Selected Podcast
Northwestern Medicine Spine Center and Study on Spine Surgery
In this episode of the Better Edge podcast, Alpesh A. Patel, MD, professor of Orthopaedic Surgery at Northwestern Medicine, discusses the Northwestern Medicine Spine Center and how the center has streamlined the complex area of spine care. He also talks about his recent publication “Spine Surgery and Ankylosing Spondylitis: Optimizing Perioperative Management,” as well as the optimal treatment strategies for patients with Ankylosing Spondylitis.
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Learn more about Alpesh Patel, MD
Alpesh Patel, MD
Alpesh Patel, MD is Professor of Orthopaedic Surgery and Neurological Surgery at Northwestern MedicineLearn more about Alpesh Patel, MD
Transcription:
Northwestern Medicine Spine Center and Study on Spine Surgery
Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine Podcast for physicians. I'm Melanie Cole. And today, we're highlighting Northwestern Medicine's Spine Center and study on spine Surgery and ankylosing spondylitis. Joining me is Dr. Alpesh Patel. He's a Professor of Orthopedic and Neurologic Surgery at Northwestern Medicine.
Dr. Patel, it's a pleasure to have you join us today. I'd like you to start by speaking to other providers about ankylosing spondylitis, how it's characterized, and why do these patients present several unique challenges that require specific attention around spine surgery.
Alpesh Patel, MD: Yeah. Thank you so much for the opportunity, Melanie. I do appreciate it. So, ankylosing spondylitis, to simplify it, is a chronic inflammatory condition that can affect a number of people, both men and women and typically presents early on with joint pain or low back pain in particular. And I think that's the crux of the discussion point, is that many younger adults will have low back pain from common issues, sprains and strains and injuries, but there's a far probably high number of undiagnosed or underdiagnosed patients with ankylosing spondylitis as a cause of low back pain.
Melanie Cole, MS: That's so interesting. So, are there conservative management options you would try before you consider surgery in a specific subset of patients?
Alpesh Patel, MD: Absolutely. So there is, to your point, again, a very small group, thankfully small group of patients who need spine surgery for ankylosing spondylitis. However, those patients, when they need surgical management, represent a level of complexity and risk that really requires subspecialty care. To answer your question about non-surgical or conservative management, absolutely it's typically anti-inflammatory medications. Although now, there are the development of new biologic treatments that have the potential to really abate some of the long-term impact of ankylosing spondylitis on both joint health as well as on cardiovascular health and other organ systems.
Melanie Cole, MS: Now, for that specific subset, Dr. Patel, tell us about your recent publication, Spine Surgery and Ankylosing Spondylitis: Optimizing that Perioperative Management, explain a few of those optimal strategies for perioperative management for patients.
Alpesh Patel, MD: Absolutely. As I mentioned, again, surgery in this patient group is a highly complex one that carries a fair amount of risk, both intraoperatively and post-operatively. And so in that publication that you referenced, we had the opportunity with some co-authors to really lay out a framework for how we approach these complex situations so that we can provide more consistent surgical advice and, again, safer and better surgical outcomes. So, that framework involves a very organized approach to patients, first of all, in the decision-making process of should this individual patient have surgery or not, that's a very nuanced question and really requires a lot of input from the patient, from the surgeon, from the patient's healthcare team, and from their caregivers and family members.
The next steps really revolve around medical optimization and understanding that ankylosing spondylitis can affect many organ systems, specifically cardiac involvement, and that's a very high risk around surgical care. So coming up with standardized approaches to assess patients prior to surgery is actually unbelievably important and not surprisingly requires coordination of care and multidisciplinary care that we have at Northwestern.
Melanie Cole, MS: And we're going to get into that. But as spine care is so complicated, Dr. Patel, how much does the experience of the surgeon matter? Do you have any technical considerations you'd like to just let providers know about as this has a learning curve when you're dealing with patients such as these?
Alpesh Patel, MD: Absolutely. I think the complexity of surgery in this patient population, to be very blunt, represents the highest degree of surgical complexity that we see in spine care. So, individuals with ankylosing spondylitis are prone to sort of two situations where we might need to intervene as surgeons. One setting is the setting of an injury or a fracture. Patients with ankylosing spondylitis can fracture much easier than individuals without ankylosing spondylitis, and those fractures can lead to neurological injuries, spinal cord injuries at a higher rate. And so, the active management of that acutely traumatized patient population, again, requires a level of experience and technical know-how that's not commonplace, and that really resides in specialized centers.
The other situation where individuals need surgery is that as ankylosing spondylitis continues, it can create spinal deformities. So, we may have heard about terms such as scoliosis, as one example of a curved or deformed spine. Ankylosing spondylitis has a little bit of a different situation, which is where people have a difficult time standing up. They're bent forward or pitched forward and create a lot of back pain and chronic disability. In that setting, there are surgical procedures that can be done to improve alignment and posture of the spine, to help improve quality of life. But again, the technical considerations of those surgeries are very high and, again, really should only be done at specialized centers with a lot of experience, not just experienced surgeons, but really a full team of healthcare providers to help in the perioperative management of these patients.
Melanie Cole, MS: Well, I'd like you to speak about that multidisciplinary approach, Dr. Patel, as there is high degree of coordination that's required. Speak about the pre-, peri- and post-operative management and how it all ties together for better outcomes. Is ERAS involved? Tell us about who are all the people that are involved.
Alpesh Patel, MD: Yeah. There's a lot too many to name, I think, entirely. But the idea is that it's not just the surgeon, it's not just the patient that are going down or going through this journey together. We include our anesthesiologists, we include our hospital medicine providers to help us in the acute management patients. We always want to involve the patient's primary care, physician or provider in that discussion as well. Ultimately, the caregivers of the patients are involved. There's a lot of stakeholders, if you will, involved in that conversation. The key part is to be really methodical and consistent in how we evaluate patients prior to surgery, so that, for example, at Northwestern with our spine program, every patient high complexity like ankylosing spondylitis; low complexity like a lumbar or cervical disc herniation goes through a very regimented perioperative assessment that's standardized. And we really, really track that closely to ensure that we're providing that high level of quality of care, but delivering it in a very consistent manner across all of our patients.
Melanie Cole, MS: One of the things I've seen that is so exciting in your field, Dr. Patel, is AI and other innovative technologies that are making spine surgeries more accurate, safer, accessible. Can you speak about what's exciting?
Alpesh Patel, MD: Oh my gosh, absolutely. This whole field is super exciting. And as we think maybe about the use case of an artificial intelligence, this idea around perioperative optimization or risk stratification is where predictive analytics that an AI algorithm might bring to the table could be really valuable. We have a group working within our department, really building out the infrastructure for good, predictive analytics to look at post-operative outcomes and how they might relate to perioperative management. So, it's a super exciting field. It's one that we're just scratching the surface of. I'm excited that in the next five to six years, we'll see a substantial amount of progress that really not just scratches an academic itch, but really solves a problem for surgeons, for patients in the delivery of safe, reproducible surgical care.
Melanie Cole, MS: Such an interesting topic and an exciting time to be in your field, Dr. Patel. As we wrap up, how is the Northwestern Medicine Center for Spine Health streamlining that patient care? I'd like you to just tell us about the program and how you'd like physicians to refer their patients and when you feel it's important that they refer their patients to the Center for Spine Health.
Alpesh Patel, MD: Yeah. Again, thank you. I would say if I were to summarize what we're doing at the Northwestern Center for Spine Health is really, we're trying to take the complexity of spine care and make it simpler. And that's simpler for patients, of course, but also simpler for our partner referring physicians, referring providers.
It's oftentimes an uncertainty, if you will, as to who to send a patient to, when to send them, why do I send them to one spine care provider versus another? And we've tried to through collaboration and consolidation of services in our spine, again, create simplicity for patients and for referring providers. Basically, we're trying to take that burden off their shoulders. So, I would say to answer your question of when should they send a patient to our spine center is really at any spectrum or any point in the continuum of a low back or a neck or a neurological event where whether it's early or relatively late, if there's a thought that, you know, my patient might benefit from advice from our spine specialists at Northwestern, they should send that patient to us and let us take on the complexity and unburden them from their practices.
Melanie Cole, MS: Thank you so much, Dr. Patel. What a fascinating interview this was. And thank you for joining us and sharing your expertise for providers that may not know a lot about ankylosing spondylitis. To refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/orthopedics to get connected with one of our providers. And that concludes this episode of Better Edge, a Northwestern Medicine Podcast for physicians. I'm Melanie Cole. Thanks so much for joining us today.
Northwestern Medicine Spine Center and Study on Spine Surgery
Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine Podcast for physicians. I'm Melanie Cole. And today, we're highlighting Northwestern Medicine's Spine Center and study on spine Surgery and ankylosing spondylitis. Joining me is Dr. Alpesh Patel. He's a Professor of Orthopedic and Neurologic Surgery at Northwestern Medicine.
Dr. Patel, it's a pleasure to have you join us today. I'd like you to start by speaking to other providers about ankylosing spondylitis, how it's characterized, and why do these patients present several unique challenges that require specific attention around spine surgery.
Alpesh Patel, MD: Yeah. Thank you so much for the opportunity, Melanie. I do appreciate it. So, ankylosing spondylitis, to simplify it, is a chronic inflammatory condition that can affect a number of people, both men and women and typically presents early on with joint pain or low back pain in particular. And I think that's the crux of the discussion point, is that many younger adults will have low back pain from common issues, sprains and strains and injuries, but there's a far probably high number of undiagnosed or underdiagnosed patients with ankylosing spondylitis as a cause of low back pain.
Melanie Cole, MS: That's so interesting. So, are there conservative management options you would try before you consider surgery in a specific subset of patients?
Alpesh Patel, MD: Absolutely. So there is, to your point, again, a very small group, thankfully small group of patients who need spine surgery for ankylosing spondylitis. However, those patients, when they need surgical management, represent a level of complexity and risk that really requires subspecialty care. To answer your question about non-surgical or conservative management, absolutely it's typically anti-inflammatory medications. Although now, there are the development of new biologic treatments that have the potential to really abate some of the long-term impact of ankylosing spondylitis on both joint health as well as on cardiovascular health and other organ systems.
Melanie Cole, MS: Now, for that specific subset, Dr. Patel, tell us about your recent publication, Spine Surgery and Ankylosing Spondylitis: Optimizing that Perioperative Management, explain a few of those optimal strategies for perioperative management for patients.
Alpesh Patel, MD: Absolutely. As I mentioned, again, surgery in this patient group is a highly complex one that carries a fair amount of risk, both intraoperatively and post-operatively. And so in that publication that you referenced, we had the opportunity with some co-authors to really lay out a framework for how we approach these complex situations so that we can provide more consistent surgical advice and, again, safer and better surgical outcomes. So, that framework involves a very organized approach to patients, first of all, in the decision-making process of should this individual patient have surgery or not, that's a very nuanced question and really requires a lot of input from the patient, from the surgeon, from the patient's healthcare team, and from their caregivers and family members.
The next steps really revolve around medical optimization and understanding that ankylosing spondylitis can affect many organ systems, specifically cardiac involvement, and that's a very high risk around surgical care. So coming up with standardized approaches to assess patients prior to surgery is actually unbelievably important and not surprisingly requires coordination of care and multidisciplinary care that we have at Northwestern.
Melanie Cole, MS: And we're going to get into that. But as spine care is so complicated, Dr. Patel, how much does the experience of the surgeon matter? Do you have any technical considerations you'd like to just let providers know about as this has a learning curve when you're dealing with patients such as these?
Alpesh Patel, MD: Absolutely. I think the complexity of surgery in this patient population, to be very blunt, represents the highest degree of surgical complexity that we see in spine care. So, individuals with ankylosing spondylitis are prone to sort of two situations where we might need to intervene as surgeons. One setting is the setting of an injury or a fracture. Patients with ankylosing spondylitis can fracture much easier than individuals without ankylosing spondylitis, and those fractures can lead to neurological injuries, spinal cord injuries at a higher rate. And so, the active management of that acutely traumatized patient population, again, requires a level of experience and technical know-how that's not commonplace, and that really resides in specialized centers.
The other situation where individuals need surgery is that as ankylosing spondylitis continues, it can create spinal deformities. So, we may have heard about terms such as scoliosis, as one example of a curved or deformed spine. Ankylosing spondylitis has a little bit of a different situation, which is where people have a difficult time standing up. They're bent forward or pitched forward and create a lot of back pain and chronic disability. In that setting, there are surgical procedures that can be done to improve alignment and posture of the spine, to help improve quality of life. But again, the technical considerations of those surgeries are very high and, again, really should only be done at specialized centers with a lot of experience, not just experienced surgeons, but really a full team of healthcare providers to help in the perioperative management of these patients.
Melanie Cole, MS: Well, I'd like you to speak about that multidisciplinary approach, Dr. Patel, as there is high degree of coordination that's required. Speak about the pre-, peri- and post-operative management and how it all ties together for better outcomes. Is ERAS involved? Tell us about who are all the people that are involved.
Alpesh Patel, MD: Yeah. There's a lot too many to name, I think, entirely. But the idea is that it's not just the surgeon, it's not just the patient that are going down or going through this journey together. We include our anesthesiologists, we include our hospital medicine providers to help us in the acute management patients. We always want to involve the patient's primary care, physician or provider in that discussion as well. Ultimately, the caregivers of the patients are involved. There's a lot of stakeholders, if you will, involved in that conversation. The key part is to be really methodical and consistent in how we evaluate patients prior to surgery, so that, for example, at Northwestern with our spine program, every patient high complexity like ankylosing spondylitis; low complexity like a lumbar or cervical disc herniation goes through a very regimented perioperative assessment that's standardized. And we really, really track that closely to ensure that we're providing that high level of quality of care, but delivering it in a very consistent manner across all of our patients.
Melanie Cole, MS: One of the things I've seen that is so exciting in your field, Dr. Patel, is AI and other innovative technologies that are making spine surgeries more accurate, safer, accessible. Can you speak about what's exciting?
Alpesh Patel, MD: Oh my gosh, absolutely. This whole field is super exciting. And as we think maybe about the use case of an artificial intelligence, this idea around perioperative optimization or risk stratification is where predictive analytics that an AI algorithm might bring to the table could be really valuable. We have a group working within our department, really building out the infrastructure for good, predictive analytics to look at post-operative outcomes and how they might relate to perioperative management. So, it's a super exciting field. It's one that we're just scratching the surface of. I'm excited that in the next five to six years, we'll see a substantial amount of progress that really not just scratches an academic itch, but really solves a problem for surgeons, for patients in the delivery of safe, reproducible surgical care.
Melanie Cole, MS: Such an interesting topic and an exciting time to be in your field, Dr. Patel. As we wrap up, how is the Northwestern Medicine Center for Spine Health streamlining that patient care? I'd like you to just tell us about the program and how you'd like physicians to refer their patients and when you feel it's important that they refer their patients to the Center for Spine Health.
Alpesh Patel, MD: Yeah. Again, thank you. I would say if I were to summarize what we're doing at the Northwestern Center for Spine Health is really, we're trying to take the complexity of spine care and make it simpler. And that's simpler for patients, of course, but also simpler for our partner referring physicians, referring providers.
It's oftentimes an uncertainty, if you will, as to who to send a patient to, when to send them, why do I send them to one spine care provider versus another? And we've tried to through collaboration and consolidation of services in our spine, again, create simplicity for patients and for referring providers. Basically, we're trying to take that burden off their shoulders. So, I would say to answer your question of when should they send a patient to our spine center is really at any spectrum or any point in the continuum of a low back or a neck or a neurological event where whether it's early or relatively late, if there's a thought that, you know, my patient might benefit from advice from our spine specialists at Northwestern, they should send that patient to us and let us take on the complexity and unburden them from their practices.
Melanie Cole, MS: Thank you so much, Dr. Patel. What a fascinating interview this was. And thank you for joining us and sharing your expertise for providers that may not know a lot about ankylosing spondylitis. To refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/orthopedics to get connected with one of our providers. And that concludes this episode of Better Edge, a Northwestern Medicine Podcast for physicians. I'm Melanie Cole. Thanks so much for joining us today.