Sentinel Sign in Standalone Anterior Cervical Fusion: Outcomes and Fusion Rate

By Dr. Kingsley Chin

Scientific Paper

Kingsley R. Chin, Fabio J.R. Pencle, Luai M. Mustafa, Moawiah M. Mustafa, Amala Benny, Jason A. Seale

Interested medical professionals can read through the full paper, as published in the Journal of Orthopaedics, here.

Background

The authors aim to demonstrate the feasibility, outcomes and fusion rate of a standalone PEEK cage in the outpatient setting.

Methods

48 consecutive patients undergoing standalone ACDF (S-ACDF) (Group 1) were compared to control group of 49 patients who had ACDF with ACP (Group 2).

Results

Analysis of follow-up at the one year period postoperative outcomes between groups 1 and 2 demonstrated no intergroup statistical significant difference in VAS neck, arm and NDI scores p = 0.414, 0.06 and p = 0.328 respectively.

Conclusion

We conclude that S-ACDF can be safely done in an ambulatory surgery center with satisfactory clinical and patient-reported outcomes.

Dr. Kingsley R. Chin, Founder of philosophy and practice of The LES Society and The LESS Institute

About Author Dr. Kingsley R. Chin

Dr. Kingsley R. Chin, Founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin is a board certified Harvard-trained orthopedic spine surgeon and professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, VisitingSpine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Studies at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.

Scientific Paper Author & Citation Details

Authors

Kingsley R. Chinabcd, Fabio J.R. Penclee, Luai M. Mustafab, Moawiah M. Mustafab, Amala Bennyae, Jason A. Sealeae

Author information

a. Less Exposure Surgery Specialists Institute (LESS Institute), United States
a. Less Exposure Surgery Specialists Institute (LESS Institute) USA
b. Herbert Wertheim College of Medicine at Florida International University, USA
c. Charles E. Schmidt College of Medicine at Florida Atlantic University, USA
d. University of Technology, Jamaica
e. Less Exposure Surgery (LES) Society, USA

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The LESS Institute Fosters Adolescent Scoliosis Care With the Best in LES

Written by Fabio Pencle & Garianne Bowen

Compiled & edited by Esther Rodriguez

Adolescent idiopathic scoliosis (AIS) is the most common form of pediatric scoliosis in individuals between the ages of 10 and 18,1 found in as many as 4 in 100 adolescents.2 By definition, idiopathic scoliosis implies the cause is unknown or not related to a specific syndromic, congenital or neuromuscular condition. Treatment options include conservative management, bracing or operative intervention.

Marketing Intern Garianne Bowen is no stranger to a life with adolescent scoliosis, although she may not have known it at first.

“Looking back, though I had the signs of scoliosis growing up, my family wasn’t aware of the potential for this diagnosis. We all thought nothing could be done of it – and though I tried to accept it, I somehow could not,” she said. Bowen spent years settling for a life that held so much more potential, in the physical and emotional space. In a world where lives are hyper visual with social media exposure, “I always felt uncomfortable in my own body. It sometimes felt like I didn’t know how to walk correctly, and that eyes were always on me. My breasts were two different sizes, my stride wasn’t straight, clothes fit awkwardly and I experienced occasional annoying back pain. My shoulder was damaged by birth and my parents attributed that to me being ‘different,'” said Bowen.

Eventually Bowen’s parents discovered an article on scoliosis – and as they read, realized she fit the mold so entirely. Because of this, they scheduled an X-ray to be read by an orthopedic surgeon, witnessing first hand their daughter’s 40 degree spinal curvature.

A proper adolescent scoliosis evaluation includes X-ray imaging from various angles.  Generally speaking, those with curves of 10 to 25 degrees are monitored for surveillance with serial X-rays. This is usually at three, six or 12 month intervals. Those with curves greater than 25 degrees but less than 40 to 45 degrees are candidates for bracing. And those with curves of over 40 to 45 degrees who are skeletally immature are considered operative candidates.3

Bowen’s 40 degree spinal curvature seen through X-ray

During her preliminary orthopedic visit, her doctor at the time being highly encouraged Bowen to undergo a spinal fusion from the neck down, a more major procedure for an adolescent scoliosis case that would limit Bowen’s flexibility and motion. But Bowen was not so on board. She became determined not to undergo surgery, adapting to a life of covering her curvature and accepting pain as the norm.

Three years post scoliosis discovery, Bowen’s mother met Orthopedic Surgeon Dr. Kingsley R. Chin at a conference. Impressed by his profile as a successful Jamaican-born, Harvard-trained spinal surgeon, she brought her daughter to him straightaway to determine a second opinion regarding treatment options. Dr. Chin assured Bowen he would not be completing a full spinal fusion, introducing a Less Exposure Surgery procedure in its place – and clarifying her every concern regarding maintaining motion post-procedure.

Dr. Chin pioneered this LES procedure, a short segment scoliosis surgery with a focus on the apical curve, gearing treatment to the levels above and below – limiting fusion levels.

“As he reassured me, my perceptions of the procedure were altered for the positive,” she said, and after further personal research and consideration, she ultimately trusted Dr. Chin to perform the surgery. “I am so grateful to have gotten to that place,” attests Bowen.

We know it’s vital to prioritize our health, but we must also expose ourselves to our options that lie ahead. Explore your varying avenues of recovery and choose the most appropriate healing method for you.

“I can personally vouch for Dr. Chin as a top orthopedic surgeon, as I begin enjoying my young years to my utmost potential – confident and free of pain.”

— Garianne Bowen

And just like that, from curvature to confidence, Bowen leads a life of health, happiness and pain-free motion.

The Less Exposure Surgery Advantage

In advancing Less Exposure Surgery, The LESS Institute aims to reduce operative time, minimize blood loss and decrease instrumentation, while improving overall outcomes. For more on adolescent scoliosis cases with The LESS Institute, see the Jamaica Gleaner article and our post titled 15-Year-Old Jamaican Girl Appreciates Life Changing Scoliosis Surgery in Jamaica by Dr. Kingsley R. Chin.

About Dr. Kingsley R. Chin

Dr. Kingsley R. Chin is a board certified Harvard-trained orthopedic spine surgeon and professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, Visiting Spine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Studies at the University of Technology, Jamaica.

1. , 3. https://www.ncbi.nlm.nih.gov/pubmed/29763083

2. https://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/adolescent-idiopathic-scoliosis 

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Option for Transverse Midline Incision and Other Factors That Determine Patient’s Decision to Have Cervical Spine Surgery

By Dr. Kingsley Chin

““I had my [cervical fusion and lumbar decompression] surgery ten days ago and I feel great, I’m wearing my heels and I’m ready to go!””

Introductory content by Fabio Pencle 

“[Dr. Chin] is a true professional… the whole team, the whole staff was great here at the LESS Institute.”

A newly published study has demonstrated that patients prefer a midline incision for cervical spine surgery.

The anterior approach to cervical spine surgery has become the standard for the treatment for degenerative disc, traumatic herniated disc and fracture dislocation. Cloward, Smith and Robinson have

devised operative techniques with modifications by several surgeons since 1958. There are varying types of skin incisions for cervical spine surgery; the incision is either on the right or left side of the trachea based on the surgical approach to the recurrent laryngeal nerve. Other factors determining the type of incision include a few pathological levels affected, if corpectomy is required and whetheraffected segments are contiguous.

Transverse midline incisions have been used by other surgical specialties such as ENT, vascular and general surgeons. This incision provides a more cosmetically acceptable result and allows for access to structures during surgery; however, few studies discuss the relevance of cosmesis. There are several named guidelines for determining surgical incision, most notably, Langer’s lines. A transverse midline incision would, however, follow the guideline by Kraissl, where the incision is made in a skin crease. The quality of surgery is judged immediately by the amount of relief of symptoms and the cosmetic.

Considering the patient-driven procedures offered to treat the same pathology, as well as recent trends in the increase in ambulatory surgery center (ASC) use, the authors felt it prudent to devise a questionnaire with the primary goal of determining the preferences of the patients. The secondary goal was to determine factors which lead to the decision to have anterior cervical spine surgery.

Scientific Paper

Fabio J.R. Pencle, Jason A. Seale, Amala Benny, Sephania Salomon, Ashley Simela, Kingsley R. Chin

To read the full paper & citations as published in the Journal of Orthopaedics, visit here.

Background

Authors aim to determine patients’ preference for surgical incision and factors affecting the decision for surgery to the anterior neck.

Methods

A questionnaire was presented prior to evaluation and if preceded to surgery followup given.

Results

243 patients completed questionnaire, with 60% female population and younger than 50 years. 151 patients preferred a transverse midline incision with a statistically significant increase in outcomes and cosmesis importance and a decrease in the importance of board certification.

Conclusion

Findings of questionnaire demonstrate that patients’ prefer a transverse midline anterior neck incision, with surgical outcomes being the overall factor affecting decision making.

About Author Dr. Kingsley R. Chin

Dr. Kingsley R. Chin, Founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin is a board certified Harvard-trained orthopedic spine surgeon and professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, VisitingSpine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Studies at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.

Scientific Paper Author & Citation Details

Authors

Fabio J.R. Penclead, Jason A. Sealead, Amala Bennyd, Sephania Salomond, Ashley Simelade, Kingsley R. Chinabcf

Author information

a. Less Exposure Surgery Specialists Institute (LESS Institute), United States
b. Herbert Wertheim College of Medicine, Florida International University, United States
c. Charles E. Schmidt College of Medicine, Florida Atlantic University, United States
d. Less Exposure Surgery (LES) Society, United States
e. Bronx Lebanon Hospital Center, United States
f. University of Technology, Jamaica

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Utility of Mobile Apps for Video Conferencing to Follow Patients at Home After Outpatient Surgery

By Dr. Kingsley Chin

Author Information

Fabio J.R. Pencle1 MB BS, Amala Benny1, Kathleen A. Quijada BS3, Jason A. Seale2 MB BS, Kingsley R. Chin2, 3 MD

1. Less Exposure Surgery (LES) Society.

2. Less Exposure Surgery Specialists Institute (LESS Institute).

3. Herbert Wertheim College of Medicine at Florida International University and Charles E. Schmidt College of Medicine at Florida Atlantic University

Study Design

Prospective questionnaire

Background Data

The role of technology in medicine has been limited to patient use in decision making for finding and assessing physicians. Teleconference is real time and live interactive program in which one set of participants are at one or more locations and the other set of participants are at another location. The teleconference allows for interaction, including audio and/or video, and possibly other modalities, between at least two sites. A study by Augestad et al has demonstrated from the literature the use of video conferencing for surgeons and its benefits especially in rural areas. Newer technology has allowed mobile video conferencing with encryption specific to the application or mobile phone. Outpatient surgery has a great opportunity to demonstrate the role of utilizing video conference (VC) in the follow up of patients postoperatively. The authors aim to assess patient’s perception to the use of mobile app for video conference (VC) with surgeon and/or staff.

Methods

Patients who presented to an orthopedic institute were presented with a questionnaire. To determine patient attitudes regarding surgery and the use of mobile VC app, we asked the surveyed participants using a 5 point Likert scale. Consenting patients completed a questionnaire of 10 questions prior to being assessed by surgeon in order to minimize any bias resulting from evaluation and treatment. Patients who proceeded to have surgery completed the questionnaire to assess difference in opinion postoperatively.

Results

120 patients completed the questionnaire preoperatively with 58% female population, 71% age younger than 65 years and 67% having a GED/higher education. A total of 36 patients had surgery with 54% female population and 60% age younger than 65 years. All patients had a mobile app for VC with 55% using WhatsApp, 40% using Facetime, 5% Skype and/or other. In person at office with a trained educator was the preferred mode and method for learning about surgical procedures. Eighty-three percent of patients thought that having mobile video app access suggested that their surgeon was more caring preop compared to 89% post op. Overall; four patients contacted the surgeon directly preoperatively. Post-surgery 5/36 patients (14%) utilized video conference to the surgeon directly, 24 patients contacted the concierge team with video conference.

Conclusion

With advances in technology, the use of mobile video conferencing adds a new forum for communication with patients. In the outpatient surgical setting this forum would improve patient-physician relations.

About Author Dr. Kingsley R. Chin

Dr. Kingsley R. Chin, Founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin is a board-certified Harvard-trained Orthopedic Spine Surgeon and Professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, Visiting Spine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Sciences at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.

About SpineFrontier

The above study utilized LES Technology from SpineFrontier – leading provider of LES Technologies and instruments – offering surgeons and patients superior technology and services.

Correspondence

Kingsley R. Chin, MD

Professor of Clinical Orthopedics

Herbert Wertheim College of Medicine at Florida International University

Attending Spine Surgeon

Less Exposure Surgery Specialists Institute (LESS Institute).

3816 Hollywood Blvd, #102 Hollywood FL 33021.

Tel: 954-640-6010 Fax: 855-411-4647 Email: kingsleychin@thelessinstitute.com

Conflicts of interest and sources of funding: We did not seek or receive any funding from the National Institutes of Health (NIH), Wellcome Trust, Howard Hughes Medical Institute (HHMI), or others for this work. KRC is a shareholder in and receives other benefits from SpineFrontier Inc., none of the other authors (FJRP, AB, KAQ and JAS) have any potential conflicts of interest to declare for this work.

Acknowledgements

The authors would like to thank Saily Lopez and the Surgical Education Responsibilities Value and Empathy (S.E.R.V.E) ™ team for their assistance with this project.

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Decreasing Radiation Dose With FluoroLESS Standalone Anterior Cervical Fusion

By Dr. Kingsley Chin

Scientific Paper

Kingsley R. Chin, MD, Fabio J.R. Pencle, MB BS, Jason A. Seale, MB BS

Interested medical professionals can read through the full paper, as published in the Journal of Spine Surgery, here.

Study Design

Level III

Objective

Adjacent segment disease and dysphagia remain concerns of anterior cervical discectomy and fusion (ACDF) with fixation using anterior cervical plates (ACPs). The authors aim to demonstrate the feasibility, outcomes and fusion rate of a standalone PEEK cage in the outpatient setting.

Methods

The medical records of 48 consecutive patients undergoing single level standalone ACDF (S-ACDF) (Group 1) were compared to our control group of 49 patients who had single-level ACDF with ACP (Group 2). Outcomes assessed included VAS neck and arm, NDI scores, and radiation dose.

Results

Forty eight patients in Group 1 (S-ACDF) and 49 patients in Group 2 (ACDF-ACP). No statistical differences in gender, age or BMI were found between groups, p=0.286, 0.691 and 0.947 respectively. There was no intergroup statistically significant difference in preoperative and postoperative outcomes. Mean radiation dose in group 1 of 24.1+/-8.2mAS and 2.0+/-0.7mSv was significantly less compared to group 2 which was 29.8+/-5.4 and 2.5+/-0.5mSv, p<0.001. The average radiation dose for single level fusion in Group 1 was 15.6+/-1.5 mAs and 1.3+/-0.1mSv this is compared to average radiation dose in Group 2 of 27.8+/-3.9mAs and 2.3+/-0.3mSv, p=0.001. The average radiation dose for two level fusion in Group 1 was 30.9+/-3.5 mAs and 2.6+/-0.3mSv this is compared to average radiation dose in Group 2 of 33.9+/-6.0 and 2.9+/-0.5mSV, p=0.012.

Conclusion

In the outpatient setting, S-ACDF has shown statistically significant intergroup difference in overall radiation dose, as well as single and two-level fusions, (p<0.001). We conclude that S-ACDF can decrease overall radiation exposure to patients. This is comparable to single level ACDF-ACP in the outpatient setting.

About Author Dr. Kingsley R. Chin

Dr. Kingsley R. Chin, Founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin is a board-certified Harvard-trained Orthopedic Spine Surgeon and Professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, Visiting Spine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Sciences at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.

Scientific Paper Author & Citation Details

Authors

Kingsley R. Chin, MD1,2,3,Fabio J.R. Pencle, MB BS3, Jason A. Seale, MB BS3

Author information

1. Herbert Wertheim College of Medicine at Florida International University

2. Charles E. Schmidt College of Medicine at Florida Atlantic University

3. Less Exposure Surgery (LES) Society

4. Less Exposure Surgery Specialists Institute (LESS Institute).

Clinical Experience and Two Year Follow up With a One-Piece Viscoelastic Cervical Total Disc Replacement

By Dr. Kingsley Chin

Scientific Paper

Kingsley Richard Chin, Jacob Ryan Lubinski, Kari Bracher Zimmers, Barry Eugene Sands, Fabio Pencle

Interested medical professionals can read through the full paper, as published in the Journal of Spine Surgery, here.

The AxioMed Freedom Cervical Disc

Background

The purpose of this study is to present clinical outcome data from a 2-year post-market study of a viscoelastic one-piece cervical total disc replacement (TDR) in Europe.

Methods

Thirty-nine patients were implanted at five surgical sites in an European post-market clinical study. Clinical outcomes included improvement of neck disability index (NDI) and visual analog scale scores for neck and arm pain from baseline to 2-year follow-up, neurological examinations, patients view on the success of surgery, complications, and subsequent surgical interventions..

Results

Thirty patients had the Freedom® Cervical Disc (FCD) implanted at a single level, and nine patients were implanted at two adjacent levels. The population had a similar distribution of male [20] and female [19] subjects, with a mean age of 45 years. All self-administered outcome measures showed significant clinically important improvements from baseline to the 2-year follow-up. Mean preoperative NDI score improved from 48% to 20%, 13%, 8%, 6% and 4% at 6 weeks, 3, 6, 12, and 24 months, respectively. Average preoperative visual analog scale (VAS) scores of the neck, right and left arm pain intensity and frequency showed significant improvement. All neurological outcome measurements showed immediate improvement from preoperative values and continued improvement throughout 2 years follow-up. From pre-op to 24 months, neurological deficits declined in the population from 21% to 6% for reflex function, 62% to 17% for sensory function, and 38% to 3% for motor function. No patients experienced a deterioration in any measured outcomes compared with the preoperative situation. Patient satisfaction increased over 2 years post-op, with 83% of patients responding that they would “definitely” choose to have the same treatment for their neck/arm condition and another 11% responding that they would “probably” choose to have the same treatment.

Lateral flexion and extension X-rays of TDR at C6/C7 at 2 years. TDR, total disc replacement.

Lateral flexion and extension X-rays of TDRs at C5/C6 and C6/C7 at 1 year. TDR, total disc replacement.

Conclusions

The FCD performs as expected in patients with single-level and two-level degenerative disc disease.

About Author Dr. Kingsley R. Chin

Dr. Kingsley R. Chin, Founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin, Founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin is a board-certified Harvard-trained Orthopedic Spine Surgeon and Professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, Visiting Spine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Sciences at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.

Scientific Paper Author & Citation Details

Authors

Kingsley Richard Chin¹, Jacob Ryan Lubinski¹, Kari Bracher Zimmers¹, Barry Eugene Sands², Fabio Pencle³

Author information

¹AxioMed LLC, Malden, MA, USA; ²RQMIS, Inc. Amesbury, MA, USA; ³Less Exposure Surgery Society, Malden, MA, USA Contributions: (I) Conception and design: All authors; (II) Administrative support: KB Zimmers, BE Sands; (III) Provision of study materials or patients: BE Sands; (IV) Collection and assembly of data: BE Sands; (V) Data analysis and interpretation: BE Sands, KB Zimmers; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Kari Bracher Zimmers. AxioMed LLC, Malden, MA, USA. Email: kzimmers@axiomed.com

Eligibility of Outpatient Spine Surgery Candidates in a Single Private Practice

By Dr. Kingsley Chin

Here, Becker’s ASC Review highlights 4 key points from this LES Society study conducted in part by The LESS Institute team.

Scientific Paper

Chin KR1,2, Pencle FJR2, Coombs AV3, Packer CF3, Hothem EA3, Seale JA2.

Interested medical professionals can read through the full paper, also published in Clinical Spine Surgery, here.

Study Design

Level III.

Purpose

To retrospectively review the eligibility of surgical patients meeting predetermined outpatient surgery criteria in a single-surgeon private practice.

Summary of Background Data

There is a burgeoning awareness among patients, surgeons, and insurers of the cost benefits and safety of outpatient spine surgeries. At the end of 2014, Centers for Medicare & Medicaid Services have released its final 2015 payment rules and codes for spinal decompression and fusion. This move confirms the safety of procedures being performed in the ambulatory surgery centers (ASCs).

Methods

We conducted a database review between 2008 and 2014 and identified 1625 orthopedic procedures. All nonsurgical spine procedures were excluded from the study. Eligibility for outpatient spine surgery was based on criteria generated from a combination of published standard of care for major operations and the chief surgeon’s experience. A matched cohort based on type of surgery in each facility of all spine surgery patients was created, group 1 (hospital patients) and group 2 (ASC patients).

Results

A total of 708 patients underwent spinal surgery during this time period with a 53% female population. A total of 557 of 708 (79%) patients were eligible for outpatient spine surgery. There were 210 surgical procedures in group 1 (inpatient) comprised of 72 decompression and 138 fusion procedures. In group 2 (outpatient), there were 347 procedures made up of 150 patients undergoing decompression and 197 undergoing fusion or disc replacement. To confirm that hospital procedures are eligible to be performed in the ASC, the χ test was performed. We found that ASC-eligible hospital patients can indeed be done in an ASC (P=0.037).

Conclusions

Outpatient spine surgery is feasible in 79% of patients in this single-surgeon private practice. On the basis of these results, a majority of spine procedures can be performed in an outpatient setting following our eligibility criteria.

About Author Dr. Kingsley R. Chin

Dr. Kingsley R. Chin, founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin is a board-certified Harvard-trained Orthopedic Spine Surgeon and Professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, Visiting Spine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Sciences at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.

About SpineFrontier

The above study utilized LES Technology from SpineFrontier – leading provider of LES Technologies and instruments – offering surgeons and patients superior technology and services.

Scientific Paper Author & Citation Details

Authors

Chin KR1,2, Pencle FJR2, Coombs AV3, Packer CF3, Hothem EA3, Seale JA2.

Author information

1. Herbert Wertheim College of Medicine at Florida International University and Charles E. Schmidt College of Medicine at Florida Atlantic University.

2. Less Exposure Surgery Specialists Institute (LESS Institute).

3. Less Exposure Surgery Society (LES Society).

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Clinical Outcomes With Midline Cortical Bone Trajectory Pedicle Screws Versus Traditional Pedicle Screws in Moving Lumbar Fusions From Hospitals to Outpatient Surgery Centers

By Dr. Kingsley Chin

Scientific Paper

Chin KR1, Pencle FJR, Coombs AV, Elsharkawy M, Packer CF, Hothem EA, Seale JA.

Interested medical professionals can read through the full paper, also published in Clinical Spine Surgery, here.

Study Design

Level III.

Objective

To report on the outcomes of midline cortical bone trajectory (CBT) pedicle screw surgical technique for posterior lumbar fixation in the outpatient surgery center (OSC) compared with traditional pedicle screws in the hospital.

Summary of Background Data

Traditional pedicle screws have been the gold standard for posterior lumbar fusion. Advances in spine surgery, including less invasive procedures have propelled the design of instruments and implants to achieve greater posterior spinal fixation, with decreased tissue destruction and higher safety margins. Biomechanical studies have validated the superior pullout strength of cortical screws versus the traditional pedicle screws and represent an opportunity to perform safe lumbar fusions in OSCs with same day discharge.

Materials & Methods

The medical records of 60 patients with prospectively collected data were reviewed. Two matched cohort groups consisting of 30 patients each, CBT pedicle screws performed in OSC patients (group 1) was compared with traditional pedicle screws performed in hospital patients (group 2). Outcomes were assessed with self-reported Visual Analog Scale (VAS) scores, Oswestry Disability Index scores, and radiologic fusion rate.

Results

Totally, 33 males and 27 females, age range (28-75), average 58±3 years. Average body mass index was 29±1.15 kg/m. A total of 65% of surgeries were at L5-S1 level. Significant improvement noted in VAS back pain scores in the OSC group from 7.8±0.5 to 2.5±0.7, P=0.001. Comparing intergroup VAS back pain scores and Oswestry Disability Index scores, OSC group demonstrated significant improvement, P=0.004 and 0.027, respectively. Fusion rate at 2 years was similar, P=0.855 between groups.

Conclusions

We successfully transitioned our lumbar fusions from hospitals to OSCs using a midline CBT pedicle screw technique. Although traditional pedicle screw placement is effective and may be viable in an OSC, we see more advantages to use midline cortical screws over traditional pedicle screws.

About Author Dr. Kingsley R. Chin

Dr. Kingsley R. Chin is a board-certified Harvard-trained Orthopedic Spine Surgeon and Professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, Visiting Spine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Sciences at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.

About SpineFrontier

The above study utilized LES Technology from SpineFrontier – leading provider of LES Technologies and instruments – offering surgeons and patients superior technology and services.

Scientific Paper Author and Citation Details

Authors

Chin KR1, Pencle FJR, Coombs AV, Elsharkawy M, Packer CF, Hothem EA, Seale JA.

Author information

1. *Herbert Wertheim College of Medicine at Florida International University †Charles E. Schmidt College of Medicine at Florida Atlantic University, Miami ‡Less Exposure Surgery Specialists Institute (LESS Institute) §Less Exposure Surgery (LES) Society, Fort Lauderdale, FL.

The LESS Institute Gives Back: Jamaica’s First A-CIFT SoloFuse-P Case

By Abagail Sullivan

On July 3, 2015 Dr. Kingsley R. Chin of the LESS Institute in Florida and Jamaican Neurosurgeon Dr. Franz Pencle performed a Less Exposure Surgery procedure on a middle age, male patient who suffered from severe myelopathy (spinal cord compression) due to a progressive degenerative disorder. The procedure took place at Cornwall Regional Hospital in Montego Bay, Jamaica. Before surgery, the patient was incapacitated. “He was basically quadriplegic,” Dr. Fabio Pencle, a LESS Institute Research Fellow who supported the case says. “On his strength test, he scored a 1/5 throughout all limbs –which means he could barely flicker his digits.” Dr. Fabio Pencle believes that the patient survived because of treatment. “Patients with similar symptoms demised because they didn’t receive timely treatment,” says Dr. Fabio Pencle.

Dr. Chin, Dr. Franz Pencle and Dr. Fabio Pencle donated their time for the case and SpineFrontier donated the SoloFuse hardware. The Less Exposure Surgery (LES) procedure was performed through a midline cervical incision, dissection to expose the affected level and a discectomy using rongeurs and burr. A DBM packed A-CIFT SoloFuse was placed and fixed with screws. This was the first case a standalone implant in Jamaica. It was also the first outpatient spine surgery done at Cornwall Hospital. The patient could sit upright twelve hours after surgery, and he tested 5/5 on a strength test in the upper limbs and 4/5 in the lower limbs –indicating that he had significant improvement in less than 24 hours.

About SpineFrontier’s A-CIFT™ SoloFuse-P™

The A-CIFT SoloFuse-P standalone Less Exposure Surgery system features a simple dual screw construct, a large graft window, large diameter screws, and slim, agile instrumentation. Its zero-profile and all PEEK-OPTIMA Natural design minimizes tissue disruption.

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Soft Tissue Swelling Incidence Using Demineralized Bone Matrix in the Outpatient Setting

By Dr. Kingsley Chin

Scientific Paper

Chin KR1, Pencle FJR2, Seale JA3, Valdivia JM3.

Interested medical professionals can read through the full paper, published in the Journal of the AAOS, here.

Aim

To assess use of demineralized bone matrix (DBM) use in anterior cervical discectomy and fusion (ACDF) in outpatient setting.

Methods

One hundred and forty-five patients with prospectively collected data undergoing single and two level ACDF with DBM packed within and anterior to polyetheretherketone (PEEK) cages. Two groups created, Group 1 (75) outpatients and control Group 2 (70) hospital patients. Prevertebral soft tissue swelling (PVSTS) was measured anterior to C2 and C6 on plain lateral cervical radiographs preoperatively and one week postoperatively and fusion assessed at two years.

Results

There was no intergroup significance between preoperative and postoperative visual analogue scales (VAS) and neck disability index (NDI) scores between Group 1 and 2. Mean preoperative PVSTS in Group 1 was 4.7 ± 0.2 mm at C2 level and 11.1 ± 0.5 at C6 level compared to Group 2 mean PVSTS of 4.5 ± 0.5 mm and 12.8 ± 0.5, P = 0.172 and 0.127 respectively. There was no radiographic or clinical evidence of adverse reaction noted. In Group 1 mean postoperative PVSTS was 5.5 ± 0.4 mm at C2 and 14.9 ± 0.6 mm at C6 compared Group 2 mean PVSTS was 4.9 ± 0.3 mm at C2 and 14.8 ± 0.5 mm at C6, P = 0.212 and 0.946 respectively. No significant increase in prevertebral soft tissue space at C2 and C6 level demonstrated.

Preoperative radiograph showing retropharyngeal/prevertebral soft tissue at the level of C2 vertebral body and at the level of C6 vertebral body.

Conclusion 

ACDF with adjunct DBM packed PEEK cages showed a statistical significant intragroup improvement in VAS neck pain scores and NDI scores (P = 0.001). There were no reported serious patient complications; post-operative radiographs demonstrated no significant difference in prevertebral space. We conclude that ACDF with DBM-packed PEEK cages can be safely done in an ASC with satisfactory outcomes.

About Author Dr. Kingsley R. Chin

Dr. Kingsley R. Chin is a board-certified Harvard-trained Orthopedic Spine Surgeon and Professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, Visiting Spine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Sciences at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.

About SpineFrontier

The above study utilized LES Technology from SpineFrontier – leading provider of LES Technologies and instruments – offering surgeons and patients superior technology and services.

Scientific Paper Author and Citation Details

Authors

Chin KR1, Pencle FJR2, Seale JA3, Valdivia JM3.

Author information

• Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL 33431, United States.

• Less Exposure Surgery Society, Malden, MA 02148, United States. fabiopencle@thelessinstitute.com.

• Less Exposure Surgery Specialists Institute, Fort Lauderdale, FL 33311, United States.