Guest Post from Deborah L. Benzil, MD, FACS, FAANS (right)
Chair, AANS/CNS Communications and Public Relations Committee
Vice Chair, Neurosurgery
Cleveland Clinic Foundation
Kristopher T. Kimmell, MD (left)
Neurosurgeon at North Kansas City Hospital/Meritas Health
North Kansas City, MO
“I know I can depend on books in times of trouble because they have a spine and two wings.”
― Ayse Aslihan Koksoy
“I’ve been dragging my feet across my back
And I’ve been rubbing my head against my neck
And I’ve been walking my fingers through my mind
And I’ve been feeling this feeling in my spine
And I believe I’ll be leaving it behind
When I don’t need a spine.”
― They Might Be Giants
The term spine engenders positive connotations of strength and stability. Conversely, to be spineless implies a lack of courage or moral character. The human vertebral column is a defining characteristic of our species and the major anatomic structure that allows us to walk upright. Consider for a moment the following stunning facts about our spines-there are:
- 33 bones.
- 100+ joints.
- 335 million degrees of flexion and extension in our necks in one year. One movement is about 13 degrees, meaning necks makes 25 million flexion and extension movements in a year!
- 40-year warranty (due to advances in public health, technology, and modern medicine, the human spine is now expected to last more than twice that long in many cases).
- 90 billion dollars in estimated direct costs of spine care annually in the United States.
Starting at the top, C1 is responsible for holding up the human head (weighing slightly more than a gallon of milk, or 4-5 kilograms) and down to the tip (the coccyx), the human spine is a complex series of bones and joints with two primary functions:
- The spine provides the structural support from the pelvis to the base of the skull, essentially holding up more than half the human body; and
- The spine is also the conduit through which the nervous system passes.
The spine also articulates with the skull, rib cage, and pelvis, with additional complex series of joints, including our discs, which provide stability while allowing for motion.
The statistics regarding spine care today are mind-numbing, especially considering the impact of time out of work and family/social issues. In the past 20 years, the United States has seen an exponential rise in the costs associated with the multitude of therapies for low back and neck pain. Spine pain and its treatment are also a core driver of narcotic use, a critical contributor to our current opioid crisis. Because of its dynamic structure and function, the spine is vulnerable to a host of conditions, with the following representing just a sampling:
- Mechanical low back and neck injuries;
- Spinal cord injury;
- Metastatic cancer involving the spine;
- Scoliosis and congenital spine anomalies;
- Degenerative (age-related) spine disease;
- Auto-immune arthritic conditions (e.g., rheumatoid arthritis, ankylosing spondylitis); and
Just as the spine is a complex framework of bones, soft tissues, and nervous system structures, the care of spinal conditions is equally complex. The country’s population is aging at a marked rate, and this aging population is increasingly susceptible to a number of spinal issues. Functional status is increasingly important and demanded by this vibrant and active population.
Over the next several weeks, Neurosurgery Blog will focus on the spine. Our goal is to shed important light on spine facts, innovation and the role of spine interventions. Misinformation regarding spine care in the U.S. is a major hindrance to understanding the important issues surrounding the care of patients with spinal conditions. We will highlight these issues through:
- Patient stories: Sharing some remarkable stories of patients who have overcome potentially devastating spinal conditions with the help of their surgeons. Central to everything we do as neurosurgeons are our patients.
- Epidemiology: Shining a light on spinal conditions that are increasing at rates that may surprise you.
- Economics: Drilling down into the dollars and cents of spine care and highlight the fact that although surgery can seem costly when compared to other treatments, in many cases, it makes economic sense.
- Value: Examining how organized neurosurgery is working with stakeholders at multiple levels to develop means of demonstrating the value of our neurosurgical care. We will highlight the NeuroPoint Alliance’s Quality Outcomes Database (QOD) as one of the most important efforts by neurosurgery in this domain, particularly as convulsive changes in our health care system demand that spine care improves with regard to quality and cost.
- Innovation: Sharing how neurosurgeons are redesigning care for patients with spinal conditions and working with other stakeholders to raise the bar for spinal outcomes.
- Advocacy: Focusing on the efforts of individuals who are working to properly value spine care and are leading the way in developing new payment models and care models to align incentives between physicians, insurers, and health care
At some point in our lives, each and every one of us will experience back or neck pain. Thus, the issues surrounding spine care matter to us all. We hope that you will keep informed and share what you learn from our posts. We also invite you to be part of the conversation by following and using the hashtag #SpineMonth.