Spinal Surgeons – The Last Resort

Truth be told, the last option that everyone should consider as treatment for lower back pain is going to spinal surgeons for a back operation. Even most doctors would agree that every back pain patient should first exhaust all conservative – and even some alternative and complementary – forms of treatment before going under the scalpel. Indeed, majority of studies have shown that most cases of back pain, including persistent or some severe pain, either resolve on their own or could be managed adequately without surgical intervention.

Indications and Complications

There are only a few indications for spinal surgery, foremost of which are treatment of traumatic injuries to the spine or the existence of symptoms of progressive neurological dysfunction (like loss of bladder and bowel function as in cases of “cauda equina syndrome“).

The reason for this is because there are just too many possible complications that might occur with surgery, both major operations and minimally-invasive surgeries. Some of the complications that might develop during surgery are bleeding, infection, tears in the dura, and nerve root damage. Worse, there is no absolute guarantee that the pain would go away with surgery. There are a number of cases of patients who have developed “Failed Back Syndrome”, wherein their back pain persisted or became worse following surgical intervention. Sadly, most Failed Back Syndrome patients are even more difficult to treat.

Spinal Surgeons – How to choose a good one?

For some patients with a low pain tolerance and in whom all conservative modes of treatment have failed to resolve their back pain, surgery is definitely the most appealing option for them. But, how sure are you that the surgeon who’ll be operating on your back is the right one?

The first thing to do is to get referrals from your family physician. Most doctors belong to a team, so they would most likely have a surgeon in mind. The best surgeon for back surgery is one who has specialized training in orthopedic spinal surgery. There are no such doctors as strictly “spinal stenosis surgeons” or other highly specialized surgeries. All orthopedic surgical specialists should be trained in all the back surgery techniques.

Next, consult with the surgeon. Make sure you have a list of questions on hand for him or her to answer. Ask about complications and prognosis after surgery. Legitimate surgeons should outline the treatment plan, explain all possible complications and outcomes of surgery. Be wary if the surgeon promises “complete cure” using “techniques” that only he or she has developed.

After making a consultation, it is strongly advisable to check the surgeon’s credentials, background and experience. One good way of doing this is by talking to the doctor’s other patients while in the lobby waiting for your appointment. Another way is by making inquiries with the medical and surgical organizations in your area.

Finding the best Spinal Surgeons…

Always make sure that you get a second or third opinion. This way, you could find a doctor to whom you can entrust your well-being.

For patients who have been advised to go under endoscopic spinal procedures, the International Society for Minimal Intervention in Spinal Surgery (ISMISS) and the International Society of Orthopedic Surgery and Traumatology (SICOT) have a few more recommendations. The endoscopic surgeon should have considerable prior experience in traditional spinal surgery techniques. This would allow for less errors on the operating table, including operating on the wrong level of the spine. Also, in the event that the problematic area to be treated could not be adequately operated on via the endoscopic approach (requiring only a small incision), he or she should be able to switch to performing major surgery.

Spinal surgeons could be the last hope of lower back pain patients in finding relief from their aches and pains, but they should be competent in their field to ensure the overall well-being of the patients under their care.

SI-BONE, a company that diagnoses and treats lower back pain, has raised $10.6 million in equity funding. New investor Skyline Ventures led the round. Using its iFuse Implant System, the San Jose-based company fuses the sacroiliac joint (SI joint), a joint in the lower pelvis, through a minimally invasive procedure. The company estimates that 15-25% of all low back pain originates from the SI joint.

SI-BONE plans to use the latest funding to increase clinical studies and educate spine surgeons in the United States and Europe. The company previously raised $1.5 million in March 2009.

PRESS RELEASE

SI-BONE, Inc. (San Jose, California), a medical device company that is pioneering the use of a minimally invasive surgical (MIS) device to treat the sacroiliac (SI) joint, today announced that it has closed $11.0 million in financing for expansion of clinical and commercial operations. The financing round was led by new investor Skyline Ventures of Palo Alto, California.

The primary purposes of the financing are to dramatically increase investment in 1) worldwide sales and marketing operations 2) expansion of the company’s clinical efforts through a retrospective minimally invasive surgical (MIS) SI joint treatment study, a prospective, multicenter study (MISSION), a European prospective study, additional post-market case studies and an animal study validating arthrodesis with the iFuse implant to further establish clinical efficacy and 3) educate spine surgeons and referring specialists in the US and Europe.

Glenn Reicin, a partner at Skyline Ventures, will join the SI-BONE Board of Directors. Reicin joined Skyline as a Partner in October 2008. From 1993 to 2008, he was a Managing Director at Morgan Stanley, covering medical devices. He was ranked in the Institutional Investor “All-America” team from 1994 through 2008, including six years as first place. In 2008, the Financial Times ranked him the top stock picker in the Medtech sector. His experience includes a leading role in bringing several companies public and provided research coverage in the areas of medical technology and devices.

“One of the reasons we invested in SI-BONE is our belief that the number of patients who suffer from SI joint dysfunction is large and dramatically underserved. Further, we believe that the minimally invasive technology and procedure invented by Dr. Mark Reiley has huge potential based on early patient results that the surgeons currently using the procedure are seeing. We are very confident in the management team led by Jeff Dunn, President and CEO. We look forward to helping them accomplish their mission of helping many patients worldwide,” said Glenn Reicin.

Jeff Dunn, CEO of SI-BONE, commented, “We are pleased that our colleagues at Skyline have agreed to bring their extensive clinical and business experience to our commercial efforts. We expect to benefit from their insights and expertise through Glenn’s board participation. The financing will further help position iFuse as the frontline MIS therapy for patients with SI joint syndromes who are unresponsive to conservative therapy.”

Surgeons across the United States are implanting iFuse and preparing to report their initial clinical data at several significant spine meetings this fall. Upcoming clinical presentations on the iFuse early experience will be made at the North American Spine Surgery (NASS) in Orlando on October 7 on the main floor and at SI-BONE’s Satellite Symposium, the American Association of Pain Management & Rehabilitation (AAPM&R) on November 5, the Society of Minimally Invasive Spine Surgery (SMISS) on November 6 and World Congress of Low Back & Pelvic Pain in Los Angeles onNovember 12. Surgeons participating in iFuse clinical evaluation include Steven Garfin, Fred Geisler, David Polly, Leonard Rudolf, J. John Halki, Arnold Graham-Smith and A. Nick Shamie.

In response to increasing awareness of SI Joint dysfunction as a debilitating symptom generator, SI-BONE, Inc. developed an innovative, patented, intramedullary implant to treat the SI Joint. The company is also embarking on a post-market multicenter study to determine its effect over time on SI Joint pathology and on symptoms associated with SI Joint dysfunction.

The iFuse Implant System is a commercially available device in the US intended for fracture fixation of large bones and large bone fragments of the pelvis for conditions including sacroiliac joint disruptions and degenerative sacroiliitis. The iFuse procedure uses a minimal incision for delivery and implantation of small, titanium implants. The implants are coated with a porous plasma spray that acts as an interference surface, designed to help decrease implant motion. These implants have substantial thickness and sophisticated metallurgy and are able to produce a much stronger construct than that of conventional pins or screws used to surgically fix boney structures. This implant technology from SI-BONE has been previously used successfully in well over 1,000 cases of dysfunctional foot joints

Original Source:

http://deals.venturebeat.com/2010/08/17/si-bone-raises-10-6m-to-minimize-low-back-pain/

When is Laser Spine Surgery Necessary?

According to the International Society for Minimal Intervention in Spinal Surgery (ISMISS) and the International Society of Orthopedic Surgery and Traumatology (SICOT), laser spine surgery (or specifically endoscopic spinal surgery) is the “gold standard” for the surgical treatment of back pain, lumbar, thoracic, and cervical disc herniations with radicular symptoms. The treatment of choice for these conditions is microsurgical microscopic disc surgery, or simply microdiscectomy.

Other indications for minimally invasive or endoscopic spinal procedures are lateral spinal canal (recess) and foraminal stenoses with radicular (or nerve root) symptoms, and degenerative facet joint cysts with radicular symptoms.

Imaging techniques are particularly helpful in determining which cases are amenable to endoscopic spine surgery. These include up-to-date MRI and CT scans, specifically those using fluoroscopy-guided, contrast-enhanced diagnostic injection. Neurophysiologic studies may also help in evaluating nerve damage or in detecting other compressed nerves.

Among the contraindications for endoscopic spinal surgery specified in the 2008 Guidelines of ISMISS are…

• Clinically relevant instabilities

• Central spinal canal stenosis

Relative contraindications include large disc herniations with cauda equina syndrome or a fresh motor deficit. Adequate decompression may not be achieved unless the interlaminar windows are large and there is good interlaminar endoscopic access.

The Importance of Physician-Competence in Conducting Laser Spine Surgery

Laser spine surgery is not without its complications, even though their occurrence is not as great in comparison with major open surgeries. Same as with major operations, according to spine institute the doctor should anticipate possible complications with the procedure, such as some bleeding, infection, dural tears and nerve root damage.

Laser Spine Surgery – What to Expect?

ISMISS recommends that surgeons should have enough experience in traditional spinal surgery techniques before getting training in endoscopic procedures. Spine surgery — whether done traditionally or via an endoscope — is still a delicate procedure and requires years of hands-on experience. ISMISS has still noted grievous errors in the operative approaches of novice surgeons in both traditional and endoscopic procedures, such as operating on the wrong side or operating on the wrong level, thus not giving any treatment to the patient at all.

Also, even though minimal complications are expected with this procedure, a surgeon should be prepared to perform major surgery in the event that the patient’s condition is more serious and could not be handled by laser spine surgery.

Image via Wikipedia

Lumbar Spine Surgery as an Option

Lumbar spine surgery for back pain is only indicated when conservative treatments did not prove helpful in relieving pain, if there is severe traumatic injury, and if the patient shows signs of progressive neurological deficits (loss of bladder and/or bowel control and increasing leg weakness). Abnormal spine curvatures such as scoliosis would also require surgery if the marked lateral deviation of the spine causes severe pain and other symptoms.

The surgical approach to spine surgery would be dependent upon the location of the affected area to allow for greater visualization and operative reach. For example, in many cases of spinal stenosis, anterior lumber spine surgery is performed together with anterior fusion as this is the best approach to the lamina and foramen.

The surgical approach is even more important in minimally invasive lumbar spine surgery wherein only a small incision is made. As an example, the anterior endoscopic approach to the cervical spine allows for effective anatomical decompression of the spinal canal and/or the nerve roots. Some of these procedures are aided by video for better visualization.

For those who are going to go under the knife or laser, there are many health websites that offer lumbar spine surgery video clips demonstrating these surgical approaches.

Two questions that are on the minds of most patients when it comes to lumbar spine surgery are…

1. What are the possible complications of the surgery?
2. How soon is the recovery?

Both major and minimally invasive lumbar spine surgeries carry the same risks of bleeding, infection, dural tears and nerve root damage, although arguably these conditions occur less with endoscopic surgeries.

Great Advantage of Minimally Invasive Lumbar Spine Surgery

The main advantage of minimally invasive lumbar spine surgery is the quick recovery time. Most patients leave the Recovery Room one hour after surgery. It also doesn’t require prolonged bed rest. A patient could return to work within two weeks and then go on with their daily routines without any restrictions in less than six weeks. Lumbar spine surgery recovery definitely takes much longer with major operations.

In the end, however, the decision of the type of lumbar spine surgery to be performed would be dependent upon the area affected and the doctor’s choice of surgical approach.

Lower Back Surgery: What Happens in lumbar spine surgery- Image via Wikipedia

Lower back surgery is actually a misnomer. What we call “lower back surgery” is specifically lumbar spine surgery or lower spinal surgery.

There are only a few indications for lower spinal surgery. These are…

• When conservative treatment is not effective in reducing pain

• When there are signs of focal neurologic deficits, such as leg weakness, sexual dysfunction (impotence), loss of bladder or bowel control (occurs when central lumbar disc herniation causes spinal abscess or cauda equina syndrome)

• When there are signs of progressive nerve problems caused by herniated discs

• Spine injury

The various types of lower back surgery each treat a specific cause of lower back pain. A patient may require only one type of surgery, but others may also need spinal fusion to further stabilize the problematic site.

Here are the most common types of lower spine surgery…

• Discectomy/Microdiscectomy: The procedure involves removing the herniated portion of a disc that has impinged upon a nerve. Discectomy serves to relieve irritation and inflammation on the compressed nerve. The procedure may involve full or partial removal of the posterior portion of the affected vertebra (called the “lamina”) to be able to reach the ruptured disc.

• Laminectomy: The procedure involves removal of herniated discs or bone spurs that press upon a spinal nerve. Laminectomy also involves enlarging the spinal canal in order to relieve pressure on the nerve caused by spinal stenosis and spondylolisthesis. This procedure may be performed with spinal fusion in order to achieve stabilization in the affected site.

• Foramenotomy: As its name denotes, it involves the removal of bone and other tissues that impinge upon the nerve as it exits the spinal column via the intervertebral foramen. This is performed when the nerve is being compressed by more than just a herniated disc.

• Spinal Fusion: This involves permanently connecting two or more bones in the spine by using screws, plates, or by creating bony bridges between vertebrae with bone grafts. This procedure aims to give the spine greater stability and thus reduce painful motion between vertebrae in causes of injured and degenerated discs and spinal fracture.

• Vertebroplasty: This procedure involves injecting bone cement into compressed vertebrae to help stabilize fractures and thus reduce pain in compressed and fractured vertebrae.

• Kyphoplasty: A variation of vertebroplasty, this procedure first involves the insertion and inflation of a balloon in between compressing vertebrae in order to expand the bone to its normal size. Cement is then injected to fill the empty space. Kyphoplasty is commonly performed in patients suffering from back pain as a result of osteoporotic and compression fractures, and can help prevent spinal deformities (such as scoliosis, kyphosis and lordosis) and height loss.

• Spinal cord stimulator implant: A minimally-invasive technique which involves implanting a spinal cord stimulator that relieves pain and other symptoms of sciatica and other chronic radiculopathies (diseases of the nerve roots).

• Lumbar Artificial Disc Replacement: A new type of surgery being explored as an alternative to spinal fusion. The procedure involves the implantation of artificial discs that would prevent painful compression between two vertebrae because of an injured or degenerated disc.

Clinical trials at the present time have yet to show conclusively the effectiveness of spinal surgery in the treatment of lower back pain. What most studies have shown is that the benefits of spinal surgery are limited when treating degenerative discs with symptoms of spinal pain. Also, there is an increased risk of complications in the use of spinal implants, including risks of blood loss, nerve injury, infection, and even repeat lower back surgery, in comparison to spinal fusion.