Selected Podcast

Treatment of the Degenerative Spine

Wayne Olan, MD, discusses conditions of the degenerative spine. He highlights compression fracture and how the initial treatment was conservative management and bracing these patients, but over the course of time, it's shown that patients who are treated earlier with minimally invasive procedures have better outcomes. Additionally, he shares how careful patient selection sets you up for success for both the physician and for the patient.
Treatment of the Degenerative Spine
Wayne Olan, MD
Wayne Olan, MD, serves as the director of interventional and endovascular neurosurgery at the GW Medical Faculty Associates. He is an associate professor and director of minimally invasive and endovascular neurosurgery at The George Washington University School of Medicine & Health Sciences. He is affiliated with The George Washington University Hospital.

Learn more about Wayne Olan, MD

Melanie Cole (Host): Welcome to GW Doc Pod, a peer to peer podcast for medical professionals with The George Washington University Hospital. I'm Melanie Cole. And joining me today is Dr. Wayne Olan. He's the Director of Minimally Invasive and Endovascular Neurosurgery at The George Washington University School of Medicine & Health Sciences, and he's affiliated with The George Washington University Hospital. He's here today to highlight treatment of the degenerative spine.

Dr. Olan, thank you so much for joining us today. As we get into this topic, I'd like you to start by telling us about degenerative spine conditions, including osteoporotic fractures, degenerative spinal stenosis. Tell us a little bit about the prevalence and the impact that they have on the quality of life of patients.

Dr. Wayne Olan: Well, first and foremost, Melanie, thank you so much for having me. It's a real privilege for me to be here and to provide this kind of care to our patients, to be at this cutting edge. So I really appreciate you giving us this opportunity. When we're talking about the degenerative spine, initially some people will initially think it means it's also about people who are more elderly. That is true to some degree, but it's certainly some of these issues we see in patients throughout their life, depending on whether they have some other conditions or lifestyles that might predispose them to early degenerative changes in their spine. So, it's not just for the more experienced people. Sort of a lot of times, this will fit everybody.

With respect to degenerative spine, we're talking about things that you acquire as you go through life, as opposed to things that are congenital or part of you when you're born or you're predisposed to. And so we're talking about things that as you go through life occur to you or occur to your spine from wear and tear or other disease processes or illnesses that might affect your bone density and things like that. So that's predominantly what we're talking about.

With respect to one of those issues, one of the big ones is osteoporosis. Osteoporosis is essentially an epidemic. More people have it than people think. There are about a million spine fractures every year in this country as a result of osteoporosis and probably close to 1.75 million other part of the body fractures or fractures in total, just from osteoporosis. As our population's aging, the number's continuing to rise and it's risen over the last 20 years. This is an epidemic. It's going to get worse as our population gets older and older. People live longer, they're more likely to get osteoporosis and then subsequently their lifestyle is more likely to lead them to a fracture.

Melanie Cole (Host): Such an interesting topic. And I agree with you completely. Now, before we discuss procedures, Dr. Olan, I'd like you to speak to other providers about some of the conservative measures that you and your special expertise would try before going into back surgery for these conditions.

Dr. Wayne Olan: Well, first and foremost, one of the things we're going to consider is a minimally invasive treatment. And the data is out there that supports what we're about to talk about, and it's not even controversial anymore. With respect to osteoporosis, if somebody undergoes or experiences a compression fracture, the pain from that fracture can be debilitating, life-changing, not just to the patient, but to their immediate family, anybody, their caretakers. Somebody who is entirely independent can be essentially dependent. There's no question about it, for a very long period of time, the initial treatment with this conservative management was bracing these patients for a period of time to see if they healed. But over the course of time, and with respect to data that's now been submitted, it's shown that patients who are treated earlier, not only do they do better, but if somebody can go through the minimally invasive procedure to fix this fracture, as opposed to being braced, they will live longer, period end. They will have a better morbidity mortality than those who are treated conservatively. And that's been established in several very large number studies out to 2 million patients.

Now, we're not talking about surgery. We're talking about minimally invasive procedures through a needlestick that don't require stitches when we're finished. They require minimal sedation. They're not an overnight stay. The patients go home the same day. And the results really are almost miraculous. Patients go from being debilitated to almost immediately postoperative back to their baseline level of pain. And not just the patient, but all their caretakers, their immediate family breathe an entire sigh of relief that they'll be able to get back to their lifestyle.

Melanie Cole (Host): Absolutely an exciting time to be in your field, Dr. Olan. So why don't you tell us about the minimally invasive spine surgeries that you're discussing, the devices that you're using, especially for spinal stenosis that can get patients from pain to dancing in two days. Tell us a little bit about these devices that you are discussing here today and how fascinating they are.

Dr. Wayne Olan: Let's talk a little bit first about vertebral augmentation or the procedures that we do as a result of an osteoporotic fracture. It used to be we'd leave the fracture in its fractured state, even though we would fill it with cement or a bone epoxy to take the pain away, it stops the bone from moving immediately. That's why you get these sort of immediate results. It's like putting a cast on it from the inside. But over the last 20 years, it's the only fracture in the body that's left in its fractured state. In other words, if you break your arm or even your collarbone or your leg, the fracture gets reduced or restored back to its anatomic relationships prior to being fixed.

Finally, we have a device called SpineJack that allows us to do that. SpineJack prior to putting the cement in, allows us to reduce the fracture, elevate back the endplate to give the vertebral body back its initial configuration prior to the fracture. From a pain relief statistic, no question it's about similar to just fixing the fracture. But without a doubt and statistically significantly, it reduces the risk of other fractures in that patient going forward by changing the configuration and restoring the height back to that vertebral body. So that's really a very, very new entree into our ability to treat these patients. The device is very easy to use. It doesn't add much time to the procedure. It doesn't cost more than anything else, and it's really become the gold standard in treating these patients, especially the ones whose first fracture has just occurred. It gives us a chance to potentially make someone's first fracture their last fracture.

With respect to spinal stenosis, it's a little bit different. Spinal stenosis is a little bit of a different entity. And it's a narrowing of the canal throughout somebody's life that holds all the nerves in your back. It happens low down in your spine. And the patients usually present with symptoms like they're able to walk for a short period of time, but then they have to sit down to relieve their pain and their pain can be debilitating, in their thighs, back in their hamstrings, in their calves. But once they sit down, the pain goes away. They'll tell you they enjoy going to the grocery store because they get to lean over the shopping cart. And the only type of exercise they can really do is ride a bike because they're kind of bent over in that state while they're sitting on the bike seat. Those are sort of dead giveaways that somebody has spinal stenosis.

Years ago, all you can do for those patients sometimes was an epidural injection and they may get relief, but you're not fixing the problem. So more often than not, that discomfort, the symptoms will come back. And then the last thing you could do is a surgical intervention. Clear operation, make an incision and take off the bone in the back to try and release that canal. Take that circle and take the back half of the circle off. The results from that have not been phenomenal, they've been okay. But it's still a significant surgical procedure that patients that may not be able to tolerate anesthesia or a surgical option are willing to take on.

So a new device has come along and it's called an interspinous spacer. And again, it's percutaneous. What does that mean? It's done through a tiny needlestick essentially that doesn't require stitches when we're done, patient goes home the same day and the results are almost immediate. You place a device in from the back and it opens up like two sets of wings, almost looks like an H. And it elevates up the distance between two vertebral bodies, subsequently releasing that pressure that's occurred on the nerves. And that's where we have a patient who had it done on Thursday and was dancing at his daughter's wedding on Saturday night.

Melanie Cole (Host): How exciting. So let's speak about patient selection and also benefits. We hear about benefits to the patient all the time, Dr. Olan, with these procedures and minimally invasive procedures, especially spinal procedures. But what about the benefits to the surgeon? You mentioned it's not a difficult procedure to learn. I'd like you to speak about that learning curve and really patient selection and how important that might be for better outcomes.

Dr. Wayne Olan: There's no question, and you just touched on probably the most important thing there is. Patient selection sets you up for success for both the physician and for the patient. The outcome is 100% a result of picking the right patient for the procedure. And not every "patient who just has back pain" is a candidate for these procedures. So someone with an acute compression fracture, meaning that the fracture has happened recently. And there's still movement in that bone, which is easy to see on an MRI, is a great candidate for what we would call vertebral augmentation, whether it be vertebroplasty, kyphoplasty, which SpineJack is one of the procedures that falls under that umbrella.

With respect to the spinal stenosis, there's no question about it, you need an MRI. The patient's symptoms should, as we described earlier, fit into that model, that it is this stenosis that's causing their problems. More often than not, we will do an initial epidural injection in those patients with lidocaine in the mix, just to show that they get temporary relief at the level that we're interested in treating. If they sort of jump through those hoops, then we know with a very high level of certainty, that that patient's going t obe be a great candidate for the interspinous spacer or that Superion product, because the last thing in the world you want to do or the patient wants to even undergo is a procedure that doesn't give them the relief that they're coming in and looking for. But if we choose patients correctly, we can really make a difference in people's lives and, as somebody once told me, change their stars going forward.

With respect to teaching the procedures, they're fairly simple, very methodical, sort of in the way you go. And they're image-guided and the image sort of milestones that we need are very easy to see. So if physicians were interested in learning them and we teach them now as part of the neurosurgery, orthopedic, and even interventional radiology residencies, we are teaching these procedures as our colleagues are graduating out of their training. They're taking these procedures with them in their bag for their patients.

Melanie Cole (Host): Dr. Olan, what a great guest you are. So I'd like you to wrap up about the unique areas that set you apart. Why it's important to refer to the specialists at the George Washington University Hospital. If someone wants to refer a patient in for treatment of the degenerative spine, when is the best time to do that? Also, and I know this is throwing a lot of questions at you at once, but what's coming in the future of spine surgery that's really exciting you the way that this Superion has done?

Dr. Wayne Olan: This is one of those exciting spots in medicine where technology and innovation are really being embraced. And partially because, one, there weren't treatments available for some of these conditions or the treatments that were available weren't providing the highest level of benefit that we would hope for. And also they might involve more intervention than patients in this portion of their lives we're sort of ready to undergo or capable of undergoing. So it's a very exciting time.

With respect to what may be coming down the pike, there's no question about it, spine surgery is moving more and more toward less and less invasive. The less invasive you can do, the quicker you can generate someone's recovery, the better these people are going to do, period end across the board.

And as we go forward, I think if we had this conversation in two or three years, disk intervention, degenerative disk disease, not just the degenerative spine and disk herniations may be something we're talking about with many more minimally invasive options for providing these patients that kind of relief.

If somebody was interested in getting in touch with us, they can easily call my office at GW. We have a pretty significant web presence, which is easy to find. You could look us up and really learn a lot about what we're doing. And probably, if you get a chance to see some of the stuff, you'll be about as excited as we are about being at this position in sort of the history of medicine to be able to provide these kind of options to our patients that really weren't there prior.

Melanie Cole (Host): Well, I can certainly hear the passion and excitement in your voice, Dr. Olan. Thank you so much. To refer your patient, please call 1-888-4GW-DOCS. Or if you have a question for one of our specialists, you can always email This email address is being protected from spambots. You need JavaScript enabled to view it..

That concludes this episode of GW Doc Pod, a peer to peer podcast for medical professionals with The George Washington University Hospital. I'm Melanie Cole. Thanks so much for tuning in today.

Physicians are independent practitioners who are not employees or agents of the George Washington University Hospital. The hospital shall not be liable for actions or treatments provided by physicians.

Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if minimally invasive surgery is right for you.