Archive for the ‘Spine Microdiscectomy’ Category
Dallas Spine Pain Center, Spine Pain Help Dallas, Dallas Spine Pain Doctors
If you are looking for a specialist in spine surgery, Dallas may be your next destination. BecomePainFree.com’s Dallas office provides:
- A free MRI or CT scan evaluation by medical staff
- Partner physicians board-certified in interventional pain management
- Free educational back pain seminars
- One of the top surgical facilities in the country
Free MRI or CT scan evaluation. Have you tried conservative therapies for your chronic back pain, and wonder if a medical procedure is the next best step? Allow our staff to evaluate your medical case. Our physicians will provide the most conservative recommendation deemed appropriate for your special case.
Free medical referral service. If you choose, your assigned patient coordinator will handle the logistics for any medical procedure recommended by one of our physicians.
Board-certified physicians. Our Dallas-based specialists collectively provide expertise in neurosurgery and interventional pain management, and provide a range of procedures, from epidural steroid injections to spinal fusion. They are unique providers of the BecomePainFree.com procedure.
Free back pain seminar. BecomePainFree.com’s Dallas office provides regular educational seminars so chronic pain sufferers can learn about the BecomePainFree.com procedure and talk directly to someone who can answer all of their questions.
Surgical facility. Victory Medical Center in Plano, TX is one of the newest surgical facilities in Dallas-Fort Worth.
Located in the center of the United States, the Dallas laser spine center also provides a convenient option for chronic back pain sufferers across the country – just a short plane-ride away. BecomePainFree.com’s Dallas office has partnered with the Hyatt Place, for traveling patients.
The BecomePainFree.com headquarters is also in Dallas TX. So when you visit, make sure to say hello to the patient coordinator and insurance teams, who strive to help patients like you find a solution for their pain.
Address:
13601 Preston Road, Suite E575
Dallas, TX 75240
Call Us: (214) 396-3647 | (888) 373-3720 Fax #: (888 )238-9155 | E-mail Us
About us: BecomePainFree.com provides patient advocacy for spine pain sufferers. Patient care may be described as a table with patients on one side looking for a solution, and physicians on the other side providing a service; since BecomePainFree.com does not practice medicine, it is uniquely positioned on the patient’s side of the table, providing a compass to navigate the often confusing world of spine surgery and interventional pain management.
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Dallas skyline (Photo credit: dherrera_96)
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Spine Surgeon Fort Worth Texas, Spine Surgeon Tarrant County, Texas Back Institute, TBI, Shawn Henry DO
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Spine Surgeon Dallas, Mayo Clinic Trained Spine Surgeon, Back Doctor, Spine Pain Doctor
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Stem Cells for Spine Surgery: 7 Points
Written by Laura Miller | May 23, 2012
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How we got here
Dr. Hynes was one of the many spine surgeons who participated in Medtronic’s original trials for BMP-2 in the 1990’s. While scientists have known about the ability of stem cells and BMP to generate bone for several years, Medtronic was the first company to develop a safe and effective molecule to stimulate cell growth. After completing the pre-market approval trials, the Food and Drug Administration granted approval for the BMP-2 product, Infuse, in 2002 for creating fusion in the Lumbar Spine placed through an anterior approach in a LT cage.
“In the original study, I experienced 100 percent of enrolled patients in my Practice achieving bone growth when combining BMP with the local cells that were already there,” says Dr. Hynes. “Local ‘stem cells’ respond to BMP and become activated thereby creating bone. When I saw it worked in 100 percent of my enrolled patients, I was a true believer. I have used it in my practice since the study and FDA approval going back greater than 10 years.”
What has changed is our ability to concentrate stem cells; Dr. Hynes harvests the stem cells from the iliac crest to combine with the BMP. It takes less than five minutes for his physician’s assistant to harvest the cells, which are spun in a centrifuge while he begins the operation. After 10-15 minutes, the cells are ready and Dr. Hynes adds a small amount to the surgical field along with the BMP. The collagen sponge is placed within an interbody LT cage to keep the material from migrating.
“This has been an effective Bone Graft method and it has been an advantage for my patients who can avoid Iliac Bone Graft surgery and Donor Bone issues and cost,” says Dr. Hynes. “It doesn’t add to my usual procedure time. It does add a small cost, but I find it’s worth the value proposition.”
Since its inception and release, surgeons have been experimenting with its use in several different capacities, on- and off-label. However, articles published in The Spine Journal in July 2011 suggest complication rates may be higher than the original studies reported. Several physicians have reported positive and negative events based on individual practice date, and further research into its use will be necessary going forward. As with all products, on label and off label use is routine practice and common place. When used correctly, minimal side effects of swelling, seroma and osteolysis occur.
What the research says
There have been several clinical studies and basic science research projects published in professional journals discussing the efficacy of using BMP with local stem cells to enhance fusion. However, research on the impact of increasing the number of stem cells is still lacking. Dr. Hynes’ current clinical work focuses on whether there is a better chance of achieving fusion with a higher concentration of stem cells.
He harvests stem cells from the iliac crest, percutaneously and painlessly, or vertebral body and extract about 60-80 ccs of blood. The desired stem cells are concentrated to a few ccs with centrifugation and has about a 50,000 cell count per “Spine Smith research data.”
“We already know the mechanism by which BMP-2 activates stem cells. The stem cells are already very effective,” says Dr. Hynes. “If we add to the population of stem cells that are already there that are available to regenerate new bone, it could make the procedure even better. Anecdotally, I have a high fusion rate for my spine patient population even before adding the extra concentration of stem cells. With the additional stem cells, I hope to achieve fusion at almost any level no matter how many levels are needed such as in degenerative scoliosis. In osteoporosis and aging spine patients, this has been extremely beneficial when compared to poor iliac crest from bone harvest.
Dr. Hynes’ ethereal practice goal is to someday be able to “guarantee” that they will achieve fusion for every patient who undergoes surgery. This means stabilization. However, fusion does not guarantee “success” of the surgery but increases odds of the surgical success. At this point, he is close, with approximately a 95 percent fusion rate. “What I want to do before I retire is to be able to guarantee a fusion,” he says. “I can’t guarantee pain relief or other clinical outcomes, but I want to be able to confidently guarantee the fusion or stabilization component.”
Options for harvesting stem cells
There are several bone graft options spine surgeons can choose from to achieve a fusion, and in the wake of recent controversies some surgeons are looking for an alternative to using BMP. Surgeons can go back to the traditional fusion method – the iliac crest – or using an allograft. Dr. Hynes says harvesting bone from the iliac crest can leave 30 percent of patients in more pain and add significant surgical time in the OR with increased blood loss. Allografts also have downsides, including graft consistency, quality, processing issues and less potential to achieve fusion than iliac crest or autogenous grafting methods.
“The bone for allografts may not be prepared correctly,” says Dr. Hynes. “We don’t always know the quality or consistency of the allograft compared to the patient’s natural bone. If I’m putting a piece of bone in patients, it’s better if it comes from their own bodies. That way, you can’t tell the difference between the bone you grow and the natural bone. (What we are doing is creating a nice bone graft that balances the biomechanics of the fusion construct better than the allograft.)”
In some cases, the allograft bone could migrate or fracture or reabsorb after the procedure, which can cause significant pain and complications, often resulting in revision procedures. By using the combination of BMP and stem cells in an interbody device, Dr. Hynes is able to avoid most of those complications because the cells are attracted to the BMP, which is restrained in the cage.
Patients should have the final say – “Informed Consent”!
Like many surgeons, Dr. Hynes describes the different fusion options to his patients and allows them to choose which procedure they feel most comfortable with. He discusses the pros and cons of each technique, including the most recent concerns about BMP, as well as his personal outcomes. He says patients often choose BMP combined with stem cells because they like the idea of regenerating their own bone naturally, avoiding the extra surgery and potential pain of iliac crest bone grafts and decreased potential or effect of donor allograft bone.
“The psychology of healing is part of this,” says Dr. Hynes. “Patients understand the procedure and like the idea of using their own cells as healing factors. People are very positive about that process because they feel like they are doing something natural instead of synthetic. Healing and surgery isn’t just biomechanics and science; it’s psychological as well. Successful outcomes of surgery depend on subjective relief as well as objective factors.”
In his practice, Dr. Hynes says a significant number of his patients chose the BMP and stem cell combination with given the option. However, when the patients choose a different option, he performs the other procedures as well. “It’s our duty to give patients their choice,” he says. “I’m not always smart enough to know what the best choice is for any one individual, but I’ve practiced many years and learned that if you take time to educate patients to all the reasonable options, they will make good decisions and take responsibility for them.”
Deciphering the complications
While Dr. Hynes hasn’t experienced significant complications among his patients, it’s clear that other surgeons have reported complications when they perform spinal fusions using BMPs. One reason for the discrepancy could be the dosage; well-documented evidence suggests that a higher dosage of BMP could cause swelling complications when used in the cervical spine. By using low doses of BMP and a pre and post-surgical protocol, swelling is completely avoidable in the cervical spine. Another factor is the surgical approach; Dr. Hynes says retrograde ejaculation (“RE”) – one of the severe complications mentioned in the studies this past summer – is a complication risk of any anterior spine surgery and not related to use of BMP. “I have performed thousands of anterior procedures before and after approval of BMP for anterior lumbar surgery and I find no difference in RE noted in my patients.”
“Every spine surgeon knows RE is a risk during anterior procedures and it usually will reverse on its own,” says Dr. Hynes. “RE occurs in an extremely low frequency. RE occurs because of disruption ‘surgically’ of small nerves to a sphincterine the bladder. BMP does not cause this effect, but the use of the electrocautery tool, during surgery, likely does. Use a small dose of BMP and a cage as well.”
In his practice, Dr. Hynes has never experienced a critical airway complication using cervical BMP. In early years, too high a dose would lead to swelling but not airway compromise which more commonly occurs with hematoma or blood clot, says Dr. Hynes. Papers published in The Spine Journal also mention cancer as an associated complication, which is something he hasn’t necessarily noted either. “I haven’t seen a rash of cancer in my patients, but I haven’t been surveying for it either,” he says.
He is currently going through his patient base to determine whether he can detect any cancer cases that could be associated with the procedure.
Whether to use BMPs
As surgeons report different findings based on their individual practice data, many of the studies and discrepancies have been reported in the media. However, full understanding of these complex issues is often lost in news reports. “I hate to see some of the surgeons and journals duking it out in the media,” says Dr. Hynes. “That isn’t the place to argue over the efficacy of stem cells and BMPs. We have to do it in the meetings where people understand the context. To lay this out in the newspapers exacerbates political agendas and confuses our patients. We need to speak honestly with each other about this at professional and scientific meetings, not in the press.”
This controversy isn’t the first time new spinal technology and procedures have been under attack. For a period of time, pedicle screws – which are a standard of care now – were under the microscope because complications were reported. In some instances, surgeons were sued and restricted from use at their hospitals for their alleged unfavorable outcomes. Now pedicle screws are the mainstay of spinal fusion procedures.
“At the time, there was only approval that pedicle screws could be used on single-level surgeries,” says Dr. Hynes. “Now we use them at multi-levels. The pedicle screws ultimately won the day, but with public stimulation ‘in the news’ in the early 1990s, we almost lost the ability to use them. This was a public attack on the advent of a new fusion technology, and now we are seeing similar phenomenon’s with BMP and other medical products.”
Covering the cost of BMP
In some cases, surgeons may have a difficult time receiving reimbursement for BMP products because they were more expensive in the past. Dr. Hynes and his colleagues have worked with hospitals and surgery centers to cover the cost in both out-of-network and in-network contracts. In some cases, patients are willing to cover the cost of using stem cells with BMP. Due to the success and demand, the cost has now become competitive considering operative costs of iliac bone surgery or allograft. “The increased volume of use and effectiveness has caused a dramatic decrease in cost,” says Dr. Hynes.
“I see patients from out of the Country and they are usually cash pay patients,” says Dr. Hynes. “We have to line item every part of the procedure to show the actual cost and there is almost no increased cost for the use of low concentrated BMP compared to iliac bone grafts or allograft when taking OR time, surgeon’s time and other OR costs into consideration.”
Fortunately, the hospitals in Dr. Hynes’ community allowed him to use BMP and conduct the clinical studies there. “We have more experience in our community with the benefits of this technology because we started so early,” he says. “Our surgeries are very efficient and our operative time is less because of our long-term experience with the procedure using stem cells and BMP.”
However, in some cases Dr. Hynes has made sacrifices to mitigate these costs. “I think about what I could live without and forego those expenses for stem cells and BMP,” he says. “I might use less expensive blades or a new set of tools for the next year. I might continue to use my old led apron or do surgery without a super drape. I’m there to give patients a better outcome and I want to make sure they have the opportunity to have the stem cells.”
More Articles on Spine Surgeons:
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What Percentage of Your Spine Practice is Medicare Patients?
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BecomePainFree.com Treats
- https://www.becomepainfree.com/
Herniated discs - Pinched nerves
- Degenerative spine disease
- Spinal stenosis
- Spondylolisthesis (slipped spine)
- Scoliosis (deformity)
- Low back pain / neck pain
- Spine trauma
- Spine infection
- Osteoporotic fractures
- Spine and spinal cord tumors
- Peripheral nerve injury
- Chiari malformation
- Cavernous malformation
- Vascular malformation
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Central Cord Syndrome
Central Cord Syndrome (CCS) is an incomplete injury to the cervical cord resulting in more extensive motor weakness in the upper extremities than the lower extremities. The mechanism of injury occurs from a hyperextension injury with pre-existent osteophytic (abnormal bony outgrowth) spurs, without damage to the vertebral column.
Mechanism and Causes of Injury
CCS occurs typically in patients with hyperextension injuries where the spinal cord is squeezed or pinched between anterior cervical spondylotic bone spurs and the posterior intraspinal canal ligament, the ligamentum flavum. The ligamentum flavum is a strong ligament that connects the laminae of the vertebrae. It serves to protect the neural elements and the spinal cord and stabilize the spine so that excessive motion between the vertebral bodies does not occur.
The injury occurs as a result of anterior and posterior compression of the spinal cord, leading to edema, hemorrhage or ischemia to the central portion of the spinal cord. The site of most injuries is in the mid-to-lower cervical cord. Due to the anatomical lamination of the corticospinal tract with the arm fibers medially, and the leg fibers laterally, the arms are affected more so than the legs, resulting in a disproportionate motor impairment.
Symptoms
Patients are typically left with motor weakness of the upper extremities and lesser involvement of the lower extremities. A varying degree of sensory loss below the level of the lesion and bladder symptoms (urinary retention) may both occur.
Incidence
This syndrome more commonly affects patients age 50 and older who have sustained a cervical hyperextension injury.
CCS may occur in patients of any age and is seen in athletes who present with not only hyperextension injuries to their neck but associated ruptured disc(s) with anterior cord compression.
CCS affects males more frequently than females.
Diagnosis
Evaluation of the patient includes a complete history, a thorough neurological exam, MRI and CT of the cervical spine, and cervical spine x-rays including supervised flexion and extension x-rays.
- Magnetic resonance imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology; can show direct evidence of spinal cord impingement from bone, disc, or hematoma.
- Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads x-rays; can show the shape and size of the spinal canal, its contents, and the structures around it.
- X-ray: Application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints. X-rays of the spine delineate fractures and dislocations, as well as the degree and extent of spondylitic changes. Flexion/extension views assist in evaluation of ligamentous stability.
Surgical Treatment
Acute surgical intervention is not usually necessary unless there is significant cord compression. Prior to the CT-MRI era, surgical intervention was thought to be more harmful because of the risk of injuring a swollen cervical cord and worsening the deficit. However, with advanced imaging technology such as CT and MRI, patients with compression of the spinal cord secondary to traumatic herniated discs and other lesions can be quickly diagnosed and surgically decompressed. In cases with anterior bony ridges and spinal canal narrowing secondary to ligamentous thickening and or stenosis, acute surgery is usually not performed until the patient has made maximum recovery. Reassessment at that time may lead to surgery depending on the underlying cause. If there is significant motor weakness after a period of recovery, or neurological deterioration or spinal instability, then surgical intervention may be considered.
Nonsurgical Treatment
Nonsurgical treatment consists of immobilization of the neck with a cervical orthosis, steroids unless contraindicated, and rehabilitation with physical and occupational therapy.
Outcome
Many patients with CCS make spontaneous recovery of motor function while others experience considerable recovery in the first six weeks post injury.
If the underlying cause is edema, recovery may occur relatively soon after an initial phase of motor paralysis or pareses. Leg function usually returns first, followed by bladder control and then arm function. Hand movement and finger dexterity improves last. If the central lesion is caused by hemorrhage or ischemia, then recovery is less likely and the prognosis is more devastating.
The prognosis for CCS in younger patients is favorable. Within a short time, a majority of younger patients recover and regain the ability to ambulate and perform daily living activities. However, in elderly patients the prognosis is not as favorable, with or without surgical intervention.
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About Minimally Invasive TLIF Transforaminal Lumbar Interbody Fusion
Overview from https://www.becomepainfree.com/
A Transforaminal Lumbar Interbody Fusion (TLIF) is an operation often indicated for patients suffering from back and/or leg pain caused by the natural degeneration of the disc space or some type of traumatic event.
The Minimally Invasive TLIF technique is a less invasive option incorporating the use of specially designed instruments that allow surgeons to achieve the same clinical goals of traditional, “open” TLIF but with much smaller incisions, causing less damage to the surrounding soft tissue.
The technique incorporates use of the II Tubular Retractor System and CD II Spinal System. The METRx® II System provides minimally invasive access to the spine through tubular portals, while the CD II Spinal System uses an innovative arc device to percutaneously (without a large skin incision) deliver screws and rods for spinal fusion.
* Through a minimal incision in the patient’s back, the surgeon uses specially designed dilators in the II Tubular Retractor System to spread the muscle and tissues of the back. A tubular retractor, or “portal”, is then inserted over the dilators to maintain a clear pathway to the spine.
* Accessing the spine through the II Tubular Retractor, the surgeon removes a portion of the bone and the disc material, and places an implant in the disc space between the vertebral bodies. This spacer may serve to restore the natural height of the disc space, “unpinch” the nerves, and act as a scaffold for bone growth or “fusion” between the vertebral bodies.
* Finally, the surgeon may use the Spinal System to place screws and rods in a minimally invasive fashion. These screws and rods are intended to stabilize the vertebral bodies while the bone fuses or heals.
Your browser may not support display of this image. Traditional, “open” TLIFs may often involve significant blood loss and a lengthy hospital stay. However, the Minimally Invasive TLIF technique may offer many patient benefits, including:
* Decreased intraoperative blood loss2
* Shorter hospital stays1
* Smaller incisions and scars
* Decreased post-operative medication needed while in the hospital1
Minimally Invasive Spine surgery These Dallas Doctors perform minimally invasive spine procedures:
(These surgeons have extensive experience in both neurosurgery and orthopedics)
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THE REAL EXPERTS IN MINIMALLY INVASIVE SPINE TREATMENTS, MIS, MINIMALLY INVASIVE SPINE, Dallas, Coppell, Fort Worth, Addison, Plano Texas, TX
BecomePainFree.com compared to traditional open spine surgery, utilizes the knowledge of important anatomy, along with cutting-edge technology, to treat your spinal condition without causing undue injury to the surrounding soft tissues. Computer-assisted technology (such as computer navigation, nerve monitoring, and pain mapping) and highly specialized tools and instrumentation provide for the safe and effective treatment of your pain. Nearly all chronic neck and back pain that cam be treated openly (the most invasive), can be performed minimally invasively at MINIMALLY INVASIVE BECOMEPAINFREE.COM™. These modern and advanced minimally invasive techniques are used to treat common back and neck degenerative conditions like herniated disc and spinal stenosis, as well as bone spurs, bulging discs, and sciatica to name a few.
MINIMALLY INVASIVE BECOMEPAINFREE.COM™ doctors are trained spine specialists who never use the typical expandable retractors. Our innovative and cutting edge minimally invasive spine equipment allows us to go between the muscle, often through an incision as small as 3 mm (the size of a large piece of rice), to avoid cutting the muscle altogether, this resulting in the most patient focused procedures which benefits include the smallest incisions you can possibly achieve, less blood loss, and considerably faster recovery times.
A few of the advantages of
MINIMALLY INVASIVE BECOMEPAINFREE.COM:
- Fellowship-trained spine surgeons
- 100% of surgeon’s practice dedicated to spine care
- Innovative pain mapping process
- Isolates specific source and location of pain
- Enables surgeons to treat tile specific area in least invasive way possible
- True minimally invasive procedures
- No retractors used
- No tearing of muscles
- Incisions as small as 3mm
- Perform latest laser spine procedures
- Customized procedures based on each patient’s specific needs
- Not one size fits all
- Comprehensive list of advanced minimally invasive procedures
- Not just one procedure that many others offer
Unlike other practices, MINIMALLY INVASIVE BECOMEPAINFREE.COM™ surgeons are trained spine specialists, more specifically, fellowship-trained and educated in the most innovative, minimally invasive technologies on the medical market. As leaders and innovators in their field, the MINIMALLY INVASIVE BECOMEPAINFREE.COM™ doctors are advisers to many international spine technology companies and have helped design many groundbreaking tools for the spine surgery industry.
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Texas Spine Consultants, Board Certified Orthopaedic Surgeon, Spine Fellowship Trained, Dr. Huntly Chapman M.D.
Dr. Huntly Chapman M.D.
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Dr. Chapman is an expert in handling worker’s compensation cases, a certified life care planner and is frequently sought out for his expertise in orthopedic surgery.
Dr. Chapman is an avid golfer and loves to fish.
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Study: Obese Patients Have Worse Outcomes After Spine Surgery
Tags: back pain | lumbar disc herniation | obese | patients | spinal surgery | spine surgeon
A recent study published in the Journal of Bone & Joint Surgery shows that obese patients have poorer outcomes after both surgical and non-surgical treatment for lumbar disc herniation.
The study examined 854 nonobese patients and 336 obese patients enrolled in the Spine Patient Outcomes Research Trial for lumbar disc herniation. After a four-year follow up period, 77.5 percent of the obese patients and 86.9 percent of the nonobese patients who receive surgery were working full time or part time.
Obese patients in both groups also reported less functional improvements were than nonobese patients.
According to an American Academy of Orthopaedic Surgeons news release on the study, obese patients didn’t have an increased rate of infection, intraoperative complication or re-operation. The benefits for nonoperative treatment were not impacted by the patient’s body mass index.
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