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Biology is destiny.
For anyone with a spine, odds are five to one that excruciating back pain is going to land you in the doctor's office someday.
"Our spine was originally designed for walking on all fours," explains Dr. Russell Hardy, the recently retired co-founder of University Hospitals' Spine Institute. "Now, we walk upright. That puts a lot of stress on the spine."
But walking upright is only part of the reason we get back problems. The other is the perks that have come with civilization, chiefly the fact that we now live longer. As we age, our spine joints become thinner and more prone to fractures and breaks. The squishy, shock-absorbing pads between them (called disks) wear down, compressing joints and pinching and twisting spinal cord nerves. Other "perks" — smoking, obesity, sitting all day at a computer, playing golf — compound the problem.
"Compounding" is exactly what drove 68-year-old Robin Brennan to the Spine Institute.
Thirty years ago, she fell off a horse. "That started my back problems," says the Hudson resident. "When I was rear-ended in a car accident 10 years ago, things got worse. -- I had leg pain and sometimes my toes were numb."
But it wasn't until she and her husband were on vacation last spring and walking became an ordeal that she decided she'd suffered enough. Having heard that University Hospitals was nationally noted for spine work, she contacted Dr. Christopher Furey at the Spine Institute.
His work-up, which included an evaluation by several members of the Spine Institute team and an MRI, showed that Brennan had spinal stenosis, a narrowing of the spaces between several vertebrae in her back. That was causing them to grind against one another and against the nerves going to her lower back and legs.
Furey recommended surgery. "He was honest," says Brennan. "He said it would improve things, especially the pain in the leg, but he didn't guarantee it would go away."
The four-hour July surgery was complicated. Not only did Furey fuse vertebrae with bolts, screws and titanium rods, he also removed and ground up some of Brennan's pelvis bone to use as a "glue" to hold things in place. But the procedure was successful.
"I still have some back pain," admits Brennan, "but I can control it with a Percocet every couple of days, and the pain in my leg is gone. I can walk all I want."
A center for excellence
Most of the procedures and materials used to "cure" Brennan's back and leg pain were developed and/or or refined at University Hospitals.
The only National Spine Network-designated center of excellence for spine care in Ohio, the Institute focuses its diagnostic, treatment, rehabilitation and research efforts on degenerative disorders, such as osteoarthritis and the kind of spinal stenosis Brennan had; on traumatic injuries, such as whiplash, that affect the spine and spinal cord; on infections and tumors that impact the spine and surrounding tissue; on congenital and/or spinal deformities, such as scoliosis; and on second-opinion consults, including those for options to correct "failed" previous back surgeries.
Membership in the elite network is based on three factors.
History: For more than 50 years, University Hospitals' orthopedic physicians have been doing groundbreaking work on spine-surgery techniques and procedures; on spine imaging; on metal and ceramic implants; and on the post-operative rehabilitation necessary to turn a successful surgery into a successful recovery.
Staff: The Institute is multidisciplinary, with nationally recognized experts in anesthesiology; orthopedics; cervical [neck], thoracic [chest] and lumbar [lower-back] surgery; neurosurgery and neurology; radiology; rheumatology, osteopathic manipulation; pain management; and rehabilitative therapies. Everyone at the Institute wears two, and sometimes three, hats: All are physicians, all are professors at Case and most are involved in research — in spine imaging, disk degeneration, implant design, bone and cartilage tissue engineering — that will further the field of spine care.
Focus: Institute staffers, who all have offices on the same floor at Bolwell Tower, are constantly thinking about spine care. "There's always been lots of cross-fertilization of ideas," says Hardy. "When you have physicians who are academics, they are always looking for the better way,' for breakthroughs, for new knowledge."
That quest — fueled by daily office consults with patients who are often so stooped by spinal degeneration that they can't sit in an office chair — is also the reason Case Medical School's department of orthopedics has been a consistent and top-ranked recipient of National Institutes of Health grants since the mid-1990s, notes Furey, whose current research focuses on ways to stimulate new bone growth.
"The medical school's affiliation with the biomechanical engineering department at Case is really moving that research along," he says.
But research by or in conjunction with the Spine Institute isn't funded only by government grants or research agreements with pharmaceutical or medical-device companies.
Relieving the pain
This July, Dr. Thomas Chelimsky, a Spine Institute neurologist and associate professor of neurology at Case, received a $983,000 grant from the Josiah Macy Jr. Foundation to fund the Primary Practice Program for Patients with Chronic Pain Project.
Based on previous research, which showed that coordinated pain-management programs lessen depression, shorten time off the job and improve quality of life, the project aims to teach primary-care physicians how to better tend their patients with chronic pain.
"Physician education is only part of the project," says Chelimsky. "We'll also be collecting data ... to see if we can't manage it [chronic pain] cheaper, too."
Peering into the future
Capitalizing on an explosion of knowledge at the molecular and cellular levels, spine research at the Institute has entered a new era. Citing research on damaged-disk replacement that's being done in Europe, and is being closely watched here in Cleveland, Furey says that "replacement disks are the next generation of implants."
Citing his own research, he adds, "In the next five to 10 years, we are going to see the use of substances that stimulate new bone formation and that will replace the need for bone grafts."
Further down the line, Hardy predicts the use of "stem-cell transplants and other biological treatments to regenerate bone and disks biologically."
When that happens, huge numbers of spine surgeons may be, happily, out of work.
12:00 AM EST
November 17, 2004