Originally posted 2/9/2010

Dr. Paul McCormick, the Spine Center’s Head, spoke at two Plenery Sessions, one on high-risk carotid artery surgery and another on Spinal Tumors.  Dr. McCormick also introduced the Rhoton Family Lecture speaker, Dr. Christopher M. Loftus, for his lecture on “High-Risk Carotid Surgery 2010″ and was Discussant for the Robert Florent MD Award for “Accuracy of ICD-9-Based and Retrospective

Assessments of Perioperative Adverse Events: Comparison with a Prospective Assessment of Complications in Spine Surgery”.  In addition to sharing his knowledge of medical subjects, Dr. Paul McCormick supports the work of Neurosurgeons in his many roles at AANS, including Executive Committee Treasurer of the the AANS Board of Directors;

Finance Committee Chair; Annual Meeting Committee Ex-Officio; Neurosurgery Research and Education Foundation (NREF) Executive Council Ex-Officio; American Board of Neurological Surgery Vice-Chair; NeurosurgeryPAC Treasurer; NeuroPoint Alliance Treasurer; Drugs, Technology, and Devices Committee Ex-Officio; and is a member of the Strategic Planning, Awards and Honors, Development, and NREF Educational Grants Committees.

Dr. Michael Kaiser was a panelist in a session where he spoke about his experiences with Cervical Spondylotic Myelopathy.

Dr. Alfred T. Ogden was a faculty member in a course specifically designed for nurses and physician assistants.  He spoke about the decision making challenges that can arise in the care of Spine patients.  He was also a faculty member in a hands-on Clinic that covered the most current minimally invasive spinal surgery techniques.

Dr. Peter D. Angevine was a Co-director in another hands-on clinic on Spinal Fusion.  This course covered the state-of-the-art techniques and instrumentation used to fuse different levels of the spine.

On Tuesday night, Dr. D’Ambrosio, of the Brain Tumor Center, Gamma Knife Center, and Spine Center, organized an event at AANS for the young members in the community.  It included good food and drink; the guest speaker Dr. Henry Brem, Chairman of the Department of Neurosurgery at Johns Hopkins University, who created a hillarious home-made video for the event; a number of our doctors; and a good time for all who came.

Cross Section of Intervertebral Disc Between Two Vertebrae

Doctors at the Spine Center are taking a leading role in the advancement of the Artificial Disc Replacement.  Getting implantable devices like these from the lab to patients requires rigorous testing and approval by the Food and Drug Administration (FDA).  These doctors are involved in both aspects.  Dr. Paul C. McCormick, head of the Spine Center, sits on an FDA panel and Dr. Michael G. Kaiser is currently in Phase III of trials for an artificial Disc for the cervical spine.

The disc in the artificial disc replacement refers to a cushiony pad between each vertebral body of the spine. These discs are made up of a fibrous outer surface and a jelly like interior and are well designed for shock absorption.   As we age, however, the disc can degenerate causing its outer lining to thin or crack allowing the jelly-like center to ooze out, or herniate.  This can be extremely painful, especially when it puts pressure on the large nerves nearby.

The condition is almost always treated conservatively at first with rest, medication, and physical therapy.  But in advanced cases this may not be enough and removal of the disc is advised.  When the problem is in the neck, the procedure that is typically done is called an anterior cervical discectomy and fusion (ACDF).  Here,  surgeons replace the disc with a spacer and fuse the area with bone grafts, metal plates and screws.  According to the Spine Center, ”This may alleviate pain but has potential disadvantages, including loss of motion and flexibility and possible further degeneration of adjacent discs.”

As an alternative, scientists have recently been developing artificial discs that can replace the degenerated ones without losing the natural movement of the neck.  Because these disc-like devices can withstand movement and are secured to the bones above and below, no fusion is necessary.

Before surgical implants like these can be used widely, they have to be tested, re-tested, and then tested again.  Finally, they have to pass the strict criteria of the FDA’s Medical Devices Advisory Committee.  Specifically, they need to pass the subcommittee, Orthopaedic and Rehabilitation Devices Panel, a panel of experts in the field including, head of the Spine Center, Dr. Paul McCormick.

The purpose of this panel is to review and evaluate, “data concerning the safety and effectiveness of marketed and investigational orthopedic and rehabilitation devices and makes appropriate recommendations to the Commissioner of Food and Drugs.”

The very first artificial cervical disc approved by the FDA, the PRESTIGE Cervical Disc, was approved in July, 2007 and since then, a number of other models have come out.  Last May, the committee conditionally approved the Bryan Cervical Disc.

Currently, Dr. Michael Kaiser from the Spine Center is conducting Phase III clinical trials for the prospective Randomized Clinical Investigation of the SECURE-C Artificial Disc.  To view patient brochures explaining the clinical trial currently under way at the New York Presbyterian, Columbia Medical Center Spine Center please see here:  SECURE®-C Cervical Artificial Disc

Learn more about Degenerative Spinal Disorders and Herniated Intervertebral Disc Disease

Dr. Paul C. McCormick presented “Randomized Clinical Trials of Cervical Arthroplasty: A Critical Review” to a recent audience of doctors and medical practitioners at the J. Lawrence Pool Memorial Research Symposium, sponsored by CUMC‘s Department of Neurological Surgery‘s Spine Center.

Just over one hundred years ago the very first surgery was performed here at Columbia University Medical Center‘s Department of Neurosurgery.  The surgeon was Dr. Charles Elsberg and he performed the removal of an intramedullary spinal cord tumor. His two step method was pioneering at the time but since then, medicine has advanced tremendously and the treatment of this condition has come a long way.

Charles Elsberg, the first chairman of the Department of Neurological Surgery at the Neurological Institute of New York, mastered and popularized surgical resection of intramedullary spinal cord tumors.

Prior to Elsberg’s work (c. 1910), surgery within the substance of the spinal cord was largely avoided due to excessively high morbidity.  Elsberg introduced the “two-stage method of extrusion” for resecting intramedullary tumors.

During the first stage of the surgery Elsberg exposed the region of the spinal cord known to harbor the tumor and proceeded to perform a myelotomy over the area. At this point Elsberg would close the wound and return for the second stage of the surgery after about 1 week.

During the second stage, Elsberg reopened the surgical wound and excised the tumor which had invariably begun the process of delivering itself from the surrounding spinal cord.  Elsberg is quoted as saying: “…no matter how markedly the tumor will seem to bulge, the surgeon must not attempt to remove the growth, for he will be sure to cause grave injury to the cord. He must leave it to nature to extrude the tumor.”

Dr. Charles Elsberg performed the first surgery at the Department of Neurosurgery 100 years ago

Elsberg’s pioneering two-stage method showed that surgery was a viable option for treating intramedullary tumors.  The advent of micro-neurosurgical techniques has precipitously advanced the surgical strategy used to treat intramedullary tumors.

Resection of intramedullary Spinal Tumors is now done in a single stage by specialists here at both the Brain Tumor Center and Spine Center.  Their techniques have come a long way since Elsberg’s time.  Now they use surgical microscopes, microsurgical tools, and often laser or ultrasonic aspiration instruments.

Today, many types of intramedullary tumors can be completely removed with low attendant morbidity. Needless to say, Elsberg did not have the benefit of such high-end technology in the operating room, making his surgical achievements that much more remarkable.

To learn more see our pages on Spinal Tumors and Neuro-Oncology.

Recently the New York Times ran an article about how to deal with the everyday aches and pains that accompany an active/sports lifestyle.  The physicians interviewed for the most part said they recommend their patients to hold off on contacting professional help unless the problem persists beyond a usual rest period.  The article got a ton of responses from readers, many of whom recommended physical therapy.

The two main therapists at the Spine Center, Megan Reinhardt, PT, DPT, MS and Evan Johnson, PT, DPT, MS, OCS took a particular interest in this article and the responses because they themselves both have an athletic background.  Dr. Reinhardt is a triathlete and Dr. Johnson was a professional dancer and is now very active in coaching basketball.

Both Johnson and Reinhardt agree that athletes definitely don’t need to see the doctor for every ache and pain and that rest heals many problems.  However, when it comes to persistent or recurrent pains they recommend seeing a physical therapist to find the underlying biomechanical process that may be contributing to the problem.  Sometimes, as many of the article comments talked about, it is just a matter of finding out if certain muscles are too tight and how to stretch them or if certain muscles are not as strong as they need to be and how to build them up.

Furthermore, Johnson and Reinhardt say it can benefit athletes in general to have their form checked and a thorough flexibility and strength assessment by a physical therapist.  They say to think of it is an “athletic service check” and that just like with your car, you don’t always want to wait until something big breaks down.

“All of us have at least slight differences in the symmetry of our muscles.  Most of us are either right handed or left and tend to perform everyday as well as athletic activities with a certain style or pattern of muscle use,” says Dr. Johnson.  ”Having someone look at the way we move and check if we have tighter or weaker muscles on one side of the body, for example, can take us a long way toward preventing injury and restoring optimal muscle balance.”

To learn more about what Megan and Evan do, see the Spine Center‘s page on Physical Therapy.

Also see the New York Times Article: Sports Injuries; When to Tough it Out and Readers Comments: Sports Injuries; When to Tough it Out

“Degenerative Lumbar Kyphosis and Global Sagittal Imbalance” was the second presentation by Dr. Peter D. Angevine at the recent J. Lawrence Pool Memorial Research Symposium, sponsored by The Spine Center.

Dr. Alfred T. Ogden of The Spine Center appeared on ABC News’ Goodmorning America Health with Tanya Rivero Thursday, April 8th at 2:30pm and 5:00pm EST.  This was his second time on the show.  Last year he discussed treatments for Lower Back Pain.  In this recent appearance he discussed Deep Brain Stimulation.

Though we think of the doctors at the Spine Center as back and neck surgeons, they are first and foremost neurosurgeons.  More than that even, they are leaders in clinical care and research involving many aspects of the nervous system.  And as such, they are regularly sought out for opinions on many different topics.

It is this training and level of experience with the whole nervous system that, in fact, makes them such good spine surgeons.

Watch Dr. Ogden’s piece on ABC’s Goodmorning America Health