The Spine Center

THE PRIMARY SOURCE FOR

COMPLEX

& ADVANCED

SPINE CARE

CONTENTS 2 OVERVIEW

4 SURGICAL SERVICES

6 TECHNOLOGY

8 SPINAL DECOMPRESSION SURGERY

10 TOTAL DISC REPLACEMENT

11 SPINE FUSION

13 MEDICAL TEAM

Spine Overview At the Spine Center at Valley View, we approach all patients with the

Our top priority is getting you back to your life.

philosophy that surgery should always be the last resort as a treatment option.

Our providers, Wade Ceola, MD, Michael Campian, DO and Natalie Arena, PA-C, work to create an individualized treatment plan for each patient, by obtaining a thorough history, conducting a physical examination, analyzing records from prior diagnostic tests, and listening to your needs and concerns.

The majority of spinal conditions can be treated without surgical intervention.

Comprehensive rehabilitation and exercise-based physical therapy play an important role in non-surgical management of most spinal problems.

Dr. Campian is board-certified in physical medicine, rehabilitation, non-operative sports medicine, and specializes in the care of musculoskeletal injuries.

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When all non-surgical treatment options have failed, and your quality of life is being adversely impacted, surgery may be recommended. Dr. Ceola is board-certified in neurological surgery with over 20 years of experience. Prior to surgery, Dr. Ceola creates a customized surgical treatment plan for each patient. All treatment plans are tailored to fit our patients’ values and lifestyles.

Our ultimate goal is to get you back to your full potential.

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Surgical Services Spinal Decompression Surgery

Complex Spine Reconstruction

• Cervical and lumbar discectomy

• Kyphosis

• Cervical and lumbar foraminotomy

• Scoliosis

• Cervical and lumbar laminectomy

• Tumor excision and reconstruction

• Synovial cyst excision

Trauma Total Disc Replacement (TDR) • Cervical and lumbar disc replacement

Spine Fusion

• Cervical, thoracic, lumbar and sacral fractures, acute and pathologic • Compression fracture • Burst fracture • Fracture dislocation

• Anterior and posterior cervical fusion • Occipito-cervical fusion • 360 anterior and posterior lumbar fusion • Anterior lumbar interbody fusion (ALIF) • Direct lateral interbody fusion (DLIF) • Oblique lateral interbody fusion (OLIF) • Posterior lumbar interbody fusion (PLIF) • Transforaminal interbody fusion (TLIF)

Tumor • Benign • Primary and secondary malignant • Intradural and extradural lesions

Peripheral Nerve Surgery

• Extreme lateral interbody fusion (XLIF)

• Carpal tunnel release (CTR)

• Minimally invasive surgery (MIS)

• Ulnar nerve release

• Sacroiliac joint fusion (SI), open and MIS

• Tumors

• Dynamic stabilization

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Physiatry Services • Fluoroscopic peripheral joint injections • Fluoroscopic lumbar spine procedures • EMG and nerve conduction testing • Management of acute and chronic musculoskeletal injuries • Non-operative management of acute and chronic tendon and ligament injuries • Non-operative management of osteoarthritis • Non-operative management of fractures • Diagnostic musculoskeletal ultrasound • Ultrasound guided injections and aspirations • Return to play after injury for athletes • On field management of sports injuries (high school, college, professional, Olympics and mass participation events) • Botox injections for spasticity

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We are here to listen, guide and provide personalized spine care.

Cutting Edge Technology Medtronic O-Arm ®–designed for surgery–designed for you O-Arm® technology scans a patient’s spine during surgery and uses the images generated to navigate safely through the spine during an operation.

The O-Arm® can be positioned without moving the patient, and the ring shaped gantry can be both opened and closed.

• The imaging ring may be tilted and angled to capture images not possible with older systems.

• Ultra-fast imaging reduces x-ray exposure of patients and staff.

• Detailed 3-D surgical site images are available for viewing in seconds, not minutes. This feature is ideal as surgeons confirm the precise placement of hardware. This may help eliminate the need for revision surgery.

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Cutting Edge Technology Medtronic stealth navigation The StealthStation™ S8 surgical navigation system has an intuitive interface, improved patient registration software, and advanced visualization to navigate neurosurgery procedures. The system offers optical and Electromagnetic (EM) tracking capabilities, and integrates with external devices like microscopes, ultrasound, and a broad array of Medtronic instruments.

The StealthStation™ S8 integrates both the O-ArmŽ and MRI data to aid in surgical navigation. In the spine, it allows for precise screw placement and is extremely useful in both minimally invasive cases where there is limited surgical exposure, and also in complex reconstruction where the anatomy may be remarkedly abnormal.

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You may be a candidate for spinal decompression if you have: • Significant pain, weakness, or numbness in your leg or foot • Leg pain that has not improved with physical therapy or medication • Difficulty walking or standing affecting your quality of life • Diagnostic tests (MRI, CT, myelogram) that show stenosis in the central canal or lateral recess

Spinal Decompression Surgery Decompression implies removal of bone or soft tissue to decompress the nerves or spinal cord. This may include lamina (bone forming the backside of the spinal canal), disc, overgrown joints, and joint cysts. The surgical approach is often dictated by a combination of location of the pathology as well as adjacent structures.

Common cervical and lumbar procedures: Discectomy involves an incision along the back of the spine in order to remove a herniated or damaged disc. It is often associated with removal of some of the bone to gain access to the disc or to extend the nerve decompression. When performed in the cervical spine, it is generally an anterior approach and is usually associated with fusion.

Laminectomy is the removal of the entire bony lamina, a portion of the enlarged facet joints, and the thickened ligaments overlying the spinal cord and nerves. Fusion may be required in some cases.

Laminotomy is the removal of a small portion of the lamina and ligaments, usually on one side. Using this method, the natural support of the lamina is left in place, decreasing the chance of postoperative spinal instability.

Foraminotomy is the removal of bone around the neural foramen, the space between vertebrae where the nerve root exits the spinal canal.

This method is used when disc degeneration has caused the height of the foramen to collapse, resulting in a pinched nerve. It can be performed with a laminectomy or laminotomy.

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Minimally Invasive Surgery (MIS) Minimally invasive surgical techniques were developed in an attempt to minimize damage to local structures during a surgical approach. MIS may decrease blood loss, minimize hospital stay, and potentially decrease postoperative pain. However, MIS is not for everyone and offers no benefit in long term outcomes.

Common MIS procedures: SI Fusion utilizes advanced computerized CT guidance to make a small incision over the SI joint on the back, where a threaded titanium hollow cage is then placed across the SI joint for stabilization and fusion.

MIS DLIF/OLIF is when a general or vascular surgeon exposes the spine from a lateral approach. The disc is removed to decompress the nerves and, if needed, the spine is re-aligned with a combination of interbody cages and titanium hardware.

MIS TLIF/PLIF is when two small incisions are made on the back of the spine. Muscle splitting techniques are then used to expose the spine on

We offer advanced spine surgery normally found in regional academic centers.

either side. An interbody cage is placed after decompression and titanium hardware is utilized for stabilization.

Spinal fusion may need to accompany decompression procedures.

Cases may include instability of the spine, spinal deformities (such as spondylolisthesis or scoliosis) and in most cases of spinal fractures.

In some cases, spinal fusion may be done at the same time to help stabilize sections of the spine treated with laminectomy. Fusion uses a combination of bone graft, screws, and rods to connect two separate vertebrae together into one new piece of bone. Fusing the joint prevents the spinal stenosis from recurring and can help eliminate pain from an unstable spine.

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“Dr. Ceola was the first doctor to come in the room with still

Total Disc Replacement (TDR)

images from my MRI, hand them to me and show me exactly what the problem was, and that

Artificial disc replacement surgery involves replacing a painful disc with an

gave me so much confidence,”

artificial one. Surgery may

Lisa says. “He knew where the

back (lumbar) or neck

be performed on the lower

problem was, and the steps we’d

(cervical). Artificial discs

need to take in order to repair it,

of mimicking the form and

and he went through my file and made sure we had exhausted every single option for treatment with surgery being the final option — that was so refreshing to hear a surgeon say.”

– Lisa Lemay, Patient

are designed with the goal function of the spine’s natural disc.

Dr. Ceola was an early pioneer of artificial disc technology, completing the original clinical trials for artificial cervical disc replacement in 2007. He performed the first cervical artificial disc replacement in 2002 using the Prestige ST implant. Lumbar TDR - total disc replacement - was FDA approved in 2004 and although not everyone will qualify for disc replacement, it can be a procedure used in cases of degenerative disc disease.

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Spine Fusion Spinal fusion is a surgery that permanently joins together one or more bony vertebrae of the spine. Fusing bones together can prevent painful motion and provide stability. An unstable spine can result from an injury, disease, or the natural aging process. Abnormal movement of the vertebrae rubbing against one another may result in back, leg, or arm pain. Fusing the vertebrae stabilizes and aligns the spine, maintains the normal disc space between the bones, and prevents further damage to the spinal nerves and cord.

Scoliosis and Complex Spine Reconstruction Colorado’s western slope patients now have state-of-the-art care and a neurosurgeon specializing in complex reconstruction surgery. Having extensive training in spinal deformities, Dr. Ceola brings advanced care to scoliosis patients.

Spinal deformity is an abnormal alignment or curve of the bony vertebral column. Adult scoliosis and kyphosis can be caused by age-related wear and tear on the back or complications from past surgeries. Moderate deformity occurs when the facet joints and discs deteriorate over time and are no longer able to support the spine’s normal posture. Pain results from stressed joints and pinched nerves, not the abnormal curve. Treatment can include medications, physical therapy, injections, or surgery.

Surgery is an option used primarily for severe scoliosis or for curves that have not responded to conservative treatment. Surgery has two main goals: to stop a curve from progressing, and to correct spinal deformity. Spinal fusion is the most common surgery to correct severe scoliosis. Within a few months after surgery, patients could find themselves enjoying normal activities.

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Why Valley View?

“My hat goes off to Dr. Ceola for the dedication of spending two days with me. Everybody at Valley View helped me through every little hurdle I’ve accomplished and encouraged me to move forward. Everyone in the hospital worked as a team.”

– George Sharer, Patient

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Our mission

Our values

To be the

Respect, accountability, trust and

leader for

teamwork guide our mission every day and help us create excellence in a

excellence in

healthy, healing environment. Each of

personalized

these values are a part of our patient-

care and healing.

centered approach to care.

At Valley View, each staff member, physician, and volunteer has taken the mission of patient-centered care to heart. Decisions are made with the primary consideration of doing what’s right for the patient and their families, creating a collaborative partnership between caregivers and patients.

Wade M. Ceola, MD, FACS, FAANS Neurosurgeon Dr. Wade Ceola obtained his Bachelor of Science degree from University of Arkansas in Fayetteville. He went on to further his education at the University of Arkansas for Medical Sciences (UAMS), where he graduated first in his class and received numerous academic awards. Dr. Ceola then completed an intern year in general surgery, followed by a neurosurgical residency at UAMS, at which time he studied under numerous pioneers in the field of neurological surgery. Post residency was followed by over fourteen years of private practice in Springfield, Missouri at the Springfield Neurological and Spine Institute, LLC (SNSI). During his tenure at

“I am so pleased with my experience and everyone who worked with me, especially Dr. Ceola. Thanks from the bottom of my heart.”

– patient

SNSI, Dr. Ceola was a principal investigator in the largest Investigational Device Exemption (IDE) study in the nation and brought the first artificial cervical disc (Prestige ST, Prestige LP artificial disc) to FDA approval. Dr. Cola has been involved in numerous scientific studies, which include spinal joint replacement, spinal cord injury, head injury, spinal fusion studies, and the MISTIE 3 trial for minimal access evacuation of intracranial hemorrhage. Dr. Ceola is a member of the North American Spine Society (NASS), the American Association of Neurological Surgeons (AANS), and the Congress of Neurologic Surgeons (CNS).

He moved to the Roaring Fork Valley with his family in December, 2014. Dr. Ceola enjoys alpine skiing, biking, hiking, weight training, reading and spending time with his family outside of his medical duties. Dr. Ceola is board certified by the American Board of Neurological Surgery and specializes in all aspects of spine care.

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Michael Campian, DO Physical Medicine and Rehabilitation and Non-operative Sports Medicine

Michael Campian, DO, is boardcertified in Physical Medicine & Rehabilitation and Sports Medicine. He specializes in the care of musculoskeletal injuries in athletes, and non-athletes. This includes musculoskeletal ultrasound, electrodiagnostics, and interventional spine. He has a special interest in the care of endurance sports-specific injuries, particularly with runners, climbers, mountaineers, and skiers. His conservative approach uses exercise as medicine and avoiding other, more invasive, procedures when possible.

Dr. Campian obtained his Doctor of Osteopathic Medicine from Michigan State University College of Osteopathic Medicine. Following medical school he completed a transitional internship at Naval Medical Center San Diego. After internship, he underwent further training in hyperbaric and diving medicine and was an Undersea Medical Officer in the US Navy where he worked for Naval Special Operations/SEALs. He subsequently completed his Physical Medicine & Rehabilitation residency and Sports Medicine fellowship at the University of Utah. Outside of work, he enjoys ultramarathon running, climbing, alpine skiing and ski mountaineering. He has a daughter with his wife, Andrea, who is a physical therapist.

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Natalie Arena, PA-C Physician Assistant Natalie has been affiliated with Valley View as a physician assistant since 2009. Her career has included specialties such as general surgery/trauma and orthopaedics.

Originally from Massachusetts, she obtained her Master’s of Science in Physician Assistant Studies from Massachusetts College of Pharmacy and Allied Health Sciences in 2005.

She has a passion for treating patients from the first encounter through recovery. In her spare time Natalie enjoys dirt-biking, snowmobiling,

“Dr. Ceola and his staff are very professional, personal and caring.

I feel quite comfortable under his care.”

– patient

skiing, mountain biking and hiking.

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Convenient Locations to Best Serve You VVH.ORG

Satellite Locations

GLENWOOD SPRINGS

ASPEN

Aspen Valley Hospital 401 Castle Creek Road, Ste. 1900 Aspen, CO 81611

Valley View Hospital 1906 Blake Avenue Glenwood Springs, CO 81601

EAGLE Eagle HealthCare 377 Sylvan Lake Road Eagle, CO 81631

WILLITS

Willits HealthCare 850 East Valley Road Basalt, CO 81621

Call for more information or to schedule an appointment: 970.384.8060

Rio Blanco GLENWOOD SPRINGS EAGLE BASALT

(WILLITS)

Mesa

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Pitkin

ASPEN