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.

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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.

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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.

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

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

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

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?

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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