The 8.7 earthquake off Russia’s eastern coast made for an unforgettable first evening at the WOA meeting in Hawaii. As the sixth-largest earthquake ever recorded, it triggered tsunami warnings across the Pacific Rim—including Hawaii. Waves between 1 and 9 feet were predicted, prompting a statewide evacuation of low-lying coastal areas. At the hotel, the lobby and convention center were on the fourth floor, so guests gathered there overnight while the hotel provided a buffet dinner. Fortunately, the tsunami spared Hawaii, and the meeting continued the next morning without disruption.

Several interesting spine papers were presented. Some notables:

A study of microdiscectomy outcomes from the Naval Hospital in San Diego showed that at an average of 200 days post-op, only 1% of discectomy patients failed the Navy’s minimal physical requirements test. This reinforces our protocols to return patients to regular activities 3-6 months post-discectomy, after 3 months of healing of the outer ligaments of the disc and following a protocol of staged rehabilitation.

One paper explored the question of whether non-tobacco smoking habits, such as vaping, have the same rate of surgical complications as cigarette smokers. Cigarette smoking has been studied extensively and is known to be a risk factor for higher surgical complication rates. A large cohort of 15,798 smokers and vapers from an insurance database was divided into two cohorts: cigarette smokers and vapers, and non-smokers. Interestingly, both smokers and vapers had a higher rate of complications than non-smokers, but the patterns differed. The vaping group had lower rates of anemia, heart attack, renal failure, infection, and narcotic abuse, but higher rates of blood clots in the legs and blood transfusion. The research concluded that both cigarette smoking and vaping patients had a higher risk for complications.

A symposium on bone health (osteopenia and osteoporosis), discussed the recent consensus for treatment after a fracture, such as in the spine, wrist, or hip. The consensus is to start with anabolic medications like Forteo (teriparatide), which help build new bone and can increase bone density by a few percentage points. However, these drugs can only be used for a limited time because of potential cancer risks. After that initial phase, treatment should shift to anti-resorptive medications such as Fosamax (alendronate) or Reclast (zoledronic acid), which help maintain the bone that has been built. In the past, treatment plans were less coordinated, but this step-by-step approach is now emerging as the standard.

Carlton tracks the beginning of his 10-year neck problem back to a ski accident. As a retired physical therapist, he successfully managed his pain symptoms non-surgically with exercises and stretches. The neck problem, however, returned after a car accident. His symptoms worsened; he now had sharp stabbing pain in his neck and shoulder, along with numbness in his hand. As a physical therapist, he knew surgery might be unavoidable.

“I knew I needed to see a spine surgeon because of my symptoms,” Carlton remembers. “My dermatologist had neck surgery with Dr. Jatana, and she decided on him after checking out about five other surgeons.”

Even so, Carlton first met with other spine surgeons who evaluated his MRI. “I went to three surgeons who all tried to sell me on a fusion,” he remembers. “A fourth surgeon talked about artificial disc replacement as an alternative to fusion, but he seemed too cavalier about it.”

Carlton knew fusing two levels in his neck would significantly limit his motion and could accelerate the damage to the remaining discs in his neck. “I’m 68 and very active. I ski, mountain bike, and scuba dive. If I had a fusion at two levels, I’d be severely limited in my motion and be at risk for a third fusion due to the degeneration at the other levels. Scuba diving, especially, requires a full range of motion—you need to look in all directions for safety, including upward. With a two-level fusion, that would have been impossible.”

When Carlton finally met Dr. Jatana, the experience was different. Carlton says, “Dr. Jatana did more due diligence and spent more time making sure I was a true candidate for disc replacement. He explained the different artificial disc options and recommended the Mobi-C, which is FDA approved for two levels in the neck.” Carlton chose disc replacement. After surgery, he wore a cervical collar for a few weeks, then steadily regained his mobility. Soon, he was back skiing and scuba diving.

“As a physical therapist, I knew spinal fusion wasn’t the right option for me,” Carlton says. “Disc replacement let me keep doing the things I love. I’d tell anyone—research your options, talk to multiple surgeons, and find one who listens. For me, that was Dr. Jatana. He and his staff cared and communicated, and that made all the difference.”

Colorado Spine Partners

Dr. David Wong, Dr. Sanjay Jatana, Dr. Gary Ghiselli, and Dr. Chris Johnson

145 Inverness Drive East, suite 100

Englewood, CO 80112

303-MY-SPINE

www.coloradospinepartners.com

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