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Confusion about Spinal Fusion, Spine Fusion, Spine Fusion Surgery, Back Fusion Surgery, Back Surgery

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Spinal Fusion is used to treat spinal instability and alleviate chronic mechanical back pain but many people are unsure of what spinal fusion actually does.  Spinal fusion is surgery to permanently connect two or more vertebrae in your spine, eliminating motion between them.

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Spinal fusion involves many techniques designed to mimic the normal healing process of broken bones. During spinal fusion, your surgeon places bone or a bone-like material within the space between two spinal vertebrae. Metal plates, screws and rods may be used to hold the vertebrae all together, so they can heal into one solid unit.

lumbar-fusion

Because spinal fusion surgery immobilizes parts of your spine, it changes the way your spine can move. This places additional stress and strain on the vertebrae above and below the fused portion, and may increase the rate at which those areas of your spine degenerate.

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Laser Spine Surgery, Laser Spine, Laser Back Surgery, New Back Surgery Procedure

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What is Laser Spine Surgery from BecomePainFree.com

Laser Back Surgery or Laser Spine Surgery is the perfect new alternative to conventional open spinal operations. In this new process, a laser is used for the removal of bone spurs so that no injury is caused to the soft tissues in the surrounding spine areas. The use of cutting-edge technology such as nerve monitoring and computerized navigation ensure the surgery is executed in a safe and smooth manner. Unlike traditional spinal surgeries, with laser surgery the patient is not made unconscious. On the contrary, a local anesthesia is done coupled with IV sedation which means the patient remains awake and totally comfortable when the surgery is performed. Moreover, since it involves the use of laser, the need for large incisions can be clearly avoided.

With our laser back surgery or laser spine surgery procedure, you do not need to stay in the hospital for a prolonged period of time from this Laser Surgery Procedure. The laser surgery is completed, in many cases, within an hour and the patient can even return home within hours after the operation.

There are a number of factors that work in favor of Laser Back Surgery or Laser Spine Surgery from https://www.becomepainfree.com/:

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Anterior cervical discectomy & fusion (ACDF), ACDF, ACDF Spine Surgery

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spinal-cord-injuries1-300x200ACDF Spine/Back Surgery Overview

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Anterior cervical discectomy and fusion (ACDF) is a surgical procedure performed to remove a herniated or degenerative disc (Fig. 1) in the cervical (neck) spine. The surgeon approaches the spine from the front, through the throat area. After the disc is removed, the vertebrae above and below the disc space are fused together. Your doctor may recommend a discectomy if physical therapy or medication fail to relieve your neck or arm pain caused by inflamed and compressed spinal nerves. Patients typically go home the same day; recovery time takes 4 to 6 weeks.

Spine Surgery

Spine Surgery

Figure 1, top. (top view of vertebra) Degenerative disc disease causes the discs (purple) to dry out. Tears in the disc annulus can allow the gel-filled nucleus material to escape and compress the spinal cord causing numbness and weakness. Bone spurs may develop which can lead to a narrowing of the nerve root canal (foraminal stenosis). The pinched spinal nerve becomes swollen and painful.

What is an anterior cervical discectomy & fusion (ACDF)?

Discectomy literally means “cutting out the disc.” A discectomy can be performed anywhere along the spine from the neck (cervical) to the low back (lumbar). The surgeon reaches the damaged disc from the front (anterior) of the spine — through the throat area. By moving aside the neck muscles, trachea, and esophagus, the disc and bony vertebrae are accessed. In the neck area of the spine, an anterior approach is more convenient than a posterior (back) because the disc can be reached without disturbing the spinal cord, spinal nerves, and the strong neck muscles of the back. Depending on your particular case, one disc (single-level) or more (multi-level) may be removed.

After the disc is removed, the space between the bony vertebrae is empty. To prevent the vertebrae from collapsing and rubbing together, the surgeon fills the open disc space with a bone graft. The graft serves as a bridge between the two vertebrae to create a spinal fusion. The bone graft and vertebrae are often immobilized and held together with metal plates and screws. Following surgery the body begins its natural healing process and new bone cells are formed around the graft. After 3 to 6 months, the bone graft should join the vertebrae above and below to form one solid piece of bone. With instrumentation and fusion working together, the bone may actually grow around the plates and screws – similar to reinforced concrete.

Bone grafts come from many sources. Each type has advantages and disadvantages.

  • Autograft bone comes from you. The surgeon takes your own bone cells from the hip (iliac crest). This graft has a higher rate of fusion because it has bone-growing cells and proteins. The disadvantage is the pain in your hipbone after surgery. Harvesting a bone graft from your hip is done at the same time as the spine surgery. The harvested bone is about a half inch thick – the entire thickness of bone is not removed, just the top half layer.
  • Allograft bone comes from a donor (cadaver). Bone-bank bone is collected from people who have agreed to donate their organs after they die. This graft does not have bone-growing cells or proteins, yet it is readily available and eliminates the need to harvest bone from your hip. Allograft is shaped like a doughnut and the center is packed with shavings of living bone tissue taken from your spine during surgery.
  • Bone graft substitute comes from man-made plastic, ceramic, or bioresorbable compounds. Often called cages, this graft material is packed with shavings of living bone tissue taken from your spine during surgery.

After fusion you may notice some range of motion loss, but this varies according to neck mobility before surgery and the number of levels fused. If only one level is fused, you may have similar or even better range of motion than before surgery. If more than two levels are fused, you may notice limits in turning your head and looking up and down. New motion-preserving artificial disc replacements have emerged as an alternative to fusion. Similar to knee replacement, the artificial disc is inserted into the damaged joint space and preserves motion, whereas fusion eliminates motion. Outcomes for artificial disc compared to ACDF (the gold standard) are similar, but long-term results of motion preservation and adjacent level disease are not yet proven. Talk with your surgeon about whether ACDF or artificial disc replacement is most appropriate for your specific case.

Who is a candidate?

Laser-Spine-Surgery1-300x243 (1)

You may be a candidate for discectomy if you have:

  • diagnostic tests (MRI, CT, myelogram) show that you have a herniated or degenerative disc
  • significant weakness in your hand or arm
  • arm pain worse than neck pain
  • symptoms that have not improved with physical therapy or medication

ACDF may be helpful in treating the following conditions:

    • Bulging and herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation and swelling occurs when this material squeezes out and painfully presses on a nerve.

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  • Degenerative disc disease: As discs naturally wear out, bone spurs form and the facet joints inflame. The discs dry out and shrink, losing their flexibility and cushioning properties. The disc spaces get smaller. These changes lead to foraminal or central stenosis or disc herniation (Fig. 1).

The surgical decision

Most herniated discs heal after a few months of nonsurgical treatment. Your doctor may recommend treatment options, but only you can decide whether surgery is right for you. Be sure to consider all the risks and benefits before making your decision. Only 10% of people with herniated disc problems have enough pain after 6 weeks of nonsurgical treatment to consider surgery.

Your surgeon will also discuss the risks and benefits of different types of bone graft material. Autograft is the gold standard for rapid healing and fusion, but the graft harvest can be painful and at times lead to complications. Autograft is more commonly used these days as it has proven to be as effective for routine 1 and 2 level fusions in non-smokers.

Who performs the procedure?

A neurosurgeon or an orthopedic surgeon can perform spine surgery. Many spine surgeons have specialized training in complex spine surgery. Ask your surgeon about their training, especially if your case is complex or you’ve had more than one spinal surgery.

What happens before surgery?

You may be scheduled for presurgical tests (e.g., blood test, electrocardiogram, chest X-ray) several days before surgery. In the doctor’s office, you will sign consent and other forms so that the surgeon knows your medical history (allergies, medicines/vitamins, bleeding history, anesthesia reactions, previous surgeries). Discuss all medications (prescription, over-the-counter, and herbal supplements) you are taking with your health care provider. Some medications need to be continued or stopped the day of surgery.

Stop taking all non-steroidal anti-inflammatory medicines (Naprosyn, Advil, Motrin, Nuprin, Aleve, etc.) and blood thinners (Coumadin, Plavix, etc.) 1 to 2 weeks before surgery as directed by the doctor. Additionally, stop smoking, chewing tobacco, and drinking alcohol 1 week before and 2 weeks after surgery because these activities can cause bleeding problems. No food or drink is permitted past midnight the night before surgery.

Smoking
The most important thing you can do to ensure the success of your spinal surgery is quit smoking. This includes cigarettes, cigars, pipes, chewing tobacco, and smokeless tobacco (snuff, dip). Nicotine prevents bone growth and puts you at higher risk for a failed fusion. Patients who smoked had failed fusions in up to 40% of cases, compared to only 8% among non-smokers [1]. Smoking also decreases your blood circulation, resulting in slower wound healing and an increased risk of infection. Talk with your doctor about ways to help you quit smoking: nicotine replacements, pills without nicotine (Wellbutrin, Chantix), and tobacco counseling programs.

Morning of surgery

  • Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
  • Wear flat-heeled shoes with closed backs.
  • If you have instructions to take regular medication the morning of surgery, do so with small sips of water.
  • Remove make-up, hairpins, contacts, body piercings, nail polish, etc.
  • Leave all valuables and jewelry at home (including wedding bands).
  • Bring a list of medications (prescriptions, over-the-counter, and herbal supplements) with dosages and the times of day usually taken.
  • Bring a list of allergies to medication or foods.

Arrive at the hospital 2 hours before (surgery center 1 hour before) your scheduled surgery time to complete the necessary paperwork and pre-procedure work-ups. An anesthesiologist will talk with you and explain the effects of anesthesia and its risks. An intravenous (IV) line will be placed in your arm.

What happens during surgery?

There are seven steps to the procedure. The operation generally takes 1 to 3 hours.

Step 1: prepare the patient 
You will lie on your back on the operative table and be given anesthesia. Once asleep, your neck area is cleansed and prepped. If a fusion is planned and your own bone will be used, the hip area is also prepped to obtain a bone graft. If a donor bone will be used, the hip incision is unnecessary.

Step 2: make an incision 
A 2-inch skin incision is made on the right or left side of your neck (Fig. 2). The surgeon makes a tunnel to the spine by moving aside muscles in your neck and retracting the trachea, esophagus, and arteries. Finally, the muscles that support the front of the spine are lifted and held aside so the surgeon can clearly see the bony vertebrae and discs.

neck

Figure 2. A 2-inch skin incision is made on the side of your neck.

Step 3: prepare to remove disc
With the aid of a fluoroscope (a special X-ray), the surgeon passes a thin needle into the disc to locate the affected vertebra and disc.

To remove the damaged disc, the vertebrae above and below the disc must be held apart. Your surgeon first inserts a spreader into the body of each vertebra above and below the disc to be removed. Gentle tension is placed on the spreader to separate the two vertebrae.

Step 4: remove the disc fragments
The outer wall of the disc (annulus) is cut (Fig. 3). The surgeon removes about 2/3 of your disc using small grasping tools, and then looks through a surgical microscope to remove the rest of the disc. The posterior longitudinal ligament, which runs behind the vertebrae, is removed to reach the spinal canal. Any disc material pressing on the spinal nerves is removed.

Figure 3. The muscles are retracted to expose the vertebra. The disc annulus is cut open and the disc material is removed with grasping tools.

Step 5: decompress the nerve
Bone spurs (osteophytes) that press on your nerve root are removed. The foramen, through which the spinal nerve exits, is enlarged with a drill (Fig. 4). This procedure, called a foraminotomy, gives your nerves more room to exit the spinal canal.

Neck Muscles

Figure 4. (top view) The disc annulus and nucleus are removed to decompress the spinal cord and nerve root. Bone spurs are removed and the spinal foramen is enlarged to free the nerve.

Step 6. prepare a bone graft fusion
Using a drill, the open disc space is prepared on the top and bottom by removing the outer cortical layer of bone to expose the blood-rich cancellous bone inside. This “bed” will hold the bone graft material that you and your surgeon selected:

    • Bone graft from your hip. A skin and muscle incision is made over the crest of your hipbone. Next, a chisel is used to cut through the hard outer layer (cortical bone) to the inner layer (cancellous bone). The inner layer contains the bone-growing cells and proteins. The bone graft is then shaped and placed into the “bed” between the vertebrae (Fig. 5).
  • Bone bank or fusion cage. A cadaver bone graft or bioplastic cage is filled with the leftover bone shavings containing bone-growing cells and proteins. The graft is then tapped into the shelf space.

spinal_implants_L

Figure 5. (side view) A bone graft (blue) is shaped and inserted into the shelf space between the vertebrae.

The surgeon may reinforce the bone graft with a metal plate screwed into the vertebrae to provide stability during fusion – and possibly a better fusion rate. An x-ray is taken to verify the position of the bone graft and the metal plate and screws (Fig. 6).

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New option: artificial disc replacement. Instead of a bone graft or fusion cage, an artificial disc device is inserted into the empty disc space. In select patients, it may be beneficial to preserve motion. Talk to your doctor – not all insurance companies will pay for this new technology and out-of-pocket expenses may be incurred.

Step 7. close the incision
The spreader and retractors are removed. The muscle and skin incisions are sewn together with sutures. Steri-Strips or biologic glue is placed across the incision.

What happens after surgery?

You will awaken in the postoperative recovery area, called the PACU. Blood pressure, heart rate, and respiration will be monitored. Any pain will be addressed. Once awake, you will be moved to a regular room where you’ll increase your activity level (sitting in a chair, walking). Patients who have had bone graft taken from their hip may feel more discomfort in their hip than neck incision. Most patients having a 1 or 2 level ACDF are sent home the same day. However, if medical complications such as difficulty breathing or unstable blood pressure develop, you may need to stay overnight. You will be given written instructions to follow when you go home.

Discharge instructions

wheelchair

Discomfort

  • After surgery, pain is managed with narcotic medication. Because narcotic pain pills are addictive, they are used for a limited period (2 to 4 weeks). As their regular use can cause constipation, drink lots of water and eat high fiber foods. Laxatives (e.g., Dulcolax, Senokot, Milk of Magnesia) can be bought without a prescription. Thereafter, pain is managed with acetaminophen (e.g., Tylenol).
  • Hoarseness, sore throat, or difficulty swallowing may occur in some patients and should not be cause for alarm. These symptoms usually resolve in 1 to 4 weeks.

Restrictions

  • If you had a fusion, do not use non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., aspirin; ibuprofen, Advil, Motrin, Nuprin; naproxen sodium, Aleve) for 6 months after surgery. NSAIDs may cause bleeding and interfere with bone healing.
  • Do not smoke. Smoking delays healing by increasing the risk of complications (e.g., infection) and inhibits the bones’ ability to fuse.
  • Do not drive for 2 to 4 weeks after surgery or until discussed with your surgeon.
  • Avoid sitting for long periods of time.
  • Avoid bending your head forward or backward.
  • Do not lift anything heavier than 5 pounds (e.g., gallon of milk).
  • Housework and yard-work are not permitted until the first follow-up office visit. This includes gardening, mowing, vacuuming, ironing, and loading/unloading the dishwasher, washer, or dryer.
  • Postpone sexual activity until your follow-up appointment unless your surgeon specifies otherwise.

Activity

  • You may need help with daily activities (e.g., dressing, bathing), but most patients are able to care for themselves right away.
  • Gradually return to your normal activities. Walking is encouraged; start with a short distance and gradually increase to 1 to 2 miles daily. A physical therapy program may be recommended.
  • If applicable, know how to wear a cervical collar before leaving the hospital. Wear it when walking or riding in a car.

Bathing/Incision Care

  • You may shower 1 to 4 days after surgery. Follow your surgeon’s specific instructions. No tub baths, hot tubs, or swimming pools until your health care provider says it’s safe to do so.
  • If you have staples or stitches when you go home, they will need to be removed. Ask your surgeon or call the office to find out when.

When to Call Your Doctor

  • If your temperature exceeds 101° F, or if the incision begins to separate or show signs of infection, such as redness, swelling, pain, or drainage.
  • If your swallowing problems interfere with your ability to breathe or drink water.

Recovery and prevention

Schedule a follow-up appointment with your surgeon for 2 weeks after surgery. Recovery time generally lasts 4 to 6 weeks. X-rays may be taken after several weeks to verify that fusion is occurring. The surgeon will decide when to release you back to work at your follow-up visit.

A cervical collar or brace is sometimes worn during recovery to provide support and limit motion while your neck heals or fuses (see Braces & Orthotics). Your doctor may prescribe neck stretches and exercises or physical therapy once your neck has healed.

If you had a bone graft taken from your hip, you may experience pain, soreness, and stiffness at the incision. Get up frequently (every 20 minutes) and move around or walk. Don’t sit or lie down for long periods of time.

Recurrences of neck pain are common. The key to avoiding recurrence is prevention:

What are the results?

Anterior cervical discectomy is successful in relieving arm pain in 92 to 100% of patients [3]. However, arm weakness and numbness may persist for weeks to months. Neck pain is relieved in 73 to 83% of patients [3]. In general, people with arm pain benefit more from ACDF than those with neck pain. Aim to keep a positive attitude and diligently perform your physical therapy exercises.

Achieving a spinal fusion varies depending on the technique used and your general health (smoker). In a study that compared three techniques: ACD, ACDF, and ACDF with plates and screws, the outcomes were [3]:

  • 67% of people who underwent ACD (no bone graft) achieved fusion naturally. However, ACD alone results in an abnormal forward curving of the spine (kyphosis) compared with the other techniques.
  • 93% of people who underwent ACDF with bone graft placement achieved fusion.
  • 100% of people who underwent ACDF with bone graft placement and plates and screws achieved fusion.

What are the risks?

No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots (deep vein thrombosis), and reactions to anesthesia. If spinal fusion is done at the same time as a discectomy, there is a greater risk of complications. Specific complications related to ACDF may include:

Hoarseness and swallowing difficulties. In some cases, temporary hoarseness can occur. The recurrent laryngeal nerve, which innervates the vocal cords, is affected during surgery. It may take several months for this nerve to recover. In rare cases (less than 1/250) hoarseness and swallowing problems may persist and need further treatment with an ear, nose and throat specialist.

Vertebrae failing to fuse. Among many reasons why vertebrae fail to fuse, common ones include smoking, osteoporosis, obesity, and malnutrition. Smoking is by far the greatest factor that can prevent fusion. Nicotine is a toxin that inhibits bone-growing cells. If you continue to smoke after your spinal surgery, you could undermine the fusion process.

Hardware fracture. Metal screws, rods, and plates used to stabilize the spine are called “hardware.” The hardware may move or break before your vertebrae are completely fused. If this occurs, a second surgery may be needed to fix or replace the hardware.

Bone graft migration. In rare cases (1 to 2%), the bone graft can move from the correct position between the vertebrae soon after surgery. This is more likely to occur if hardware (plates and screws) are not used to secure the bone graft. It’s also more likely to occur if multiple vertebral levels are fused. If this occurs, a second surgery may be necessary.

Transitional syndrome (adjacent-segment disease). This syndrome occurs when the vertebrae above or below a fusion take on extra stress. The added stress can eventually degenerate the adjacent vertebrae and cause pain.

Nerve damage or persistent pain. Any operation on the spine comes with the risk of damaging the nerves or spinal cord. Damage can cause numbness or even paralysis. However, the most common cause of persistent pain is nerve damage from the disc herniation itself. Some disc herniations may permanently damage a nerve making it unresponsive to decompressive surgery. In these cases, spinal cord stimulation or other treatments may provide relief. Be sure to go into surgery with realistic expectations about your pain. Discuss your expectations with your doctor.

Sources & links

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Sources

  1. Bose B: Anterior cervical instrumentation enhances fusion rates in multilevel reconstruction in smokers. J Spinal Disord 14:3-9, 2001.
  2. Hilibrand AS, et al.: Impact of smoking on the outcome of anterior cervical arthrodesis with interbody or strut-grafting. J Bone Joint Surg Am 83-A:668-73, 2001.
  3. Xie JC, Hurlbert RJ. Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study. Neurosurgery 61:107-16, 2007.

Links Come see on of our Doctors today please visit https://www.becomepainfree.com/

www.spine-health.com
www.spineuniverse.com

www.knowyourback.org

Glossary

allograft: a portion of living tissue taken from one person (the donor) and implanted in another (the recipient) for the purpose of fusing two tissues together. 

annulus (annulus fibrosis): tough fibrous outer wall of an intervertebral disc.

autograft (autologous): a portion of living tissue taken from a part of ones own body and transferred to another for the purpose of fusing two tissues together.

bone graft: bone harvested from ones self (autograft) or from another (allograft) for the purpose of fusing or repairing a defect.

discectomy: a type of surgery in which herniated disc material is removed so that it no longer irritates and compresses the nerve root.

foraminotomy: surgical enlargement of the intervertebral foramen through which the spinal nerves pass from the spinal cord to the body.

fusion: to join together two separate bones into one to provide stability.

herniated disc: a condition in which disc material protrudes through the disc wall and irritates surrounding nerves causing pain.

interbody cage: a device made of titanium, carbon-fiber, or polyetheretherketone (PEEK) that is placed in the disc space between two vertebrae. It has a hollow core packed with bone morsels to create a bone fusion.

osteophytes: bony overgrowths that occur from stresses on bone, also called bone spurs.

posterior longitudinal ligament (PLL): a strong fibrous ligament that courses along the posterior surface of the vertebral bodies within the spinal canal from the base of the skull to the sacrum.

vertebra (plural vertebrae): one of 33 bones that form the spinal column, they are divided into 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal. Only the top 24 bones are moveable.

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Study: Obese Patients Have Worse Outcomes After Spine Surgery

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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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World-renowned Orthopedic Surgeon Sues Medical Device Company For Breach Of Contract, Nuvasive

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BUFFALO, N.Y., Jan. 16, 2013 — /PRNewswire/ — Andrew Cappuccino, M.D., a world-renowned orthopedic surgeon based in Buffalo, has filed a lawsuit in U.S. District Federal Court, Southern District of California, accusing NuVasive, Inc., of breach of contract. NuVasive Logo - 2005

In a civil complaint filed today, Dr. Cappuccino charges NuVasive, a Delaware corporation, with principal offices in San Diego, with failure to pay a $660,000 “milestone payment” tied to Federal Drug Administration (FDA) approval of a medical device. The device, used in spinal procedures, was developed by Cervitech, Inc., a company in which Dr. Cappuccino was a prime investor and which was acquired by NuVasive.

The California company acquired New Jersey-based Cervitech in April 2009, in cash and stock deal valued at $80 million, contingent on FDA approval of Cervitech’s cervical disc-replacement device. NuVasive agreed to pay $47 million upfront and another $33 million when government approval was granted.

Under terms of the share-purchase agreement, Dr. Cappuccino and his fellow Cervitech inventors were to receive payments within 30 days of FDA approval of the Cervitech-developed device.  That approval was granted on October 26, and all other former Cervitech shareholders were paid with the exception of Dr. Cappuccino.

The surgeon is seeking the payment promised him under the share purchase agreement, as well as interest from the day of the breach and attorneys’ fees and costs.

Alan J. Bozer, a partner with Buffalo-based Phillips Lytle LLP, one of Western New York’s best-known law firms, who represents Dr. Cappuccino in this matter, said that NuVasive has admitted that payment is due to Dr. Cappuccino but is withholding payment for reasons unrelated to the Cervitech matter.

Chapin Fitzgerald LLP, of San Diego, CA, is Dr. Cappuccino’s co-counsel in the breach of contract claim.

Dr. Cappuccino is a spine surgeon with Buffalo Spine Surgery (www.buffalospinesurgery.com) in Lockport, N.Y., and has served on the medical staff of the Buffalo Bills for many years. In addition to his work on the artificial cervical disc, he led the field in bringing minimally invasive and lateral spine surgery, disc replacement and spine motion preservation as the new standards of care for spine surgery.

He attracted international attention in the medical and sports worlds as the orthopedic surgeonwho treated Buffalo Bills football player Kevin Everett for his cervical spine injury suffered in a game in 2007. Dr. Cappuccino’s use of induced hypothermia garnered world-wide headlines for the technique that likely staved off paralysis in the player.

Dr. Cappuccino’s areas of expertise include cervical spine disorders, degenerative disc disease, lumbar spine disorders and degenerative spinal conditions, among others. He was one of the first surgeons to be certified by the American Board of Spine Surgery. He is also a fellow of the American Academy of Orthopedic Surgeons, diplomat of the American Board of Spinal Surgery Charter and a fellow of the American College of Surgeons.

He ended his consultancy position with NuVasive in 2011 and now serves as chair of the Surgeon Advisory Board of Lanx, a Colorado-based medical- device company focused on developing innovative devices for spinal surgery. The board consists of neurosurgeons and orthopedic spine surgeons from around the world who provide guidance to the company

Phillips Lytle LLP, established in 1834, is a multi-disciplined law firm with offices in New York State and Canada.  The firm represents a diverse, multinational client base, including Fortune 500 companies, global, regional and local financial institutions, mid-sized and emerging businesses, and individuals on important matters affecting their businesses and personal wealth.  For more information, visit www.phillipslytle.com.

Contact: Rebecca E. Farbo Phillips Lytle LLP 716-847-8307

 

SOURCE Phillips Lytle LLP

Written by becomepainfree

January 21, 2013 at 4:25 am

Robotic Guided Spine Surgery, State Of The Art Spine Surgery Technology, Robotic Spine Surgery, Spine Surgery Robot

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Spinal disorders encompass a spectrum of pathologies which  result in either pain, deformity or paralysis to the patient.

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No age is spared and the need for the surgical correction of the problem crosses the barrier of age and gender.

Most of the surgical procedures involve the fusion, stabilization or correction of the deformity or pathology by putting in screws in the individual vertebrae.

Screw placement is fraught with inherent risk of injury to the nerves, spinal cord or blood vessels, as it is a free hand procedure based on the surgeon’s orientation of the anatomy and guided by a radiological device called C arm.

The disadvantage was the lack of accuracy in these machines to detect possible injury to the vital structures in complex anatomical deformities of the spine or in patients who were already oper-ated and needed a revision surgery.

Thus a need for a more accurate and safe guidance device to improve the safety levels in screw placement was increasingly felt.

The concept of a monitoring and navigating device to aid the surgeon in operating on deformed and crooked spines has been developed since the late 1990s.

The early systems rely on the use of reference points on the spine, which are fed into a computer which calculated the path of a safe screw in the vertebra, based on a CT scan reconstruction of the spine.

This system has its own flaws and required the surgeon to navigate the spine, which makes the process cumbersome.

Moreover the accuracy of such systems in large trials was suspect, as it is still a free hand procedure.

This led to the development of a highly advanced state of the art technology, where a small robot aligns itself in the direction of the pedicle, which is a part of the backbone where the screws are put. The robotic arm is moved by a software which matches the preoperative high resolution CT scan of the patient’s spine with the images of the patient’s spine captured by a C-arm, which is a portable X-ray device used to see the bones during orthopedic surgery.

Once the bones are matched and the individual parts are registered on the machine this aligned robotic arm guides the surgeon to place the screws in a very accurate fashion.

The path of the screws is planned by the surgeon on the day prior to the surgery on a computer.

All the details of the surgery including the sizes of the screws and implants, number of implants and the various other angles and distances for the respective screws are programmed by the surgeon.

On the day of the surgery, these details are available to the surgeon at the click of a button. This makes the whole procedure faster, safer and more accurate.

The recent advances in spine surgery has included Minimally Invasive Spine Surgery, also called Keyhole surgery in common parlance.

In these surgeries, the skin is not cut in great lengths on the back.

The entire surgery is done through one or more small incisions the sizes of small keyholes.

This gives the patient the advantage of a faster return to work and easier rehabilitation, lesser blood loss and pain.

For these types of surgeries, a  number of X rays are taken during the surgery to determine the correct level and the exactness of implant placement.

This endangers the patient, surgeon and other operating room personnel to a lot of radiation hazards. The robotic  guided surgery  decreases the amount of radiation exposure by 10 times vis-à-vis a standard keyhole procedure.

Ever since the Spine Surgery Unit headed by Dr Sajan Hegde conceived of getting this technology to India for the first time, it has been followed very keenly in the hospital.

The robotic guidance system called Mazor Rennaisance, is developed by an Israeli company called Mazor Robotics Limited.

The company sent its prog-rammers  and trainers to Chennai to our Hospital to train and instruct the various theoretical and practical intricacies. An instructional course with training was given to the surgeons, OT nurses and all the other involved personnel.

A dry run on bone models was carried out and once it was sure that all the systems necessary were in place, only then Dr Hegde’s team went ahead and performed the surgeries.

Since the whole team was new to this procedure, a few technicians and programmers from the company came down to India along with the machine and helped in the initial few surgeries to avoid any glitches.

Since its launch to date, close to 20 spine surgeries have been operated, some of which were extremely complex deformities and would have been very difficult, if not impossible to perform without guidance.

One young girl, who had been operated many times on her back for her scoliosis with failures at each attempt, came to us with a desire to get operated for the deformity. During the surgery we saw that the whole of the anatomical landmarks necessary for the free hand placement of the implants was lost and there was no way the screws could have been put.

It was at that time we realized the value of the robotic guided system to enable us to place the screw in the bone without any damage to the blood vessels or nerves.

Another patient who was suffering from severe kyphosis (hunch-back) due to a disease called Ankylosing spondylitis was operated with a deformity correction and eventual straightening of the back.

Many of the surgeries which were planned to be done in the minimally invasive way were executed with as less as 10% of the radiation in a standard C arm guided keyhole surgery.

There are patients in whom the robot has been used to obtain tissue for biopsy from an exact preplanned location, as in the case of an elderly woman with breast malignancy and metastases to the spinal column.

Another useful instance has been in a middle aged lady who had a severe scar on her back due to a previous burn. This lady came to us with infection of the backbone  and incomplete paralysis of the lower limbs.

Since the skin of the back did not permit a standard open back surgery, a keyhole stabilization was done beautifully using the robot.

Planning and executing of this project was both technically and logistically  difficult. There  were initial teething problems in getting everything to fall in its place.

The time taken in the initial surgeries was slightly long. But the learning curve became shorter with each case.

Once all the participants in the surgery were familiar with the procedure of the robot, the surg-ical times decreased drastically.

Also the understanding of the system improved and hence a smooth flow was seen in the oper-ation theatre in the subsequent cases. This technology (Rennaissance, Mazor) has helped us to achieve accuracy levels as high as 98% compared to a standard free hand accuracy which rarely exceeds 90 percent.

More so in the scenario of a very complex deformity in young adults or children where the risk of improper and dangerous surgery is high, the robot has assured the surgeon and the patient with the high safety levels it provides.

Though the instrument is expensive and requires the use of a certain amount of disposables each time, the actual cost incurred to the patient rarely exceeds an additional 20 percent on the total expenses for the surgery.

The patient can be comfortable knowing that the surgery planned is a highly accurate one and that there is no scope for any untoward complication. Thus the benefits compared to the extra cost involved are high enough to take this up. With respect to the hospital, we can be proud that we are the first hospital to introduce this technology in Asia (outside of Israel ), beating countries like China , Singapore , Japanand Korea to the mark.

This has helped brand our hospital as a pioneer in the safe management of complex and otherwise dangerous spinal deformities.

As of date, we have patients from other countries too who have been operated using this state of the art technology.

This bears testimonial to our superiority in technology advancement in the field of spine surgery, making our hospital one among the top centers in the world. The operating room personnel too are benefitted as the radiation exposure due to an image intensifier is reduced to miniscule proportions.

The surgeon and his team, at the end of the day, return home with the satisfaction of having done an accurate and safe surgery.

At the same time we would like to also mention that the surgery as such is normal as a conventional surgery, but the robot finds the safest possible path.

In that sense the robot does not replace the surgeon, as is the normal misconception. On the contrary, the surgeon is backed up by the foolproof planning done prior to the surgery on the robotic software.

Our review of all the patients operated has been excellent and we can confidently assert that the robotic guided surgery has made spine surgery a safer proposition, in addition to reducing the stress on the surgeon and his team in the operation theater.

The future of spine surgery is shaping in the direction of minimally invasive surgeries where the stress shall be on earlier return to productive activity to the patient and reduction of the hospital stay and expenses.

From the surgeon’s perspective too, the use of the robotic guiding systems would mean more safety levels, lesser radiation hazards and stress free situations in the operating room.

Technology is ever advancing and it is the duty of the medical fraternity to keep abreast with it as the patient has the right to benefit from every such advancement. 

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Mayo Clinic, Spine Surgeon, Mayo Clinic Back Surgeon, Mayo Clinic Pain, Mayo Clinic Fellowship Trained Surgeon, Mayo Clinic Doctor, Mayo Clinic Back pain

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We have two spine surgeons in our group and one on the way from the world famous Mayo Clinic. These Mayo Clinic surgeons are some of the best in the United States of America both of these Mayo Clinic trained doctors work in Texas. Dallas, Fort Worth, San Antonio we ave you covered with Mayo Clinic trained spine surgeons. Here is the information on these doctors below.Check out our website at https://www.becomepainfree.com/

Call Us: (214) 396-3647 | (888) 373-3720
Fax #:  (888)238-9155 | E-mail Us

Steven J. Cyr, M.D., FAAOS

Mayo Clinic Trained Spine Physician

Steven J. Cyr, M.D., FAAOS 

Steven J. Cyr, M.D., is a Board Certified Orthopaedic Surgeon who received extensive training to specialize in the delicate science of Spine Surgery. Anyone who knows Dr. Cyr well will tell you that he is a man driven for quality and excellence. His high standards can be seen throughout his educational process and career.
He received top honors at Southwest Texas State University by graduating Summa Cum Laude and Valedictorian with a Bachelor of Science in Biology. In addition to rigorous academics, he was also a member of the Bobcat football team during his three years at SWTSU.

Dr. Cyr gained early acceptance into medical school and earned his MD from the University of Texas Health Science Center in San Antonio. He then began his service to the United States Air Force with a transitional internship at Wilford Hall Medical Center. He served the air force community as a flight surgeon for two years before beginning residency training in orthopaedic surgery at Wilford Hall.

Following residency, Dr. Cyr was honored to be chosen from among the country’s top residents as the only fellow for the highly competitive and prestigious spine fellowship at the Mayo Clinic in Minnesota. This training program has ranked number one for orthopaedic and neurosurgical training programs in America for the last 20 years. Mayo combines these two fields, giving their surgeons an understanding of nerve and spine function unparalleled in most other programs.

Upon completion of his fellowship, Dr. Cyr and his family moved back to San Antonio, where he served the military population as the Chief of Air Force Spine Surgery and Spine Surgery Consultant to the Surgeon General of the Air Force. For six years, Dr. Cyr taught future air force orthopaedic surgeons in residency at Wilford Hall and has twice served our war wounded in Iraq at the Air Force Theater Hospital in Balad.

He has brought innovative techniques to the military and was the first to perform the total disc replacement procedure as well as endoscopic spinal surgery. He specializes in complicated spine issues and has gained notoriety for successful repairs of failed surgeries on patients from numerous other states and around the world. Dr. Cyr’s expertise and skills are now available to civilian patients at the Orthopaedic and Spine Institute, where his passion for excellence and quality keep him at the leading edge of spine surgery.

Mayo Clinic Trained Spine Physician

Dr. Venkat Sethuraman M.D. 

2 (1)

Mayo Fellowship Trained Board-Certified Spine Surgeon
Minimally Invasive Spine Specialist

Education Undergraduate: Rutgers College, New Brunswick, NJ

Medical: Medical College of Pennsylvania, Philadelphia, PA Training Orthopaedic Surgery

Residency: Thomas Jefferson University Hospital, Philadelphia, PA Spine

Fellowship: Mayo Clinic, Rochester, MN

Hospital Affiliations Baylor Irving Medical Center Irving Coppell Surgical Center Irving


Offices:

Coppell :

2021 N. MacArthur Blvd 400 West IH 635 Bldg. @, Suite 115

Irving:

Plaza 1, Suite 200
Irving, TX 75061
Irving, TX 75063

Plano:

2301 Marsh Lane,
Plano, TX 75093


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2021 N. MacArthur Blvd, IrvingTx, 75061
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 Call Us: (214) 396-3647 | (888) 373-3720
Fax #:  (888)238-9155 | E-mail Us
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