• Labor Day Safety Watch: Tips for Better Spine and Brain Health
• Montanans work hard, play hard; area leads nation for back surgeries
• Giving doctors a better view: Imaging makes delicate procedures easier, less invasive
• New Hope for Bad Backs
• Montanans Back to Work, Play Far Sooner After Newest Spine Surgery
• National Neurosurgeon Stand-Out Joins NRN

Labor Day Safety Watch: Tips for Better Spine and Brain Health

FOR IMMEDIATE RELEASE, August 30, 2007 - Like most Montanans, Michael Copeland, M.D., of Northern Rockies Neurosurgeons enjoys physical activities but also takes measures to avoid brain and spinal cord injuries, which can cause permanent impairment, paralysis, and sometimes death.

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"Montanans work hard, play hard; area leads nation for back surgeries"

By DIANE COCHRAN Of The Gazette Staff, Published on Monday, December 04, 2006

Bill Renney blames most of his back trouble on a rock.

Renney's wife spied the lichen-covered stone last summer while the couple was hiking near Cooke City.

"She found a real nice rock," Renney said. "She encouraged me in ways wives can to get said rock."

So he did. The next day, his right leg went numb and pain began arcing out of his lower back.

Read more at http://www.billingsgazette.net/articles/2006/12/04/news/local/20-back.txt

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"Giving doctors a better view: Imaging makes delicate procedures easier, less invasive
Technology produces 2-dimensional view of the insides of blood vessels"

By DIANE COCHRAN Of The Gazette Staff, Published on Saturday, February 24, 2007

Thanks to a tiny piece of crosshatched metal, Johnny Lewis is seeing things a lot more clearly.

Shorter than a paper clip and more slender than a No. 2 pencil, the neurovascular stent tripled the blood flow through a vessel in the Cody, Wyo., man's brain and probably saved his life.

The stent was implanted earlier this week at St. Vincent Health-care with new technology that allowed Lewis' neurosurgeon to guide it into place using multidimensional, real-time imagery of the insides of the patient's veins.

It was the first surgery of its kind in Montana, according to the hospital, and was possible in part because of a new X-ray machine called a biplane.

Read more at http://www.billingsgazette.net/articles/2007/02/24/news/local/25-biplane_v.txt

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New Hope for Bad Backs
Cutting-edge option of artificial disc replacement gives sore Montana backs a break

It’s a sore situation – an estimated 12 million Americans suffer from low-back pain because of degenerative disc disease. But a recent approval by the Food and Drug Administration (FDA) has brought a breakthrough treatment to Montana: Artificial vertebral discs.

The disc comprises two metal plates separated by a rubber cushion, which completely replaces the body’s natural disc. Although in use in Europe for years, artificial disc replacement (ADR) got FDA approval only in October 2004, and just a few dozen have been performed in Montana. Billings-based Northern Rockies Neurosurgeons have been successfully implanting the devices for a year, and Drs. Michael Copeland and Yves Meyer together have performed more than a dozen ADR surgeries over the past 12 months.

“It’s been gratifying to be able to offer our patients this new alternative,” said Dr. Copeland. “Patients report a noticeable increase in mobility over spinal fusion and fewer complaints of soreness following the surgery.”

Increased flexibility over a lifetime
Degenerative disc disease is a natural wear-and-tear process that causes the soft, cartilage-like discs between vertebrae bones to weaken and dry out over time. The disc gradually loses its ability for shock absorption and literally falls out of sync, placing extra pressure on the surrounding vertebral nerves. The result, more often that not, is incapacitating pain.

Until recently, spinal fusion (in which vertebrae are fused together) was the only solution for the 250,000 Americans annually who needed surgery for damaged discs. By removing the damaged disc and joining together adjacent vertebrae with a bone graft, spinal fusion helps to alleviate most pain.

The drawback is that fusion significantly reduces a patient's range of motion, since a part of the spine that was once flexible is now immobilized. Sometimes fusion also accelerates the deterioration of the discs above and below – leading to more surgeries and an increasingly stiff and less mobile patient. It can be especially debilitating for young patients, who tend to live long enough to experience the ongoing chain reaction.

Slowing the rate of deterioration
People with degenerative disc disease should first undergo conventional therapy methods to lessen the discomfort, but if all else fails, the next alternative is surgery. Most people have back surgery because they have pain. Disc replacement, like spinal fusion, is just another option for lessening or even eradicating the hurt.

“Artificial disc replacement patients are much less likely to experience the accelerated deterioration of surrounding discs, so the need for future surgeries may be greatly reduced,” said Dr. Meyer. “This really does offer new hope to patients with difficult back problems.”

An artificial disc is made of two metallic endplates and a moveable polyethylene center (imagine it as an Oreo cookie). Six spikes on each side of the implant are pushed into and attached to spinal vertebrae during the surgery, which typically takes two to three hours. Once in place, the disc device is designed to help align the spine and mimic its natural range of motion.

Following ADR surgery, the patient can return to work in six to eight weeks instead of the six to nine months typical with fusion.  In fact, since there is less pressure on surrounding discs and no need for a bone graft, studies show the surgical success rate of disc replacement ranges from 80 to 90 percent, compared to 70 to 80 percent for fusion.

“The benefits with artificial disc replacement are clear,” said Dr. Copeland. “Not only is recovery quicker, but unlike older procedures, we can now restore normal function, preserve movement and reduce the stress on the adjacent vertebrae. This is really the new frontier for spinal surgery, and it will likely only get better in terms of opportunities and outcomes as we learn more.”

Not all patients are optimal candidates for the surgery depending on factors such as age, health and insurance coverage. For more information, visit www.NorthernRockiesNeurosurgeons.com or call 866.822.1530.

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Montanans Back to Work, Play Far Sooner After Newest Spine Surgery
Gentler procedures slash hospitalization, recovery time to a fraction

BILLINGS – Traditional spine surgeries that require up to a week’s hospitalization and one year to resume normal activities are rapidly being eclipsed by procedures that often require a single night’s hospitalization – and a return to daily activities within a few months.

The new spine procedures – minimally invasive surgery (MIS) ­– are changing the way Montanans repair their hard-working bodies, offering advanced treatments that are kinder and gentler.

Bozeman fitness enthusiast Char Holtzworth thought her leg pain was just part of being an active woman and lifelong runner at mid-life. After months of discomfort, in which the operating-room nurse had to give up running and spinning, Holzworth was eventually diagnosed with spondylolisthesis, in which a vertebra slid forward and pressed on her leg nerves.

After thorough research on the Internet, Holzworth was convinced that MIS was the best way to proceed because of its faster recovery time, superior technique (utilizing a small incision rather than cutting through muscle), minimal blood loss, and confidence that she would “get her life back.”

“Patients are often stunned by the rapidity of their recovery,” said Robert Replogle, M.D., of Northern Rockies Neurosurgeons, who treated Holzworth. “One of the first things they tell us is that they wish they hadn’t waited so long.”

Replogle is among the first wave of Montana spine surgeons capable of performing MIS.

“One problem patients have during recovery is they feel so good they tend to do too much too fast,” he said.

In MIS, the surgeon reduces incisions by using an endoscope with miniature cameras, microscopes, miniature fiber optics, and fluoroscopic monitors. The fluoroscope’s three-dimensional x-rays allow the surgeon to operate through a half-inch incision rather than much larger intrusions into muscle and other delicate tissue.

Equally effective as traditional spine surgery, MIS creates far less post-operative pain, potential for complications, blood loss, and shorter recovery time. Patient hospital stay is only two days or less, with resumption of daily activity within a few months, with almost no scarring.

Holzworth’s procedure, in which the misaligned vertebra were re-fused, occurred in late September 2006 and she’ll return to work in January.

“All I have is a small scar,” she said. “I don’t have to wear a brace, and no one can even tell I had a procedure. “I’m so glad I did it. I forgot what it was like to be pain-free.”

In addition to performing brain surgery, neurosurgeons diagnose and treat disorders of the entire nervous system and the spinal column, spinal cord, brain and peripheral nerves. Not all patients are optimal candidates for the surgery depending on factors such as age, health and insurance coverage.

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National Neurosurgeon Stand-Out Joins NRN
Celebrated physician brings first-of-its-kind brain surgery skill to a four-state region

BILLINGS, MONTANA, July 31, 2006 – Nationally renowned brain and spine surgeon Robert Replogle, M.D., joins the Northern Rockies Neurosurgeons (NRN) medical staff August 1, becoming the first physician in a four-state area able to perform a breakthrough surgery for aneurysms.

Dr. Replogle’s arrival in Billings means that patients in Montana and surrounding states will no longer have to travel to far-flung medical centers in Minnesota or Colorado for some of the most advanced brain and spine surgeries. His skills include operating on aneurysms – ballooning of weakened arteries in the brain, which can be fatal if they rupture – by accessing the brain through an artery in the upper leg. The technique eliminates the need for cutting through the skull and greatly reduces patient discomfort and recovery time.

Dr. Replogle is also an expert in the evolving field of minimally invasive spine surgeries, which reduce incisions in the back to as small as the diameter of a dime. The result is a dramatic improvement in healing time. In some cases, patients go home from the hospital the same day.

In addition, Dr. Replogle also holds the distinction of being one of less than ten neurosurgeons in the United States to have been awarded a dual fellowship in cerebrovascular and endovascular neurological surgery. Both kinds of operations utilize blood vessels to access specific areas in the body.

“Billings is getting one of the nation’s superstars of neurosurgery,” said Lashman Soriya, M.D., NRN co-founder. “We already have the highest standards for patient outcomes in the region. But it’s especially true now that we can also offer the same level of innovative treatments as some of the best neurosurgical centers in the world.”

Prior to his Billings arrival, Dr. Replogle served as Assistant Professor at the University of Texas Southwestern Departments of Neurosurgery and Neuroradiology.

Dr. Replogle graduated from Stanford University with honors and earned his medical degree from the University of Chicago Pritzker School of Medicine. He later completed an internship and residency at the University of Virginia. In 1995, Dr. Replogle became board certified in neurosurgery, and since then has participated in research projects at Harvard Medical School and the Max Planck Institute in Munich, Germany.

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