The Neurosurgery Spine division has a presence at all of the hospitals and most of the outpatient centers in the UPENN Health System. This Division is large, dynamic, robust, and growing. The progressive sub-specialization within the Department of Neurosurgery has facilitated the Division to provide focused experiences in education, clinical care and research. The Division is based at the Spine Center at Pennsylvania Hospital (“The Nation’s First Hospital”). The Center is an integral part of the Department of Neurosurgery at Pennsylvania Hospital and takes advantage of the co-localization and collaboration of associated sub-specialty programs all located within a single building, the Spruce Building, which is a pavilion of the hospital.
The Spruce Building and Spine Center specialists include Neurosurgery, Orthopaedics (Spine), Neurology (EMG testing), Psychiatry, Physical Medicine and Rehabilitation, Pain specialists from the Department of Anesthesiology, Social Work, and others. The building has a floor dedicated to out-patient physical therapy and occupational therapy (Good Shepherd Penn Partners). The Spine Center has a large number of examination rooms where patients are seen by the specialists and advanced practice providers. Dedicated treatment rooms with holding and recovery areas where patient receive injection and other therapies with image guidance are a key component to the “One Stop Shop” concept of the Spine Center. The Gamma-Knife Center, MRI suites, advanced radiation treatments (including Cyber-Knife and other focused therapies), EMG testing, and operating rooms are all housed within or connected to the Spruce Building as well.
Advanced spinal services are delivered at the Hospital of the University of Pennsylvania (HUP), and Penn Presbyterian Medical Center (PPMC). HUP has an emphasis on the care of patients with spinal column cancer in addition to degenerative conditions. The surgeons at PPMC have extensive experience managing spinal column trauma, spinal deformity, minimally invasive spine surgery, and peripheral nerve disease. All of the hospitals have full complement of surgical adjuncts including 3-D imaging and reconstruction, laser ablative therapies, ultrasound guidance, microscopes, endoscopes, neurophysiological (spinal cord and nerve) monitoring and others.
Out-patient centers where spine specialists are available for consultation are distributed throughout the PA, NJ and DE areas. Larger centers with multi-modality assessment options are located in Radnor Township (PA), Valley Forge (PA), Yardley (PA), King of Prussia (PA), and Cherry Hill (NJ).
The Spine faculty pride themselves on collaborative care for the maximum benefit of the patient. This collaboration extends into South Jersey with a partnership at Virtua Our Lady of Lourdes Hospital in Camden, NJ, a regional referral center, to provide a full range of treatments for routine and complex spinal conditions. This integration has also occurred with spine providers at Lancaster General Hospital and Princeton Medical Center, where cases and outcomes are reviewed.
Clinical Sub-Divisions
1. Minimally-Invasive Surgery
The Department has specialists who are leading and advancing minimally-invasive spinal surgery. This subspecialty performs surgery through smaller incisions with less tissue retraction and blood loss. This results in shorter time in the hospital and less surgical trauma. The use of enabling technology has greatly expanded minimally invasive surgical techniques to a variety of pathologies.
2. Complex Spinal Reconstruction for Deformity
Spinal instability, scoliosis and progressive deformities are common conditions through all age groups. These conditions can occur due to prior surgery, tumor, conditions present since birth, or degenerative changes. This may result in spinal pain and reduced activity levels. Due to complexity of these cases a team-based approach including both neurosurgeons and orthopedists is utilized. Blood-saving techniques are used routinely. The division has an extensive experience in surgical correction and post-operative management.
3. Spinal Stenosis and Instability
Spinal stenosis is a common condition where pressure is exerted on the spinal cord and/or nerves. These conditions are progressive and cause reduced walking ability and loss of the fine motor skills necessary for activities of daily living. They may also cause pain due to spinal instability. The subspecialists in this field have extensive experience in surgical correction and post-operative management. They also perform studies that reduce the need for fusion.
4. Spinal Tumor Management
Tumors in the spinal cord, nerves, or spinal column cause progressive neurological problems and pain. The management of these conditions requires complex, multi-specialty care with consultation of other specialists such as Oncology, Radiation Oncology, Plastic Surgery, Orthopedic Oncology, and Physical Medicine and Rehabilitation. Patients are presented to a group of specialists for multiple opinions and suggestions as to the best strategies for treatment. The evolution in surgical care for patients with spinal tumors utilizes both open and minimally invasive techniques to optimize patient outcomes.
5. Pain Treatments
A new addition to the department will be specializing in the treatment of painful conditions, including spinal pain.
6. Trauma
The Department has nationally-recognized physicians with expertise in the management of spinal trauma. Through a collaborative approach with Neurocritical Care and Rehabilitation physicians, the Penn Spinal Trauma Program has extensive expertise in care for spinal cord and spinal column injury patients. The patients are cared for in a specialized setting throughout their hospitalization into discharge to specialized rehabilitation facilities.
Education
The Department of Neurosurgery provides many opportunities for education of medical students, post-graduate students, Penn physician residents in training, visiting physician residents, fully-trained physicians interested in honing the expertise, and national/international visiting physicians. The Spine Division accepts highly-qualified physicians to work for a limited time as Fellows. These physicians come from other nationally-recognized programs to be immersed in the enriched Spine program here at Penn Medicine. The diversity of pathology coupled with engaging faculty creates an environment for fellows to have an impactful, transformative experience.
