Major Surprise From NASS’ Best Paper // Spinal Elements Steps UP for Children with Major Donation // and More!

Wrong Cervical Fusion Diagnosis, Doctor! Here’s Why.

Using the largest series ever undertaken—262 surgically explored segments—Kwang Sup Song M.D., Dan Riew, M.D. and the Cervical Spine Service at Washington University are defining plain radiographic criteria for anterior cervical fusion. They have found that when using plain X-rays, 2mm of interspinous motion (ISM) was inaccurate for diagnosing anterior cervical fusion status. Dr. Riew tells OTW, “There remains controversy surrounding the use of interspinous motion (ISM) on flexion/extension cervical radiographs as a way of determining anterior cervical fusion status; the issue is the exact distance and measurement accuracy. There are many previous studies using different criteria for diagnosing cervical fusion as being solid using plain X-rays. In a paper recently accepted by JBJS, we found that the interspinous distance of >1mm at 150% magnification on a plain X-ray, where the adjacent, non-fused segment moved at least 4 mm (to ensure that there was an adequate flexion and extension view) was the best way to tell if there was a pseudoarthrosis. This was based on objective criteria using CT as well as surgical exploration for confirmation. Many people have used criteria such as less than three degrees of angular motion, but this gives inaccuracies. Despite widespread literature, we found that 2mm of ISM was inaccurate for diagnosing fusion status. To our knowledge, this is the first report of dynamic plain radiographic parameters for determining fusion status that equal CT scans and our results were strengthened by the largest number of segments surgically analyzed.”

NASS’s Fellowship Award Goes to…Deb Kumar Roy!

Deb Kumar Roy, MBBS, MRCS (Ed) from Birmingham, UK has been honored with the 2013 NASS Clinical Traveling Fellowship Award. Dr. Roy, who is with the Department of Neurosurgery at The Queen Elizabeth Hospital, tells OTW, “This fellowship involves visiting a few of the best spinal units in the U.S. and learning what is the practice in the units considered best in the world in terms of patient care, protocols for managing various spinal pathologies, use of modern techniques and the importance of multidisciplinary team approach in the management of various spinal conditions like tumors, trauma and infection. My role will be in the capacity of a clinical observer and as such I will be in operating rooms, outpatient clinics, and departmental meetings. I will be spending a month in the U.S. and will be visiting Johns Hopkins University Hospital in Baltimore with Professor Ziya Gokaslan, Rothman’s Spine Institute in Philadelphia with Dr. Todd Albert and in Cleveland clinic with Dr. Edward Benzel. I am really happy and I am looking forward to meeting spending time in the best spinal units in the world.”

NASS’ Best Paper for 2013 Delivered Surprising Data!

A team from Hong Kong recently walked away with a “Best Paper” award from the annual Meeting of the North American Spine Society (NASS). Their finding? That a mere baseline MRI in patients without back pain can accurately predict first-time lower back pain and its severity. The study was led by Dino Samartzis, Ph.D. (C) from the Department of Orthopaedics and Traumatology at The University of Hong Kong. He tells OTW:

“A low back pain risk profile was identified based on baseline MRIs and environmental/lifestyle factors. This profile focused on the development of first-time low back pain episodes. In that risk profile, heavy workload increased the risk of first time low back pain; however, being active and engaging in physical activity decreased the risk. Having overall disc degeneration or disc bulging/extrusion doubled the risk of developing low back pain. Having moderate to severe disc degeneration of the lumbar spine significantly increased the risk of developing first time low back episodes. A ‘dose response’ of lumbar degeneration and pain profile was identified. The more lumbar disc degeneration, the more severe the pain. This is the largest prospective study ever conducted to address if baseline MRI characteristics can predict in asymptomatic individuals who will develop first time low back pain and severity of pain.

This study identifies clinically relevant spinal phenotypes that are related to the development of low back pain and its severity. This study further stresses the importance of the phenotype of disc degeneration and its clinical relevance. Understanding clinically relevant spinal phenotypes may lead to better understanding of ‘red flag’ findings on MRI. This study will further contribute to various genetic and biomarker studies looking to identify clinically relevant degenerative phenotypes. As such, novel preventative and therapeutic interventions may be developed in the future, which may lead to a healthier and productive society.

Our study is the largest ever conducted to assess our objectives, and one that in particular looked at the phenotype of degenerative changes in a different manner. What this study has also taught us is that the phenotype of how degenerative changes are regarded needs to be properly defined and standardized, and that environmental and lifestyle factors cannot be disregarded in the make-up of the pain profile. Conducting such a huge study can be very costly and time consuming in many parts of the world, in particular the USA. We were fortunate to draw from our ongoing population-based study (Hong Kong Disc Degeneration Cohort), which we have continued to follow-up subjects on different platforms at different time points since they were initially recruited.

I want to acknowledge my coauthors, Kenneth Cheung and Keith Luk from Hong Kong (Department of Orthopaedics and Traumatology, The University of Hong Kong) and Jaro Karppinen from Finland (Institute of Clinical Sciences, University of Oulu). The study was funded by the Hong Kong Area of Excellence and Theme-Based Research scheme programmes.”

Spinal Elements Donates $250, 000 to Children

The Make-A-Wish Foundation and the St. Jude Children’s Research Hospital are benefitting from the generosity of the people at Spinal Elements. Just recently, as the annual NASS meeting wound up, Spinal Elements announced that an estimated $250, 000 for children’s charities will have been raised from its Hero Allograft sales by the end of 2013. Two $125, 000 check presentations were made to local Make-A-Wish and St. Jude representatives, and local Make-A-Wish and St. Jude families were honored and spoke of how the organizations have changed their lives. Dr. Mike Leahy, one of the first surgeons in the U.S. to participate in Spinal Elements “Pledge to Be a Hero” program, was also honored at the event. Dr. Leahy uses Hero allograft exclusively.

Spinal Elements is the first spine company to donate 100% of the net proceeds from the sale of its allograft tissue product called Hero to charities benefiting children with life-threatening medical conditions. Although many companies earn significant profits from the sale of allograft, Spinal Elements has chosen to donate all profits from the sale of its Hero allograft to Make-A-Wish Foundation and St. Jude Children’s Research Hospital.

“Spinal Elements sees Allograft as much more than a product or a commodity, “said Jason Blain, president and co-founder of Spinal Elements. “Allograft is the physical embodiment of a human life and deserves that level of respect. We are honored to be stewards of this precious gift.”

Todd Andres, CEO and co-founder of Spinal Elements, said, “We feel that the best way to pay respect to the donation of human tissue is to donate our efforts to get it to the patients who need it and to extend that gift to ailing children. We refer to that as honoring the gift and paying it forward.”