Health Quest: Advanced Spine Care across the Mid-Hudson

By Jennifer Webster
Tuesday, October 10, 2017

Offering an expansive range of minimally invasive and open procedures, as well as conservative treatments, Health Quest supports robust spine programs at each of its hospitals, making high-quality care locally available to patients.

From left to right: Nicholas Renaldo, MD*, board-certified orthopedic spine surgeon and Medical Director of Spine Surgery at Vassar Brothers Medical Center; Omar N. Syed, MD, FAANS*, board-certified neurosurgeon and Co-director of Spine Surgery at Putnam Hospital Center; Andrew Peretz, MD, FAAOS*, board-certified orthopedic spine surgeon and Co-director of Spine Surgery at Putnam Hospital Center; and Richard B. Perkins, MD*, board-certified orthopedic spine surgeon and Medical Director of Spine Surgery at Northern Dutchess Hospital

The field of orthopedic surgery and neurosurgery, especially spine surgery, is evolving rapidly, and Health Quest is providing surgeons with the resources they need — equipment, imaging and highly trained personnel — to offer patients the most recent procedures. Whether it’s a guided injection, a minimally invasive disc replacement or a complex fusion surgery, each procedure is planned in advance based on detailed imaging and rigorous analysis of the patient’s needs. And, at all Health Quest facilities, patients are treated like guests, enjoying comfortable accommodations and receiving care from attentive, knowledgeable nurses.

Vassar Brothers Medical Center

All of Health Quest’s hospitals attract accomplished physicians to their medical staffs due to factors including an excellent nursing staff, first-class patient amenities and an institutional commitment to supporting surgeons with advanced tools and technologies, says Nicholas Renaldo, MD*, board-certified orthopedic spine surgeon and Medical Director of Spine Surgery at Vassar Brothers Medical Center.

Dr. Renaldo reviews a spine surgical candidate’s X-ray.

“I’ve lived in the Hudson Valley for six years,” Dr. Renaldo says. “My work centers around Vassar Brothers, and I am also on the medical staff at Northern Dutchess Hospital. Over that time, I’ve seen a lot of resources committed to orthopedic and spine surgery, allowing us to increase the number of services we provide, offer minimally invasive surgeries and perform complex operations.”

For instance, Vassar Brothers recently acquired Medtronic’s O-arm System, an intraoperative imaging system.

“These types of devices represent a significant investment, but they allow us to perform larger and more complicated surgeries,” Dr. Renaldo says. “From the organizational standpoint, Health Quest has supported us not only on the technological side, but on the inpatient side. They care for patients well and dedicate extensive resources to them. Orthopedic hospital rooms are more private, for example. Health Quest has invested more resources at the bedside, including a full-time orthopedic clinical coordinator. Patients coming in for elective procedures have a great experience; all their needs are met.”

“The orthopedic surgeons on the medical staff at Vassar Brothers Medical Center care for adults with conditions such as herniated discs, spinal arthritis causing stenosis of the spine, and spinal fractures,” he says. “This care involves numerous minimally invasive procedures, such as kyphoplasty, in which cement is injected into broken vertebrae in people with osteoporosis. This is performed through a needle incision and takes only 10 to 20 minutes.”

Spine surgeons at Vassar Brothers also perform microdiscectomy to relieve leg pain from herniated discs.

“The surgery is performed through an incision less than 1 inch long,” Dr. Renaldo says. “The procedure takes less than an hour. Patients are soon ambulatory, and the procedure produces good results. We are highly successful with cervical fusions, disc replacements and surgery for pinched nerves in the neck, as well.”

In addition, the spine surgeons on the medical staff at Vassar Brothers Medical Center perform larger, open procedures when needed, such as fusion surgery for patients with degenerative scoliosis. Even in these cases, however, physicians use intraoperative navigation systems and specialized implants to speed the procedures and make them less invasive.

Craig M. Shannon, MD*, and Dr. Renaldo perform spine surgery at Vassar Brothers Medical Center utilizing the O-arm.

At Vassar Brothers Medical Center, orthopedic surgeons and neurosurgeons closely collaborate in the care of spine patients, enhancing patient outcomes.

“We’re a cooperative program, and we work together on issues such as quality control and planning more complicated procedures,” Dr. Renaldo says. “This is especially true in trauma cases. We each bring something to the table in terms of knowledge of the musculoskeletal and nervous systems.”

As Medical Director, Dr. Renaldo wants to continue growing the spine program at Vassar Brothers, and Health Quest supports his mission.

“Vassar Brothers Medical Center is continuing to add resources, acquiring new equipment and exploring robotic technology that can sync up with our navigation system,” he says. “The hospital has experience in robotic surgery in many departments, and we hope to add those capabilities for spine surgery, as well. The hospital has a new state-of-the-art facility planned for 2019, and the spine program will benefit from that.”

Family medicine physicians should feel confident with a local referral to Health Quest, Dr. Renaldo says.

“We have achieved a high level of quality, and patients are comfortable receiving treatment here,” he says. “We have access to the same technology and specialists found in larger facilities. My goal as Medical Director and surgeon is to provide patients with the most directed, focused treatment and the least invasive procedures to correct their problems and help them quickly recover function.”

Spotlight: Surgical Mapping

To visualize minimally invasive spine procedures, surgeons require ways to see inside the body. This is especially true for spine surgeons, as the vertebrae can move along many planes — arching forward and backward, bending side to side, and rotating. An accurate procedure must be precisely aligned in three dimensions.

To that end, Health Quest has invested in advanced imaging. One device, the O-arm System by Medtronic, allows continuous intraoperative imaging. A rounded gantry circles the body, allowing a full-circle image to be obtained in seconds. The system allows 2- or 3-D imaging, displaying large areas in clear detail on a 30-inch digital flat screen.

Before surgery, the physician designates navigation points, which he or she can confirm against live imaging. Because bodies have great variety and tolerances in some surgeries are very tight, accurate, real-time imaging with the ability to correct preoperative maps against any shift during the procedure is crucial.

The imaging system allows physicians to track the movement of their instruments, as well, visualizing the surgical tools in relation to the patient’s anatomy. In this way, Health Quest’s spine surgery patients benefit from highly precise procedures performed, as often as possible, through extremely small incisions.

Putnam Hospital Center

Health Quest’s devotion to offering advanced procedures near where patients live and work extends to Putnam Hospital Center, as well. For more than 20 years, Andrew Peretz, MD, FAAOS*, board-certified orthopedic spine surgeon and Co-director of Spine Surgery at Putnam Hospital Center, has worked to build an active and innovative spine surgery program at Putnam Hospital Center. Five years ago, he was joined in this endeavor by Omar N. Syed, MD, FAANS*, board-certified neurosurgeon and Co-director of Spine Surgery at Putnam Hospital Center. Today, the hospital has a minimally invasive program supported by state-of-the-art equipment and highly trained operating room staff.

Dr. Peretz and technologist Deneen Zirofsky review a patient’s X-ray.

Dr. Peretz and Dr. Syed perform cervical arthroplasty, kyphoplasty, and procedures to treat spinal stenosis and spondylolisthesis, and provide fracture care at Putnam Hospital Center. They also remove spinal tumors. Many surgeries are performed on an outpatient basis.

“The most common procedures performed at Putnam Hospital Center are those that relieve neurologic impingement or radicular nerve pain,” says Dr. Peretz. “Those surgeries have high success rates and predictability of outcomes.”

Drs. Peretz and Syed approach cases conservatively, getting to know patients and educating them about nonsurgical as well as surgical options to treat back pain.

“I see patients multiple times before surgery, often involving the family in the decision-making process,” Dr. Syed says. “The hospital has started a spine education class.”

Held monthly in the Putnam Hospital Center auditorium, the class welcomes all who suffer from neck or back pain. The surgeons on the medical staff at Putnam Hospital Center review physical therapy, pain management and other nonsurgical approaches. They also explain the thought process that leads physicians to recommend surgical or nonsurgical alternatives.

“Often, surgery is not needed,” Dr. Syed says. “Many people experience significant improvement with access to appropriate physical therapy and pain management, and we have excellent programs in those areas on the Putnam Hospital Center campus.”

Patients who are advised to undergo surgery also receive specialized instruction, including information about what to expect before, during and after a procedure. Case managers in the hospital oversee their care, and nurses with expertise in surgical recovery help patients control their pain and begin to ambulate. From basic transfers to toileting and using stairs, patients practice the movements they’ll use in daily life so they can feel comfortable returning home after their hospital stay. In addition, patients are welcome to reach out to their surgeon after the procedure if they have additional questions.

Dr. Syed explains spinal anatomy to a patient at Putnam Hospital Center.

Putnam Hospital Center’s spine surgery program has a bright future.

“Technology and procedures are always advancing,” Dr. Peretz says. “We continue to explore better ways, more precise ways to perform surgery. We examine innovations, but we also keep in mind that technology is no substitute for expert knowledge and good patient care.”

Dr. Syed looks forward to the introduction of image-guided surgical techniques, in which navigation systems combine with intraoperative imaging, resulting in extremely accurate and safe procedures.

“Health Quest recognizes Putnam Hospital Center is in a location where we can serve a significant number of people,” Dr. Syed says. “Many patients have known the hospital for decades. They’ve seen their parents come here, and we treat their children, too. Putnam Hospital Center has made a commitment to invest in highly trained surgeons, advanced equipment and extensive community outreach. Offering a wide variety of treatments for spine conditions means patients can continue to receive care in a familiar setting, close to home.”

“The program is about healing patients and helping them obtain the quality of life they desire, using a team approach in pursuing this goal,” Dr. Peretz adds. “Whether recommending pain management, physical therapy or surgery, we want patients to overcome any spinal ailment that prevents them from living life fully.”

Spotlight: Motion-preserving Surgery

Cervical arthroplasty is motion-preserving surgery to replace damaged discs in the cervical spine. Herniated discs in the neck can lead to pain and weakness that radiate into the arms and hands. Traditionally, discectomy paired with fusion surgery has been performed as a solution, but fusion limits mobility in the area of the repair.

Cervical arthroplasty to introduce an artificial cervical disc solves this problem. Rather than using plates and screws, surgeons remove the damaged disc through a small incision, then implant an artificial disc system made of two metal plates and a durable plastic insert. The plates are fitted to the vertebrae on each side of the damaged disc’s former location. Once in place, they can move front to back and left to right around the insert.

Cervical arthroplasty produces results that reduce pain and approach the normal range of motion of the neck. Patients who undergo the procedure often return to work sooner than fusion surgery patients, without the need for a neck brace.

Northern Dutchess Hospital

At Northern Dutchess Hospital, surgeons such as Richard B. Perkins, MD*, board-certified orthopedic spine surgeon and Medical Director of Spine Surgery, have a long history of offering spine procedures in the safest, most minimally invasive fashion possible. Health Quest has supported Northern Dutchess Hospital’s mission to offer leading-edge spine care.

Dr. Perkins scrubs in for a spine surgery procedure at Northern Dutchess Hospital.

“Our relationship with the hospital is excellent,” Dr. Perkins says. “From the nursing staff to hospital leadership, we enjoy great connections. The doors are always open, and we can communicate exactly what we need to facilitate care.”

These strong bonds lead to continuity in relationships, both between surgeons and the hospital, and among hospital employees. The result: a close community tightly focused on patient well-being.

“I’ve been on the medical staff of Northern Dutchess Hospital since 2002,” Dr. Perkins says. “Northern Dutchess has a community hospital feel; we can offer our patients personalized care in a way that’s reflected throughout the culture of the hospital.”

Nursing staff, operating room technicians and radiology staff contribute to that ethos, Dr. Perkins says.

“It’s really a superb community of folks who work here, distinguishing us from other, more institutional medical centers,” he says. “We’re a small, tight-knit group, but we’re capable of performing a vast array of spine surgeries.”

Dr. Perkins confers with his nurse, Viviana Vazquez, post-surgery.

Common procedures include repair or replacement of herniated discs in the cervical spine, treatment for lumbar spinal stenosis, and fusion surgery. Northern Dutchess spine surgeons also frequently perform the kyphoplasty procedure to shore up fractured vertebrae.

“We rely on minimally invasive techniques for all operations when possible,” Dr. Perkins says. “It leads to less tissue dissection, less blood loss, faster recovery and less pain. For example, in kyphoplasty, we perform the surgery through a tiny hole, with no stitches or bleeding. On average it takes about eight minutes to complete a procedure. Similarly, in minimally invasive lumbar microdiscectomy, patients can go home the same day.”

Even some fusion surgeries can be performed in minimally invasive fashion. For example, in the procedure lateral lumbar interbody fusion, surgeons use an approach through the patient’s side to fuse lumbar vertebrae and reduce back or leg pain. Minimally invasive sacroiliac fusion involves stabilizing the sacroiliac joint to lessen lower-back pain.

“We use small tubes to insert fusion material, avoiding large incisions and minimizing bleeding,” Dr. Perkins says. “Patients often go home the day after surgery. We’re leaps and bounds removed from conventional methods of performing fusion surgery.”

Even less invasive is the array of conservative treatments Dr. Perkins and his colleagues provide for back problems. Each patient receives a personalized treatment plan, starting with nonoperative approaches such as physical therapy, medication, pain management and spinal injections, depending on the condition. Many patients never require surgery, Dr. Perkins notes.

When they do, however, each surgery is planned carefully and the hospital stay is made as brief and pleasant as possible. Patients are cared for by nurses who in many cases have been with Northern Dutchess for much of their careers.

“It’s a huge advantage to the patient and family when staff members have worked together for many years and are highly skilled,” Dr. Perkins says. “They’re proud of what they do, and that’s demonstrated in the delivery of better patient care and warm interactions with family. They’re familiar with the equipment, routine and surgeries we perform, which makes a huge difference to the surgeon in the operating room, as well.”

Health Quest’s support of the spine program at Northern Dutchess Hospital is evident in the program’s quarters in the expanded hospital. Patient rooms and operating areas are new, Dr. Perkins says. The operating suite has been revamped specifically to support spine surgery, while patient rooms resemble accommodations in luxury hotels.

“It’s a five-star experience,” Dr. Perkins says. “We deliver advanced spine surgery, and continuity of care extends to the hospital floor, where our patient care team and case managers are seamlessly integrated with our program.”

Spotlight: Kyphoplasty

Vertebral compression fractures are typically caused by trauma. In a healthy person, a fall might be the cause; for a person with osteoporosis, the trauma might be minimal relative to the damage done. Bone disease such as cancer can also cause vertebral compression fractures. These fractures lead to pain and numbness. They may also cause incontinence or inability to urinate if they press against the spinal cord. Vertebral compression fractures most frequently occur in the thoracic region of the spine.

Pain medicine and muscle relaxants are first-line treatments, but to stabilize the fracture and prevent a damaged vertebra from pressing into the spine, surgery is often required. An innovative, minimally invasive procedure to correct vertebral compression fractures, kyphoplasty “spaces out” the damaged vertebra and fixes it in place.

With the patient prone, the surgeon makes a small incision in the back. He or she threads a tube containing a balloon into the fractured vertebra. Inflating the balloon, the surgeon returns the vertebra to its original height and creates a space inside it, then removes the balloon and injects bone cement in its place, creating a cast of the vertebra from the inside. The cast quickly hardens.

Health Quest surgeons often perform the procedure in 10 to 20 minutes. Patients typically go home the same day or, at most, spend one night in the hospital. This X-ray-guided procedure quickly solves what could otherwise be a chronic, degenerative condition.

Local Access

Whether Vassar Brothers Medical Center, Putnam Hospital Center or Northern Dutchess Hospital, a referral to a Health Quest facility allows patients to access excellent spine care close to home. They can undergo a broad spectrum of advanced, quality-of-life-enhancing procedures, along with high-level conservative treatments and rehabilitation.

“We offer cutting-edge care, delivered in a safe and, frequently, minimally invasive manner,” Dr. Perkins says. “Patients return home with minimal postoperative discomfort. There is no reason for anyone to travel outside the area to receive advanced spine care.”

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