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Spine Surgery Insert.Indd Spine Surgery CONVENIENT ACCESS ADVANCED CARE CLOSE TO HOME COLLABORATING WITH COLLEAGUES WHEN TO REFER CONDITIONS AND SYMPTOMS LEADING EDGE TREATMENT ADVANCED TECHNIQUES NEW EQUIPMENT OFFERS ADDED CAPABILITY CARE INTEGRATION WITH SPINE AND PAIN MANAGEMENT CENTERS ANCILLARY SERVICES FOR SPINE SECOND TO NONE 1 1 DIRECTORY X-ray/spine CONVENIENT ACCESS Beverly Hospital provides advanced orthopedic spine surgery and comprehensive, coordinated care for patients with spine disease. Patients benefit from • Ready, easy access to North Shore office locations and hospital resources • Immediate emergent care and timely referral appointments • Convenient office locations on the North Shore, which include: Coastal Orthopedic Associates The Medical Building 77 Herrick Street Beverly, MA 01915 978-927-3040 Beverly Hospital at Danvers Medical and Day Surgery Center 480 Maple Street Danvers, MA 01923 978-927-3040 New England Orthopedic Specialists 4 Centennial Drive Peabody, MA 01960 978-531-0800 Beverly Hospital at Danvers Medical and Day Surgery Center 480 Maple Street Danvers, MA 01923 978-531-0800 Front cover: Sports Medicine North Orthopedic Surgery Bone scan of the spine Orthopedics Specialty Center One Orthopedics Drive Peabody, MA 01960 978-818-6350 Visit beverlyhospital.org for more information on orthopedic spine surgery at Beverly Hospital. 2 CT of Vertebra ADVANCED CARE CLOSE TO HOME Spine capabilities include the gamut of noninvasive, • Radiology and imaging services with invasive and minimally invasive spine intervention, 3T MRI and 64-slice CT scanners to assist featuring advanced surgical techniques and with preoperative treatment planning and multidisciplinary care. Patients benefit from: postoperative follow-up • Tertiary spine surgery and treatment • Integrated Spine and Pain Management within the Beverly Hospital community Centers at the new Beverly Hospital at for continuity of care, and without the Danvers Medical and Day Surgery Center inconvenience of going to Boston • Center for Rehabilitation and Sports • Board certified, fellowship trained spine Medicine with therapists who have specific surgeons, skilled and experienced, and on expertise in cervical and lumbar spine par with downtown colleagues • Plenty of free parking • Ready and easy access to quality services including preoperative teaching, tests, labs and postoperative rehabilitation COLLABORATING WITH COLLEAGUES Spine surgeons work closely with the referring phone, email and fax. Evidence-based practices, community and offer primary care physicians digital images and studies, growing reliance on immediate access and consultation for emergent electronic medical records, and prompt medical patients, and timely appointments. Surgeons brief reports enhance service to referring colleagues and the referring community on patient progress via expedite patient treatment plans. WHEN TO REFER Back and neck problems are epidemic, plaguing • Night pain 80 percent of the American public at one time or • Severe constitutional symptoms another. Most are self-limiting and resolve within two to four weeks. Initial treatment by a primary • Associated cancers care physician is most appropriate and includes • Loss of bowel and bladder control anti-inflammatory medications, ice, heat, pain • Severe neurologic deficit medicine and gradual mobilization and resumption of activities. Spine surgeons welcome the opportunity to provide second opinions, as well as to evaluate patients who The red flag exceptions that call for early referral to do not respond to early, conservative treatment for an orthopedic spine surgeon are: cervical, thoracic and lumbar disorders. 2 3 CONDITIONS AND SYMPTOMS Spine surgeons treat or coordinate care with primary • Acute and chronic low back pain including care physicians, other specialists, and/or the Beverly arthritis, myofascial pain and osteoporosis Hospital Spine and Pain Management Centers for a • Compression fractures range of conditions and symptoms such as: • Spinal tumors • Radiating neck, arm, and back or sciatica pain (cervical and lumbar radiculopathy, and • Spinal infections neurologic compression of the cervical or lumbar spine) typically caused by herniated Spine surgeons within the Beverly Hospital disc, degenerative disc disease or spinal community treat all manner of back pain, spinal stenosis conditions, deformity and tumors, with few exceptions. In rare instances, they will refer unusually • Cervical and lumbar stenosis complex spine surgery cases (such as catastrophic • Myelopathy• SPONDYLOLISTHES paralysis, intradural tumors or vascular malformations) • Spondylolisthesis, either degenerative to affiliated downtown tertiary institutions. or isthmic LEADING EDGE TREATMENT Care begins with careful evaluation, and specialty • Microdiscectomy diagnostics as needed featuring sophisticated imaging • Microforaminotomy/laminotomy modalities such as 3T MRI, CT studies and bone scans, among others. Coordinated services focus on • Posterior procedures including posterior conservative and noninvasive procedures (injection lumbar interbody fusion (PLIF) and and/or physical therapy) with progression to surgical transforaminal lumbar interbody fusion (TLIF) treatment as appropriate. Comprehensive surgical expertise ranges from traditional to state-of-the-art procedures, with proficiency in minimally invasive technique. Advances in less invasive techniques to minimize collateral tissue damage enable spine surgeons to do the least amount of surgery to derive the maximum amount of benefit. In addition to fracture and tumor treatment, surgical procedures of note include: Cervical Spine • Anterior cervical discectomy and fusion (ACDF) including cervical discarthroplasty • Artificial disc replacement • Posterior decompression and fusion Thoracic Spine • Kyphoplasty MRI of the lumbar sacral Lumbar Spine spine • Anterior lumbar interbody fusion (ALIF) • Artificial disc replacement • Microdecompressions and fusions, including open approach and X-Stop • Dynamic stabilization • Laminectomy 4 • Lateral lumbar interbody fusion (XLIF) 4 ADVANCED TECHNIQUES Some of the more sophisticated spine expertise and Spinal fusion: a number of techniques, all of techniques within the Beverly Hospital community which introduce bone graft material, typically with include the following procedures: hardware, using either a posterior, anterior or lateral approach to treat principally disc degeneration, Artificial disc replacement: an emerging fractures, certain types of spinal deformity, alternative to spine fusion that replaces a spondylolisthesis and/or spinal instability. These degenerative disc with prosthetic material. procedures include: • Anterior cervical discectomy and fusion an alternative to traditional Dynamic stabilization: (ACDF): an operation through the front of fusion that relieves pain and promotes motion in the the neck to remove all or part of the disc and affected area of the spine, for more flexibility and fill the space with a bone graft. less likelihood of secondary pain on the adjacent spine levels. • Posterior lumbar interbody fusion (PLIF): surgeons access the spine through the lower Interventional pain management: in collaboration back to remove the damaged disc and fill with spine surgeons, the Beverly Hospital Pain the empty disc space (interbody) with bone Management Center offers injection therapies, graft material. percutaneous disc decompression (to shrink • Anterior lumbar interbody fusion (ALIF): contained herniated discs without surgery) and a procedure similar to PLIF, except the implantable techniques (such as spinal cord surgeon approaches the spine through the stimulation and intrathecal pumps) to treat upper abdomen instead of the lower back to fuse and lower back pain. the disc space. • Transforaminal lumbar interbody fusion a minimally invasive, percutaneous Kyphoplasty: (TLIF): an open or minimally invasive procedure using bone cement to treat vertebral procedure similar to PLIF, except the compression fractures related to osteoporosis. surgeon inserts the bone graft material from Through two tiny incisions, surgeons insert an the side instead of the back. inflatable bone tamp into the spinal column and use inflated balloons to help raise the collapsed vertebra. • Lateral lumbar interbody fusion (XLIF): a The balloons are deflated and removed, leaving a minimally invasive procedure whereby the cavity within the bone, which is then filled with surgeon makes two small incisions in the cement to support the surrounding area, prevent patient’s side to spare major muscles in the further collapse, and form an internal cast to keep back. the vertebra in place. • Percutaneous posterior instrumentation: percutaneous placement of hardware for Microdecompression: a comprehensive term stabilization, often used as an adjunct to for several types of operations – including other fusion procedures. microdiscectomy, microforaminotomy, laminotomy and laminectomy – to relieve pressure on the spinal X-Stop: a titanium implant placed percutaneously nerves by enlarging the space where the affected nerve to open the space in the spinal canal (under local exits the cervical or lumbar spinal canal. The surgeon anesthesia, without surgery) to relieve radiating pain removes a minimal amount of bone, over the affected from stenosis (pinched nerves). nerve, and the underlying disc material, to relieve pain. The procedure is performed with minimal alteration of the mechanical structure of the spine. 4 55 A fluoroscopy image of a diagnostic and therapeutic selective nerve root
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