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ORTHOPEDICS
Andrews' Dr. David Chandler on the past 30 years of
spinal innovation
By Eric Oliver
D
avid Chandler, MD, an orthopedic
spine specialist at Gulf Breeze,
Fla.-based Andrews Institute
for Orthopaedics & Sports Medicine,
reviewed the last 30 years of spine surgery
innovation, offering insights into an array
of advancing technologies in an interview
for Andrews' Institute.
Note: Transcript was edited for style.
Dr. David Chandler: irty years ago, we
had limited instrumentation to correct and
stabilize spinal deformities and instabilities.
Around that time, we began using pedicle
screws, which are screws placed into a
column of bone connecting the back of the
spine to the front. ere was some initial
controversy about the procedure, but pedicle
screws provided superior fixation and
correction in situations that could not be
managed by previously available instrumen-
tation. Subsequently, we also discovered the
adverse effects of rigid fixation in a spinal
fusion with accelerated degeneration and
instability at adjacent spinal levels. Unfortu-
nately, over the past 30 years, [while] there
has been a concerted effort in advancing
instrumentation with increased utilization
[there's been] little improvement in patient
outcomes.
In response to the appreciation of this
accelerated spinal degeneration next to
spinal fusions, there was interest in de-
veloping motion-preserving technologies.
One of these new technologies is total disc
replacement, which was designed to ad-
dress back pain resulting from painful disc
degeneration. There are narrow criteria
for TDR, but the procedure has improved
long-term outcomes and diminished
adjacent segment degeneration compared
to patients undergoing fusion for the same
problem.
Kyphoplasty is another procedure intro-
duced to address painful compression
fractures for which we had no effective
treatments to expedite pain relief and
improve the course of the disease. During
the 1990s, physicians in France began
pressurized injections of bone cement
into a fractured spine bone. A refinement
of this procedure in the U.S. added the
placement of balloons into the broken
bone. This addition allowed for correction
of the deformity and created a cavity for
injection of thicker bone cement at lower
pressure. The improved injection tech-
nique provided better control of cement
flow and less unwanted cement leakage.
This procedure is still controversial, as are
so many things in the treatment of spinal
conditions.
Another exciting area of development is
performing nerve cauterization in the center
of the vertebra for patients with back pain.
A pilot study several years ago in Europe
evaluated a procedure to burn nerves in the
center of the bone to help to decrease the
back pain. Recent approval recently allows
for application in the U.S.
Spine surgery is better at relieving limb
pain from nerve compression than it is for
relieving neck and back pain. Research
continues to explore new interventions
with different techniques, medications and
therapies.
Research in device development continues,
but over time, there is probably going to
be an evolution away from the focus on
the use of instrumentation to [increased
use of ] biologic interventions. Currently,
[surgeons use biologics including] platelet-
rich plasma and, now, stem cells [in spinal
fusion procedures]. Biologics development
and utilization is an area of ongoing re-
search. Currently, there is a broad applica-
tion of biologics with several practitioners
making promises on which they can't
deliver, and which are not supported by
sound, rigorous science.
Finally, we have improved the way physi-
cians and patients interact to select a treat-
ment that is appropriate for the patient; one
must always consider the natural history of
the disease and weigh the risks of proposed
interventions. Shared decision-making and
patient engagement have also advanced over
the last 30 years; now, there is more sharing
of knowledge to help the patient understand
and assist them in making the decision that
is best for them.
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Orlin & Cohen Orthopedic Group acquires
10-physician orthopedic practice in New
York: 4 notes
By Laura Dyrda
Merrick, N.Y.-based Orlin & Cohen Orthopedic Group acquired Long Island
Bone & Joint.
Four things to know:
1. Long Island Bone & Joint is an independent practice with offices in
Riverhead, Port Jefferson and Southampton, N.Y. The practice is focused on
orthopedic surgery, computer-assisted knee reconstruction, sports medicine
and spine surgery.
2. LIBJ has 10 physicians who will join Orlin & Cohen Orthopedic Group
after the acquisition.
3. Orlin & Cohen Orthopedic Group is an affiliate of New Hyde Park, N.Y.-
based Northwell Health and has 12 offices focused on orthopedics.
4. The financial terms of the acquisition were not disclosed.
"We saw a natural connection with the talented professionals at Long Island
Bone & Joint and knew it made sense," said Michael Passet, CEO of Orlin &
Cohen.
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