Horizon Winter 2012 - HSS

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WINTER 2012HorizonSpine CareInstituteat Hospitalfor SpecialSurgeryS69069 A new01 30.indd cov11/31/12 8:29 AM

The spine. This graceful, yet sturdy, structure is theOn the Cover:central axis of our bodies – allowing us to stand tall andDuring the fall of his sophomore year at Universityof Tampa, Darius Farahaniawoke in the middle ofthe night to excruciatingpain. The pain turned outto be the result of a herniated disc in his lower back,which led to sciatica andnumbness in his right leg.A family friend directedthe Farahani family to HSSand Dr. Andrew Sama.Darius had the surgery onDecember 28, 2010 andwas back in his dorm byJanuary 19th. “HSS is justthe best. We felt very, verycomfortable there,” Mrs.Farahani said. “Since thesurgery, we have writtenDr. Sama’s phone numbernumerous times recommending him to family,friends, and friendsof friends!”bend freely. When all of its vertebrae and accompanyingnetwork of muscles, bones, cartilage, and nerves areintact and working together, the spine is a remarkableexample of mechanics in motion. However, if any one ofthese components is damaged or diseased, the spinecan be the source of intense pain and chronic disability.This issue of Horizon focuses on the incredible spine –Play Ball Againits subtleties, strengths, and vulnerabilities – and theunique role it plays in the movement and function ofour daily lives. From the Hospital’s pioneering advancesin spine fusion in the 1930s to the development ofnon-surgical interventions and approaches to relieveback pain today, the Spine Care Institute at Hospital forSpecial Surgery continues to set the pace for progressContentsDiagnosing a SpineDisorder4in the diagnosis and treatment of spine disease.Treating SpineDisorders WithoutSurgery8S69069 A new01 30.indd cov2The Spine CareInstitute Team12A Guide to SpineSurgery141/31/12 8:29 AM

Multiple Perspectiveson Spine CareChances are if you mention back pain,a conversation is sure to follow. Spineproblems are so prevalent in today’ssociety – affecting 8 out of 10 peopleat some point during their lives – that virtuallyeveryone knows someone who suffers from atemporary twinge to a chronic condition, withnumerous manifestations in between. One ofthe most challenging decisions for an individual with back pain or a spinal disorder is determining where to start the process of care.The Spine Care Institute at Hospital forSpecial Surgery is helping to make thesedecisions easier. How? By bringing togetherwithin a single program nearly 50 physicians,spine surgeons, and health professionalswith expertise in diagnosing and treating alllevels of spine disease.Dr. Frank Cammisa, Chief of the Spine Service, and his medicaland surgical colleagues have established a comprehensiveprogram for patients with spinal disorders.The inherent intricacy of the spine –with its multiple levels of bones, joints, discs,Cervicalcartilage, and nerves running from the base ofthe skull to the tip of the tailbone – requires anumber of disciplines to interact simultaneouslyto address associated symptoms and disorders.“From the most current diagnostic procedures and non-operative managementdiscapproaches to state-of-the-art surgicalinterventions, the Spine Care Institutecalls on its multidisciplinary team ofvertebraespecialists to ensure that patientsreceive the right care at the righttime,” says Frank P. Cammisa, Jr., MD,ThoracicChief of the Spine Service at HSS.“We need to be able to obtaincomprehensive evaluations by anesthesiologists, pulmonologists, andother medical specialists in a coordinated fashion as is provided by HSS inorder to best prepare patients forsurgery,” says Oheneba Boachie-Adjei,MD, Chief of the Hospital’s ScoliosisService, who sees children, adolescents,and adults with some of the most chalLumbarlenging spine deformities.Roger F. Widmann, MD, Chief of theHospital’s Pediatric Orthopedic Service,and his team treat children with threemajor types of scoliosis in the pediatricpopulation. Congenital scoliosis is a spinaldeformity present at birth. Idiopathicscoliosis is a deformity that developsSacralduring childhood and adolescence.When scoliosis is associated with otherThe Spinal ColumnThe spinal column is a pillarconditions, such as cerebral palsy, it isof support consisting of 33referred to as neuromuscular scoliosis.vertebrae, including 7 inthe neck, 12 in the middle“We approach each of these situationsregion, 5 in the lower back,Coccyxdifferently depending upon the child’s5 fused at the base of thespine, and 4 fused to formage and stage of development,” saysthe tailbone. Between theseDr. Widmann. “In some situations nonvertebrae are discs that servesurgical management is appropriate.”as shock absorbers.1S69069 A new01 30.indd Sec1:11/31/12 8:29 AM

Spine surgeon Dr. Patrick O’Leary prepares for his nextoperation. He and other surgeons at HSS provide a widerange of expertise from treating herniated disks to correctingcomplex deformities.“As a premier institution for musculoskeletal disorders, Hospital for Special Surgeryprovides patients with access to physicians andhealth professionals who have unparalleledexpertise in bone, soft tissue, and joint conditions,” says Thomas P. Sculco, MD, Surgeonin-Chief. “Our orthopedic surgeons performover 25,000 surgical procedures a year – withapproximately 10 percent of them for spinedisorders.”Among these surgeons is Patrick F.O’Leary, MD. In the more than three decadesthat Dr. O’Leary has been performing spinesurgery, he has diagnosed and treated mosttypes of spine disorders and injuries. Theexperience of Dr. O’Leary, along with theoutstanding expertise of each of the Hospital’sorthopedic surgeons who specialize in spinesurgery in children, adolescents, and adults,continues to set HSS apart in the world ofspine care.Coming Together for Spine CareSpine disease impacts a patient’s quality of lifein varying degrees. HSS patients are professional athletes who injured their spine whilepursuing their sport; those who suffer fromdegenerative disc disease or a herniated disc;others who have a major spinal deformity; andthose who have an undiagnosed condition butare troubled by persistent pain and neurological symptoms. The Spine Care Instituteharnesses the Hospital’s collective knowledgeand experience in spine care to provide eachindividual coming to HSS with a completespine evaluation and the most appropriate planfor his or her particular situation. According tothe Hospital’s spine surgeons, the vast majorityof people who have back pain do not have asurgical problem and never will. For thesepatients, the Spine Care Institute provides anon-surgical strategy that may include anynumber of conservative approaches, such aspain management techniques and physicaltherapy. For the patient who requires surgery,the Institute’s spine surgeons have expertise inthe full range of procedures.An internist-rheumatologist at HSS for 25years, C. Ronald MacKenzie, MD, will help manage the non-surgical approaches for the evaluation and treatment of patientssuffering with spinal conditions. Also, in collaborationwith other non-surgical specialists, and the spine surgeons aswell, Dr. MacKenzie is currently developing and will overseethe medical and perioperativeaspects of care at the Institute,which extends from thepreoperative evaluation topost-surgical recovery. “TheSpine Care Institute is establishing clinical protocols thatencompass the entire spectrumof need for our patients, from initial diagnosisand treatment, right through the perioperativecare of the patient who ultimately requiressurgery,” says Dr. MacKenzie.“Through the Spine Care Institute, patientshave access to a seamless continuum of careamong the many disciplines and resourcesavailable to treat spinal disorders,” says Dr.Sculco. “Patients appreciate and expect thisfrom Hospital for Special Surgery.” Optimizing Patient CareDr. C. Ronald MacKenzieemphasizes the importanceof the involvement of medical doctors in the care of thespine patient and the rolethey play in the continuityof care for patients duringall phases of evaluation,treatment, and recovery.2 Multiple Perspectives on Spine CareS69069 A new01 30.indd Sec1:21/31/12 8:29 AM

Myth vs FactMyth: If you see a surgeon, surgery will always beMyth: Back pain will only get worse with age.recommended.Fact: Many times, HSS spine surgeons will see patientsFact: At the Spine Care Institute of Hospital for Specialin their 40s or 50s with moderate spine pain who want toSurgery, a multidisciplinary team of spine specialistshave surgery because they fear the pain will worsen ascollaborate on the decision of whether surgery or athey age. However, certain pathologies are self-limitingnon-operative plan of treatment is the best course toand resolve by themselves. That is important to knowtake for an individual patient. With the right diagnosisbecause it allows patients to make educated decisions onand a clear understanding of spine anatomy, the physi-whether to delay surgery and see if they improve withcian can make an informed and appropriate plan ofconservative treatments, such as physical therapy and/ortreatment.image-guided injections.Myth: Spine surgery should be avoided at all costs.Fact: If there are non-operative modalities that will offerthe same outcomes, those certainly should be recommended first. However, there are certain types of spinepain that are associated with either nerve compressionor instability where studies have shown that surgicalintervention is statistically the best option for thepatient. Other types of back pain tend to have moreMyth: Spine surgeons do not collaborate with complementary care and alternative medicine practitioners.Fact: At the Spine Care Institute, we believe that thesemodalities, when practiced as part of a multidisciplinaryteam, play a role in the care of the spine patient. TheHospital’s Integrative Care Center contributes to thecomprehensive care for spine patients. (Read more onpage 8.)success with non-operative, conservative care. Our roleat the Spine Care Institute is to make sure that thepatient is matched with the appropriate treatment,whether surgical or not.Myth: Spine surgery carries a high risk of paralysis.Fact: Like any surgical procedure, spine surgery doeshave certain risks, but the actual risk of neurologiccomplication is very low. To reduce anesthetic risks,Myth: Minimally invasive surgery is the preferredapproach for spine surgery.Fact: While there is an appropriate place for minimallyinvasive procedures in spine surgery, it is only one ofmany approaches used to address spine pathologies.new techniques have been developed by our spinalanesthesia specialists. At Hospital for Special Surgery,our neurologists are pioneers in spinal cord and nervemonitoring during surgery. All of these techniques havebeen developed to minimize risk.In the Spine Care Institute, we prefer to use the term“less invasive.” The common perception of “minimallyinvasive” is that if surgery can be done through a smallerincision, it is the better way to go. Most important,however, is using the least invasive surgical approachthat will allow the spine problem to be corrected withoutcausing damage to adjacent healthy structures. Inselecting a procedure for a patient’s spine disorder, HSSspine surgeons consider a number of factors, includingMyth: Immediate postoperative recovery from spinesurgery is very uncomfortable.Fact: At Hospital for Special Surgery, we have greatlyminimized postoperative pain and nausea – two commonaftereffects of spine surgery. The Hospital’s pain management specialists have refined the delivery of medications to manage pain after surgery, making it much moreeffective, with fewer side effects.diagnosis, location of the pathology, and complexity ofthe deformity.3S69069 A new01 30.indd Sec1:31/31/12 8:29 AM

Diagnosing a Spine DisorderDr. Richard J. Herzog, Director of Spinal Imaging, calls on MRI,CT scans, and X-rays, as needed, to help guide the appropriate treatment for patients.“But superior imaging is only one part of theequation,” says Dr. Herzog. “Ongoing collaboration with spine specialists at the Spine CareInstitute provides the optimal working conditionto reach the correct diagnosis and treatmentplan for our patients with spinal disorders.”Understanding Imaging ExamsPatients with back or leg pain and other spinedisorders may benefit from a number of radiology tests; the selection of a test is based onthe patient’s symptoms and physical exam.Traditional X-rays may be the initial exam toassess spinal alignment and to detect evidenceof degeneration or trauma. X-raysare usually obtained with thepatient standing in order to determine how weight-bearing affectsspinal alignment. “In some patientsevidence of spinal instability mayonly be detected with the patientupright,” adds Dr. Herzog.injured areaIf additional information isrequired to evaluate a patient withspinal symptoms, magnetic resonance imaging (MRI) is usuallythe next diagnostic test to elucidate the cause of a patient’s painor disability. Computed tomography (CT), myelography, andA Look Insidediscography are additional exams that may beMaria Latapolski’s MRIemployed to evaluate the disc, vertebrae, andimage demonstrates postoperative changes from anerve roots.laminectomy, along withWhen performing an MRI exam, it is opa fusion, as well as a compression deformity of twotimal to utilize a high-field strength magnet,vertebral bodies in thei.e., 1.5 or 3.0 Tesla, to maximize the informalumbar spine suffered ina motor vehicle accident.tion provided by the exam. High-resolutionSee Ms. Latapolski’s storyMRI images facilitate the evaluation of allat right.the components of the spine that may be thesource of pain, including the disc, vertebrae,and the adjacent soft tissues and muscles. Inorder to maximize the value of MRI to evaluatepatients with musculoskeletal disorders, theHospital’s MRI specialists have pioneered thedevelopment of specific protocols and technology for imaging a wide range of orthopedicconditions – a capability not generally availableelsewhere. Critical to the treatment of a spinedisorder are the tests and proceduresthat enable the cause and consequences of the problem to be pinpointed. At HSS, the Department of Radiologyand Imaging and the Department of Neurologyprovide highly focused diagnostic expertisefor the evaluation of spine disorders, withradiologists and neurologists using theirparticular skills in a complementary mannerto arrive at a precise diagnosis.“As radiologists, our job is to detect anypathologic condition that may affect the spineand to provide this information in a clear andconcise report to clinicians who are treatingpatients with spinal disorders,” says RichardJ. Herzog, MD, Director of Spinal Imaging.“Continuing advancements in MRI and CTtechnology have enhanced our capacity toimprove our diagnostic capabilities.”4 Diagnosing a Spine DisorderS69069 A new01 30.indd Sec1:41/31/12 8:29 AM

MagneticResonanceImagingA New OutlookMaria Latopolski is nostranger to MRIs. Thediagnostic imagingprocedure, which shehad in the Hospital’sMusculoskeletal MRICenter, was critical toguiding her care. Mrs.Latopolski had sufferedinjuries to her spine intwo separate automobileaccidents – five yearsapart. Both times, sherequired surgery, whichwas performed by Dr.Frank Cammisa. Dr. SethWaldman, in conjunctionwith spine surgeon Dr.Alexander Hughes, thenimplanted a permanentspinal cord stimulator,which delivers an electrical current to provideher with ongoing painrelief. Says her husband,Hospital for SpecialSurgery has “put thesmile back in her eyes.”5S69069 A new01 30.indd Sec1:51/31/12 8:29 AM

Dr. Herzog and his team are exploring newtechniques to evaluate the spine postoperatively when instrumentation has been used tocorrect the spine disorder. This includes theuse of MRI protocols previously developed atHSS to image joint replacements and otherhardware and new CT protocols for optimalimaging when there is metal instrumentationin the spine.Employing Neurological EvaluationsDr. Dale Lange leads a team of highly trained neurologistswho conduct nerve and muscle evaluations of patients withspine disease.“With CT it is possible to create 3-dimensional images of the spine, which provideinformation not available with routine X-rays,”explains Dr. Herzog. “CT is an excellent toolfor evaluating complex boney anatomy andtraumatic changes that may occur after injury.”To enhance the diagnostic value of MRIand CT imaging, the Hospital’s radiologists cancombine CT and MRI studies when studyingspine pathology. “Combining CT and MRI information provides an additional means to assesscomplex spinal conditions,” says Dr. Herzog.The radiologist’s interpretation is key tohelping surgeons determine the appropriatetreatment for the patient. “In other words,” explains spine surgeon Alexander P. Hughes, MD,“you can have a patient with abnormal findingsfrom an MRI point of view, but that doesn’tmean that the problems seen on the MR imageare the reason for their pain. The findings needto be interpreted within the context of the patient’s history and symptoms while differentiating between natural, age-related changes andthose associated with a particular condition.”At Hospital for Special Surgery, diagnosticevaluations are performed by neurologists andneuromuscular specialists to look at mobilityissues and other symptoms that may relate tospine disease. “Neurological studies are usedto identify deficits, such as muscle weaknessand nerve involvement, associated with thepatient’s spine disorder,” says Dale J. Lange,MD, Neurologist-in-Chief at HSS. “Thesestudies also help to determine if, in additionto spine disease, there are other problemscausing the patient’s physical disability, ifnerves and muscles are functioning properly,and if the findings correlate with the presenting clinical problem.”One of the diagnostic studies commonlyperformed by a neurologist is a somatosensoryevoked potential study, which, combined withEMG and nerve conduction studies, providesa multi-dimensional analysis to assess theseverity of the spinal cord disease, identifynerve deficits related to the spine disorder, andeliminate or confirm causes of these defects.“With this test, we deliver electricalimpulses to an arm or leg and follow the electrical response through the spinal cord andup into the head as it moves from the skin tobrain, where sensation is appreciated,” saysDr. Lange. “By measuring the time it takes fornerves to respond to the stimulation, we candetermine if and where the impulse may beslowed or blocked, depending on the severity of a spine problem. These studies provideanother approach for assessing severity of thespine disease.” X-rayCT scanMyelogramDiscogramMultiple PerspectivesHospital for SpecialSurgery’s radiologistsincorporate a number ofsophisticated imagingexams, as needed, topinpoint the causeand consequences ofspinal disease. Theseinclude X-rays, computedtomography (CT),myelography, anddiscography shownabove, as well as MRIshown on page 7.6 Diagnosing a Spine DisorderS69069 A new01 30.indd Sec1:61/31/12 8:29 AM

Chase andStephanieColemanMRI CenterRoom with a ViewPatients with spinaldisorders benefit fromthe imaging expertisefound in the Chase andStephanie Coleman MRICenter at Hospital forSpecial Surgery – thelargest orthopedicdedicated MRI facility inthe world. The Center’sfocus on musculoskeletalconditions has allowedMRI protocols to bedeveloped specificallyto look at all of theelements of the spinalcolumn – the spinal cord,nerve roots, discs –enabling the radiologistto provide a detailedassessment of thepatient’s spine anatomyto the physician so anearly and accuratediagnosis can be madeand treatment recommended accordingly.7S69069 A new01 30.indd Sec1:71/31/12 8:29 AM

Treating Spine DisordersWithout SurgeryA“lthough this is Hospital for ‘SpecialSurgery,’ we are also dedicated toexploring all non-operative optionsavailable to spine patients,” saysphysiatrist Peter J. Moley, MD. “Treatmentplans are devised through a careful history,physical exam, and review of the pertinent radiographic studies. The patient is then treatedwith a combination of rehabilitation medicineand the appropriate use of interventionalspinal injection techniques.”The Role of Rehabilitation MedicineThe Hospital’s Department of Physiatry can bean invaluable first step for patients with a backproblem. Physiatrists are physicians whospecialize in the non-operative treatment ofspine and other musculoskeletal disorders.“When patients come in with back pain, it isour job to figure out why they are having thepain and the underlying reason for symptoms,”says physiatrist Jennifer L. Solomon, MD. “It isan important responsibility. Based on what wefind, we then want to be as aggressive nonoperatively as we can to get the patient better.”“Effectively managing a patient with a spinal disorder relies on a comprehensive evaluation,” says Joseph H. Feinberg, MD, Director ofthe Department of Physiatry. “We see patientswho have both acute and chronic back orspine-related issues. The spine is a complicated structure, and there are a number ofpotential generators that might be the sourceof pain and pathology. The physiatrist’s evaluation process begins with compiling a completehistory detailing the patient’s medical issues,as well as work, recreational, and sports activities, since this information can help localizethe problem. Electrodiagnostic testing may berecommended in our diagnostic process forcertain neurological symptoms or abnormalfindings. We can then determine if there is anerve injury or disorder.”“Our team of physiatrists and physicaltherapists have a wealth of experience treatingpatients with non-operative spine disorders,”says Christopher Lutz, MD. “This experienceenables us to pinpoint which strategies willwork best for a patient’s particular situation andadjust them accordingly as the patient progresses. To accomplish this, we work together withthe patient and the Hospital’s skilled physicaltherapists to develop an individually tailoredexercise program to help restore range ofmotion, strength, and endurance. Patients arealso advised on how their daily activities canimpact their spine, so their plan of care willinclude instruction on proper lifting, movement,and posture, which can help prevent futurerecurrences.”Physiatrist Gregory E. Lutz, MD, is at theforefront of research in regenerative medicine,which holds great promise in helping to healstructures, such as discs, that are difficult torestore. “We are currently conducting studiesin which we take cells from the patient’s bloodand inject them into the disc to see if we canstimulate a repair response,” says Dr. Lutz.“We are also involved in a study where we areinjecting growth factor into the disc to try toturn on the disc’s inherent ability to heal itself.These are some of the first studies that havebeen done in the world in this area.”Promoting Spine Health ThroughIntegrative CareA Healing TouchThe Integrative Care Centerprovides an array ofcomplementary therapies forthe spine patient that mayinclude classes in Pilates,which focus on developingcore strength, increasingflexibility, and improvingposture; acupuncture,performed here by Dr. JeffreyNgeow; massage; as wellas physical therapy andchiropractic services.Within an environment that promotes wellnessand healing, the Hospital’s Integrative CareCenter (ICC) provides non-operative treatments for patients with spine issues.8 Treating Spine Disorders Without SurgeryS69069 A new01 30.indd Sec1:81/31/12 8:29 AM

Exercise and PainManagementThe Art of LivingFor almost 15 years,Jeanette Sisk hadproblems with her back.When her back painwould flare, she wouldhave intermittenttreatment for relief,but did not want to haveany major intervention.In 2003, Ms. Siskherniated a disc anddecided to try anepidural steroid injectionunder the care of Dr.Vincenzo Castellano ofthe Hospital’s IntegrativeCare Center. “I hadimmediate relief,” saysMs. Sisk, an art historian.“It was like night andday. I was kicking myselffor waiting so long.”Today, with a combination of injections andexercises taught by herphysical therapist, Ms.Sisk is looking forward toa pain-free future.9S69069 A new01 30.indd Sec1:91/31/12 8:29 AM

Aija Paegle, PT, MPT, CFMT, CPI, uses a combination of manualtechnique and therapeutic exercise to help relieve pain andrestore function in patients with spine disease.The ICC offers treatment options that includecare by physiatrists and physical therapists, aswell as medical acupuncture, chiropractic care,and massage therapy. “If we can diagnoseindividuals with spine problems early enough,then surgery can, at times, be prevented byimplementing therapies that help them to leadmore comfortable and healthier lives,” saysVincenzo Castellano, MD, Medical Director ofthe ICC.The Many Ways of Managing PainPain management, once a subspecialty of anesthesia, is now becoming a specialty of its own.“Pain management is truly an art that we arealways trying to refine,” points out anesthesiologist Daniel I. Richman, MD, a specialist inpain management and acupuncture. “There isconstant growth with new technology and newpharmacology. As a keener understanding isgained of the details of how the central nervous system works, horizons are opening formanipulating pain mechanisms for the benefitof patients.”At Hospital for Special Surgery, physicians in the Departments of Anesthesiology,Physiatry, and Radiology and Imaging arehighly skilled in pain management techniques,treating more than 28,000 patients in 2010.Procedures included epidural steroid injections to reduce inflammation around thenerves in the spinal cord and image-guidedinjections of a short-acting anesthetic andanti-inflammatory steroid to provide immediate relief, especially in patients with an acuteexacerbation of symptoms.“A large percent of pain management involves outpatient injection therapy,” says SethA. Waldman, MD, Director of the Hospital’sDivision of Musculoskeletal and InterventionalPain Management since 1996. Board-certifiedin both anesthesiology and pain medicine,Dr. Waldman specializes in therapeuticand diagnostic spinal injections, andthe management of neurologic pain.According to Dr. Waldman, the mostcommon issues treated with injectionsinclude low back pain caused by acutesciatica from disc herniation and acutecervical pain. Injections can also be diagnostic, helping to pinpoint the source of the paingenerator in order to determine the appropriate intervention.“More aggressive pain managementprocedures, such as epidural infusions andradiofrequency ablations, are performed inthe hopes of keeping patients from needingsurgery,” says Dr. Waldman. “At the other endof the spectrum are palliative approaches.These include implantable types of therapiessuch as a spinal cord stimulator, which is likea pacemaker for the spine, or an intrathecalpump that allows pain medicine to be delivered directly into the spinal fluid.”“You have to have a very keen understanding of the way the pain signaling system – fromthe spinal cord to the brain – is altered insomebody who is in chronic pain and somebody who is taking high doses of pain medication,” says Dr. Richman. “Our goal is for ourspine patients to have a less painful experience, whether they need surgery or not.” A Hands-on ApproachIn skilled hands, epidural injections bring relief to manypatients with back pain.10 Treating Spine Disorders Without SurgeryS69069 A new01 30.indd Sec1:101/31/12 8:30 AM

EpiduralInjectionsTargeting thePain SourceDr. Seth Waldman hasmore than 15 years ofexperience in the field ofinterventional and medical pain management,specializing in therapeutic and diagnosticspinal injections. Epiduralsteroid injection is one ofmany techniques used tocontrol pain in a patient’slower back. The physicianinjects a corticosteroidmedication around theaffected nerve to relievepressure and inflammation. At times, the procedure may be performedwith a fluoroscope, aspecial X-ray machinethat allows the physicianto visualize the patient’sanatomy for precise needle placement, deliveringmedication directly to aspecific nerve root.11S69069 A new01 30.indd Sec1:111/31/12 8:30 AM

The Spine Care Institute TeamThe Spine Care Institute at Hospital for Special Surgery has assembled a multidisciplinary team of experts in the care of back pain and spine disorders. Through theInstitute, patient services are comprehensive and coordinated, providing all relatedresources – from radiology and neurology for diagnosis, to physiatry, rehabilitation, andpain management therapies, to surgical interventions – under one umbrella of care. As aCenter of Excellence, the Spine Care Institute complements its clinical efforts with a major59741121412831161061013Harvinder S. Sandhu, MD 2 Stavros G. Memtsoudis, MD, PhD 3 Joseph M. Lane, MD 4 Charles B. Goodwin, MD 5 Alexander P. Hughes, MDJeMe Cioppa-Mosca, PT, MBA 7 Christopher Lutz, MD 8 Patrick F. O’Leary, MD 9 Matthew E. Cunningham, MD, PhDC. Ronald MacKenzie, MD 11 Russel C. Huang, MD 12 Richard J. Herzog, MD 13 Allan M. Lans, DO 14 James C. Farmer, MD12S69069 A new01 30.indd Sec1:121/31/12 8:30 AM

research agenda and a comprehensive education program for patients, fellows, and othermedical professionals, as well as the general public. Having clinicians from each specialtywithin the Spine Care Institute collaborate on the discussion of cases is key to renderingthe right diagnosis, and subsequently, the appropriate treatment. According to membersof the Spine Care Institute, the more experts you have, the more their informationwill be used in an optimal manner to help patients with spinal disease and e Abjornson, PhD 16 Joseph H. Feinberg, MD 17 Jennifer Johnson 18 Roger F. Widmann, MD 19 Oheneba Boachie-Adjei, MDBernard A. Rawlins, MD 21 Federico P. Girardi, MD 22 Seth A. Waldman, MD 23 Frank P. Cammisa, Jr., MD

Horizon WINTER 2012 Spine Care Institute at Hospital for Special Surgery WINTER 2012 S69069_A_new01_30.indd cov1 1/31/12 8:29 AM

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