Spinal cord injury is a major life-changing event. Whether spinal cord injury is caused by trauma, infection, degenerative disorder, vertebrae dislocations or tumors, it can result in a drastic change in the life of patients and their families. At Barnes-Jewish Hospital and Washington University, surgeons from the Department of Neurosurgery and the Department of Orthopedic Surgery work in unison to preserve spinal function and alleviate pain.
Combined, the two have one of the largest clinical practices in the United States for the surgical management of adult and pediatric spinal deformities and complex reconstructions. Each year, the spine division sees approximately 3,000 new patients in consultation and performs approximately 1,400 spinal surgeries. The clinical care and research is among the most advanced available, and these physicians have published more scientific peer-reviewed articles about research or treatment for spinal conditions than any other center.
The expertise of the Washington University spine surgeons extends well beyond local reach. “Over half of new patients come from outside Missouri and Illinois,” says Keith H. Bridwell, MD, chief of orthopedic spine surgery. “They come from all 50 states and other countries.”
“We’ve even operated on spine surgeons and physicians from many of the other major medical centers around the country,” adds Bridwell’s partner Daniel Riew, MD, chief of cervical spine surgery in the department of orthopedics and director of the Orthopedic and Rehabilitation Institute for Cervical Spine at Washington University Orthopedics.
Comprehensive and specific
Spine surgeons at Barnes-Jewish are able to coordinate care with other neurologic and orthopedic specialties, as well as oncology, radiology, internal medicine and physical medicine and rehabilitation. In fact, when patients first have symptoms, they most often go to a rehabilitation/physiatry doctor, who specializes in conservative management of orthopedic conditions. These specialists then determine whether the patient needs surgery or can be treated with medication or physical therapy.
“At Washington University we are fortunate to work with highly qualified neurosurgeons who also specialize in spinal care. We wouldn’t be able to do our jobs without the expertise of neurosurgery. Drs. Paul Santiago and Neill Wright at Barnes- Jewish are all fabulous, talented spinal neurosurgeons,” Bridwell says.
These relationships mean treatment is based on the specific disorder and not on which department first examined the patient. “From the nurses to the technicians and medical assistants, we have one of the most complete and structured systems specifically for the care of spine conditions,” says Neill Wright, MD, Washington University neurosurgeon specializing in the care of cervical spine conditions.
If spinal surgery is needed, patients are referred to one of eight surgeons specializing in specific spinal disorders and conditions. For example, Riew is the only physician in the country whose practice is entirely dedicated to cervical cases. Bridwell and his partner, Lawrence Lenke, MD, co-chief of pediatric and adult spinal, scoliosis and reconstructive surgery, are two of the top physicians in thoracic and lumbar spine deformities (scoliosis, kyphosis, spondylolisthesis) and are among the most prolific researchers. In addition to their active involvement in spine research, Washington University spine specialists serve as national leaders in their field, with Bridwell serving as president of the Scoliosis Research Society from 2002 to 2003, and Lenke currently in that role.
Jacob Buchowski, MD, MS, director of the Orthopedic Center for Spinal Tumors, in conjunction with neurological surgery provides comprehensive care of oncologic and degenerative disorders. By collaborating, Buchowski, Santiago and the other spinal neurosurgeons at Barnes-Jewish offer a “one phone call” service to the community. Patients with both spinal and spinal-cord abnormalities can be rapidly triaged with a cooperative effort.
Complex cases may be co-managed by both an orthopedic surgeon and a neurosurgeon. Buchowski and the neurosurgical spine surgeons have an unparalleled interest and experience in dealing with tumors of the spine. and spinal cord. Santiago, Stewart and Wright are all specialists in treatment of disorders of the cervical spine from straightforward discectomies to the resection of complex tumors involving the spine and base of the skull. As neurosurgeons, they also treat conditions within the spinal canal such as spinal cord tumors and build up of fluid within the spinal cord (syrinx).
“When Drs. Santiago, Wright and I discuss complex cases, it is interesting to see the different ways in which we think about and approach the same problem,” says Stewart. “This process leads to unique insights and ultimately better patient care.”
Stewart also has an interest in lumbar degenerative spondylolisthesis (slipping forward of one vertebrae on another). He treats this with both the standard technique of decompression and fusion as well as some of the new minimally invasive techniques of interspinous stabilization.
“Regardless of the spinal problem you have, we have a specialist with high expertise who can help you,” Bridwell says. “We may all take care of the spine, but in completely separate ways. When I began my career here in 1984, there was no spine specialization. My goal was to build the kind of team we now have. We have trained almost 50 orthopedic spinal surgeons, including Drs. Lenke, Buchowski and our newest member Lukas Zebala.”
“What people fear most about spinal care is paralysis,” Riew says. “Many don’t get care because they are afraid of having a surgeon make a small slip and losing function of their limbs. Because of our specialized expertise, patients of Barnes-Jewish can have confidence in a doctor who has performed the procedure 3,000 times with no paralyzed outcomes.”
Leadership and Innovations in the field
While Washington University spine surgeons develop the latest procedures, they also make traditional procedures better and more reliable.
“We perform the most advanced surgeries, but our main innovations have to do with experience and reliability,” Bridwell says.
For example, a few spine surgeons perform complicated vertebral column resections (VCRs) to realign and stabilize severely deformed spines. But Lenke employs a novel technique, pioneering an approach through a single incision in the back of the spine to perform the entire correction in a single operation versus two operations through both the patient’s back and side.
In 2004, Wright developed a procedure known as translaminar fixation of the axis. The technique, now used around the world to stabilize vertebrae in the upper cervical spine, reduced risks and made it possible for more surgeons to perform atlantoaxial stabilization surgeries more safely.
Instead of relying on restrictive spinal fusions to correct neck deformities, both departments are advancing the use of artificial disc replacements. Riew, Santiago, Stewart and Wright have been actively engaged in clinical trials to study the efficacy of artificial cervical disc surgery. Bridwell was recently awarded a 5-year $2.5 million National Institutes of Health grant to study treatment of advanced adult spinal deformity.
“In order for any surgical technique to become useful, results must be uniform and the technique should be easy to teach. All of our spinal surgeons are frequent lecturers at national and international meetings and physician training courses,” notes Santiago.
Through the latest research and advanced clinical care, the entire spine service is preserving patients’ mobility and ways of life.
“I think we are a unique group in that we all truly love what we are doing, and that passion can be seen in the dedicated care we provide to our patients,” Wright says. “We follow a patient’s progress through their entire treatment, from the detailed initial evaluations to the rehabilitation process.
Lukas Zebala, MD, an orthopedic specialist in minimally invasive surgery and degenerative conditions of the spine, is the newest physician to join the team. “He will expand the horizons of what we do here to include and advance minimally invasive surgeries,” Bridwell says. Buchowski and Zebala are working closely with Heidi Prather, DO, to open and manage the Washington University Spine Center in Chesterfield. This will be a collaborative approach for the treatment of acute back pain and related spinal pathologies.