Research and Innovation in Spine Care

Medical science is an imperfect science. The present day medical and surgical treatments have evolved over a period of centuries with laborious and painstaking research into what gives best solutions to diseases of human body. However, all solutions and treatments are far from perfect and doctors and scientists are involved in constant research and innovations to give better solutions and treatments. Medical science requires constant learning and skills to recognize and adapt newer modalities of treatment for benefit of patients. This is much more true for surgical science as the impact of surgical interventions are more instantaneous and drastic than medical therapy. Surgeons not only need to adapt to newer techniques evolved by others but also be sensitive and pursue research into their daily practice. A small variation in technique, which may be giving a substantial benefit to patient recovery and outcome can eventually lead to innovations. Spine surgery is probably witnessing a radical change in techniques and modalities of treatment over the last 2 decades which has substantially improved patient recovery and outcomes.

  • What is research?

    It is a keen and honest enquiry into the results of our surgery seen over a period of years among the patients treated by us. It requires painstaking documentation of the events on a daily basis and objective assessment of results when patients come.for follow-up. With good research we can evaluate what is working best in our own experience for our patients.

  • What is innovation?

    Any newer surgical techniques or modifications of the presently available treatment can lead to innovation. However, all newer techniques cannot be called innovations. Only those specific newer techniques or modifications which constantly give a better results with substantial improvement in benefits to patient over the presently available modalities of treatment can be called as innovations. It goes a step beyond the painstaking research and requires exploration into the unknown. However, innovations in surgical field needs to be taken with utmost sense of responsibility with the single aim of providing better results to patient and not just for the sake of creating something new.

    Research and innovations by VITUS GROUP It gives us immense pleasure to bring to your notice that our group of professionals are not only delivering the best possible treatment for your spinal problems but also are constantly involved in improving the results of our treatment through research and innovations. Research starts with meticulous documentation of our daily practice. We have been maintaining all our patient records along with surgical details and complications on a daily basis, which gives us an opportunity to find out what works best for our patient population. Needless to say that what works best for the western population may not work so well for our population. For instance, our research into the surgical practices to prevent postoperative infections has yielded results with substantial decrease in our infection rates.

  • Research Initiative:

    We, at Jain Institute of Spine-care And Research, now have a platform where we can initiate research in the field of spine surgery. The first step in the pursuit of research is the evaluation of our own results in a scientific manner. This involves meticulous data collection and maintenance of patient follow-up for analysis of surgical results over a period of time.

    To start with we undertook a study on surgical site infection which is the most common complication in any surgical procedure and compared our results with that available in the literature. Below are the study results of postoperative surgical site infection at our centre from Nov 2011 to DEC 2012 (14 months) Table 3.

    Table 3: Postoperative surgical site infection seen at our centre from Nov 2011 to DEC 2012 (14 months) in various spinal disorders.

    Diagnosis

    No. of patients

    Superficial Infections

    Deep Infections

    Total Infections (%)

    KYPHO-SCOLIOSIS

    44

    0

    0

    0

    CERVICAL DEGENERATIVE DISEASE

    32

    0

    0

    0

    FAILED BACK

    43

    0

    1 (2.3%)

    1 (2.3%)

    SPONDYLOLISTHESIS

    53

    1 (1.88%)

    1 (1.88%)

    2 (3.77%)

    LUMBAR Degenerative DISEASE

    126

    0

    2 (1.58%)

    2 (1.58%)

    SPINAL TUBERCULOSIS

    37

    1 (2.7%)

    1 (2.7%)

    2 (5.4%)

    THORACIC MYELOPATHY

    7

    0

    0

    SPINAL TRAUMA

    60

    0

    0

    SPINAL TUMOR

    26

    0

    0

    Total

    428

    2 (0.46%)

    5 (1.16%)

    7 (1.63%)

    Based on our results there were 1.63% surgical site infections with 1.16% deep and 0.46% superficial infections during the period of 14 months. 2 patients among these required revision surgery with wound lavage before the infection settled down. None of them required removal of implants. An internal audit did not find any significant association of surgical site infection with co-morbidities like diabetes/ Hypertention, old age or the type of ward in which the patient was admitted.

    Infection rates based on 108,419 spine surgery cases from the Scoliosis Research Society Morbidity and Mortality database has shown overall rates of postoperative superficial and deep wound infections as 0.8% and 1.3%, respectively. Tumor Surgery, Scoliosis and Kyphosis correction surgery and revision spine surgery had higher rates of infection ( 3 to 5%). In this regard, the rates of infection experienced at our institute are significantly lesser than the range of worldwide infection rates.

    We are also pleased to inform you that prospective research projects in surgical treatment of cervical disc prolapse and Spinal tuberculosis have been initiated at our institute. Each member of our group has been involved in research and as a group we have good number of original research papers published in reputed international journals.

  • Innovation By Vitus GROUP

    We take pride in bringing to your notice that one of the innovative methods developed by our group has been accepted internationally as a favourable technique for insertion of cervical pedicle screws. Pedicle screws have changed the results of spine surgery and made it patient friendly. With stabilization using pedicle screws, most of the patients undergoing spine surgery walk in a day or two after spine surgery, which was not the case 15 years back when all patients with spine surgery were on bed rest for a month or two. However, Use of pedicle screws in cervical spine is still not widely practiced due to the fear of complications, especially injury to vertebral artery. Our group has developed a modified technique of insertion of cervical pedicle screws which significantly decreases the chances of complications. The technique is now being accepted widely and has already been presented in the annual meeting of North American Spine Society(NASS) and is published as a technical paper in the prestigious The Spine Journal in Feb. 2014.

    http://www.thespinejournalonline.com/article/S1529-9430(13)01573-8/abstract. At present we are the only center in karnataka practicing cervical pedicle screws and have the largest series of cervical pedicle screw insertions in the country. Many more innovative methods are being evaluated by our group and only those that give substantial benefit to the patient shall progress to the stage of publication and usage by wider surgeon community.

  • Publications of Vitus Spine

    1. The medial cortical pedicle screw--a new technique for cervical pedicle screw placement with partial drilling of medial cortex. Mahesh B, Upendra B, Mahan RS. Spine J. 2014 Feb 1;14(2):371-80. doi: 10.1016/j.spinee.2013.09.033. Epub 2013 Oct 19.

    2. Perforations and angulations of 324 cervical medial cortical pedicle screws: a possible guide to avoid lateral perforations with use of pedicle screws in lower cervical spine. Mahesh B, Upendra B, Vijay S, Arun K, Srinivasa R. Spine J. 2017 Mar;17(3):457-465. doi: 10.1016/j.spinee.2016.11.011. Epub 2016 Nov 16.

    3. Addressing Stretch Myelopathy in Multilevel Cervical Kyphosis with Posterior Surgery Using Cervical Pedicle Screws. Mahesh B, Upendra B, Vijay S, Arun K, Srinivasa R. Asian Spine J. 2016 Dec;10(6):1007-1017. Epub 2016 Dec 8.

    4. Complication rate during multilevel lumbar fusion in patients above 60 years. Mahesh B, Upendra B, Vijay S, Kumar GA, Reddy S. Indian J Orthop. 2017 Mar-Apr;51(2):139-146. doi: 10.4103/0019-5413.201704. PMID: 28400658

    For more information on these research topics kindly write to : vitusspine@gmail.com

Meet Our team
Dr. Mahesh B.H

M.S (Ortho) AIIMS
New Delhi
Spine Surgeon

Dr. Upendra B.N

M.S (Ortho) AIIMS
New Delhi
Spine Surgeon

Dr Raghavendra Rao D

MS Ortho, AFSA Spine(France)
Spine Surgeon

Dr. Vijay S

MS (Ortho)
Fellowship in Spine Surgery
(CMC, Vellore)
Spine Surgeon

Dr. Anand Jayaraman

M.B.B.S MRC Psych (UK)
Consultant Psychiatrist
(Pain Management)

Dr. Arun Kumar G.C

MS (Ortho)
Spine Registrar

Dr Vinay Jain K

MS (Ortho)
Spine Registrar

Mrs. Leena

Secretary & Co-ordinator

Mr. Gangadhar A.S

Co-ordinator