ASK THE DOCS

 

                           

Robert C. Kime III, M.D.                                       Olumide “Ollie” Danisa, M.D.

Orthopaedic Spine Surgeon                                    Orthopaedic Spine Surgeon

  In current practice there is a lot of overlap between orthopaedic spinal surgeons and neurosurgeons.  We both perform surgical procedures that involve decompression of compressed nerves and/or fusion of spinal elements.  However, the background from which we approach these problems differs slightly.  Neurosurgeons operate on the brain as well as the spinal cord, and have extensive training in working with these delicate structures.  They still remain the specialist of choice (over orthopaedists) for dealing with intra-spinal tumors and masses.  Although they do work with bone, to some degree, (skull, vertebrae), they do not have extensive experience with treatment of fractures of other bones.  This becomes important when dealing with spinal fusions, which involve creating new bone across and/or between spinal segments. The knowledge and clinical experience of the orthopaedic spinal surgeon tends to be superior in this arena.

Orthopaedic spinal surgeons are able to diagnose and treat a large variety of spinal conditions with equal ability to neurosurgeons, including herniated discs, spinal fractures, degenerative disc disease, discogenic pain disorders, and facet disease.  The primary goal when assessing a spinal problem is to try and determine the exact cause for the patient’s symptoms.  An orthopaedists’ understanding of both bony anatomy and neuroanatomy uniquely qualifies him to accomplish this.  This also allows the formulation of a treatment plan tailored to the patient's specific problem, greatly improving the chance for a successful outcome.

  While previously separate and distinct, training of orthopaedic spinal surgeons and neurosurgeons has become much more convergent and overlapping in the past decade.  Even professional educational meetings typically include both specialists on the faculty.  Classically, orthopaedists were better trained on spinal instrumentation and neurosurgeons more adept with the difficult re-do cases, but this has changed.  Neurosurgeons have become much better educated in application of instrumentation, and orthopaedists have learned much from their neurosurgical colleagues.

  I personally trained with an excellent orthopaedic spinal surgeon at Duke University , but also have learned a great deal of neurosurgery while "on the job." After completing my 6-year residency at Duke, I worked with both types off specialists in the Air Force as well as Drs. Ritchie Gillespie and Crysl Willison, neurosurgeons here in Harrisonburg .  Earlier in my career I performed numerous surgeries jointly with these neurosurgeons, bringing our collective abilities together for the patient's benefit.  I learned how to perform dural repairs and difficult re-do decompressions.  My experience has enabled me to now perform the majority of these procedures independently.  My partner Dr. Ollie Danisa has also trained extensively with both orthopaedic spinal surgeons and neurosurgeons at the University of Virginia as well as at Duke University .  He has also completed an additional year of spine fellowship training beyond his orthopaedic residency.  Application of new technology to the spine has been largely spearheaded by orthopaedic spinal surgeons.  New technology such as minimally invasive spinal surgery for removal of herniated discs, lumbar or cervical decompressions, or even fusions is now available right here at Hess Orthopaaedic Center . 

  Our background in performing arthroscopic procedures in other joints, such as the knee and shoulder, has helped to facilitate this.  Dr. Danisa and I attend regular continuing medical education courses in spinal surgery, and employ some of the newest technologies.  We are currently using BMP, or bone morphogenic protein in select cases for spinal fusion.  This substance enables the formation of new bone fusions even more effectively than iliac crest bone grafting, which was the old "gold standard."  Disc replacement surgery for both cervical and lumbar discs is on the near horizon.  However, embracing new technology must always be done with a modicum of caution, to ensure both patient safety as well as to ensure that we are not compromising long-term results.  One of my Duke professors used to say, "Never be the first or the last surgeon to do a new procedure."

  In conclusion, there is tremendous overlap between orthopaedic spinal surgeons and neurosurgeons.  Perhaps we should just call ourselves spinal surgeons.  Neurosurgeons remain the specialist of choice for tumors within the thecal sac, but other than this we both treat spinal conditions equally well.  We treat cervical and lumbar disc herniations, degenerative disc disease and most fractures of the spine.  The vast majority of patients can be treated non-operatively and can benefit from a combination of medications, physical therapy, activity modification, weight loss, smoking cessation, bracing, and epidural steroid injections or nerve root blocks.

These initial treatments can be facilitated by our non-operative providers, Dr. James Schwartz and Nurse Practitioner Mary Koogler.  Both of these providers have a ready pipeline to Dr. Danisa and me for referral of those patients that fail these non-surgical treatments.  Cases that involve rapid neurological compromise or intractable pain are quickly referred to one of us for surgical consideration. We have an extremely well-qualified physical therapy team at our downstairs rehabilitation center that can assess and treat many spinal problems. Aquatic therapy is also available and can be a tremendous benefit to the overweight patient with back problems who claims he "can't lose weight."

This arrangement ensures rapid access of our patients to appropriate care, with an emphasis on conservative management and surgery only when necessary, as a last resort. We believe in treating patients just as if they were our own family.  You can feel confident that a patient that is referred to Hess Orthopaedic Center will be well cared for and will receive the most contemporary treatment available.

 

Robert C. Kime III, M.D.

Orthopaedic Spinal Surgeon

  A NOTE FROM THE CEO

  In today’s ever-changing healthcare industry, one thing stands clear: our commitment to provide the most appropriate healthcare with consideration and professionalism to those that we serve.  With the population in our service area growing, we are faced with many new challenges.  There are new insurance plans with different requirements for both our patients and our practice.  Changing State and Federal compliance issues along with immense differences in insurance carrier contracts place more responsibility on the practice and press our staff to constantly update and upgrade their skill sets.  Our staff takes this challenge very seriously and works as patient advocates while assuring the comfort and confidentiality of each patient.

  Today’s orthopaedic practice looks different from those of the past.  Today we see new technology, higher demands and more educated patients with instant access to medical information and guidance from the internet.  The look and demands have changed, but our core commitment and mission statement have remained the same:  to treat each patient as an individual with respect and interest in their concern.

  I have asked our Clinical Administrator and physicians to commit to seeing all new patients within 8 working days and urgent patients within 2 working days.  Patients will be seen within these time constraints by the first available physician available at our practice.  Emergencies will be seen same day at our practice.  Some emergencies can be treated in the office; however, some (depending on the injury) may be referred to the Emergency Department and the Orthopaedist on-call at the hospital.  When a patient or referring physicians’ office calls to schedule for a particular provider and that provider is booked at the time of request, the patient will have the opportunity to schedule with another provider at our office.  Our staff will help direct the patient to a provider that is able to treat their specific orthopaedic needs.  Of course, if a patient only wishes to see a particular provider in our group, and the issue is not emergent, the patient will be scheduled for the next available appointment with that specific provider.  Emergencies and extended patient visits often occur, but we have creative scheduling options that will help alleviate some of the wait time for the patient.

  We appreciate the relationships that we have created with our referring physicians.  If there are any questions, suggestions or any problems, please contact us immediately so that we may work out an appropriate solution.  You may reach us at 540-434-1664.  Please ask for Sue Sipes, our Clinical Administrator, who will be glad to assist you.  We look forward to your feedback and the opportunity to serve our community. 

  B.E. “Bucky” Chisholm, III

Chief Executive Officer