Easton Hospital’s Comprehensive Spine Management Program combines physical therapy, pain management and surgical expertise to customize care and optimize results for patients with cervical and lumbar pain.
When increasing numbers of patients began presenting at Easton Hospital’s emergency room with back and neck pain, the hospital sought to fill a community need in the region by implementing its Comprehensive Spine Management Program in 2014.
“We wanted a coordinated approach to back pain,” explains Christine Biege, Vice President of Quality and Support Services at Easton. “Even though we do have a standardized approach to our patients, not everybody’s pain is the same, so our 3 Ways 2 Heal program is exactly that — physical therapy, pain management and, if necessary, surgery.”
The initial component of Easton’s multidisciplinary 3 Ways 2 Heal program is physical therapy. Easton utilizes the McKenzie Method, a diagnostic and therapeutic process clinically demonstrated to enhance patient outcomes.
“We use this particular method to assess the patient through the use of repeated movements,” says Christopher Johns, PT, DPT, OCS, Certified MDT, who works directly with the physicians of Easton’s spine program to customize care plans for patients. “By doing this, we learn what motions improve or exacerbate a patient’s condition. We also help patients understand their back or neck and learn which movements to avoid. Based upon our evaluation, we follow a protocol to select the best exercises to help patients and develop an understanding of their pain responses to certain movements.”
From left, Christopher Johns, DPT; Vito Loguidice, MD; Amy Huber, Spine Center Navigator; and Fern Dougherty, RN, Director of Orthopedic Services
A study published in 2011 in the journal Spine compared the McKenzie Method with spinal manipulation for patients with chronic low-back pain. The McKenzie Method yielded better outcomes on multiple measures.
“At two months follow-up, the McKenzie treatment was superior to manipulation with respect to the number of patients who reported success after treatment (71% and 59%, respectively),” the authors of the study note. The group receiving the McKenzie Method treatments also “showed improvement in level of disability compared to the manipulation group.”
An integral component of Easton’s Comprehensive Spine Management Program, physical therapy also helps to fill a community void in services.
“Particularly in certain areas of this region, where there had been limited access to services, patients didn’t have much of an opportunity for therapy,” says Johns. “Now, they have access to physicians who understand mechanical diagnosis and therapy. We’re able to give the best to the patient.”
“The mainstay of treating back and neck pain has always been physical therapy,” adds Vito Loguidice, MD, a spinal surgeon who is board-certified in orthopedics and by the American Board of Spine Surgery and who played a key role in developing and implementing Easton’s spine program. “McKenzie exercises have been the most effective in controlling pain.”
The second step of 3 Ways 2 Heal — pain management — incorporates an effective combination of evidence-based conventional and alternative approaches.
Scott Naftulin, DO
Scott Naftulin, DO, a specialist who is board-certified in physical medicine and rehabilitation and subspecialty-certified in pain medicine, notes factors the pain management team considers when determining the most effective medication for each patient.
“For oral medications, we look at the patients’ comorbidities, medical conditions, diagnoses, medicines they may already be taking and their particular situation,” says Dr. Naftulin, Clinical Professor at Philadelphia College of Osteopathic Medicine, Clinical Professor in DeSales University’s Master of Science in Physician Assistant Studies program, past president of American Osteopathic College of Physical Medicine & Rehabilitation, and a Master Instructor for the International Spine Intervention Society.
“Injections, depending upon what we are trying to accomplish, could include local anesthetics or numbing medications, as well as corticosteroids,” he adds.
“One patient who came to us had been in pain for years. Nobody had really been able to manage his pain. He came here and he’s been pain-free for a month now. We are very happy with that.”
— Christine Biege, Vice President of Quality and Support Services at Easton Hospital
Epidural, sciatic nerve block and sacroiliac joint are some of the more common injections given as part of the pain management treatments, according to Dr. Loguidice.
Dr. Naftulin points to another of the program’s strengths, as well: its utilization of nontraditional methods for pain relief.
“We are able to provide the most up-to-date, contemporary treatments, both mainstream and alternative,” he says. “We offer platelet-rich plasma therapy, stem cell injection, radiofrequency neurotomy and spinal cord stimulation.”
Minimally Invasive Spinal Surgery
When patients completing the first two components of 3 Ways 2 Heal still have pain, surgery is an additional option to promote healing and enhanced quality of life.
Vito Loguidice, MD, with Fern Dougherty, RN, Director of Orthopedic Services
“Most patients don’t need an operation,” Dr. Loguidice says. “Most need physical therapy, medications and possibly injections. When spinal surgery is indicated, we perform the operation that has the least amount of trauma to the body and the best results. Frequently, these procedures can be performed minimally invasively. The muscle-sparing techniques and small incisions permitted by this approach decrease postoperative pain and speed recovery.”
The minimally invasive approach also may reduce infection risk. A 2009 study in the Journal of Neurosurgery: Spine found that only three of 1,274 patients undergoing minimally invasive spine surgery developed postoperative surgical site infections. The authors concluded, “Minimally invasive spinal surgery techniques may reduce postoperative wound infections as much as 10-fold compared with other large, modern series of open spinal surgery published in the literature.”
While physicians in the program have the experience and expertise to produce excellent surgical outcomes, Dr. Loguidice emphasizes that surgery is rarely necessary.
“Of the patients in Easton Hospital’s Comprehensive Spine Management Program, only four have needed an operation,” he says. “Typically, about 5 percent of the patients seen in a spine center need some kind of surgical intervention. The vast majority will see significant pain reduction with time and therapy.”
Accelerated, Coordinated Care
Amy Huber, Spine Center Navigator, with Joseph Grassi, MD
Guiding patients through the 3 Ways 2 Heal program, Spine Center Navigator Amy Huber expedites appointments and facilitates coordination and communication among the members of Easton’s multidisciplinary team, patients and their primary care physicians.
“Once I receive the referral from the emergency room, family physician or the patient, as well as the medical history, I schedule an appointment for the patient within 24 to 48 hours,” Huber says.
Recognizing that patients are dealing with sometimes debilitating levels of pain, the program also prioritizes accelerated diagnosis and treatment. The hospital setting aids in providing lab results, MRIs or X-rays quickly, notes Huber.
“A true advantage of our program is that we see patients promptly, and we have Amy to shepherd them through various aspects of the program,” Biege says. “We can arrange physical therapy or pain management, and Amy follows through to make sure patients are improving. They are not out there on their own. If they have physical therapy for a week and are not seeing any relief, Amy can rapidly coordinate with the Spine Center physicians to arrange additional treatments.”
“Nobody gets lost in this system,” adds Fern Dougherty, RN, Director of Orthopedic Services at Easton Hospital. “We can get patients a diagnosis quickly and get them on the path to feeling better.”
3 Ways 2 Heal: By the Numbers
Huber and Dougherty, who track the progress of all patients in 3 Ways 2 Heal, note the program has a 92 percent complete satisfaction rating among the 192 patients who have completed the program since April 2014, including the four patients who had surgical intervention.
Initially, the program launched to Easton’s hospital-owned practices, but its success spurred its reach to patients referred by physicians from throughout the area, according to Biege.
When to Refer
Joseph Grassi, MD, (left) with Christopher Johns, PT, DPT, OCS, Certified MDT
“Patients with any kind of pain in their neck or back that has been present for 48 to 72 hours, recurrent symptoms or radiating pain indicating nerve compression, or neurologic deficits such as a foot or wrist drop or any kind of weakness in their limbs should be seen quickly to address any potential neurologic loss,” advises Joseph Grassi, MD, who is board-certified in physical medicine and rehabilitation.
Dr. Naftulin says prompt referral of patients can markedly enhance outcomes.
“The sooner we get to the patients, the more likely we are to improve their quality of life,” he says. “A multispecialty center such as that at Easton Hospital offers the team approach that provides the greatest benefit to patients.”
For more information about the 3 Ways 2 Heal at the Comprehensive Spine Management Program at Easton Hospital, call 855-SPINE-32 (855-774-6332) or visit eastonspine.com.