination is made based on history, physical examination and x-rays
You should have at least six months of conservative treatment (e.g., medications, physical therapy, etc.) without relief of symptoms
Your vertebrae must be dimensionally large enough to support the device
You must not have an active infection, either throughout your body or localized to your spine
You must have good bone quality (no osteoporosis or osteopenia)
You must not be allergic to cobalt chromium, molybdenum, polyethelene, titanium, or tantalum
You must be old enough that the bones in your body are mature and no longer growing
You must not have spinal anatomy that would prevent implantation of the device or cause the device to be unstable in your body, as determined by your doctor

Learn more about other devices we use for lumbar artificial disc replacement on our website.

Remember, these are just criteria for the artificial disc replacement device. Only you and your doctor can decide the best treatment for you and your condition.

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10 Tips for a Healthy Back

2011-12-28T08:22:00.000-08:00

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

Standing: Keeping one foot forward of the other, with knees slightly bent, takes the pressure off your low back.
Sitting: Sitting with your knees slightly higher than your hips provides good low back support.
Reaching: Stand on a stool to reach things that are above your shoulder level.
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.
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.
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.
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.
Control Your Weight: Additional weight puts a strain on your back. Keep within 10 lbs. of your ideal weight for a healthier back.
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.
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?

2011-12-13T14:37:00.000-08:00

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

2011-11-28T10:52:00.001-08:00

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

2011-11-22T11:53:00.001-08:00

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

2011-10-27T08:56:00.000-07:00

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

2011-10-12T10:28:00.000-07:00

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"

2011-10-10T09:27:00.000-07:00

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

2011-09-21T14:45:00.000-07:00

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

2011-09-19T09:15:00.000-07:00

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.

In preclinical trials, 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 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

2011-09-09T10:12:00.000-07:00

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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