1. Twin Cities Edition
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Twin Cities
Spine Center
A Specialty Practice Devoted to
Patient Care, Education and Research
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Twin Cities Spine Center
A Specialty Practice Devoted to Patient Care, Education and Research
By Marian Deegan
In a quiet corner of the Abbott Northwestern campus, framed Spine Center and Twin Cities Scoliosis Spine Center practices were
photographs adorn the office of Twin Cities Spine Center (TCSC) combined in 1998 to create TCSC.
staff surgeon Dr. Francis Denis. One frame holds a photograph of a Today, this independent specialty practice is one of the largest
lovely Brazilian woman on horseback. A panoramic view captures a spine centers in the world, with 10 surgeons devoted exclusively
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grinning Midwesterner standing next to a Sherpa on the summit of to spinal conditions, over 90 professional and support staff and a
Mount Kilimanjaro. Another image features a beaming Italian man full research department. TCSC surgeons see approximately 6,000
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standing amidst Roman ruins. Behind these smiles are individual new patients a year, and handle an estimated 2,800-3,000 spine
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stories of personal triumph over physical adversity, triumphs made surgeries annually.
possible by the work of TCSC. “We offer spinal management resources including outpatient
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evaluation, treatment, and 24-hour on-call consultations,” explainsD
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TCSC evolved out of the pioneering practice of Dr. John H.
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Moe — widely regarded as the founder of spine and scoliosis PRO
staff surgeon and President Dr. Timothy A. Garvey. “Our practice
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research and treatment. In the 1940s, he helped to establish the specializes in treatment of degenerative conditions,
first dedicated inpatient hospital spine unit. Dr. Moe’s Minnesota expertise in scoliosis, kyphosis IS S
T and spondylolisthesis. Although
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Many typical spinal implants can be placed through minimally invasive surgical approaches. Dr. Manuel Pinto (right) and Dr. James Schwender
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(left) perform a minimally invasive eXtreme lateral interbody fusion through E1¼ inch incision.
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PHOTOS BY DAVID GINSBERG
3. we have a reputation for handling complex
high-risk cases, our surgeons also enjoy
treating more routine issues.”
Central to the TCSC commitment to
education is their fellowship program,
which has trained 140 spine surgeons
over 38 years. “Our goal,” says staff sur-
geon and Fellowship Director Dr. Ensor
Transfeldt, “is to train well-rounded
surgeons who know how to perform
excellent surgery and, particularly,
know how to evaluate patients, make
good decisions about who needs surgery
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and recommend appropriate treatment
plans.” The TCSC program has at-
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tracted fellows from 19 countries and
visiting physicians from 33 countries
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including China, Turkey, India, Iran,
Israel, Argentina, Brazil, Botswana and ED.
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Australia. Although most patients come H
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from the surrounding five-state area, the TLY
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practice also receives national and inter-
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national referrals through relationships ENT
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cultivated with visiting physicians. DOC
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Dr. Denis, who came to the Twin Cities
from France to study with Dr. Moe, USE
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remembers a young Brazilian patient he
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treated. “We have worked with colleagues UNAU
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in Brazil since the ’70s,” he explains.IA, INC
PHOTO BY DAVID GINSBERG
“This
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little girl was brought to us by MEparents.
her
The girl’s motherUNSH INE and insist-
was a surgeon,
ed on being08
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0 present through her daughter’s
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surgery. It was over seven hours — a big
surgery.” He smiles. “This little girl grew Dr. Daryll Dykes (staff surgeon) discusses a case with Dr. Nicholas Wills (Fellow).
up to become a steeplechase champion in
Brazil. I have her photograph in my office.” explains Dr. Garvey. “We believe strongly that research and
Participants in TCSC’s international visitors program reflect education add value to our care. With the support of our research
changing global dynamics. “As China has strengthened its global department, and the assistance of Dr. Robert Winter, our physi-
presence, we’ve seen a significant increase in the number of visit- cians published 10 papers this year in leading spine and medical
ing Chinese surgeons,” relates Dr. Denis. “For decades, China journals. We conduct weekly continuing education conferences.
was closed to the outside world. Today, the Chinese government Every Thursday, a faculty member presents a lecture for fellows
provides funding to send surgeons to study with us. The tradi- and staff on a select topic. Practice partners are involved with
tional acupuncture methods for anesthesia and Eastern approach national organizations including the Scoliosis Research Society,
to medical problems are rapidly being supplemented with Western the Cervical Spine Research Society, the Society of Minimally
methods. Chinese surgeons arrive with laptops to demonstrate Invasive Spine Surgery, the North American Spine Society, the
the work they are doing. Interestingly, some of the best teaching AAOS and ABOS. We are also involved in local community
hospitals in China are the military hospitals. Our international organization work.”
program gives us the ability to learn about new developments The international scope, subspecialty focus, technical re-
around the world, to have wonderful ideas brought to us and to sources and surgical expertise of a major spine program provide
take new procedures with us when we travel.” a rich range of treatment resources. TCSC offers subspecialty
The TCSC philosophy of practice embodies Dr. Moe’s dedica- experience with instrumentation for the low back, mid back and
tion to patient quality care, education and research. “We aren’t neck, as well as the complex technology required to reposition
the practice for surgeons who focus exclusively on operating,” the spine in scoliosis, kyphosis and other deformity conditions.
4. sent a panoramic photo of himself on a
mountain summit. On the photograph
he’d written: “I wanted you to know that
your spine surgery made it up to the top
of Mount Kilimanjaro.”
TCSC surgery styles reflect the trend
toward less-invasive procedures. Staff
surgeon Dr. James Schwender is a na-
tional leader in minimally invasive spine
techniques and serves as Vice President
first elect of the Society for Minimally
Invasive Spine Surgery. Dr. Manuel Pinto
also takes a leadership role with newer,
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less-invasive procedures. “There are
several techniques,” says Dr. Denis. “We
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choose what is best for the individual pa-
tient. Success depends on a combination of
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technology and the surgeon’s art. We do
not rely on the X-ray CR drill alone; weD. E
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also rely on a sense of feel. I thinkIwe are
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humble enough to know Y P it’s the right
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decision to refer to one of our partners.
Dr.EN T ISPerra and Dr. John Lonstein
Joseph
CUM a lot of experience with children’s
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spine issues as well as spine problems in
USE people with dwarfism. If I had a child with
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UN AUT consult with John.”
,INC. Clinical research has been integral to
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008 days of his practice,” notes Dr. Garvey. “He
©2 focused on clinical research of scoliosis
patients at a time when little published data
was available.”
PHOTO BY DAVID GINSBERG
Today, patient evaluations benefit from
years of data collected by TCSC to better
guide treatment options. Access to the
Foundation for the Advancement of Spinal
Knowledge biomechanical lab helps the
Dr. Amir Mehbod examines a patient during a recheck appointment following lumbar physicians, fellows and visitors conduct
spine surgery. biomechanical research to evaluate surgi-
cal products used in spine surgery. These
This depth of focus benefits patients with simple as well as more studies identify products that create the safest, most effective
complex spine issues. corrections.
“There is always a risk when you are working around nerves,” “One of the most exciting developments on the horizon is
explains Dr. Garvey. “We have access to interoperative X-ray and improved disc replacement for the lower back and neck,” notes
real-time neuro monitoring with a neurologist to measure spinal Dr. Garvey. “We’ve participated in studies with a variety of com-
cord and nerve root function. Many institutions do not have the panies, and see some very promising products coming out of FDA
patient volume to support such high-quality technology.” trials, particularly for neck treatment.”
When a Twin Cities attorney fractured his spine in a riding Staff surgeon Dr. Kevin Mullaney has utilized cervical disc
accident, TCSC surgeons drew on the full array of available replacement to treat patients with work-related neck injuries.
technology to repair the injury. Five years later, the patient “Patients were able to maintain cervical range of motion and return
5. to work in a very timely manner,” Dr. Mullaney notes. unstable spine, I’m not able to fix it. I can’t operate on pain. I have
TCSC has also participated in research for children with to verify a specific problem.” The presence of psychosocial issues
scoliosis to improve the predictability of developmental risks. also demands careful evaluation. “Patients with nonorganic pain are
“Testing genetically analyzes saliva samples from young scoliosis high risk,” says Dr. Garvey. “We may elect to work with the family
patients,” explains Dr. Garvey. “The children are studied over doctor and a psychologist or psychiatrist to address psychosocial
a 20-year period to track and evaluate developmental issues issues before surgery is considered.”
through young adulthood. This data allows surgeons to more “For any patient, it is best to address issues with conservative
accurately assess potential risks. Genetic analysis stratifies therapy first,” says Dr. Denis. “It would be ideal to have a family
children with a low risk of developing a severe spinal curve. practitioner call us to explore issues like epidural steroid injections,
This enables us to reassure parents early on, avoiding years of or to request an MRI review. Personally, I would love that, but I
angst and uncertainty. Tests can also indicate higher genetic know that demanding schedules and large practices make direct
risks, even if a child has only a 25º curve on presentation. This communication difficult for referring physicians. If I could change
gives us more information when we are considering surgery to the way things are done, I would try to increase opportunities for
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prevent the curve from increasing.” direct consultation. We do offer a provider consult line for physi-
Active research underlies TCSC’s conservative approach to cians during clinic hours.”
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surgery. Only 25% of new patients go on to surgery within “We want our patients to have a great experience from the
two years. “There are several circumstances in which we minute they come into the clinic, through the hospital and after
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just cannot justify surgical intervention,” says Dr. Garvey. “I they leave,” says Dr. Garvey. “We survey patient satisfaction with
have an elderly patient in the hospital now who is too physi- our clinic and hospital care. We study and grade ourselves everyD.
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month. We sit down, look at each other’s cases, andOHIB
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cally ill to be a good surgical candidate. Sometimes the risks talk about
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of surgery are so great that even though there is potential benefit, LY P
them. All of these efforts reflect our commitment to ongoing
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you can’t do it.” quality of care. S ST
T Ispecialty,” Dr. Garvey reflects,
Patients with unrealistic expectations are also not good surgical “If you ask me why I choseN
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candidates. “They may be experiencing pain,” Dr. Garvey explains, it’s C
“I’d tell you that DObecause spine puts everything together. I treat
IS
men,OF TH children and geriatrics. There is a diagnostic chal-
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“but unless I can identify a compressed nerve, a bad joint or an women,
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EDthe Foundation for the Advancement of Spinal Knowledge
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Research Fellows Dr. Xiujun Zheng and Dr. Rahul Chaudhari, working in
biomechanics lab run by Chunhui Wu, Ph.D. UTH
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PHOTO BY DAVID GINSBERG
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Left to right: Manuel R. Pinto, M.D.; JamesN Schwender, M.D.; Ensor E. Transfeldt, M.D.; Daryll C. Dykes, M.D., Ph.D.; Francis Denis, M.D.;
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Kevin J. Mullaney, M.D.; Joseph H. Perra, M.D.; John E. Lonstein, M.D.; Timothy A. Garvey, M.D.; Amir A. Mehbod, M.D.
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lenge. You08 SU talk to people; you have to have a relationship
have to that I might pre-retire and improve my golf game. But I find that I
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with© patients. We have the assistance of excellent high-tech
your would miss my practice tremendously. It’s not just that I am happy
imaging. And then, this is a subspecialty where you can actually being a surgeon; I really enjoy the rapport with my patients. It is
fix things. You make people better, and that is very gratifying.” wonderfully rewarding to have the feeling that you understand
“There are so many patient stories,” muses Dr. Denis. “One of them and are able to make a recommendation that reassures them.
my patients was a young man from Rome. He had Elephant Man At the time of surgery, it is great to see my patient in the preopera-
disease, a terrible case of neurofibromatosis. Three surgeries in tive unit and have them smile and be comfortable. It is gratifying to
Italy had left him paraplegic. When his family brought him to have the impression that you have made a difference in someone’s
see me, I told him that I didn’t know if I could help him. His life. I think my golf game is going to have to wait.” ■
chances of recovery were very low. He had been paralyzed for a
month; he had no sensation, no motor function at all. Following
surgery, he still could not move anything. I didn’t think it was
going to happen. This young man returned to Rome. Three
months later, I received a video from him. He was walking
between parallel bars.” 600 Piper Building Phone: (612) 775-6200
Dr. Denis smiles. “Eventually, he walked completely normally. 913 East 26th Street Fax: (612) 775-6222
My wife and I went to Italy, and visited him during our trip. He Minneapolis, MN 55404-4515 E-mail: info@tcspine.com
walked with us through Rome, showing us sights, and took us to
dinner at a little restaurant with his family. It was very ceremonial, www.tcspine.com
very beautiful. His father showed me the X-rays, and the family
presented me with a gift of black truffles. I was very touched. Minneapolis, St. Paul, Shakopee, Burnsville,
Wyoming, Cambridge, Grand Rapids
“Not so long ago,” Dr. Denis chuckles, “I had briefly considered
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