Summer
2008
| Topics |
Message from the Fellows Education Chairmen for DePuy Spine
Carl Lauryssen, MD; Nathan Lebwohl, MD
Hello and welcome to another installment of the Future Leaders in Spine Surgery Newsletter! As always we hope you find this newsletter to be a valuable source of information.
This issue features a number of interesting articles. Dr. Jack Chen from Irvine, CA shares his experience in treating patients with osteoporosis. Dr. Chen discusses the clinical options for treating this patient population.
Also, Dr. Patrick Cahill from Shriner’s Children’s Hospital in Philadelphia shares his experience with the DePuy Spine Education through Visitation program. This program is an excellent opportunity to learn from industry leaders in a one-on-one setting.
Karen Zupko and Associates provides us with an update from a previous article regarding the National Payer Identifier requirements for reimbursement through Medicare. This is a must read for all of us!
Congratulations to the winners of the 2nd Annual DePuy Spine Clinical Research Paper Challenge! For more information on what papers won this year’s Challenge see the “Pioneering What Matters” section in this newsletter.
We hope you enjoy this issue. To be a contributing author or to request content please feel free to contact Stephanie West at DePuy Spine.
As always please feel free to contact any one of us should you need assistance or support with your practice or your fellowship. Our contact information is listed below:
| Carl
Lauryssen, MD Olympia Health Center drcl@olympiamc.com |
Nathan Lebwohl,
MD University of Miami nlebwohl@aol.com |
Message from DePuy Spine DePuy Spine Management Board
Ian BurgessVice President Research & Development
As part of the growing Spine market, surgeons and companies like DePuy Spine understand the need for innovation. Our goal is to develop solutions to help you help patients with unmet needs, whose outcomes could be further improved through product innovation. As a result we invest heavily in discovery, development, and pre-clinical and clinical research.
DePuy Spine continues to innovate in multiple areas of new technology. We commit a high proportion of our R&D resources to transformational technologies that have the potential to dramatically improve patients’ lives. But we cannot do this on our own: We recognize that you, as Spine surgeons of the future, have a vital part to play. In a health care compliant way, it is important for us to partner in this process.
The health care environment is changing and it is important not only that we develop innovative products and technologies, but that we conduct clinical research to demonstrate the value of these new technologies. DePuy Spine aspires to lead the way on incorporating evidence-based studies that demonstrate both the clinical and economic value of products and technologies to stakeholders that include patients, surgeons, hospitals, and payers.
This newsletter serves as a conduit between us, to inform and challenge as together we collaborate and innovate in the world of Spine. I encourage you to read on and I invite your feedback in this important dialogue.
Regards,
Ian Burgess
WW Vice President, Research & Development
Iburges2@dpyus.jnj.com
Section I: ASK THE EXPERT – Treating Osteoporosis
Interview conducted by Stephanie West, DePuy Spine Manager, Medical Education
Dr. Jack ChenOrange, CA
Dr. Jack Chen is a subspecialty trained orthopaedic spine surgeon. His clinical practice in Orange, CA is devoted to treating both adult and pediatric patients with spinal disorders. His interests include degenerative conditions of both the cervical and lumbar spine, including herniated discs, spinal stenosis, and spondylolisthesis. He also has extensive knowledge of spinal deformity, including kyphosis and scoliosis. Furthermore, he has unique experience in treating spinal tumors and trauma, and has won basic science research awards in spine infection and spine biomechanics.
I recently called Dr. Chen to discuss his preferred treatment for patients with Osteoporosis.
SW: We know that osteoporosis is a growing issue in the aging population today. Associated with this disease is the incidence of vertebral compression fractures. The pain associated with compression fractures of the vertebra has been a significant problem for patients. Can you give us a sense of the extent of the problem and what treatment options exist for these patients?
JC: In the United States alone, more than 700,000 osteoporotic vertebral fractures occur each year, more than the number of osteoporotic hip and wrist fractures combined.
More than 150,000 patients per year are hospitalized for pain associated with these fractures, costing more than 1.6 billion dollars per year.
The National Osteoporosis Foundation estimates that osteoporosis related pathology causes more immobile days in bed for patients than stroke, heart attack, or breast cancer.
For these patients, conservative treatment consists of bed rest, activity modification, bracing, and pain medications. However, since these patients are often very elderly and frail, these traditional treatments may not always be satisfactory. Elderly patients are sensitive to the effects of narcotics, they are more vulnerable to the complications associated with bed rest, and bracing is often very uncomfortable for them.
Fortunately, for the patients who do not have relief of their pain with traditional measures, cement augmentation of their fracture can alleviate their symptoms. read more
Section II: IN MY EXPERIENCE – Education through Visitation
Patrick Cahill, MD Philadelphia Shriners Hospital
The DePuy Spine Education Through Visitation Program is designed for orthopaedic and neurosurgeons who have completed their residency and fellowship training, and who devote a substantial portion of their practice to spine surgery. Qualified participants will have the opportunity to meet experienced surgeons in either a one-on-one setting or in a small group setting. Participants attend live surgery and discuss surgical technique, indications and clinical results. Program content is customized according to the needs of the participating surgeon.
Dr. Patrick Cahill is an Orthopaedic surgeon from Philadelphia Shriners Hospital. He has recently participated in the DePuy Spine Education Through Visitation Program. I conducted an interview with Dr. Cahill to hear how this program benefited him in his professional career and the impact it had on his patient care.
SW: Please describe your experience with the Education Through Visitation program.
PC: I spent 2 days with Dr. Frank Schwab at the Hospital for Special Surgery. During my time there I was also able to meet with Dr. Schwab’s partners Drs. Baron Lonner and Thomas Errico, which was an added bonus.
Before the surgeries Dr. Schwab and I discussed the case and the possible treatment options. He showed me the software he uses for pre-operative planning. The software allows Dr. Schwab to create digital images of the spine to allow him to understand the impact of his surgical plan on spinal alignment before he operates on the patient. I spent one day in the OR with Dr. Schwab and observed 2 adult deformity cases. I watched his technique on treating patients with sagittal imbalance. I also spent some time in the OR with Dr. Lonner and observed a surgery involving a patient with adolescent idiopathic scoliosis.
Dr. Schwab and his partners joined me for dinner after the first day of surgery. This was a great opportunity to “pick their brain” on topics such as how to seek out career building research projects and how to build a successful practice.
During my fellowship I had the opportunity to spend 2 days with Drs. Harry Shufflebarger and Michael O’Brien. That experience was also very beneficial to me. read more
Section III: A Look Ahead – Upcoming Education / Events
| 2008 Calendar | ||||
| Date | Meeting | Location | Web |
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| 9/18 - 9/20 | AAOS Contemporary Techniques in Spine Surgery 2008 | Rosemont, IL |  |
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| 9/19 - 9/19 | Introduction to MIS/VBA | Orlando, FL | ||
| 9/20 - 9/25 | Congress of Neurological Surgeons (CNS) | Orlando, FL | |
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| 9/27 - 9/27 | Nursing - Spine Fundamentals: Surgical Solutions for Spine Pathologies | Pittsburgh, PA | |
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| 10/2 - 10/4 | Aging and Complex Spine Summit | San Diego, CA | ||
| 10/4 - 10/4 | Nursing - Advanced Spine Surgery | Richmond, VA | |
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| 10/14 - 10/18 | North American Spine Society (NASS) | Toronto, CN | |
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| 10/23 - 10/24 | Advanced MIS Techniques for Complex Spine / VBA Training | Baltimore, MD | ||
| 10/23 - 10/24 | Techniques for Spinal Deformity: A Neurosurgical Perspective | Las Vegas, NV | ||
| 11/6 - 11/7 | Spinal Deformity Tutorial | San Diego, CA | ||
| 11/6 - 11/8 | PAWS: Current and Emerging Issues in Complex Lumbar Spine Surgery | St. Louis, MO | |
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| 11/7 - 11/8 | 2nd Int'l Congress on Early Onset Scoliosis and Growing Spine | Montreal, Canada | |
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| 11/8 - 11/9 | Emerging Techniques and Technologies in Spine Surgery | Toronto, Canada | |
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| 11/13 - 11/14 | Adult Deformity Tutorial | Dallas, TX | ||
| 11/13 - 11/14 | Advanced Deformity Visitation | Miami, FL | ||
| 11/14 - 11/15 | Society for Minimally Invasive Spine Surgery (SMISS) | Las Vegas, NV | |
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| 11/21 - 11/22 | 15th Annual Brussels International Spine Symposium | Brussels, Belgium | |
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| 12/3 - 12/7 | International Pediatric Orthopaedic Symposium | Lake Buena Vista, FL | |
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| 12/3 - 12/6 | Cervical Spine Research Society (CSRS) | Austin, TX | |
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*For more information regarding DePuy Spine Medical Education events please contact the DePuy Spine Medical Education department at 1-800-741-8075.
Section IV: Other Educational Opportunities
DePuy Spine continues its commitment to alternative educational programs and is proud to communicate a new educational offering that has been funded via an educational grant.Roundtables in Spine Surgery: Prognostic Genetic Testing for Adolescent Idiopathic Scoliosis
Edited by: Peter O. Newton, MD, and Harry L. Shufflebarger, MD
A new issue of Roundtables in Spine Surgery has been published by Quality Medical Publishing. This issue begins with an article on "Demystifying the Genetic Test for Scoliosis" then moves to the Roundtable Discussion which features a distinguished panel of experts who specialize in pediatric spinal deformity. The Discussion is organized around three different patient scenarios: (1) a patient with no genetic testing, (2) a patient with a high-risk of curve progression test result, and (3) a patient with a low risk of curve progression genetic test result. The panelists energetically debate recommended treatment options, potential benefits of the test, and how the technology can be integrated with existing practices. The goal is to provide readers with a valuable base of information to evaluate how prognostic genetic testing can benefit their practices and ultimately their patients diagnosed with adolescent idiopathic scoliosis. Finally, 2 AMA PRA Category 1 credit(s) are available with this issue to physicians who review articles and complete the test.
Healthcare Professionals may receive a complimentary copy of this issue, or past issues, by clicking this link: http://www.qmp.com/ssrtables.php and entering Priority Code: dpssrt.
Section V: Must Read Clinical Articles – Suggestions from the Fellows Education Chairmen
To obtain a free copy of these articles simply click on the link below.Effects of Age and Comorbidities on Complication Rates and Adverse Outcomes After Lumbar Laminectomy in Elderly Patients. Li, et al SPINE 33(11): 1250-1255, 2008.
http://www.docurights.com/drmaker.cgi?vid=9179&objid=392232
Vertebral Artery Injuries Associated with Cervical Spine Injuries: A Review of the Literature Fassett, et al J Spinal Disord Tech 21(4): 252-258, June 2008
http://delivery.sheridan.com/downloads/mobile/LWW_140629_CP.exe
Prospective Cohort Analysis of Disability Reduction with Lumbar Spinal Fusion Surgery in Community Practice Robertson, et al J Spinal Disord Tech 21(4): 235-240, June 2008
http://delivery.sheridan.com/downloads/mobile/LWW_140630_CP.exe
SECTION VI: DePuy Spine in the Journals
As part of our commitment to further the clinical evidence in the spine community, we are proud to offer the following clinical research articles that further support the use of our products. To obtain a free copy of these articles simply click on the link below.Effects of Age on Clinical and Radiographic Outcomes and Adverse Events Following 1-level Lumbar Arthroplasty after a Minimum 2-year Follow-up. Guyer, et al J Neurosurg Spine 8:101-107, 2008
http://delivery.sheridan.com/downloads/mobile/AANS_140353_CP.exe
Effect of Previous Surgery on Clinical Outcome Following 1-level Lumbar Arthroplasty Geisler, et al J Neurosurg Spine 8:108-114, 2008
http://delivery.sheridan.com/downloads/mobile/AANS_140355_CP.exe
Section VII: DePuy Spine News - PIONEERING WHAT MATTERS
Section VII.I: 2nd Annual DePuy Spine Clinical Research Paper Challenge Winners
The 2nd Annual DePuy Spine Clinical Research Paper Challenge recently came to a close. The participation in this year’s event was excellent. We received a high number of entries and choosing the winner was a really tough job!Enrollment for the 2008-2009 program will begin soon. Information regarding the contest will be sent out within the next few weeks. The following are the winners of this year’s top prizes
1st Place: Daniel Hoh, MD
University of Southern California, Los Angeles, CA
Multi-center study of the safety and durability of 2204 cannulated pedicle screws placed for percutaneous spinal stabilization.
2nd Place: Sanjay Dhall, MD
Emory University, Atlanta, GA
Clinical and Radiographic Comparison of Mini-Open TLIF to Open TLIF in 42 Patients with Long-Term Follow Up
3rd Place: Jeffrey Rihn, MD
Thomas Jefferson University, Philadelphia, PA
Autograft versus rhBMP-2 in Single-level Transforaminal Lumbar Interbody Fusion: A Clinical and Radiographic Comparison.
The 3rd Annual DePuy Spine Clinical Research Paper Challenge is scheduled to launch on September 15, 2008.
Section VII.II: DEPUY SPINE RECOGNIZES WINNERS OF ANNUAL SPINE RESEARCH AWARD
ISSLS Prizes for Lumbar Spine Research Presented During SpineWeek 2008The International Society for the Study of the Lumbar Spine (ISSLS) awarded this year’s ISSLS Prize for Lumbar Spine Research to three groups of researchers for their studies on disability from back injuries, tissue engineering of annulus fibrosis, and the structural relationships within the lumbar intervertebral disc annulus, it was announced today by DePuy Spine, the sponsor of the award, which was presented during SpineWeek 2008. read more
Section VII.III CONFIDENCETM Cement System
In May 2008 DePuy Spine launched the CONFIDENCE Cement System. The CONFIDENCE System consists of a proprietary hydraulic-based delivery system that provides precise placement of a specially formulated high viscosity polymethylmethacrylate (PMMA) bone cement directly into vertebral bodies to stabilize fractures and to potentially reduce pain. read moreSection VII.IV EXPEDIUMTM PEEK ROD
In May 2008 DePuy Spine launched the EXPEDIUM PEEK Rod System, a load-sharing posterior instrumentation system designed to increase anterior column loading and support the interbody fusion process in the thoracolumbar spine. read moreSection VII.V VIPERTM 2 MIS System
In April 2008 DePuy Spine launched the VIPERTM2 Pedicle Screw Fixation System (VIPER2), a new minimally invasive spine system offering comprehensive instrumentation and implant options that can be used on a wide range of spinal pathologies including deformity, trauma, tumor and degenerative disc disease."The VIPER2 System will help surgeons bring the benefits of a minimally invasive approach to a much broader range of complex spinal pathologies," said Robert F. Heary, MD at the University of Medicine and Dentistry of New Jersey. "This is clearly a revolutionary next generation product." read more
Section VIII: Practice Nuances
NPI Update 2008Mary LeGrand, RN, MA, CCS-P, CPC
Kimberley Pollock, RN, MBA, CPC
KarenZupko & Associates, Inc.
As a result of HIPAA (Health Insurance Portability and Accountability Act) legislation, providers are required to apply for a NPI – National Provider Identifier - which will be utilized by all payors to identify providers on insurance claims. The NPI replaces all previously issued provider identifier numbers from Medicare and other plans. The deadline for receiving and initiating use of the NPI or the NPI/legacy number was March 1, 2008. According to Medicare, if a claim is submitted without an NPI on or after the March 1 date, the claim will be rejected. NPIs, once issued, remain with the physician even if he or she moves or joins or leaves a group.
If practicing physicians and fellows want to be paid for the work they perform after the NPI implementation deadline, the NPI must be listed on the insurance claim form. In addition, physicians who perform and bill for consultations will have to include the NPI of the physician requesting the consultation (primary care physician, etc) on the claim from. Having and sharing NPI with other providers is therefore critical to maintaining steady cash flow. Visit the following website https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do to search for the NPI of individual providers or organizations. read more
DePuy Spine does not endorse or recommend practice management firms. Physicians should research practice management consulting options before choosing one to work with.
Section IX: Practice Opportunities:
Shasta Orthopaedics & Sports Medicine, a highly respected and innovative
orthopaedic sub-specialty group practice, located in beautiful Northern California
has an immediate opportunity for an additional fellowship trained spine surgeon
(Orthopedic or Neurosurgical) and one additional Physiatrist. The candidate
must be board eligible; board certification is preferred. Shasta Orthopaedics
& Sports Medicine has developed a patient focused spine center, called ShastaOrtho
Spine Institute that has been on operation since late 2004. The Spine Institute
is a state of the art program providing current techniques for both non-operative
and operative treatment for neck and back patients of the North State and beyond.
The Spine Institute provides those with back and neck problems as well as the
medical community a resource for the treatment usually found only in large metropolitan
areas or University settings. read more The appearance of job opportunities in this newsletter in no way serves as an endorsement of the opportunity, the practice, or the surgeons thereof, by DePuy Spine. These opportunities are included as a courtesy to the practice and a service to the target audience of this newsletter. DePuy Spine reserves the right to reject any or all future submissions for any reason.
SECTION X: Spine Case Challenge #5
Submitted
by Nathan Lebwohl, MDThe patient is an 89-year-old male with a longstanding history of mild, chronic, low back pain. There is no history of radiculopathy, weakness, bowel or bladder dysfunction. His only other medical problem is coronary artery disease.
1. The most likely diagnosis is:
a) lymphoma of L4
b) metastatic prostate adenocarcinoma
c) Paget's disease L4
d) hemangioma L4
2.Classic radiographic findings of Paget's disease affecting the spine include:
a) vertebral enlargement
b) picture window appearance of vertebral body
c) ivory vertebra
d) all of the above
3. Differential diagnosis of ivory vertebra includes:
a) hemangioma
b) osteosarcoma
c) metastatic Carcinoma of the prostate
d) lymphoma
e) all of the above
4. Neurologic deficit in Paget's disease may be due to:
a) arterial steal syndrome
b) spinal stenosis
c) platybasia
d) all of the above
References: Hadjipavlou A.G. et all Paget's disease of the spine and its management, Eur Spine J. 10:370-84 (2001)
Download File - http://delivery.sheridan.com/downloads/mobile/LWW_140628_CP.exe
Answers to the Spine Case Challenge #4
The patient is a 59-year-old Haitian male with a 2-month history of progressively increasing neck pain. He has normal strength and reflexes. There is no history of trauma, systemic illness, fever, weight loss, or night sweats.
1) The most likely diagnosis is:
a) vertebral osteomyelitis and discitis (correct answer)
b) insufficiency fracture
c) multiple myeloma
d) metastatic adenocarcinoma
2) In vertebral osteomyelitis, the most common infecting organism is:
a) Pseudomonas aeruginosa
b) Propionibacterium acnes
c) Staphylococcus aureus (correct answer)
d) Mycobacterium tuberculosis
**3) A normal ESR rules out the diagnosis of vertebral osteomyelitis in:
a) all cases
b) all but 1% of cases
c) all but 20% of cases (correct answer)
d) only half of all cases
4) Predictors for paralysis in patients with spinal infections include:
a) rheumatoid arthritis
b) diabetes mellitus
c) advanced age
d) cervical spine infection
e) all of the above (correct answer)
There was a surprising variation of opinion about the correct answer to question #3. For more information on the topic of vertebral osteomyelitis click on the link to the following article.
Pyogenic and fungal vertebral osteomyelitis with paralysis. Eismont FJ, Bohlman HH, Soni PL, Goldberg VM, Freehafer AA. J Bone Joint Surg Am. 1983 Jan;65(1):19-29.
http://delivery.sheridan.com/downloads/mobile/RW_140683_CP.exe
Hematogenous Pyogenic Spinal Infections and Their Surgical Management Hadjipavlou, et al.
SPINE 2000 25(13): 1668-1679.
http://delivery.sheridan.com/downloads/mobile/LWW_140628_CP.exe
Winners of Spine Case Challenge #4
Congratulations to:- • Jahangir Asghar, MD, Philadelphia, PA
-
• Rakan Shahaltough, MD, Amman Jordan
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