Spine News

WJZ-TV Artificial Disk Replacement Surgery Good Fortune Nation's First Double Disc Surgery Charite Disc Replacement Amazing Feats Patient Information for Cervical Disk Replacement Study - PDF

Good fortune, great doctors help coach avoid a tragedy

12/08/04 Nelson Coffin email: ncoffin@patuxent.com Given all that the students, faculty, alumni and friends of Loyola Blakefield have gone through this fall trying to deal with the spinal-cord injury to junior football player Van Brooks, one can only imagine how the news of an assistant varsity wrestling coach's brush with a similar fate was received. The whole school community must have been unnerved by the near-tragic events a few days before Thanksgiving when Mike Zito, 35, was hurt while demonstrating a takedown. Hurt might not be the right word, considering that Zito suffered temporary paralysis - quadraparesis in medical terminology - for 15 minutes after his head hit the mat at an awkward angle. Fortunately for the coach, he was able to stand on his shaky legs to reassure his son, Michael, a sixth-grader at Loyola who was in the wrestling room that day. Eventually, the elder Zito walked down to meet his sister, Rosalie, who happened to be in the area. She drove the mile to the St. Joseph Medical Center, where Zito told emergency personnel that he had a broken neck. Quick reaction by doctors, an infusion of high doses of steroids and a 3 1/2-hour surgery to decompress his spinal cord a couple of days later may have saved Zito's life and almost certainly saved him from a lifetime spent in wheelchair. His prognosis, thanks to physicians such as St. Joseph chief of spinal surgery Dr. Paul McAfee, is good. Zito is expected to make a full recovery and, despite a cumbersome neck brace and a metal plate that was inserted into his neck during the surgery, is already walking. "It's amazing what a difference just a few more minutes of spinal cord compression makes in terms of a higher risk that the patient will not recover," McAfee said. Zito still seemed to be in a state of shock over the sudden and tumultuous series of events that might have turned his life around. The self-employed contractor won't be able to work for quite awhile, yet he's probably very happy with the outcome. "All I know is what should have been is not, and what might have been didn't happen," Zito said. Unfortunately, Brooks' injury was much more severe. More than 10 weeks have elapsed since what seemed to be an ordinary tackle turned into a tragedy in a Sept. 25 football game at Georgetown Prep in Bethesda. However, the Brooks story does have its share of positive chapters being written, such as what happened over the weekend at the Towson school. A celebrity auction was staged to raise funds for Brooks' medical expenses. Items included autographed equipment, uniforms and/or photos from such local luminaries as Ravens linebacker Ray Lewis, Ravens Coach Brian Billick, the 1955 Baltimore Orioles, late Baltimore Colt legend Johnny Unitas, Orioles Hall of Fame pitcher Jim Palmer and all-time Oriole favorite Cal Ripken. Considering tickets to the event were $50, and corporate sponsors added to the take, it's easy to see how more than $250,000 was raised for Brooks and his family. For anybody else whose pockets may not be as deep as their concern for the 16-year-old's plight, the Van Brooks Recovery Fund is accepting donations for the worthy cause. Just send a tax-deductible gift to the Van Brooks Recovery Fund, 114 E. Lexington St., Baltimore. MD 21202.

First Two Level Artificial Disc Surgery in U.S. Performed at St. Joseph Medical Center   WHAT:  Surgeons implanted a two level Charité Artificial Disc replacement into a patient with degenerative disc disease on Friday November, 20, 2004 at St. Joseph Medical Center, for the first time in the U.S.  Dr. Paul McAfee, chief of Spinal Surgery at St. Joseph Medical Center along with vascular surgeon Dr. Sam Saeidy replaced discs L4-5 and L5-S1 in a 57-year-old woman. Two level artificial disc surgery expands the opportunity to provide relief for patients with degenerative disc disease.  Thirty percent percent of patients suffer from more than one diseased disc.   Approved by the FDA on October 26, 2004, the Charité artificial disc is the first motion-preserving device for chronic lower back pain and degenerative disc disease.  Spinal fusion surgery, which limits motion and may place stress on the adjacent discs, has been the common surgical treatment for degenerative disc disease, with 200,000 procedures performed in the U.S. annually.  DePuy Spine, which produces the Charité disc, predicts 20 percent of spinal fusion cases will be replaced by artificial disc surgery in the next two years, once enough surgeons are trained in the intricate replacement surgery.   “The actual two level replacement surgery is very straightforward, as long as the spinal surgeon partners with a talented vascular surgeon,” says Dr. McAfee.   However, he explains, “The challenge is convincing insurance companies to cover the cost of modern innovative surgical techniques.  It will simply take more time for insurance companies to authorize this medical advancement, which increases and preserves spinal flexibility…The Charité replacement has improved the care of patients at St Joseph Medical Center over the last four years, where we pioneered this innovative surgical procedure.” A similar advancement on the horizon will help neck problems.  “In the next several months, we will be evaluating a cervical disc replacement procedure at St Joseph Medical Center, which looks very promising,” says Dr. McAfee.   St. Joseph Medical Center, one of 15 spine centers (and the only Maryland center) in the two-year, randomized Charité study, enrolled one of the largest numbers of patients.  Those who received the artificial disc improved more quickly, were discharged from the hospital a half-day earlier, and had pain and function scores statistically superior to the fusion patients.    More than 7,000 patients world-wide have received the Charité disc, which has been available in more than 30 countries for several years. The Charité artificial disc is made of two metallic endplates and a polyethylene core.   St. Joseph Medical Center is a 365-bed nonprofit, regional medical center in Towson, Md., and a member of Catholic Health Initiatives. Founded in 1864 by the Sisters of St. Francis, St. Joseph has been recognized by “U.S. News & World Report” as one of America’s best orthopaedic facilities and is a nationally ranked Top 100 heart hospital. For more information about St. Joseph Medical Center, visit sjmcmd.org.

First Artificial Disc FDA Approved St. Joseph Medical Center only study site in Maryland   WHAT:  The CHARITE™ Artificial Disc was approved by the U.S. Food and Drug Administration on Tuesday, October 26, making it the first motion-preserving device approved for use for chronic, lower back pain and degenerative disc disease.  Until now, lumbar spinal fusion surgery, which produces limited motion, has been the common surgical treatment for degenerative disc disease, with 200,000 procedures performed annually in the U.S.  At St. Joseph Medical Center, one of 15 spine centers that took part in the two-year  randomized study, 60 patients were enrolled in the double blind study, and another 50 patients were enrolled as continued access patients to be followed for up to five years. The study demonstrated that patients implanted with the CHARITE Artificial Disc improved more quickly, were discharged from the hospital a half-day earlier, and had pain and function scores that were statistically superior than the fusion patients.   WHO: Dr. Paul McAfee, chief of Spinal Surgery, St. Joseph Medical Center and main investigator of the CHARITE study at St. Joseph Medical Center Dr. Ira Fedder and Dr. Justin Tortolani, orthopaedists and co-investigators   The CHARITE Artificial Disc is made of two metallic endplates and a polyethylene core that allows for motion and function very much like a normal disc.  Two-thirds of the 304 patients enrolled in the U.S. study received the new disc, while one-third had traditional spinal fusion surgery.  More than 7,000 patients throughout the world have received the new disc, which has been available in more than 30 countries prior to the U.S. study.  St. Joseph Medical Center was the only center in Maryland to participate in the CHARITE study.

Amazing Feats

Recently, Dr. Paul McAfee and Dr. Ira Fedder, along with staff from Orthopaedic Associates and St. Joseph Medical Center accomplished two amazing feats that are worth noting.

First: Dr. McAfee was asked to assist a New Zealand surgical team via satellite.  Below are pictures of Dr. McAfee as a "virtual assistant" for an operation in New Zealand performed in a mobile surgical van.  The procedure was an SB charite disk replacement. A studio was set up in a hotel room in Washington DC and Dr. McAfee, was able to assist  via satellite .  The event was part of a medical conference in New Zealand.   According to Dr. McAfee, the procedure and event went well.

Second: To view the surgery please click on the link below: http://www.istreamplanet.com/srs/default.asp?np=surgeryi This link shows the entire surgery at St. Joseph Medical Center as viewed from the International Congress -- The Emerging Technologies Meeting in Washington, in October. This is the only surgery thus far recognized on the Scoliosis Research Society Website. This is the most prestigious Spinal Society in the world. Dr. McAfee and Dr. Fedder with the help of a team from OA, and St. Joseph Medical Center performed the first telesurgery of the Charite Lumbar Disk Replacement surgery in the United States.  The procedure is expected to be approved by the FDA later this month. Physicians attending an emerging tecnologies meeting in Washington DC were able to view the surgery and ask questions.  According the Dr. McAfee and Dr. Fedder, "The surgical procedures went extremely well and the patients are recovering in brilliant fashion. The nursing staff, as always, did an unbelievably great job."

"These pictures should convey the magnitude of the effort put forth to allow great surgical teaching yet still provide un-equalled compassionate care," said Dr. McAfee.