THE EMORY SPINE CENTER: Overview and Clincal/Research Interests of Faculty

January 20, 1997

Media Contacts: Sarah Goodwin, 404/727-3366 - sgoodwi@emory.edu
Kathi Ovnic, 404/727-9371 - covnic@emory.edu
http://www.emory.edu/WHSC/

Putting Down the Scalpel
Picking Up the Scalpel
Not a Rehab Center
Faculty
National Spine Network
Teaching Collegues
Summary

PUTTING DOWN THE SCALPEL

When is back surgery "absolutely necessary" and when is it not? Spine experts at the Center have made answering this question a science of sorts. Knowing that up to 90 percent of back pain subsides on its own within a month or two, staff carefully evaluate those patients with recurrent pain and those who have undergone multiple prior surgeries.

They conservatively use imaging technologies for diagnosis, reserving time- and cost-intensive choices such as magnetic resonance imaging (MRI) for appropriate cases. They believe that dense modalities like MRI should be used wisely; the group's studies on the incidence of abnormal MRI scans of the cervical spine, lumbar spine and knee have been published widely in the medical press. And the cost-effective imaging algorithms the Emory doctors have devised for the neck, herniated disc, spinal stenosis and shoulder/arm have been well-received at scientific meetings.

Similar quality-based treatment protocols applied to large work situations have proven highly successful, with success measured in lowered time lost from work, fewer re-injuries and new injuries, lower costs for both patient and employer, and increased patient satisfaction.

Once the diagnosis becomes clear, many Center patients never need to see a surgeon. They are treated by one of two physiatrists, physicians who reduce pain and restore mobility through medication and rehabilitative exercise.

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PICKING UP THE SCALPEL

When surgery is deemed necessary, each patient's case is reviewed at a group conference by all staff surgeons (and phyiatrists). Cases are directed to surgeons with particular areas of expertise such as scoliosis or complex cervical problems. Cases of spinal tumors, for instance, may be referred to neurosurgeons affiliated with the Center.

Surgeons at the Center are proud of their unusually low yearly rate of back surgeries: about 40 surgeries per 100,000 persons compared to 190 per 100,000 persons for the Southeast. The surgery rate has remained low over the past few years, when total patient visits to the Center have increased about 15 percent annually.

The dramatic increase in patients from all along the East Coast has been attributed to the Center's intense focus on three vital groups: patients, referring doctors and third-party payors. About 70 percent of patients are seen within three weeks and many within a few days (an internal query indicated that 99.1 percent of patients were highly satisfied with their visit and would refer a friend to the Center). Every referring doctor receives a report within two days of the patient's appointment. And a primary care advice line has been created so that case managers and primary care doctors may seek advice from Center staff to avoid unnecessary referrals and diagnostic tests as well as to ensure that nonoperative treatments have been maximized.

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NOT A REHAB CENTER

The Emory Spine Center focuses on treatment, prevention and research of all types of spine disorders. Center patients are referred to the appropriate hospital within the Emory University System of Health Care for inpatient physical therapy services or to the Center's in-house outpatient physical therapy section. Expertise encompasses virtually all adult spinal disorders including acute and chronic low back pain, routine discectomy, herniated disc, spinal decompression (narrowing), spinal infections (such as tuberculosis or meningitis), tumors, complicated deformities (such as scoliosis) and musculoskeletal injuries.

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FACULTY

Scott D. Boden, M.D. -- Center director and orthopaedic surgeon specializing in the spine; associate professor of Orthopaedics; clinical interests involve degenerative disorders of the cervical, thoracic and lumbar spine; author of popular text The Aging Spine: Essentials of Pathophysiology, Diagnosis and Management (W.B. Saunders Co., 1991) and dozens of scientific papers from business-oriented to basic science, including a prospective outcome study on cost-effective algorithms for managing low back pain, sciatica and back injuries; and another study of the effects of managed care on the treatment of spinal disorders; also directs the Whitesides Orthopaedic Research Laboratory, where he is investigating ways of making new bone and stronger bone using growth factors as bone graft substitutes; investigating gene expression in spinal fusion.

Thomas E. Whitesides, M.D. -- Founding member of Center and orthopaedic surgeon specializing in the spine; professor of Orthopaedics; director of Emory Spine Fellowship, which is one of the nation's most competitive; known for taking on highly complicated surgeries; some patients have undergone numerous unsuccessful surgeries elsewhere; is known worldwide for developing unique approaches to certain back and neck surgeries; recipient of the 1996 Leon Wiltze Award of North American Spine Society for his lifetime contributions to the field; current research interests are on nicotine and its negative effect on spinal fusion.

John G. Heller, M.D. -- Orthopaedic surgeon specializing in the spine; associate professor of Orthopaedics; performs the range of spinal surgeries, but is especially adept at treating complex cervical deformities; actively performing biomechanical research on spinal instrumentation.

William C. Horton, M.D. -- Orthopaedic surgeon specializing in the spine; associate professor of Orthopaedics; manages all spine problems, though gifted in helping children and adults with complex deformities, particularly scoliosis; performs volunteer surgeries on patients in developing countries; conducting research in optimizing the stability of internal fixation systems for the spine; interested in the art of diagnosing low back pain.

D. Hal Silcox, M.D. -- Orthopaedic surgeon specializing in the spine, assistant professor of Orthopaedics; special expertise in new minimally invasive surgical procedures; piloting studies to do laparoscopic spinal fusions on an outpatient basis; investigating the combination of growth factor technology with less invasive surgery.

Howard Levy, M.D. -- Physiatrist; assistant professor of Orthopaedics and Physical Medicine and Rehabilitation; specializes in nonoperative management of spinal disorders, particularly lumbar problems and therapeutic injections.

Susan Dreyer, M.D. -- Physiatrist; assistant professor of Orthopaedics and Physical Medicine and Rehabilitation; conservative treatment options; diagnostic and therapeutic cervical injections and interested in treatment of complex pain syndromes in facet joints and sacroiliac joints.

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NATIONAL SPINE NETWORK

The Emory Spine Center, in conjunction with the Emory University System of Health Care, has joined with 21 other spine centers of excellence around the country to collect and share patient data for major outcome study data analysis and to help devise better spine management guidelines. Emory Center Director Scott D. Boden, M.D., is founder and chair of the expanding network, which is actively developing relationships with large employers, third-party payors and managed care organizations. The goals of the National Spine Network are to increase quality and decrease cost of spine care by appropriate utilization and use of patient outcome data from large populations. This information helps guide the optimal timing and type of treatment interventions.

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TEACHING COLLEAGUES

The Center serves as a resource for training primary care physicians about the complexities of treating back pain in their own patients. They offer twice a year a practical continuing medical education course on diagnosis, examinations and effectively using physical therapy and medications.

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SUMMARY

These innovative initiatives have made Emory Spine Center one of the most noted in the world. The Center's vision encompasses excellence in patient care, patient services, teaching and research. This balanced approach combined with a motivated staff ensures a successful future and more important innovations that will advance the field of spinal disorders.

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For more general information on The Robert W. Woodruff Health Sciences Center, call Health Sciences News and Information at 404-727-5686, or send e-mail to hsnews@emory.edu.