“What makes our new center unique is that we offer a ‘one stop shop’ where a patient can be seen by a surgeon and other experts as needed, get updated imaging and other tests, receive a diagnosis and be given a treatment plan tailored to their specific needs all on the same day,” says Han Jo Kim, MD, director of the new center and HSS spine surgeon. He adds that other centers could take weeks or even months to line up all the necessary appointments and provide a care plan recommendation.

Spine care at the CSSC is bolstered by a combination of highly specialized experts across multiple specialties and a decade of HSS-led research on advanced surgical techniques and recovery pathways. This has helped them transform the most challenging spine surgeries into much more straightforward operations with lower complication rates and faster recovery times.

“We have shortened the time it takes to do these surgeries, reduced complications, decreased patients’ length of stay in the hospital and shortened their recovery time, allowing patients to get back to what they love most,” says Dr. Kim.

The range of specialties the CSSC offers include anesthesiology, infectious disease, interventional radiology, metabolic bone, neurology, pain management, physical therapy, physiatry, and spine surgery. Care navigators help make the care experience easier by guiding patients through next steps, coordinating appointments and when possible, arranging visits with the appropriate physicians and receive any necessary imaging on the same day.

“We are integrating clinical triage so we can get the right patient to the right physician the first time for the care they need, as well as ensure a smooth experience for the patient and the physicians involved,” says HSS spine surgeon Andrew Sama, MD, co-chief of HSS Spine.

This streamlined approach is particularly helpful for the over 1,000 patients who travel to HSS annually from out of state or out of the country to see our surgeons, nearly 500 of whom receive surgery here.

“We want to meet patients where they are, and if they’re traveling a far distance, it’s especially important to make the most of their time here,” says HSS spine surgeon Sheeraz Qureshi, MD, MBA, co-chief of HSS Spine.

CSSC care is available to adult and pediatric patients at HSS locations in Manhattan, Long Island, Brooklyn, Queens, New Jersey, and Connecticut. “HSS has invested a lot into our regional sites so that we can bring complex spine care to the communities we serve,” adds Dr. Qureshi. This builds on the recently opened multidisciplinary Spine Center in Paramus, which expands access to world-class spine care through a collaborative approach and state-of-the-art facilities.”

Another focal point of the CSSC at HSS is the development of a clinical registry to detect and study genetic indicators of risk for a variety of postoperative complications.

“This is next-level precision medicine, where we are using a person’s genetic makeup to mitigate certain risks or complications that they are likely to face after surgery,” explains Dr. Kim. “For example, if we find that somebody is genetically prone to infection or blood clots, we can give them medication to minimize or prevent those risks and ensure they have the smoothest recovery possible.”

To learn more or to request an appointment by submitting your case to the CSSC at HSS, please visit: https://www.hss.edu/departments/spine/complex-spine-and-scoliosis-center

Patient Success Story:

For 20 years, Long Island resident Susan had been living with diffuse idiopathic skeletal hyperostosis (DISH), an osteoarthritic condition that causes ligaments and tendons in the spine to calcify, leading to stiffness and pain. In 2023, after two traumatic falls, Susan endured a spinal cord injury, leaving the 57-year-old unable to lift her head. She scheduled an appointment with Dr. Kim for an evaluation for reconstructive surgery.

“I was totally looking down, and I couldn’t lift my head to see ahead of me. I was very limited, and it was challenging to get around with my walker. I would have been miserable if I had to live the rest of my life like that,” says Susan.

“I knew from my research that Dr. Kim was a superior surgeon, but I was also impressed with how he spoke to me and not at me, and used words I could understand,” Susan recalls. “I felt a connection with him right away and was relieved when he said he could help me.”

Susan had surgery in June of 2025 and after six weeks of recovery and rehabilitation, she says her life has changed for the better.

“Dr. Kim corrected my posture immensely so I can stand up straight, look forward, and see people ahead of me now. My chin is up!” she says. “He changed my appearance and made me look healthier, so I don’t appear distorted or in pain. I’m deeply grateful for what he’s done. Dr. Kim and the care team at HSS made such a meaningful difference in my life.

While Susan has some lingering weakness from the prior spinal cord injury and DISH, having surgery with Dr. Kim has improved her quality of life, allowed her to continue living independently and given her the chance to help care for her aging parents.

A pars fracture ­— also called spondylolysis — is a break in the pars interarticularis, a narrow area of bone connecting two vertebrae in the spine. It typically occurs in the lumbar spine (lower back). About 7 percent of all adolescents experience a pars fracture, and that number can rise to as much as 50 percent among teens engaged in high-risk sports such as gymnastics, football, and soccer.

While these injuries can heal on their own after a six- to eight-week break from sports, one in five adolescents continues to experience a non-healing fracture (nonunion). The pain often returns after resuming activity, and some athletes have been told to quit sports entirely. "Nonunion can cause persistent back pain and, in certain cases, even require lumbar fusion later in life if the fracture results in a vertebral slip, where the vertebrae slip out of place," explained Austin Kaidi, MD, an orthopedic surgery resident at HSS and the study's lead author.

About seven years ago, HSS spine surgeon Sheeraz Qureshi, MD, Co-Chief of HSS Spine and the study's senior author, began using a spine surgery robot to plan the placement of surgical screws in novel ways. His work sparked a shift in the way the HSS surgeons approached pars fracture repairs.

The new minimally invasive technique involves the placement of a single screw through a 1 cm incision — far smaller than traditional surgery to repair a pars fracture, which is performed through a larger incision and requires bone grafting. The robotic procedure is performed on an outpatient basis and is associated with an easier, shorter recovery.

Study: Robotic Pars Repair Allows Early Return to Activity for Adolescents with Symptomatic Spondylolysis: A Case Series

Dr. Kaidi, Dr. Qureshi, and their colleagues performed a retrospective review of nine adolescent patients with lumbar spondylolysis (mean age 16) who had robotic-assisted pars repair at HSS using the single-screw technique. Patients had endured back pain before the surgery for an average of 8 months. After surgery, they participated in an 8-week physical therapy program that started with walking and gradually re-introduced sports-specific exercises.

After a mean follow-up of 11.4 months, five patients had returned to the same or an even higher level of sports. One patient had residual back pain and did not return to sports. Three patients had CT scans at one year demonstrating union of the fracture. The athletes were able to return to activity in as little as six weeks. "Although nonsurgical treatment should always be tried before considering surgery, we were surprised by the effectiveness of this technique for enabling athletes to return to sport," said Dr. Kaidi.

HSS is a leader in robotic-assisted single-screw pars repair and one of only a handful of institutions worldwide who have published on this technique. This study is the largest series ever reported in these patients.

"This safe and effective procedure is changing the way the medical community thinks about these injuries. We are moving away from 'do nothing for 6 weeks' to a more elegant, proactive solution," concluded Dr. Qureshi. “Early minimally invasive spine surgery can prevent future complications. We're not only caring for patients while they are young, but also helping them in the long run.”

Reference

Robotic Pars Repair Allows Early Return to Activity for Adolescents with Symptomatic Spondylolysis: A Case Series

Authors: Austin Kaidi MD, MSc, Michelle Zabat, MD, Amy Xu, MD, Adin Ehrlich, BS, Tomoyuki Asada, MD, PhD, Harvinder Sandhu, MD, Russel Huang, MD, Sravisht Iyer, MD, and Sheeraz Qureshi, MD, MBA

The new Spine Center joins two additional facilities HSS recently opened to expand its footprint in Northern New Jersey: HSS Paramus – Midland Ave, a full-service outpatient center; and the HSS Northern NJ Surgery Center in Mahwah, which marks the first-ever HSS surgery center dedicated to ambulatory procedures in the state. Together, these facilities provide Bergen County residents and beyond with greater access to world-class surgical and non-surgical care across a broad range of specialties.

“HSS has long set the standard for excellence and innovation in spinal care,” said HSS President and CEO and Surgeon-in-Chief Emeritus, Bryan T. Kelly, MD, MBA. “Together with the HSS Northern NJ Surgery Center and HSS Paramus – Midland Avenue, the Spine Center reflects our commitment to making high-quality care accessible to local communities as well as the growing need for spine services in New Jersey.”

A key feature of the center is its integrated approach to spinal health. A multidisciplinary team of experts—including specialists in spine surgery, pain management, neurology, physiatry, and radiology—work together to deliver consistent, first-rate care.  

“Each of our physicians specializes in treating people with conditions and injuries affecting the spine,” said Anil S. Ranawat, MD, a sports medicine surgeon and medical director of the HSS Spine Center in Paramus. “This high degree of expertise and collaboration ensure that each patient receives an individualized treatment plan tailored to their specific needs, supporting optimal outcomes and continuity of care.”

The spine center, located at 140 E. Ridgewood Avenue, Suite 175S, spans 14,000 square feet and includes 11 exam rooms.

“The HSS Spine Center provides specialized care for all types of conditions and injuries affecting the back and neck, from the most common problems to the highly complex, including scoliosis,” said Andrew A. Sama, MD, a spine surgeon and co-chief of HSS Spine. “Our team includes physicians with expertise in the latest nonsurgical approaches, as well as skilled spine surgeons with advanced training and special expertise.”

At HSS, conservative treatment is always the first line of care, while surgery is the last resort, said Sheeraz Qureshi, MD, MBA, a spine surgeon and co-chief of HSS Spine. “A variety of therapies are available to address pain, prevent further damage and help patients regain mobility without the need for surgery,” he explained. “However, if it is needed, HSS spine surgeons are at the forefront of robotic-assisted and minimally invasive procedures that are beneficial for patients.”

Surgeries are performed at the HSS Northern NJ Surgery Center in Mahwah or at the main hospital in Manhattan.

For more information about the HSS Spine Center, please visit: www.hss.edu/njspine

Since its 2020 opening, HSS Florida has provided surgical and nonsurgical care for approximately 40,000 patients with conditions including joint pain, traumatic and sports-related injuries, osteoarthritis, and back pain, as well as conditions affecting the hand and upper extremities. Patients have come from counties across Florida and as far away as New York, New Jersey, and Connecticut.

The 60,000-square-foot facility offers comprehensive clinical orthopedic care, advanced diagnostic and on-site imaging services, physical therapy, performance testing, and an innovative outpatient total joint replacement program. Patients receive the same high-quality care that HSS delivers at all its locations, closer to home.

The location currently supports four operating suites enabled with state-of-the-art technology, a focus that transcends surgery into all options for care. “I am so proud to bring HSS-level care to this community, especially non-surgical care as a first line of treatment,” said Tara M. McCoy, CEO of HSS Florida. “We are able to offer innovative alternatives to surgery with our comprehensive approach. This is in part due to HSS Florida’s top-of-the-line rehabilitation center, which has multiple technologies that objectively measure and track patients’ progress, such as motion capture systems, force plates, and strength-testing systems. It is our honor to provide these cutting-edge treatments to this population of active adults, retirees, elite athletes, and professional dancers, and we look forward to continuing to do so over the next five years and beyond.”

The growing need for orthopedic care in Palm Beach County has led HSS Florida to double the number of physicians, from seven to 14, and operating rooms, from two to four. Exam room capacity has also increased. On the diagnostic side, HSS radiologists, who are fellowship-trained in musculoskeletal imaging, bring unmatched expertise to every case to ensure the right diagnosis and treatment from the very start. 

“When we opened HSS Florida five years ago, we were committed to delivering the most advanced treatments; exceptional, personalized care; and an unwavering focus on quality and experience,” said Sheeraz Qureshi, MD, MBA, co-chief of HSS Spine and Chief Medical Officer of HSS Florida. “It is our responsibility to not only maintain these standards, but also to expand access to our world-class expertise, ensuring the best care for every patient.”

As a trusted leader in the community, HSS Florida is committed to encouraging collaboration and knowledge-sharing across local and statewide organizations to establish strong partnerships that will optimize patient care.

“Working closely with respected area institutions is integral to ensuring we continue to deliver the highest-quality care and support for our patients,” said Bryan T. Kelly, MD, MBA, President and CEO at HSS. “Our recently announced collaboration with the University of Miami, our new state-of-the-art facility on the NCH North Naples Hospital campus, and our partnership with Tenet Healthcare exemplify HSS’s growing footprint in Florida. By fostering strong partnerships and sharing knowledge, we ensure patients receive comprehensive, seamless care from the experts they trust.”

HSS Florida is located at 300 Palm Beach Lakes Boulevard in West Palm Beach. For more information or to schedule an appointment, visit HSS.edu/florida or call 561-657-4600.

Led by renowned orthopedic surgeon, Francis J. Hornicek, Jr., M.D., Ph.D., UHealth’s Department of Orthopaedics includes the University of Miami Sports Medicine Institute, medical provider for the Miami Hurricanes and the Miami Marlins. The department is the only academic, full-service multidisciplinary orthopedics program in South Florida and is a leader in research using stem cells, refining microsurgery for amputations, treating back pain and musculoskeletal oncology.

“We are pleased to announce this collaboration even before we open our doors at UHealth SoLé Mia,” said Dipen J. Parekh, M.D., chief operating officer of UHealth and founding director of Desai Sethi Urology Institute. “UHealth and HSS are both academic medical centers similarly focused on leading research and delivering excellence to patients in a clinical setting. This alliance will truly make UHealth SoLé Mia an unparalleled medical destination for our local community and beyond. Patients from across the nation already look to UHealth and HSS for world-class care. This collaboration brings the best of both worlds under one roof.”

Specialized since 1863, HSS has been ranked No. 1 in orthopedics worldwide since Newsweek introduced that ranking five years ago and has been ranked No. 1 in orthopedics nationwide for 15 consecutive years by U.S. News & World Report (2024-2025). HSS is the world’s largest academic medical center specializing in musculoskeletal health and is the official hospital of the Brooklyn Nets, the New York Giants, the New York Knicks, current WNBA champions the New York Liberty, the New York Mets, the New York Red Bulls, UFC and other high-performing sports organizations.

“HSS is committed to making the world’s highest-quality musculoskeletal care accessible to more people,” said Sheeraz Qureshi, M.D., M.B.A., chief medical officer, HSS Florida and co-chief of HSS Spine. “This goal relies on strategic collaborations with like-minded organizations and leveraging these relationships to enhance care models from routine to complex musculoskeletal conditions. We are proud to partner with the University of Miami Health System and look forward to advancing the field of orthopedics together for South Florida residents.”

As part of this collaboration at the North Miami facility, UHealth will build a musculoskeletal program that includes imaging, physician services, ambulatory surgeries and rehabilitation services. Medical Director for Integrated UM/HSS Orthopedics Musculoskeletal Program, Lee Kaplan, M.D., M.H.C.M., and Senior Administrative Officer, Monica Calcines, J.D., will work in consort with Dr. Qureshi with the goal of unified and consistent care delivery. UHealth and HSS will also work together to recruit specialized surgeons to enhance orthopedic services offered at SoLé Mia.

With the help of the University of Miami Strategy Team led by Chief Strategy and Transformation Officer Aaron Snyder and Executive Director Ina Hoxha, the impact of this strategic alliance will have reach well beyond the North Miami facility, enhancing the quality, patient experience and outcomes of the UHealth orthopedics department. Dr. Hornicek describes the collaboration as “a win-win for patients in South Florida. We’re bringing in the top orthopedics program in the nation to work hand in hand with our already-stellar faculty. This will only improve access and patient outcomes for our community.”

“Guided by our mission to improve mobility and enhance quality of life for all, HSS is committed to building partnerships that drive innovation and deliver lasting impact,” said Tara M. McCoy, chief executive officer, HSS Florida. “We value the power of collaboration. Our shared commitment to musculoskeletal health will enable us to make meaningful progress together.”

“We are bringing together two powerhouses in the orthopedic field,” said Dr. Kaplan, who is director of the University of Miami Sports Medicine Institute. “This will benefit the patients of South Florida who live an active lifestyle and make this area a destination for care.”

In addition to the newly formed affiliation, UHealth and HSS will host the 9^th Annual Winter Technology & Innovation in Orthopedics Symposium in Ft. Lauderdale. The two-day event in January features specialized presentations of the latest advances in orthopedics, including joint replacement, sports medicine and spine surgery.

ABOUT UHEALTH

UHealth – University of Miami Health System delivers leading-edge patient care by top-ranked physicians who treat some of the most complex cases. Powered by the Miller School of Medicine’s ground-breaking research and medical education, UHealth is the region’s only academic-based health care system. With a comprehensive network of nearly 40 outpatient facilities, its flagship hospital in the heart of Miami’s Health District, and more than 1,800 providers across South Florida, UHealth is a vital component of the community that is leading the next generation of health care. UHealth is home to Bascom Palmer Eye Institute, the No. 1 ranked eye hospital in the nation by U.S. News & World Report, Sylvester Comprehensive Cancer Center, the region’s only NCI-designated cancer center, Desai Sethi Urology Institute, dedicated to urologic research and discovery, and a neurology and neurosurgery program ranked in the top 20 in the nation. These programs, along with 100 other specialties, make UHealth a trusted destination for compassionate, research-based care. UMiamiHealth.org

As Co-Chief of HSS Spine and holder of the Patty and Jay Baker Chair in Minimally Invasive Spine Surgery, Dr. Qureshi is an internationally recognized leader in the field of minimally invasive and motion-sparing spine surgery. In his expanded role as Chief Medical Officer, Dr. Qureshi will oversee clinical operations and quality across all HSS Florida locations and for HSS at NCH. He will also partner with HSS Florida CEO Tara McCoy to make HSS care more accessible to more people across the state of Florida and cultivate relationships with industry, employers and other strategic partners. Dr. Qureshi will maintain his leadership role and clinical practice at the HSS Main Campus in New York.

“I am thrilled to welcome Dr. Qureshi to our team. He brings a wealth of clinical experience and proven leadership history to HSS Florida,” said Ms. McCoy. “I’m looking forward to collaborating with him to expand high-quality leading-edge treatment options to patients across the state.”

“I am honored and deeply grateful for the opportunity to collaborate with a dynamic Florida clinical team and staff who are dedicated to improving orthopedic care in the communities we serve,” Dr. Qureshi said. “Together, we will continue to provide more people with the high-quality orthopedic care they have come to expect from HSS.”

David Backstein, MD, is Appointed Medical Director of HSS at NCH

Dr. Backstein is an orthopedic surgeon specializing in primary and revision total knee replacement and primary hip replacement. He has special expertise in the use of minimally invasive and robotic techniques in joint replacement surgeries. Dr. Backstein, who joined HSS at NCH earlier this year from the University of Toronto where he led the division of orthopedics at Mount Sinai Hospital, is the recipient of numerous awards for clinical research and has published more than 200 papers in peer-reviewed journals. He regularly presents his work at conferences all over the country and around the globe.

Dr. Backstein succeeds Dr. Helfet, who has helped to guide the first year of the HSS at NCH collaboration. As Founding Medical Director, Dr. Helfet will continue to serve the Naples community, providing education on HSS and the new HSS at NCH Musculoskeletal Center as well as partnering with the HSS and NCH philanthropy teams. Additionally, he will serve as a conduit between HSS at NCH and HSS’s main campus in New York City, helping to foster increased clinical alignment.

“Dr. Helfet’s expertise has been paramount in establishing the musculoskeletal center and the Orthopedic Service, and his collaboration with Dr. Backstein will ensure that our world-class orthopedic care and outstanding patient experience are seamless for communities in southwest Florida,” said Dr. Padgett. “Dr. Backstein’s leadership complements our dedication to excellence and to move healthcare forward for the residents of Florida and beyond.”

“We are excited about these additions to leadership. We continue to strengthen our collaboration while enhancing our ability to deliver outstanding orthopedic health services,” said Paul Hiltz, President and CEO, NCH. “This marks an exciting new chapter for HSS at NCH.”

“Fostering a stronger collaboration between HSS and NCH clinicians, researchers, and industry partners to find clinical solutions for patients in our Florida communities will be a primary focus for me in my new role,” said Dr. Backstein. “I’m looking forward to working with Dr. Helfet and the greater care team to bridge the gap between clinical need and outcomes.”

The HSS at NCH musculoskeletal center, now under development, spans more than 80,000 square feet and will be the centerpiece in the HSS at NCH collaboration to elevate orthopedic care in Naples and Southwest Florida. The facility will offer outpatient and inpatient orthopedic services, including an ambulatory surgery center, imaging, and rehabilitation, and will be jointly operated by HSS and NCH. The HSS at NCH facility is scheduled to open in 2025.

Research highlights include the evaluation of artificial intelligence (AI) chatbots to provide accurate answers to medical questions about spine surgery, and two retrospective studies analyzing outcomes in both knee and hip replacement surgeries performed with robotic assistance. 

HSS Research Evaluates Whether AI Chatbots Provide Reliable Medical Information

A study co-authored by Sheeraz Qureshi, MD, MBA, co-chief of HSS Spine and colleagues identified nine frequently asked questions about cervical spine surgery, which they considered to be of particular clinical relevance. Question topics ranged from the benefits and drawbacks of different surgical approaches to side effects and recovery after surgery. The questions were inputted one at a time into ChatGPT version 3.5. Two experts in cervical spine surgery who were not involved in designing the questions rated the chatbot’s responses on accuracy, appropriateness, and readability. On average, the responses received a score of 8.1/10, with a 3.9/5 for accuracy and a 2.2/3 for appropriateness. The main drawback the reviewers noted was that ChatGPT failed to provide comprehensive responses, often omitting important factors. AI chatbots are more accurate than expected when asked to answer medical questions about spine surgery, however patients still need to use extreme caution when turning to these tools for help with medical decision-making.

New HSS Studies Highlight the Benefits of Robotic-Assisted Joint Replacement Surgery

HSS investigators presented two retrospective studies analyzing outcomes in both knee and hip replacement surgeries performed with robotic assistance.

The first study co-authored by HSS hip and knee surgeon Seth A. Jerabek, MD, and colleagues found that the use of a surgical robot during total knee replacement surgery reduced the need for manipulation under anesthesia, an outpatient procedure that may be prescribed when physical therapy after surgery becomes too painful for the patient due to joint stiffness caused by scar tissue.

The second study led by HSS hip and knee surgeon Elizabeth B.  Gausden, MD, MPH and colleagues compared short-term outcomes (e.g., rates of dislocation, re-operation, revision, and patient-reported outcome measures) of the anterior versus the posterior approach in robotic-assisted total hip replacement surgery. The investigators found that hip replacement has excellent outcomes with each respective approach when performed by surgeons with extensive experience in that approach. Additionally, it is likely that the very low incidence of instability or dislocation overall can be attributed to the use of robotic technology for planning and execution.

“In the past 20 years, the Internet has been probably the number-one place that people go for medical information,” says Sheeraz Qureshi, MD, MBA, co-chief of HSS Spine and co-author of the study. “I haven’t yet heard from any patients who have used ChatGPT or other chatbots in this way, but it’s definitely where we see things going. The same way that people use search engines to look for medical information now, we expect they will use chatbots in the future, including in their decision-making process.”

For this study a team of investigators identified nine frequently asked questions about cervical spine surgery, which they considered to be of particular clinical relevance. Question topics ranged from the benefits and drawbacks of different surgical approaches to side effects and recovery after surgery. The questions were inputted one at a time into ChatGPT version 3.5.

Two experts in cervical spine surgery who were not involved in designing the questions rated the chatbot’s responses on accuracy, appropriateness, and readability. On average, the responses received a score of 8.1/10, with a 3.9/5 for accuracy and a 2.2/3 for appropriateness. The main drawback the reviewers noted was that ChatGPT failed to provide comprehensive responses, often omitting important factors. For example, it described a particular procedure as being more challenging without mentioning that the level of challenge depended on patient indications as well as the surgeon's overall practice, training and comfort with the technique. 

The experts noted that the responses were easier for people to understand than research literature, which can be complicated for non-experts. Flesh-Kincaid Grade Level analysis determined that ChatGPT's responses were at the level of a junior in high school, compared with primary literature, which is aimed at scholars working in the field. They also appreciated that responses from ChatGPT were always prefaced with a statement regarding consulting an expert for medical advice.

Dr. Qureshi explains that one serious concern with using a chatbot versus a web search is that it’s not clear where the information is being sourced from. “Most people know not to blindly trust everything they find on the Internet,” he says. “If a search takes you to the webpage for HSS or another well-established medical center, you can feel confident that the information has been vetted by experts.”

The researchers plan to continue studying this topic to better understand how patients are using AI tools. Ultimately, their hope is to identify opportunities to ensure that when AI is responding to medical queries it is prioritizing the most reliable and credentialed information.

What follows are some highlights from the meeting:

Intravenous versus Oral Administration of Acetaminophen Perioperative to Instrumented Lumbar Fusion: A Single-Center, Randomized Controlled Trial

In patients undergoing certain orthopedic surgeries, giving intravenous (IV) acetaminophen for pain relief has been shown to have fewer side effects and potentially lower risk than opioids but is associated with higher costs than oral acetaminophen. In this single-center, randomized controlled trial, investigators led by Darren R. Lebl, MD, MBA, and Celeste Abjornson, PhD, prospectively evaluated clinical outcomes of IV versus oral acetaminophen after circumferential lumbar fusion. One hundred patients between the ages of 18-85 were randomly assigned to one of the two groups (50 in each) and were included in the study. There was a specific dosing regimen that started within the three hours prior to surgery and continued for the next 48 hours. Patients were able to access supplemental opioid analgesics as needed. The researchers found that morphine consumption was significantly lower for the IV acetaminophen group compared with the oral acetaminophen group within the first 48 hours post-operatively. The average daily morphine usage after 48 hours for those who received the IV acetaminophen regimen was also significantly lower. The research suggests that IV acetaminophen is a safe and effective supplement to opioid-based pain management after surgery, and that it provides a promising option for pain control.

Authors: Gregory Paschal; Fedan Avrumova; Philip Paschal; Ellen M. Soffin, MD, PhD; Joseph Nguyen; Federico P. Girardi, MD; Andrew A. Sama, MD; Frank P. Cammisa Jr., MD; Darren R. Lebl, MD, MBA; Celeste Abjornson, PhD, (HSS)

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Racial Disparities in Outpatient Anterior Cervical Discectomy and Fusion and Cervical Disc Replacement

Recent reports have suggested disparities within cervical spine surgery, including lower utilization rates and worse perioperative outcomes for Black patients. In this retrospective cohort study, a team led by HSS resident Troy B. Amen sought to assess whether these disparities also exist for outpatient cervical spine surgery. Using data collected by the American College of Surgeons National Surgical Quality Improvement Program between 2010 and 2019, the team looked at patients who underwent primary anterior cervical discectomy and fusion (ACDF) or cervical disc replacement (CDR) and stratified them by race and ethnicity. They categorized procedures as inpatient or outpatient based on length of stay. They found that, overall, Black patients were significantly less likely to undergo ACDF (5.9%, vs. 10.6% of white patients) as well as CDR (19.9%, vs. 26.1% of white patients) as outpatients. Between 2010 and 2019, these disparities increased, even when adjusting for other factors. The findings highlight the need for renewed intervention by orthopedic surgeons and policymakers to address inequalities in outpatient care.

Authors: Troy B. Amen; Patawut Bovonratwet, (HSS); Samuel S. Rudisill (Rush Medical College); Lauren Barber; Yusef Jordan, (HSS); Abhinaba Chatterjee (Weill Cornell Medicine); Jung Kee Mok (UNC Chapel Hill); Nathan Varady; Sheeraz Qureshi, MD, MBA (HSS)

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Improving Racial and Ethnic Disparities in Ambulatory Surgical Center Utilization for Anterior Cervical Discectomy and Fusion

Although racial and ethnic disparities within the field of spine surgery have been documented, the link between the recent emergence of ambulatory surgical centers and access to these procedures in the outpatient setting isn’t known. A study led by HSS resident Troy B. Amen sought to assess disparities in the use of these outpatient surgical centers among white, Black, and Hispanic patients having spine surgery. The investigators also looked at how racial differences have changed between 2015 and 2018. Using data from the Healthcare Cost and Utilization Project New York State Ambulatory Database, the researchers looked at differences in same-day discharges in patients having anterior cervical discectomy and fusion (ACDF). They found that during this time, Black and Hispanic patients were significantly less likely to undergo ACDF surgery at an ambulatory center compared with white patients, but that these disparities lessened over time. They note that these improvements are encouraging and may help counteract previously documented disparities in spine surgery in the inpatient setting, although additional research is needed to confirm that.

Authors: Troy B. Amen, (HSS); Abhinaba Chatterjee (Weill Cornell Medicine); Sheeraz Qureshi, MD, MBA (HSS)

Predictors of Non-improvement After Minimally Invasive Lumbar Spine Surgery

Minimally invasive surgery of the lumbar spine is associated with good clinical outcomes, but a small number of patients may not improve, or may even worsen, after this surgery. A study led by HSS research fellow Junho Song sought to identify predictors of patients who are not likely to improve. The study included 448 patients who underwent minimally invasive transforaminal interbody fusion, laminectomy, or microdiscectomy at HSS between 2017 and 2021. At follow-up of at least six months after surgery, the patients were categorized as better, the same, or worse. A total of 66 patients reported no significant improvement; among these, 35 patients reported worsening after surgery, and the rest reported no change. Patients who did not fare as well were more likely to be older or obese. The researchers found that smoking was also a factor for those who didn’t do as well, likely due to changes in metabolic systems and local vasculature caused by tobacco use. The investigators say these findings provide valuable evidence that may be useful for improving the selection of patients to undergo minimally invasive spine surgery. They may also help to establish clearer patient expectations for those undergoing this procedure.

Authors: Junho Song; Pratyush Shahi; Kasra Araghi; Robert Kamil; Dimitra Melissaridou; Sidhant Singh Dalal (University of Arkansas for Medical Sciences); Daniel Shinn; Sheeraz Qureshi, MD, MBA; Sravisht Iyer, MD (HSS)

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Robotics Reduces Radiation Exposure in Minimally Invasive Lumbar Fusion Compared to Navigation

For minimally invasive spine surgery, navigation and robotics technologies have helped reduce surgeons’ exposure to ionizing radiation. Studies have compared radiation exposure during surgery using robotics or navigation to procedures using traditional fluoroscopy, but none have compared robotics and navigation to each other. This study compared the two techniques in terms of fluoroscopy time and radiation dose for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). The study included 111 patients in the robotics cohort and 133 patients in the navigation cohort. The investigators, led by HSS research fellow Pratyush Shahi, found that for both one- and two-level TLIFs, the fluoroscopy time for surgical procedure, total fluoroscopy time, and total radiation dose were significantly less with robotics compared to navigation. For one-level TLIFs, the overall time of radiation exposure was also lower.  Overall, time in the operating room was similar, with robotic procedures lasting longer but requiring less time for setup and image capture. Based on these findings, the investigators say robotic surgery leads to a significant reduction in radiation exposure both for the surgeon and the patient compared to navigation, but multicenter prospective trials are needed to confirm these findings.

Authors: Pratyush Shahi, Sidhant Singh Dalal (University of Arkansas for Medical Sciences); Junho Song; Daniel Shinn; Robert Kamil; Kasra Araghi; Sheeraz Qureshi, MD, MBA (HSS)

Hospital for Special Surgery (HSS), the academic medical center specialized in musculoskeletal care since 1863, today announced the appointment of Sheeraz Qureshi, MD, MBA as co-chief of HSS Spine, effective October 1, 2022. Dr. Qureshi will succeed Harvinder S. Sandhu, MD, MBA, and joins Andrew A. Sama, MD, as co-chief of HSS Spine. Dr. Sandhu will become Co-Chief Emeritus of HSS Spine and Medical Director of HSS Orthopedics with Stamford Health, succeeding Charles “Chip” Cornell, MD, who will retire next month. 

Dr. Qureshi joined HSS in April 2017. His clinical practice focuses on minimally invasive and motion-sparing spine procedures using the latest technologies. He has authored or co-authored more than 200 articles published in peer-reviewed journals, given more than 100 invited lectures and contributed to educational videos, and trained surgical fellows nationally and internationally.  Dr. Qureshi also works with leading implant manufacturers, pioneering innovations in disks and implants for restoring height and proper spinal alignment.

“Dr. Qureshi is an exceptional spine surgeon, researcher and educator,” said Bryan T. Kelly, MD, MBA, surgeon-in-chief and medical director of HSS. “I look forward to working with him and Dr. Sama as they take HSS Spine to even higher levels of excellence.”

“I’m excited to lead HSS Spine together with Dr. Qureshi, with a shared vision to expand our services with a laser focus on the patient journey from initial diagnosis to rehabilitation,” said Dr. Sama.  “Our team will continue to pioneer advances in spine care, conduct rigorous research, and adopt new technologies and techniques when they are proven to provide better care and achieve better outcomes.”

“I’m honored to join Dr. Sama in leading the specialists who have already made HSS the nation’s most popular and successful spine treatment center,” said Dr. Qureshi, who also serves as the Patty and Jay Baker Chair in Minimally Invasive Spine Surgery and was recently promoted to professor of orthopedic surgery at Weill Cornell Medicine.  “Our multidisciplinary team personalizes for each patient the latest evidence-based options, from conservative, nonsurgical therapies to surgical treatment for the most complex conditions.”

More than 22,000 patients a year are treated for back and neck pain by the HSS Spine team.  While the majority are treated non-surgically, HSS performs 138% more spine surgeries than the next leading hospital. 

“Our spine service is a key reason why HSS has been ranked the #1 orthopedic program in the world, and in the United States for 13 consecutive years,” said Louis A. Shapiro, president and CEO at HSS. “I know that Drs. Qureshi and Sama and the HSS Spine team will continue to advance the field and create new possibilities for our patients.”

HSS is recognized internationally as a leader in pioneering treatment for the full spectrum of spine conditions for over 22,000 spine patients each year at locations in New York, New Jersey, Connecticut, and West Palm Beach, Florida. The Lauder Family Spine Center, which will open in 2024, will build upon the exceptional spine care offered across the HSS enterprise. The Center will span the new state-of-the-art HSS Kellen Tower, Pavilion, and main hospital buildings on the New York City main campus.

“We are grateful for Leonard and Ronald Lauder’s tremendous generosity and continued commitment to HSS,” said Bryan T. Kelly, MD, HSS Surgeon-in-Chief and Medical Director. “This gift, in establishing the Lauder Family Spine Center, will enable our world-class medical team to do what they do best, even better. This is not just an investment in HSS but also in our community and the world.”

This contribution builds on the Lauder family’s longstanding dedication to HSS and vision for elevating the care of patients impacted by debilitating orthopedic conditions. The Lauder family’s support of HSS extends over thirty years, having funded vital programs to advance the treatment of pediatric orthopedic conditions, improve care for underserved patients, and pioneer new approaches in pain management.

“We are committed to supporting all the outstanding physicians at HSS who are defining the future of medical care and proud to make this gift in honor of Dr. Sheeraz Qureshi,” said Leonard and Ronald Lauder. “With the Lauder Family Spine Center, we are supporting the excellent spine care for which HSS is so well known and ensuring HSS remains at the forefront of the field well into the future.”

“I am deeply moved by Leonard and Ronald Lauder’s commitment,” said Sheeraz Qureshi, MD, MBA, Patty and Jay Baker Chair in Minimally Invasive Spine Surgery and Associate Attending Orthopedic Surgeon at HSS. “The Lauder Family Spine Center will have a profound impact on the lives of our patients and their families.”

The extraordinary support of Leonard and Ronald Lauder comes at a pivotal moment. “The incredible partnership of the Lauder family has allowed us to reach a crucial threshold of support for our expansion plans and will benefit all the patients who will count on HSS for healing and hope for decades to come,” said Louis A. Shapiro, President and CEO at HSS. 

The findings are especially noteworthy, according to Sheeraz Qureshi, MD, MBA, HSS spine surgeon and the study’s senior investigator, because a standard open spinal fusion generally entails a much longer recovery and slower return to activities than a standard lumbar decompression. This study is available online as part of the AAOS 2020 Virtual Education Experience.

“Our study is the first of its kind to look at return to activities and discontinuation of narcotic pain medication after single-level lumbar decompression or single-level lumbar spine fusion performed with a minimally invasive technique,” said Dr. Qureshi, who is also the Patty and Jay Baker Endowed Chair in Minimally Invasive Spine Surgery at HSS. “In our study, all the patients in both groups were able to resume driving and return to work within three weeks of surgery. When you compare this time frame to that of standard open spinal fusion surgery, it’s really striking. Patients having a standard spinal fusion could take six months or longer for a full recovery.”

Degenerative conditions of the lumbar (lower) spine, such as a herniated disc or spinal stenosis, are common causes of pain and disability. Patients may consider surgery when conservative treatments such as medication and physical therapy fail to provide relief.

Lumbar decompression surgery is performed to relieve pain by removing a small section of bone or part of a herniated, or bulging, disc that is pressing on a nerve. Spinal fusion, a more extensive surgery, is performed to eliminate painful motion or to stabilize and strengthen the spine. Surgeons join two or more vertebrae together, sometimes using screws and connecting rods.

Over the past few years, minimally invasive spine surgery has gained in acceptance and popularity, Dr. Qureshi said. The technique uses smaller incisions than standard spine surgery and aims to minimize damage to nearby muscles and other tissues.

The study included patients who had elective one-level MI lumbar decompression or one-level MI lumbar spine fusion between April 2017 and July 2019 by a single orthopedic surgeon at HSS. Patients included in the analysis were driving or working before surgery, or were administered narcotic pain medication post-operatively.

Investigators found that it took the 117 decompression patients a median of three days to discontinue narcotic pain medication, while it took a median of seven days for the 51 spinal fusion patients.

With respect to driving, the analysis included the number of patients who were driving pre-operatively and returned to driving after surgery. It took 88 decompression patients a median of 14 days to resume driving, while the 45 fusion patients took 18 days.

Researchers found no statistically significant difference in the time patients in each group needed to return to work. To explain that finding, Dr. Qureshi noted that both MI decompression and MI fusion utilize the same type of initial approach to reach the spine with approximately the same size incisions. There is significantly less tissue damage compared to standard open spine surgery, which may explain the similar rate of return to work.

With respect to discontinuing narcotics, although minimally invasive spine surgeries reduce incision sizes and tissue damage overall compared to open spine procedures, MI fusions are still more extensive surgeries, so pain medication may be needed for a longer period of time, according to Dr. Qureshi. Concerning driving, he says it’s possible that fusion patients take longer to recover their driving reaction times compared to patients who have decompression surgery.

Disclosures: Dr. Qureshi has no disclosures that are relevant to this study.

Researchers studied patients who had outpatient surgery, as well as patients who had a hospital stay. Early outcomes were compared between the inpatient and outpatient groups.

"In our study, the surgical setting did not impact patient-reported outcomes. The results suggest that multi-level ACDF can be performed safely in the outpatient setting without an increased risk of complications in appropriately selected patients," said HSS surgeon Sheeraz Qureshi, MD,MBA.

Read the full article at Becker's ACS Review.

The research, titled, "A Comparison of Multilevel Anterior Cervical Discectomy and Fusion Performed in an Inpatient versus Outpatient Setting," was presented today at the American Academy of Orthopaedic Surgeons Annual Meeting in Las Vegas. 

"An emphasis on reducing healthcare costs has led to numerous surgeries in a wide range of specialties being performed on an outpatient basis," said Sheeraz Qureshi, MD, MBA, the Patty and Jay Baker Chair in Minimally Invasive Spine Surgery at HSS. "Single-level ACDF, in which one disc is removed, is one of the most common spine surgeries performed in an outpatient setting." 

ACDF may be performed when pain is ongoing and nonsurgical treatments fail to provide relief. The procedure involves removing the damaged disc or discs, as well as any bone spurs that have developed. After the disc is removed, a bone graft is inserted in the open space. The graft serves as a bridge between the two vertebrae to create a spinal fusion. To relieve symptoms, the surgeon may remove one disc (single-level ACDF) or multiple discs (multi-level ACDF). 

Despite the success of single-level ACDF in the outpatient setting, concerns over increased post-operative complications, including respiratory problems, have curtailed the performance of multi-level ACDF in the outpatient setting, according to Dr. Qureshi. He and colleagues set out to compare early outcomes and safety in multi-level ACDF in the inpatient versus outpatient setting, looking at various patient and procedural factors.

The study included patient demographics; baseline patient differences, such as additional health issues; blood loss; operative time; hospital length of stay; and complications. Researchers also compared patient-reported outcomes, which evaluated improvement in pain, function and well-being from the patient’s perspective. 

Of the 103 patients in this study, 57 had surgery as outpatients and 46 had a hospital stay. The inpatients were older (median age 57 versus 52 years old). 

Outpatient surgery was performed more often when there were fewer discs being removed. Of the 83 two-level ACDF cases, 60.2% were outpatient surgeries. Of the 20 three-level cases, 35% were in the outpatient setting. Outpatients had shorter operative times (71 versus 84 minutes) and a significantly shorter hospital length of stay (8.5 versus 35.8 hours). There was no difference in postoperative pain. 

At six month follow-up, both groups reported significant improvement in pain and function. 

"In our study, the surgical setting did not impact patient-reported outcomes. The results suggest that multi-level ACDF can be performed safely in the outpatient setting without an increased risk of complications in appropriately selected patients," Dr. Qureshi noted. "Specifically, the patient’s age, additional health conditions, and number of levels being fused should be taken into consideration when deciding whether to perform multi-level ACDF in an outpatient setting."

"The FDA has allowed us to do this trial without randomizing. There are about 20 centers involved in this clinical trial; some are designated as experimental and others as control. At HSS, all patients who decide to enter the trial will get the new investigational treatment," said Harvinder Sandhu, MD, a spine surgeon who is leading the trial at HSS in New York City.

Degenerative spondylolisthesis with spinal stenosis is one of the most common problems that occurs in lumbar spine. "It affects primarily adults over the age of 40 and presents as a combination of back pain and pain that goes down the legs with activities," said trial investigator Sheeraz Qureshi, MD, spine surgeon at HSS. "We are always looking for nonfusion alternatives for everything we do, and LimiFlex is an exciting nonfusion option. This trial will help us determine if it is a long term solution."

Degenerative spondylolisthesis is diagnosed when one vertebra slips forward over the one below it. The condition is a disease of aging in which the bones, joints and ligaments in the spine become weak and less able to hold the spinal column in alignment. Degenerative spondylolisthesis most commonly occurs in the L4-L5 level of the lower spine, but can also occur at the L3-L4 level. Females are three times as likely to be diagnosed with the condition than males.

"Degenerative spondylolisthesis results from arthritis in the joints, which then ultimately leads to some abnormal movement of the vertebrae, which then results in this closing up of the nerve channel, the stenosis," said Dr. Qureshi. "The most common treatment is to do a decompression to get rid of the stenosis to open up the nerve channel, and to do a fusion to prevent the spondylolisthesis from getting worse."

The LimiFlex Clinical Trial will evaluate the safety and effectiveness of decompression and stabilization with the LimiFlex Paraspinous Tension Band, compared with the standard treatment, decompression and transforaminal lumbar interbody fusion with concomitant posterolateral fusion for the treatment of lumbar degenerative spondylolisthesis (Grade I per Meyerding classification) with spinal stenosis. LimiFlex is designed to stabilize the spine without fusing it. The device is made of two spring-like titanium rods that are wrapped around the back of two spine segments, allowing the spine to move in a controlled manner. Clinical trial investigators will collect data from all trial sites and compare clinical outcomes of patients receiving LimiFlex with patients who receive the conventional treatment.

"We are going to use standardize measures for those outcomes. We also want to see how many patients may require future surgery or have problems at other levels of the spine," said Dr. Sandhu. "There is an ongoing theory that one of the downsides of fusion is that it puts additional stresses on other levels of the spine. With the LimiFlex, in theory, if you don’t actually completely join the vertebrae together and fuse them, allowing some degree of motion, that puts less stress on other levels. The hypothesis is that these patients will be less likely in need of future surgery." The trial will help answer this question.

To be eligible for the trial, patients must be between the ages of 25 and 80 and have lumbar degenerative spondyloslisthesis (grade I per Meyerding classification), at one level from L1 to S1, with radiographic confirmation using X-Ray. Exclusion criteria includes morbid obesity (BMI >40), history of cancer in last five years, involvement in litigation because of spinal condition, and planned hip or knee replacement surgery.

This article was featured in the May 13, 2018 print edition.

"Current technologies have focused on applications primarily for thoracic and lumbar," said Dr. Qureshi.

He explained that cervical spine surgery is still considered relatively untapped as a minimally invasive procedure. While companies are starting to consider cervical minimally invasive options of screws, rods and fusion devices, Dr. Qureshi noted that there is no immediate groundbreaking technology available.

This article appeared in the April 20, 2018 print issue.