Columbia Neurosurgery » Spine

Kaiser Promoted to Associate Professor

Department Author — Mon, 09 Jan 2012 22:41:50 +0000

We are pleased to announce that Dr. Michael Kaiser, an expert in complex spinal deformity, has been promoted.

In addition to being Associate Director of the Spine Center, he is now Associate Professor of Clinical Neurological Surgery.

This is an honor well deserved. Congratulations Dr. Kaiser!

McCormick and Kaiser Teach Residents at Spine Camp

Department Author — Tue, 22 Nov 2011 06:00:03 +0000

Dr. Paul McCormick

Dr. Paul McCormick and Dr. Michael Kaiser from the Spine Center recently returned from Illinois where they taught residents from around the country the finer points of spinal stabilization.

This annual three day meeting is sponsored by the American Association of Neurological Surgeons (AANS) and is held just outside of Chicago at the North American Spine Society ’(NASS) training facility. This year Dr. McCormick was the honored guest.

Dr. Michael Kaiser

Dr. Kaiser, who has participated every year since the meetings began in 2006, tells us, “We like to refer to it as ‘spine camp’ with 40 residents selected from around the country to attend. It is a relatively rigorous course – we start the days between six thirty and seven AM and work until five PM. The day is split between didactic sessions and cadaver labs to provide residents a hands-on opportunity to apply the concepts learned during lectures.”

In addition to teaching residents, the meeting is an opportunity for national leaders in spine to discuss current events, policy initiatives, and academic endeavors.

Researchers Seek to Understand Best Treatment Alternatives for Cervical Spondylotic Myelopathy

Department Author — Tue, 23 Aug 2011 22:11:07 +0000

Dr. Hani Malone

Resident Dr. Hani Malone and Dr. Michael Kaiser from the Spine Center are currently conducting clinical research to determine the optimal treatment strategies for patients presenting with cervical spondylotic myelopathy (CSM), a degenerative process of the neck that can lead to neurological deficits and impaired quality of life.

Dr. Kaiser is currently chairman of the Guidelines Committee for the AANS/CNS Joint Section of Spine and Peripheral Nerve Disorders, the function of which is to establish standardized treatment paradigms for various spinal disorders based on the best available medical evidence.

Dr. Hani Malone is one the rising stars in the Columbia University neurosurgical residency program, who had developed a strong interest in spine surgery and promises to be a future leader in this field.

CSM is the most common cause of myelopathy (injury to the spinal cord) in adults older than 55 years, often causing progressive disability and compromising the patient’s quality of life. Patients will often present with hand numbness, loss of dexterity, gait instability, and compromised urinary control.

The goal of surgery for CSM is to relieve pressure on the spinal cord and prevent further injury, while maintaining spinal stability. Surgeons have developed a number of different approaches to treat CSM, but the optimal surgical approach for a given patient remains an area of debate.

In order to establish the best treatment alternatives, Drs. Malone and Kaiser have been reviewing the clinical experience of the Columbia University spine surgeons over the past 8 years, where over 500 patients with CSM have been treated.

Development of a prospective patient database has become a national initiative, with the hope that such data will define specific patient characteristics that can be used to determine the optimal surgical approach.

This is particularly true with CSM since there are a number of surgical alternatives that may be considered. In addition to stabilizing and improving neurological function, maintaining and/or restoring the optimal spinal configuration is a major surgical objective to minimize chronic pain, prevent progressive deformities, and maximize quality of life.

Dr. Michael Kaiser

This research is ongoing and Drs. Malone and Kaiser will be submitting the preliminary work presentation at upcoming national neurosurgical meetings, including the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves and the AANS Annual Meeting.

Spine Center Featured in Back-in-Action Webcast

Department Author — Thu, 03 Feb 2011 19:34:04 +0000

On the first of the month, New York Presbyterian Hospital premiered their Back-in-Action Webcast. The show featured our Spine Center and it was a huge success.

An official at the NY Presbyterian Hospital told us, the program landed in the upper third of pre-taped events that they have launched and they expect continued viewership amongst people who missed the premier.

The Back-in-Action webcast focuses on medical and surgical treatments available for patients with:

Cervical Myelopathy

Cervical Herniated Disc & Radiculopathy

Lumbar Disc Herniation

Spinal Stenosis, Spondylolistheis

Lumbar Degenerative Deformities

Vertebral Compression Fractures

You can still see the Back-in-Action webcast on ORlive today!

The Hip Bone’s Connected to the…Neck Bone(?) and Spine Surgeons Don’t Take it Lightly

Department Author — Tue, 28 Dec 2010 06:00:20 +0000

Originally posted 2/9/2010

Amazingly, surgeons can take bone from one part of the body and place it in another and it will grow there. Bone is one of the only tissues in our body that can regenerate in this way. If you break your leg, for example, not only will the break heal but extra bone grows in. This is called a bony callus and it makes the area that was broken stronger than ever. Spine surgeons often make use of this natural phenomenon to perform a spinal fusion. That is, they use the natural growing powers of bone to stabilize a segment of the spine.

They often do this when a part of the spine has to be removed. The space that is left needs to be filled in and the area stabilized. Surgeons often fill in the space with bone taken from the patient’s own hip. This bone graft is locked into place with screws and a metal plate to keep it from moving.

Over time, the bone knits into the bone around it and forms a fusion.

Harvesting bone from a patient’s hip is not done lightly, however. Dr. Michael Kaiser from the Spine Center told fellow surgeons at the Congress of Neurological Surgeons Meeting that the hip pain that can result is often underestimated. He said that depending on the patient, other options may need to be considered.

Bone taken from the patient’s own body is ideal because of its convenience. It is also ultra compatible, and does the job with few complications. When the bone is taken from the hip, however it becomes another surgical site. Most of the time that is OK because the patient is given pain medicine and the bone heals up with no problem. Occasionally though, the pain persists and can be a problem in and of itself.

Dr. Kaiser talked about some alternatives. Bone, for example, can be taken from a cadaver. This bone can also mesh in with the patient’s bone and form a natural fusion, but because it comes from another person, there is a risk of infection or incompatibility.

Substances like titanium, ceramic, carbon, or polymers can also be used in place of bone. These are strong and don’t usually react negatively with a patient’s body but won’t organically fuse to the other bone.

As an alternative to fusion in the case of spinal disc disease, Dr. Kaiser is involved in clinical trials for the use of an artificial disc replacement. No bone needs to be harvested and movement of the cervical spine is retained.

The development of new materials and devices continues to advance but in many cases, spinal surgeons like Dr. Kaiser are making the best use of the body’s own natural resources and sometimes that means that bone from the hip is indeed connected to the bones in the neck.

Spine Center Well Represented at CNS 2010

Department Author — Tue, 16 Nov 2010 06:56:10 +0000

Dr. Paul McCormick

Director, Dr. Paul McCormick, joined his fellow Spine Center surgeons, Dr. Peter Angevine and Dr. Michael Kaiser as presenters this year at the Annual Meeting of the Congress of Neurological Surgeons (CNS).

Dr. McCormick was director of a Practical Course entitled Spine Update: A Critical Assessment of Peer- Reviewed Spine Literature for the Practicing Neurosurgeon. Joining him in this course, as a presenter, was Dr. Angevine.

Dr. Peter Angevine

Dr. Angevine was one of the speakers for another course on the latest in Spinal Deformity Surgery, as well as for a Special Course on Spinal Fusion. He also spoke at a Luncheon Seminar on the treatment of the Aging Spine and he took part in a Consensus Session on the use of Bone Morphogenic Protein, in which he specifically spoke about its cost effectiveness.

Dr. Michael Kaiser

Dr. Kaiser was also very active at the conference. He co-directed a Practical Course entitled Cervical Spondylotic Myelopathy and Radiculopathy: Treatment Approaches and Options. Then, he presented at a course on New Clinical Practice Guidelines for treatment of the Degenerative Cervical Spine. Lastly, he spoke at two different Luncheon Seminars; one on Pseudoarthrosis of the Cervical and Lumbar Spine and another entitled Cervical Spondylotic Myelopathy and OPLL: Guidelines for Surgical Management.

Whew, those guys were busy!

Feldstein Speaks about Chiari Malformations at CNS Meeting

Department Author — Thu, 28 Oct 2010 21:13:42 +0000

Dr. Neil Feldstein from the Pediatric Neurosurgery Center recently spoke at the Annual Meeting of the Congress of Neurological Surgeons. He was part of a panel of presenters on Surgical Management of Chiari and Syringomyelia. In particular he spoke about the management of Chiari I Malformations with non-dural opening techniques.

Based on the evidence, Dr. Feldstein recommended nondural opening for all patients except those with: Rapid progression of scoliosis with underlying syrinx; Rapid progression of neurologic dysfunction; Recurrence after nondural decompression WITHOUT bone regrowth; or for those likely to require posterior occipital-cervical fusion.

More Evidence That Riskiest Part Of Chiari Surgery May Not Be Necessary

McCormick Visiting Prof at Mayo and USF

Department Author — Wed, 06 Oct 2010 07:09:58 +0000

Dr. Paul C. McCormick from the Spine Center is widely recognized as the world’s preeminent expert on the surgical management of spinal cord tumors.

In this capacity, McCormick is heading to the Mayo Clinic as a visiting professor and lecturer on the topic. Shortly after that, he will lecture again at the University of San Francisco (USF).

Also, see our blog 100 Years Later, Neuro Institute Is Still At The Forefront When It Comes To Your Back to learn more about the treatment of Spinal Tumors.

Spinal Cord Injuries; Children Need Special Consideration

Department Author — Mon, 02 Aug 2010 06:53:48 +0000

Fortunately, Spinal Cord Injuries are not that common in children. They only make up between one and ten percent of all spinal cord injuries. (That comes to about 1000 incidences per year.)

When they do occur, however, they can be the worst kind of tragedy. ”For this reason”, says Dr. Richard Anderson from the Pediatric Neurosurgery Center, “it is important to understand the typical mechanisms of injury in children and their special treatment needs.”

In children under 8 years old, spinal cord injuries are most often located in the cervical spine (the neck region.)

This is because of the unique anatomy and biomechanics of children in this age group. They usually have a disproportionately large head, underdeveloped neck musculature, and a much more flexible spinal column. This has to do with the shapes of the bones and an increase in flexibility of the joints. (For more information about this, see our blog: Pediatric Spine- Not Just Smaller- Different.)

The increased flexibility in their spinal column does not proportionately apply to their spinal cord, however. According to Anderson, “while the column has 2 inches of play, the cord has a mere quarter inch.” This means that in an accident, the spinal column can be thrust in one or more directions that exceed the flexibility of the cord resulting in grave injury.

Spinal cord injury itself happens in two phases. The first is the irrevocable force that actually injures the spinal cord. The second is what happens afterward. While the original injury can’t be undone, doctors do have some control over how a child survives the second phase.

Immediately after injury, the child’s spine must be stabilized to prevent any further mechanical injury from an unstable spine, or the possibility of loose bone fragments. The injury itself will also trigger a complex cascade of events throughout many systems within the body that can cause further damage.

Among these are severe inflammation, shock, and changes in the immune system. Physicians can use a number of medications and other therapies to mitigate these effects and they need to be sensitive to the dosage requirements specific to children.

An X-Ray needs to be taken as soon as possible to begin to determine the extent of the injury. Dr. Anderson emphasizes, that there can be a spinal cord injury present even when X-Rays appear normal. He urges that if a physician suspects injury based on their examination, then dynamic imaging studies, a CT scan, or MRI should be performed.

He recommends further, that if any instability is discovered, then surgery should be considered regardless of whether the cord has sustained any injury. This is because an unstable spinal column is extremely dangerous and poses a continued risk until it is stabilized.

The surgical procedures performed on children need to take not only their smaller size into consideration but also their unique biomechanics too. Dr. Anderson says, “Thorough preoperative planning is critical.”

The continued growth of young children is a large consideration both in planning surgery and in how long the child should be followed afterward. Surgeons may often opt for less instrumentation placed inside the body and greater external bracing to allow for continued growth and to maximize the exceptional healing potential that children have. Dr. Anderson recommends at least yearly follow-up until the the child is fully grown.

To learn more, see our blog; Pediatric Spine- Not Just Smaller- Different, our pages on Spinal Cord Injury, and Pediatric Trauma.

McCormick & Kaiser Speak at National Conference on Best Spinal Care

Department Author — Tue, 27 Jul 2010 06:02:29 +0000

Dr. Paul McCormick

Dr. Paul McCormick, and Dr. Michael Kaiser from the Spine Center have just returned from speaking at The National Conference on Comparative Efficacy of Treatments for Lumbar Spine. The meeting was held at the University of Wisconsin School of Medicine and Public Health.

Dr. Michael Kaiser

According to Dr. Daniel K. Resnick of the University of Wisconsin, “This marks the first time groups representing patients, spine care providers, policy makers, Medicare, private insurance and health information technology experts have come together around this issue.”

View a Recap From the Conference.