SPINE SERVICE
Frank P. Cammisa, Jr., MD, Chief James C. Farmer, MD Federico P. Girardi, MD Charles B. Goodwin, MD Russel C. Huang, MD Joseph M. Lane, MD Patrick F. O’Leary, MD Andrew A. Sama, MD Harvinder S. Sandhu, MD
2008-2009 > Developing non-fusion technology, including total disc replacement > Forming the Integrated Spine Research Program dedicated to the advancement of spine research at Hospital for Special Surgery > Developing methods to enlist a patient’s own tissues to produce growth factors to improve fusion > Participating in the NIH-funded Spine Patient Outcome Research Tool (SPORT) study, a multicenter randomized clinical trial of surgical and non-surgical approaches to the treatment of spine disease > Pursuing basic science research in orthobiologics to improve bone healing in fusion procedures
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The Spine Service provides expertise in the full range of cervical, thoracic, and lumbar spine disorders, including degenerative conditions, spinal deformities, infections, tumors, and metabolic diseases.
Association based on two-year outcome studies of patients who had surgery, compared to those treated only with nonsurgical methods, showed significantly better improvement in their pain, function, and satisfaction.
A major initiative in 2008 was the further development of the Spine Care Institute, a multidisciplinary center of clinical excellence, research, and education in operative and non-operative spine care.
Other prospective randomized clinical trials have included non-fusion technologies, specifically in lumbar and cervical total disc replacement. This has resulted in the development of specific registries of patients who have undergone these procedures. In addition, the Spine Service is designing a clinical outcomes instrument to better assess patient disability secondary to spinal disease.
Progress continued on the formation of the Integrated Spine Research Program in which both the Spine Service and Scoliosis Service will collaborate on clinical trials and together build a clinician-scientist program dedicated to advancing spine research. The program seeks to improve understanding of the basic biological processes associated with spinal disorders and their associated pain syndromes, and to explore new methods and technologies for treatment. These include the use of an artificial disc and nucleus, and regenerative medicine techniques to reverse the process of disc degeneration. The Spine Service participates in a number of prospective randomized clinical trials, the most significant of which has been the NIH-funded Spine Patient Outcome Research Tool (SPORT) study, a multicenter randomized clinical trial of surgical and non-surgical approaches to the treatment of disc herniation, stenosis, and degenerative spondylolisthesis. Reports published in The New England Journal of Medicine and the Journal of the American Medical
Our physicians are also pursuing methods to enlist a patient’s own tissues to produce growth factors—either through platelet-enriched plasma or concentrated stem cells taken from bone marrow—to improve fusion. In collaboration with the Hospital’s Department of Biomechanics, the Spine Service has continued with research in orthobiologics specifically related to bone healing in animal fusion models. Our clinician-scientists have studied bone morphogenetic proteins, demineralized bone matrices, and betatricalcium phosphates. The Spine Service has also been involved with the Department of Biomechanics in a program for retrieval analysis of total disc replacement arthroplasties that have been explanted. Research in gene expression is also underway to understand the degenerative cascade that could lead to new methods of intervention.