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Physiatrists Surgeons Neurointerventionalist Neurologists |
CINN
has specialists available to evaluate job requirements and susceptibility
to back injuries. If you are interested in this service, please contact
Lisa Dombro at ldombro@cinn.org
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Editor’s MessageThis issue of the Discussant, CINN’s electronic newsletter, acknowledges the accomplishments of the CINN spine practitioners at the Neurologic & Orthopedic Hospital of Chicago. The work performed by these physicians has been recognized as the best in the state. In our opinion the 2008 HealthGrades Award speaks not only to the excellent outcomes achieved in surgery, but also to the rigorous multidisciplinary approach in determining what patients are appropriate for surgery. In fact, as a result of CINN’s robust physiatry program, the vast number of patients suffering from back and neck pain are actually treated without surgery. This collaboration between surgical and non-surgical specialists is evident in everything we do. As a further example of our multidisciplinary philosophies at work, the programming offered through this year’s Spring Spine Series once again looks at diagnoses causing neck pain from both a surgical and non-surgical perspective. We are offering this program at three locations throughout the Chicagoland area in March, April and May. We hope you can join us. The last article included in this issue addresses a topic all of us should be concerned with – stroke. As you have undoubtedly heard in the past, stroke is the third leading cause of death in the United States and the leading cause of disability. This article refreshes our knowledge of a leading cause of stroke – carotid artery disease – and discusses some of the new treatment options and the results from recent studies. As a proud member of CINN’s spine surgery team, I welcome you to take a closer look at CINN and share any questions or comments with us. Dean
G. Karahalios, M.D. |
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CINN Neurosurgeons Comprise Top Spine Surgery Program in the State
As members of the medical staff of the Neurologic & Orthopedic Hospital of Chicago (NOHC), CINN is proud to announce that NOHC has been recognized as the number one spine surgery hospital in Illinois by HealthGrades. In addition, the NOHC spine surgery program, which is exclusively comprised of CINN neurosurgeons, is acknowledged as being among the top five percent in the country according to the Tenth Annual HealthGrades Hospital Quality in America study. The HealthGrades Research analyzed patient outcomes at all of the nation’s hospitals over the past three years. The study also concluded that NOHC is:
- A recipient of the HealthGrades Spine Surgery Excellence Award
- The only hospital in Illinois to receive spine surgery excellence award
- Five-star rated for spine surgery
- Five-star rated for back and neck surgery two years in a row
- Five-star rated for spinal fusion
The HealthGrades Study examines nearly 5,000 hospitals nationwide and identifies key trends in their quality of care. HealthGrades researchers analyzed Medicare discharges from virtually every U.S. hospital between 2004 and 2006. They compared actual performance to predicted performance for patient outcomes during that time period.
The Neurologic & Orthopedic Hospital of Chicago is the country’s only freestanding acute care facility dedicated exclusively to neuroscience and orthopedic services. During 2007, more than 2,000 neurosurgical and orthopedic surgeries were performed at NOHC. CINN neurosurgeons were in large part the founding medical staff members of NOHC over five years ago. Today, the medical staff at NOHC is over 150 strong and is comprised of the seventeen CINN physicians, as well as leading orthopedic surgeons, podiatrists, radiation oncologists, internists, and others.
NOHC is located at 4501 N. Winchester Street in Chicago. For more information on NOHC, visit www.neuro-orth.org.
CINN Announces Spring Spine Series
Due to the overwhelming response to last year’s program, CINN again this year is hosting an educational forum for professionals interested in spine care. “Advances in the Treatment of Cervical Stenosis and Chiari Malformation” was developed to provide insight into two conditions that frequently go undiagnosed. Until recently, Chiari Malformation (CM) was regarded as a rare condition. However, today’s estimates suggest that up to 2 million Americans may have CM. Oftentimes, CM is overlooked or confused with the symptoms associated with multiple sclerosis, migraine, fibromyalgia, or psychiatric disturbances.
Similarly, cervical stenosis is a common cause of neck pain, most often occurring in patients over 50 as a result of aging and “wear and tear” on the spine. Like CM, cervical stenosis is difficult to diagnose. Early recognition and the understanding of treatment options are imperative in preventing progression of the condition. This educational event has been designed to educate attendees on the nuances of diagnosing and treating CM and cervical stenosis. Surgical advancements in the treatment of cervical stenosis, including the recently FDA-approved, Prestige® Cervical Disc will be specifically addressed.
“Advances in the Treatment of Cervical Stenosis and Chiari Malformation” will be offered on:
- Tuesday, March 25, 2008 from 6:00-8:30 PM at the Doubletree Hotel in Alsip
- Tuesday, April 15, 2008 from 6:00 – 8:30 PM at Maggiano’s in Oakbrook
- Tuesday, May 20, 2008 from 6:00 – 8:30 PM at the Renaissance Chicago North Shore Hotel in Northbrook
The Chicago Medical Society designates this educational activity for a maximum of 2 category 1 credits towards the AMA Physician’s Recognition Award. The Illinois Nurses Association has approved this program. The Illinois Chiropractic Society’s Continuing Medical Education Committee has approved this educational program for 2 credit hours Category 1 credit. Acupuncturists will earn 2 CE credit hours provided by the Neurologic & Orthopedic Hospital of Chicago.
Registration is required for these programs. The cost of the program is $25.00 per person (non-refundable) and includes CME/CE credits, dinner and drinks. To register by phone please call 773-250-1009 or to register on-line go to www.cinnfoundation.org.
Gridiron Game Plan: Maximize Performance Minimize Injuries
Two CINN physicians, Dean Karahalios, M.D. and Daniel Hurley, M.D. have been asked to join some of the Chicagoland’s leading sports medicine experts in a day-long symposium for parents, coaches and sports-medicine professionals addressing the injuries most common in high school football. The symposium, scheduled for April 5, 2008 at St. Ignatius High School, will include presentations from John Hefferon, M.D., NBA-league physician, Preston Wolin, M.D., former team physician for DePaul University, as well as Jim Novak, football coach for Northern Illinois University, and Tim Lang, former strength coach for the Texas Rangers. Dr. Karahalios, CINN neurosurgeon will be discussing concussions and neck injuries. Dr. Hurley, CINN physiatrist, has been asked to address lumbar spine injuries in football. Please see www.neuro-ortho.org for more details and registration information.
New Options in the Fight Against Stroke
Carotid artery disease is defined as the narrowing of the arteries that supply blood to the brain. Like vessels in the heart that become clogged with fat, cholesterol and other substances, the carotid artery is also vulnerable to the disease process called atherosclerosis. As a result, carotid artery stenosis is a major risk factor for ischemic stroke, which accounts for approximately 85 percent of all strokes. Twenty-five percent of ischemic strokes are reportedly due to carotid artery disease.
Transient ischemic attack (TIA) is the most common warning sign of stroke, and thus carotid artery stenosis. Momentary weakness in the arm, leg or on one side of the body, loss of vision and slurred speech are associated with TIA.
High blood cholesterol, hypertension, advanced age and diabetes are among the risk factors for carotid artery disease. Smoking is a significant factor as the risk of stroke in smokers is about twice that of nonsmokers.
At a time when stroke is the third leading cause of death and the leading cause of long-term disability in the United States, the medical community has taken great interest in reducing patients’ risk of disease. Borne from this movement is increased attention to minimally-invasive treatments, particularly endovascular therapies, to address blocked arteries.
Conventional Treatments
Depending on several factors, treatment options for carotid artery disease range from medical management to surgical intervention. And in a short period of time, endovascular therapies have rapidly moved onto the radar of physicians and patients.
The surgical treatment of carotid artery disease, called carotid endarterectomy (CEA), has been studied for over four decades and is widely used as a way to reduce stroke risk. Through an incision in the side of the neck, the surgeon removes the plaque causing the carotid artery to narrow.
In general, patients considered at low risk for surgery with varying degrees of moderate (50 percent to 69 percent) to severe stenosis may benefit from intervention. In patients with arteries narrowed less than 50 percent, medical management with antiplatelet agents and anticoagulants is considered an appropriate strategy. (TABLE)
Endovascular Emergence
INDICATIONS FOR TREATMENT OF CAROTID ARTERY DISEASE |
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Carotid Endarterectomy (CEA)
Asymptomatic Patients
Carotid Angioplasty and Stenting (CAS) Symptomatic Patients
Asymptomatic Patients
Medical Management
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Today’s well-established carotid artery disease algorithm excludes most high-risk patients from surgical intervention. This inherent gap has left the door open for endovascular therapies, specifically carotid angioplasty and stenting (CAS).
During the minimally-invasive CAS procedure, the endovascular specialist enters the circulatory system through the femoral artery, threading a balloon catheter and stent system to the carotid artery. Once there, the stent, a wire mesh tube, is deployed to open the narrowed artery. At the same time, an embolic protection device is used to catch any debris that may break away from the artery wall and travel to vessels in the brain.
The Rising Curve of CAS
Steadfast commitment of the endovascular specialist has helped forge a new and durable path in the treatment of both symptomatic and asymptomatic carotid stenosis. Technological advances coupled with increased physician experience are dramatically impacting patient outcomes. In fact, stenting outcomes parallel those of CEA.
CINN neurovascular specialists, Thomas Grobelny, M.D. and Demetrius Lopes, M.D. are among the leaders in the country in treating and preventing stroke. For more information about the services they offer refer to www.cinn.org.
Spine Care Health: Back on Track
CINN has created a new spine care health booklet, "Back on Track" which provides an overview of basic back pain facts, treatments, as well as detailed instructions for proper posture and body mechanics. Did you know that smoking and obesity contribute to the incidence of back pain? Did you know that exercises, especially those focused on strengthening core abdominal muscles can help alleviate back pain? A primer on basic spine anatomy and conditions along with easy to read diagrams is also provided. Through the generosity of The CINN Foundation, we are able to provide you and your clients copies of this booklet free of charge. If you are interested, please log onto the CINN website at www.cinn.org and click on "Back on Track.