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.

The evening will be hosted by Bruce Beck, lead sports anchor at NBC 4 New York, and guests will be treated to a musical performance by nine-time Grammy Award-winner Sheryl Crow, who was recently inducted into the Rock and Roll Hall of Fame.

“We are privileged to recognize Dr. Cammisa for his outstanding contributions to HSS and to the field of spine surgery,” said Bryan T. Kelly, MD, MBA, HSS president, surgeon-in-chief and medical director. “Throughout his distinguished career, Dr. Cammisa has been an international leader in clinical care, education and research. His pioneering efforts have advanced minimally invasive spine surgery and motion preservation techniques, bringing innovations to patients worldwide.”

“It is an honor to present Joe and Clara Wu Tsai with the 2023 Tribute Dinner Award. As owners of two iconic professional basketball teams, they understand the importance of high-level musculoskeletal care to ensure peak performance in athletes,” said Louis A. Shapiro CEO at HSS. “As philanthropists, the Tsai’s are having a profound impact on the health and well-being of people globally through their investments in neuroscience and the science of human performance.”

Funds raised at the Tribute Dinner will advance the HSS mission to provide the highest quality care to help people everywhere return to what they need and love to do. Guests will include leaders and luminaries in business, health care, sports, philanthropy, finance, and entertainment.

The cocktail reception will begin at 6:15 p.m. Dinner, the award ceremony and Sheryl Crow’s performance will start at 7:15 p.m.

FRANK P. CAMMISA, JR., MD

Frank P. Cammisa, Jr., MD, is Chief Emeritus of HSS Spine and a Professor of Clinical Surgery at Weill Cornell Medical College. He specializes in the surgical treatment of spinal disorders. His areas of expertise include spinal reconstructive surgery, minimally invasive surgery, athletic spinal injuries, and motion preservation techniques. He served as Chief of the HSS Spine Service for 22 years.  Under his leadership, the service grew into a multidisciplinary spine program inspiring significant advances in patient care and substantial growth of our world-class spinal surgical educational program.  During Dr. Cammisa’s leadership, the Spine Fellowship Program trained over 120 clinical fellows that are represented around the globe.  In addition, he founded the Integrated Spine Research Program at HSS to bring research from concept to clinical driving innovation in spine care and providing opportunities for research fellows and students. 

In addition to Dr. Cammisa’s active clinical practice, he conducts research to advance the treatment of complex spine conditions. He has received numerous prestigious research grants from various funding agencies, including the National Institutes of Health. He has been recognized by New York Magazine as one of “12 doctors who are reinventing medicine,” based on his research of artificial disc replacement to relieve debilitating back and neck pain.  He is on the medical staff of the New York Giants and is a spinal surgery consultant to the National Hockey League Players Association.   

Dr. Cammisa has published over 250 original scientific papers in prestigious medical journals and has made more than 500 scientific presentations at national and international meetings.  He has co-authored more than 30 chapters in medical textbooks and edited a textbook titled “Dynamic Reconstruction of the Spine.” His numerous awards include the Lewis Clark Wagner Award, the AOA North American Traveling Fellowship, the Nancy Kane Bischoff Award for Teaching, EOA Spine Research Award and Founder’s Award, the NASS Outstanding Paper Award, the LSRS Best Paper Award, the ISSLS Best Paper Award, Best Paper and the Best Clinical Paper Awards at IMAST and the Outstanding Publication Award from the Austrian Society for Spine Surgery.

Dr. Cammisa graduated from Tufts University, summa cum laude with election to Phi Beta Kappa. He graduated from the College of Physicians and Surgeons of Columbia University and was elected to Alpha Omega Alpha National Honor Medical Society. He completed his general surgery residency at Columbia Presbyterian Medical Center and his orthopedic surgery residency at Hospital for Special Surgery. His fellowship in spinal surgery was completed in the Departments of Orthopedic Surgery and Neurological Surgery at the University of Miami, Jackson Memorial Medical Center and The Miami Project to Cure Paralysis. 

JOSEPH C. TSAI

Joe Tsai is a co-founder and executive vice chairman of Alibaba Group. He is a member of the board of directors of Alibaba Group and its financial services affiliate, Ant Group.

Mr. Tsai is governor of the Brooklyn Nets, alternate governor of the New York Liberty, and chairman of the teams’ home arena, Barclays Center. He played Division 1 lacrosse at Yale and owns two professional indoor lacrosse teams in the National Lacrosse League: the San Diego Seals and the Las Vegas Desert Dogs. Mr. Tsai is an investor in the Premier Lacrosse League and the Los Angeles Football Club of Major League Soccer.

Through the Joe and Clara Tsai Foundation, Mr. Tsai and his wife, Clara, are active philanthropists supporting initiatives in education, research, social justice, economic mobility, the arts and humanitarian relief during the COVID-19 pandemic. He is a founding board member of The Asian American Foundation (TAAF), a non-profit that provides resources to Asian American Pacific Islander (AAPI) communities to combat hate and discrimination and support AAPI advocacy, prosperity and representation.

Mr. Tsai is a member of the J.P. Morgan International Council, EXOR Partners Council, and International Advisory Council of the Hong Kong Stock Exchange. He is a trustee of The Lawrenceville School.

Prior to Alibaba Group, Mr. Tsai was a private equity investor in Asia for Investor AB of Sweden’s Wallenberg family. He practiced tax law as an associate with Sullivan & Cromwell LLP in New York. He is a graduate of Yale College, where he received a Bachelor of Arts degree in 1986, and Yale Law School, where he received his JD degree in 1990.

CLARA WU TSAI

Clara Wu Tsai is a businesswoman, investor, and philanthropist. Ms. Wu Tsai is the governor of the WNBA's New York Liberty and, along with her husband, is an owner of the NBA's Brooklyn Nets and the NLL's San Diego Seals. As vice chair of BSE Global, she oversees all matters relating to civic and community engagement, fan development and the role Barclays Center plays within Brooklyn.

As founder of the Joe and Clara Tsai Foundation, Ms. Wu Tsai pursues philanthropic investments across the arts, sciences and social justice spaces. She established the Social Justice Fund in 2020 to work toward economic mobility and racial justice in Brooklyn, New York. She is a founding partner of the REFORM Alliance, which seeks to reform the criminal justice system.

In science and technology, the Foundation supports the Wu Tsai Neurosciences Institute at Stanford University and the Wu Tsai Institute at Yale University for understanding human cognition. In 2020, Ms. Wu Tsai founded the Wu Tsai Human Performance Alliance, which works across six universities to bring together world-class talent to advance the science of human performance.

Ms. Wu Tsai serves on the boards of trustees for Stanford University, New York Presbyterian Hospital and Lincoln Center for the Performing Arts. She serves on the advisory board for the Institute for Protein Design at the University of Washington. She was an executive producer of Into the Okavango, a 2018 conservation documentary; Blue Bayou, a 2021 drama; and Unfinished Business, a 2022 documentary about the WNBA.

Previously, Ms. Wu Tsai was general manager of the Hong Kong operations of Taobao, China’s

largest online shopping website, and a vice president at American Express in New York and Hong Kong. Ms. Wu Tsai holds a Bachelor of Arts degree in International Relations and a Master of Arts degree in International Policy Studies from Stanford University, as well as an MBA degree from Harvard University.

Many spinal surgeries require the use of implants called pedicle screws to stabilize the spine. Precise positioning of these screws is critical for a successful outcome. “Two-dimensional biplanar radiographs [BPR] have been the gold standard to confirm pedicle screw placement in spine fusion surgery for many years. However, when utilizing BPR, there is the potential that a two-dimensional image alone will not properly demonstrate the successful placement of a screw,” said Darren Lebl, MD, a spine surgeon at HSS and principal investigator of the study. “As an alternative, three-dimensional intraoperative imaging systems are now available, offering improved visualization.”

Dr. Lebl and colleagues set out to compare the accuracy of BPR versus 3D imaging when assessing intraoperative pedicle screw placement. “Our study is the first to compare the differences in intraoperative biplanar radiography and 3D imaging for pedicle screw accuracy in thoracic and lumbar cases using robotic technology,” Dr. Lebl noted.

Investigators analyzed data from 103 patients who underwent spinal fusion by a single surgeon from 2019 to 2022. Pedicle screw placement was assessed with both intraoperative BPR and 3D imaging in each case.

“CT scans taken after surgery were compared to the findings of intraoperative BPR and 3D imaging to detect either false-positive or false-negative readings,” explained Fedan Avrumova, BS, an HSS clinical research coordinator who presented the study at the AAOS meeting. “False positive findings are instances when BPR imaging suggests the screw was not in an acceptable position, while in fact a more advanced 3D image (intraoperative 3D scan or postoperative CT scan) showed the screw to be in an acceptable position. Conversely, a false negative instance was when a BPR image led one to believe or looked as though the screw was in an acceptable position, when in fact a more advanced 3D image or post-operative CT scan showed that it was in fact not acceptable.”

Postoperative CT imaging revealed a clinically significant number of patients who had false-negative and false-positive screw placement readings on BPR. However, screw position shown on intraoperative 3D imaging was found to be much more accurate, Avrumova added.  

“Based on our study, BPR imaging may lead one to think a screw is acceptable when in fact it is not, and also may miss many screws that are not in fact acceptable. In our study, it was approximately one percent of cases where this occurred. However, for surgeons and centers that implant hundreds and thousands of screws per year, this is going to result in a significant clinical impact for many people,” Dr. Lebl noted. “Even one misplaced screw can have a significant impact for a patient, a surgeon, and a hospital system. Therefore, based on these findings, we suggest that for intraoperative confirmation of screw position 3D imaging may soon represent a new standard of care.”

Authors: Fedan Avrumova, BS; George Gorgy, MD; Philip K. Paschal, MS; John A. Carrino, MD, MPH; Darren R. Lebl, MD (HSS)

Augmented reality refers to digital information that is superimposed on a user’s view of the physical environment, providing images that can’t be seen with the naked eye. AR navigation in spine surgery superimposes 3D images of a patient’s anatomy onto the surgeon’s view of the operative field. Critical elements include a preoperative CT scan of the patient’s spine, which is used to plan and perform the surgery, and an augmented reality headset worn during the procedure.

The system Dr. Cammisa uses consists of a near-eye-display headset and the elements of a traditional navigation system. During surgery, it accurately determines the position of surgical instruments in real time and superimposes them on the patient's CT data. It has been likened to giving surgeons “x-ray vision,” enabling them to see structures underneath the skin.

“The technology allows us to visualize the patient’s 3D spinal anatomy during surgery to accurately guide instruments and place surgical implants, such as pedicle screws, while looking directly at the patient rather than at a separate computer screen,” Dr. Cammisa explained. “Improved control and visualization of the patient’s anatomy and critical structures can lead to a more precise, efficient surgery and can enhance safety." 

He notes that the technology allows for a highly personalized surgery that can be used for most spinal procedures requiring the use of implants. People with degenerative disc disease, spinal stenosis and spinal deformities may be candidates.

Dr. Cammisa notes that as more surgeries are performed with the augmented reality system, patient follow-up and data collection will enable HSS researchers to compare AR to other technologies used in spine surgery to evaluate outcomes.

HSS has specialized in musculoskeletal care since 1863 and is ranked no. 1 for orthopedics worldwide and nationwide. Stamford Health is an independent, non-profit healthcare system committed to caring for the community through a wide range of high-quality health and wellness services offered by Stamford Hospital, Stamford Health Medical Group and ambulatory locations throughout southwestern Connecticut. Stamford Hospital has been recognized by U.S. News & World Report as a “High Performing Hospital” including in the specialty area of Orthopedics, has achieved Magnet Designation for Nursing Excellence and Planetree Gold Certification for Excellence in Person-Centered Care. The collaboration was formed to bring world-class orthopedic care closer to home for southern New England residents.

HSS Orthopedics with Stamford Health offers a comprehensive array of surgical and non-surgical orthopedic services, including sports medicine, sports rehab, joint replacement, and treatment of all conditions affecting the spine, foot and ankle, and hand and upper extremities. HSS orthopedic specialists consult with patients at locations in Stamford, Hamden, and Wilton. If surgery is necessary, HSS surgeons operate at the award-winning Stamford Hospital and Stamford Health Tully Health Center.

Introduced this year at the HSS Stamford location at Chelsea Piers, HSS Orthopedics Now provides patients 16 years of age and older access to orthopedic care for sudden injuries and severe pain, in order to triage, diagnose, treat, and when needed referral to a higher level of care in an expedited timeframe.

“I’m honored to step into this new role and continue building upon the momentum of our relationship with Stamford Health,” said Dr. Sandhu. “Opportunities for growing the initiative include providing the full spectrum of musculoskeletal care across multiple specialties for sports, degenerative, and arthritic related conditions without the need to travel outside the region.”

Before joining HSS in 1997, Dr. Sandhu was chief of the spinal surgery service at UCLA. His clinical practice specializes in minimally invasive spine surgery, robotic surgery, and the use of spinal biologics to enhance healing. Dr. Sandhu is also actively engaged in researching and developing medical devices and instruments used in spinal surgery and holds several patents. In addition, he has authored or co-authored well over 100 articles published in peer-reviewed journals and has received research awards from the North American Spine Society, the Orthopaedic Research Society and the International Society for the Study of the Lumbar Spine, including the prestigious Volvo Award in Spinal Research.

“I look forward to working with Dr. Sandhu as we expand the offerings of our collaboration with HSS to serve more patients in need of high-quality orthopedic services,” said Kathleen Silard, President & CEO at Stamford Health. “We pride ourselves on partnering with the best, and with HSS we’ve created a world-class center for musculoskeletal care in Connecticut. In the coming years, we’ll continue to expand the Collaborative’s geographic footprint in Connecticut, grow the number of providers and enhance our programmatic services to best meet the needs of our community.”

“HSS Orthopedics with Stamford Health will benefit greatly from Dr. Sandhu’s vision and expertise as a clinician, researcher and educator,” said Louis A. Shapiro, president and CEO at HSS. “We thank Dr. Cornell for his exceptional leadership in establishing and evolving our unique collaboration with Stamford Health, to provide an unsurpassed level of orthopedic care align with HSS best practices to thousands of residents living in Connecticut and New England.” 
 

About Stamford Health

Stamford Health is a non-profit independent healthcare system with more than 3,700 employees committed to caring for the community through a wide range of high-quality health and wellness services. Patients and their families receive expert, compassionate care through the system’s 305-bed Stamford Hospital; Stamford Health Medical Group, with more than 40 offices in lower Fairfield County offering primary and specialty care; a growing number of ambulatory locations across the region; and support through the Stamford Hospital Foundation.

Stamford Health is known for its expert, person-centered care through its many recognitions and partnerships. Stamford Hospital is the only hospital in Fairfield County, CT to receive a grade of A from The Leapfrog Group, an independent watchdog organization for protecting patient safety. U.S. News & World Report has recognized Stamford Hospital as a High Performing Hospital. The Centers for Medicare and Medicaid Services (CMS) rated Stamford Hospital as a five-star hospital for Overall Quality. The American Nurses Credentialing Center has granted Stamford Hospital Magnet Status, which recognizes superior patient care with the highest level of safety, quality and patient satisfaction. Stamford Health is Planetree Gold-Certified for Excellence in Person-Centered Care Hospital of Distinction.

Stamford Health is also a major teaching affiliate of the Columbia University Vagelos College of Physicians and Surgeons and has recently expanded its relationship with Columbia to offer treatment and expertise from Columbia University Irving Medical Center’s nationally recognized heart surgeons. Stamford Health and Hospital for Special Surgery have created a premier center for specialty orthopedic care right in Stamford, CT. Additionally, in 2020 Stamford Health’s Carl & Dorothy Bennett Cancer Center entered into an expanded collaboration with Dana-Farber Brigham Cancer Center.

Dedicated to being the community’s most trusted healthcare partner, Stamford Health puts patients first to build long-lasting relationships. For more information, visit StamfordHealth.org. Like us on Facebook and follow us on Twitter, Instagram, YouTube, and LinkedIn.

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.”

Cervical disc disease, or degenerative disc disease, is the progressive deterioration of spinal discs and arthritic changes in the facet joints. During this procedure, surgeons will test the safety and efficacy of removing discs at two levels and implanting an artificial disc device at each level of the cervical spine between the vertebrae where the disc was removed. The artificial disc will serve to stabilize the spine while preserving greater motion than a conventional fusion surgery.

Previous patients who underwent artificial disc replacement reported greater improvements in their pain relief, mobility, and activities of daily living than those who underwent spinal fusion surgery, the standard treatment. It is less invasive but as effective as spinal fusion surgery, however the procedure using this particular device has not been validated through a clinical trial to date.

“The concern with doing a fusion type operation is that over the long term the other discs have to accommodate for the motion lost at the fused level,” said Darren Lebl, MD, a minimally invasive spine surgeon who is leading the research at HSS. Over time, the increased mechanical demand on the surrounding vertebrae can make the discs in the region more vulnerable to additional degeneration.

“We do know very clearly that fusion is limiting motion,” Dr. Lebl added. “The concept of the two-level disc replacement is to preserve motion with two moving mechanical devices.”

To be eligible for participation, patients must be between the ages of 18 and 69 years and have received a diagnosis of radiculopathy (impingement of the nerves in the spinal column) or myelopathy with radiculopathy, a more severe form of damage to the spinal cord involving vertebrae in the neck, defined at cervical discs C3 through C7. Patients must also be experiencing symptoms associated with disc problems, such as neck or arm pain, decreased muscle strength and abnormal reflexes that has not responded well to conservative treatments such as rest, heat, physical therapy and pain relievers.

The trial will include at least 390 patients once enrollment is complete. Patients will receive regular evaluations for two years after surgery and may be examined in periodical follow-up visits for a total of seven years.

For more information about the trial at HSS, contact Philip Paschal at paschalp@hss.edu or 917-260-4285.

The new site broadens access to world-class musculoskeletal care for patients who live in the Wilton area, as well as those living north and south along the Route 7 corridor. The Wilton medical facility, located in the Whitlock Building within the Wilton Crossing complex at 195 Danbury Road, Suite 200, offers a robust range of services: spine, sports medicine, physiatry, and adult reconstructive and joint replacement.

The Wilton facility expands HSS’s network of locations in Connecticut. HSS Stamford at Chelsea Piers Connecticut provides world-class orthopedic care with patient visits, diagnostic capabilities and treatments across a broad range of specialties. The new facility also adds to the greater Fairfield County locations that HSS operates in collaboration with Stamford Health. These include surgical capabilities at HSS Orthopedics at Stamford Health, located on the fifth floor at Stamford Hospital, and at HSS Orthopedics at Stamford Health’s Tully Health Center; patient visits at HSS Orthopedics at Stamford Health-Hamden; and HSS Sports Rehab locations in Stamford, Greenwich, Wilton and New Canaan.

HSS Orthopedics at Stamford Health-Wilton features access to HSS physicians, nurses, support staff, and exam rooms. Patients who need x-rays, MRIs or physical therapy services can visit Stamford Health’s nearby facility at 372 Danbury Road, across from Wilton High School, or HSS Stamford at 1 Blachley Road at Chelsea Piers.

“Our overarching goal with this new location in Wilton, as with all of our other suburban facilities in Fairfield County, is to bring world-class care closer to home for patients who live here,” explains John Finger, senior vice president of NY Regional Market at HSS. “HSS commits fully to the communities we serve by establishing affiliations with local school teams, offering educational programs and sponsoring events to promote health and activity. We live here, we work here and our kids go to school here. We look forward to building a thriving community partnership in Wilton.”

“We’re thrilled to be expanding our collaboration with HSS to serve the community in Wilton,” said Jonathan Bailey, Senior Vice President of Operations and Chief Operating Officer for Stamford Health. “Growing our presence in Wilton represents a multi-year initiative, and these orthopedic offerings will complement the suite of services we already provide patients at our Danbury Road location including Primary Care, Radiology & Lab Services, Physical Therapy and 11 other specialties.”

This funding will support Dr. Dahia’s Spine Development and Regeneration Lab to study the potential of two important developmental molecules in the reversal of age-related intervertebral disc (IVD) pathologies and in the treatment of chronic back pain.

“Approximately 70 percent of the U.S. population is affected by chronic back pain, negatively impacting longevity and quality of life,” said Dr. Dahia. “There is currently no treatment available for disc degeneration, which is a big concern when you look at the world’s aging population. With the lack of treatment options, people can become dependent on strong pain relievers such as opioids.”

“It is an incredible honor for Dr. Dahia to receive these two NIH grants,” said Lionel B. Ivashkiv, MD, chief scientific officer at HSS. “Being awarded an NIH grant is the highest metric of scientific quality and impact. The application itself is peer-reviewed and quite rigorous.”

Dr. Dahia received the first 5-year grant for $2.8 million from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)/NIH R01 to study the role of the sonic hedgehog (SHH)/Brachyury axis in the maintenance of the postnatal IVD. This work aims to identify the role of Brachyury, a critical developmental molecule first reported in the nucleus pulposus cells of postnatal disc by Dr. Dahia herself in 2009, in the growth and maintenance of the postnatal IVD, how its age-related loss causes disc pathologies and peripheral sensitization and pain, and whether this can be prevented. The study findings will also identify targets to reverse painful disc pathology and help regenerate the disc.

She was then awarded the National Institute of Aging (NIA)/NIH R01 5-year grant for $3.3 million to study the role of developmental signaling pathways in the maintenance of spinal discs. The study is focused on understanding the crosstalk between major developmental signaling pathways interacting with SHH signaling (also first shown by Dr. Dahia in 2009) in temporal regulation of the different components of the IVD and their beneficial effect in maintenance and activation of disc progenitor cells. The research intends to discover if there is a potential for disc regeneration using its own cells, and is being done in collaboration with Todd J. Albert, MD, spine surgeon and surgeon-in-chief emeritus of HSS. Dr. Albert and his team will test Dr. Dahia’s findings in clinical conditions.

“Initially, we found that these crucial developmental molecules are expressed in very young spinal discs, and recently we observed that they decline with age and disc pathology, hence we are now evaluating their function from stages of growth and maturation to aging,” explained Dr. Dahia.

Dr. Dahia has committed her career to developing a full understanding of disc biology as they grow, mature, and age to identify potential avenues for therapeutics. She previously received an NIH grant in 2014 to study how the Wnt/SHH signaling loop controls IVD growth and differentiation. When Dr. Dahia began her research in disc biology over a decade ago, she was one of the first to study the beneficial role of developing molecules in the postnatal spine. Now, this is being adapted in other musculoskeletal research in a broader sense.

According to Dr. Dahia, other researchers have tried to use stem cells to solve these issues, but the cells are unable to survive due to the harsh microenvironment of the disc. “Our lab’s process is unique, as we aim understand the cellular and molecular basis of disc pathology and know how to intersect it, using our unique and novel genetic strategies,” she noted.

Dr. Dahia’s Spine Development and Regeneration Lab at HSS concentrates on understanding the role of key developmental cell signaling pathways and molecules in the development and homeostasis of various musculoskeletal tissues including the IVD, spinal column, growth plate, and tendon. The lab’s primary focus is on IVD development and maintenance and whether developmental pathways and molecules can prevent age-related disc pathologies and associated neurological symptoms or regenerate the degenerated discs.

“These scientific discoveries can directly impact future directions of musculoskeletal research to best improve clinical outcomes,” said Dr. Dahia who noted that HSS research is aimed at enriching the lives of patients suffering from debilitating orthopedic and rheumatic conditions.

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 use of robotics and computer navigation in spinal surgery is rapidly expanding. Increasing numbers of hospitals and spine surgeons are adopting the technology, which aims to enhance precision, accuracy and predictability, according to Darren R. Lebl, MD, MBA, a spine surgeon at Hospital for Special Surgery (HSS).

He believes the technologies have reached a tipping point. “I think they’re good enough to greatly improve what we do in terms of minimally invasive surgery,” said Dr. Lebl. “In my own practice, I’ve seen the benefits for patients in terms of a shorter hospital stay, quicker mobility and decreased healing times.”

The main barriers to implementing the new technologies include additional time in the operating room (OR) and concerns regarding the accurate placement of pedicle screws. Many spinal surgeries require the use of hardware such as pedicle screws to stabilize the spine, and precise positioning is critical.

Dr. Lebl and colleagues at HSS launched a study to evaluate the accuracy of robotic- and navigation-assisted technology in screw placement. They also set out to determine the extra time needed in the OR, noting that there is a learning curve for a surgical team when implementing a new system.

The study, “K-wireless Robotic and Navigation Assisted Pedicle Screw Placement in Adult Degenerative Spinal Surgery,” was presented today at the American Academy of Orthopaedic Surgeons (AAOS) 2021 annual meeting. The results were also published in The Journal of Spine Surgery in June 2021.

“Our main finding was that the screw positioning was very accurate, and the additional time needed to adopt these technologies into practice was small,” Dr. Lebl noted. “In our study, the speed of robotic screw placement showed improvement within the first several cases.”

The research included 65 adult patients (mean age of 59) with lumbar degenerative pathology who underwent a robotic-navigated posterior spinal fusion from June 2019 to July 2020. A total of 364 instrumented pedicle screw implants were planned robotically. A single orthopedic surgeon performed the surgeries using the Medtronic Mazor X Stealth Edition system.

The robotic/navigation time in the OR, screw placement times and positioning times were recorded. Following screw placement, all patients had intraoperative 3D fluoroscopy, and screw trajectory was compared to a preoperative CT image. Reasons for conversion from robotic navigation to k-wire or freehand technique were recorded.

“The spine surgeon in the study had more than 10 years of experience and had placed thousands of screws with previous techniques, such that he had alternatives if it was determined that robotic-assisted placement of a screw would not be possible,” said Fedan Avrumova, BS, a research assistant in the HSS Spine Service. “It is important to note that the robot can be a valuable ‘assistant’ but does not replace surgical experience and good judgment.”

The mean time per screw placement was 3.6 minutes robotically versus 3.7 minutes freehand, with a significant decrease in time between the first 10 and last 10 cases: 5.5 minutes versus 2.3 minutes. Setting up the robotic navigation system in the OR showed a decrease in time between the first 10 and last 10 cases: 9 minutes versus 6 minutes.

“Many spine surgeons recognize the value of the technology, but the concern has been the additional time needed in the OR,” Dr. Lebl said. “As we got further along in our study, we found that it actually saved time in the OR. The benefits of the technology easily outweigh the additional time needed in the early implementation of the system because the accuracy is unmatched.”

“When we evaluated outcomes, we found zero complications and no revision surgeries were needed,” Ms. Avrumova noted. “The surgical team learned how to use the robot successfully and became more efficient with robotic implantation when compared to conventional minimally invasive and conventional open techniques. In addition, the accuracy was as good as, if not better than, open or conventional minimally invasive techniques, which we confirmed with a 3D imaging study in every patient during surgery.”

“Just a few years ago, there were two FDA-approved robots to assist in spine surgery. Now there are five or six,” said Dr. Lebl. “The technology is revolutionizing the way we do things, and it’s a very exciting time to be a spine surgeon.”

Study Title: “K-Wireless Robotic and Navigation Assisted Pedicle Screw Placement in Adult Degenerative Spine Surgery”

Authors: Fedan Avrumova, Kyle Morse, Madison Rae Heath, Roger F. Widmann, Darren Richard Lebl. All at HSS.

Disclosures: Dr. Lebl has received research support from Medtronic.

Today at the American Academy of Orthopaedic Surgeons (AAOS) 2021 annual meeting, details of an enhanced recovery pathway developed for these patients were presented and the improvements that patients saw after being treated with this approach were described. The results of the investigation into its effectiveness were also published in January 2021 in The Spine Journal.

“In today’s healthcare environment, we’re all looking for ways to decrease costs and improve the quality of care we deliver,” says HSS spine surgeon and principal investigator Han Jo Kim, MD. “We wanted to see which factors were modifiable in the care of these patients, to help us decrease the time spent in the operating room and patients’ length of stay and minimize complication rates.”

The team started using its enhanced recovery pathway in February 2019. The study reports data from 40 patients who underwent fusions of at least five vertebrae in the lower back using the new protocol. Although spinal fusions of five or more vertebrae are considered complex procedures, they are relatively common and used to treat a number of conditions.

“Traditionally, these patients stayed in the hospital for at least seven or eight days,” Dr. Kim says. “This procedure has a high reported complication rate, and a high rate of revision surgeries, 90-day readmissions and dependence on rehabilitation facilities upon discharge. For those reasons, we thought it would be an important operation to evaluate when we started targeting methods to improve complex spine surgery.”

One key component of the new treatment pathway was always using the same surgical team, including surgical technicians, nurses and anesthesiologists. After surgery, the same physical therapy team cared for all the patients in the study, and patients were mobilized three times a day. Rigorous patient selection was also important for ensuring that patients could fully benefit from the optimization.

During surgery, the team focused on minimizing blood loss and keeping the time spent in the operating room as short as possible. When feasible, powered surgical instruments were used. The surgeries were done in four stages of one hour each, so that all members of the team would know how to anticipate the next phase of the operation.

Several changes were made postoperatively as well. The regimen for pain medication was modified to reduce the complications seen from narcotics. The patients were prompted to get out of bed the same day as their surgery, instead of waiting until the next day. And physical therapy sessions were increased from twice a day to three times a day.

When compared with matched patients treated without the optimized pathway, the study population achieved remarkable results. No patients went to the intensive care unit following surgery, compared with a usual rate of 30%. Hospital stays were decreased from an average of 7.3 days to 4.5 days. A higher rate of patients were discharged home versus to a rehabilitation facility (95% versus 65%). Overall patient outcomes at one year were equivocal.

“HSS is uniquely positioned to execute a program of this kind, because everyone here is dedicated to orthopedic surgery and care. That enables us to create and initiate optimized pathways,” Dr. Kim says. “Not every hospital has the infrastructure and resources to build this type of program, but we wanted to share what we did so other centers could model it. Ultimately, the goal is to improve the quality of care that we provide for patients and to decrease the costs by instituting such pathways across multiple healthcare systems in the country that care for complex spine patients.”