Stem Cell Surgery Therapy

Stem Cell Surgery Therapy

Scientific advances over the past several decades have led to a multitude of new treatments for countless medical conditions including stem cell surgery. For decades, bone marrow transplant (following high dose chemotherapy to treat cancer) has relied on the ability of stem cells to repopulate the patient’s bone marrow with viable stem cells capable of forming all of the types of cells found in our blood. One of the more recent discoveries regarding stem cells is the way in which they can be harnessed to help enhance the treatment of many other conditions. As a neurosurgeon who specializes in the treatment of spinal disorders, I use human adult stem cells for surgery to help speed recovery and optimize outcomes for patients suffering from a variety of spinal conditions, and more uses for these stem cells are being discovered every day.

The topic of stem cell surgery and the treatment of medical conditions has been the subject of intense interest and even some controversy. With this article I will attempt to describe some of the ways that stem cells help in the treatment of a variety of medical conditions, as well as dispel some of the myths and misconceptions about stem cell surgery.

Stem Cell Surgery Treatment

When I am discussing a treatment plan with my patients, many of them are surprised that we will be using stem cells to aid in their recovery, as if this treatment were something out of science fiction. In reality, our bodies use stem cells every day to help keep us healthy and to repair damage done to our tissues that occurs during even normal activities.

The term stem cell usually refers to a group of cells that have the capability to replicate themselves and to also form numerous different cell types. The term totipotent stem cell refers to a cell that has the ability to grow into all the cell and tissue types found in the body, while the term pluripotent stem cell refers to a stem cell that has a somewhat more limited capability to grow into different cell and tissue types. A totipotent stem cell, when placed in the proper environment, can grow into muscle, bone, cartilage, or anything else the body needs to repair damage.

In a sense, the fertilized egg would be considered the ultimate totipotent stem cell, because it develops into a complete human being. For most practical medical applications a pluripotent stem cell is all that is needed to help the body heal.

In some patients, after exhausting all non-surgical treatments, it becomes necessary to remove either a cervical or lumbar intervertebral disc and replace the disc with something that will encourage the growth of new bone that will, over time, fill the space once occupied by the disc.

This process is called fusion, and in my practice, I use adult stem cells to help in the recovery of my patients who are undergoing spine surgery where a fusion of the spine is needed. Achieving a solid fusion has been a major focus of research in the spine surgery community for decades. Stem cells have been shown to help achieve this solid fusion by providing a collection of cells that are capable of developing into osteoblasts, a type of cell that is responsible for new bone formation.

During stem cell surgery, the patient’s own stem cells are obtained by drawing off bone marrow and then using a high speed centrifuge to isolate their stem cells. These stem cells are then introduced into the area where the fusion is desired along with other material and factors to help encourage the proper development of the stem cells into the osteoblasts needed to make new bone and ensure a solid fusion.

In addition to this very valuable use for stem cells, new and potentially even more exciting uses for stem cells are being explored every day. Recently, the introduction of stem cells into a variety of places such as hip and knee joints that are in the early stages of deterioration have shown promise in halting the usually progressive destruction of these areas.

Currently, I am preparing to begin a research study that will enroll patients who are in the early stages of disc degeneration to undergo injection of their own stem cells into the problem disc in an attempt to halt the deterioration and return the disc to its usual state of health. Hopefully, this or a similar treatment will one day make the need for spinal fusion a thing of the past.

Stem Cell Controversy

Most of the controversy associated with the stem cell surgery and medical treatments involves the use of embryonic stem cells. There is considerable misinformation regarding this topic, even among doctors. Although there are an estimated 10,000 cases a year in the country in which adult stem cells are routinely used to treat a variety of conditions, there are no routine uses for embryonic stem cells and very few clinical trials in place.

This is not because the use of these cells is prohibited, as some believe, but rather because the use of embryonic stem cells creates technical challenges in controlling the propensity of these cells to develop into cancer. Until this hurdle is cleared, the use of embryonic stem cells will continue to be severely limited.

Aching Back - Fusion Surgery

Got an Aching Back? Need Some Answers?

Consider the spine, the body part that on X-rays resembles a strange undersea creature. Also known as the backbone and more inclusively as the vertebral column, it’s busy all the time transmitting signals from the brain, controlling reflexes and serving as a conduit for information. The way it works and keeps us vertical is awesome.

But as anyone who has suffered from a slipped disc or other back problems will tell you, the spine also can cause a lot of grief. That’s where Dr. Michael A. Leonard, executive director of the Alamo Neurosurgical Institute, comes in. Shoring up spines and making them function the right way is the doctor’s specialty.

At the Alamo Neurological Institute, Leonard employs some of the most advanced medical methods and cutting-edge technology to cope with the “ouch” that ails you. He’s currently working in partnership with SpineSmith, a recognized leader in the biological approaches to treating injury and disease at the cellular level.

The surgical procedure he calls “a real breakthrough” is known as Fusionary. It involves using a patient’s own adult stem cells, which are harvested to enable fusion surgery (a surgical procedure frequently employed by spine surgeons) without the need for a separate surgical procedure to harvest bone graft. It’s a major step forward for physicians and patients, as Leonard explains, since it enables the surgeon to achieve the desired results with less pain for the patient.

“Human stems cells can be made to accomplish almost anything you want them to do,”

the physician points out. “With Fusionary (fusion surgery), we are able to shorten recovery time, shorten the length of the hospital stay and improve patient outcome. We are just beginning to scratch the surface on the indications for adult stem cells, and I believe their usage will grow in importance and take on a variety of roles in medicine in the future. Someday they could make more traditional surgery obsolete.”

Leonard, who was born 44 years ago in Far Rockaway, N.Y., had a two-fold reason for going into medicine. One, he loves science. Two, he takes great satisfaction in helping people achieve wellness and a good quality of life. There were no doctors in the family to inspire him in this direction, he notes, but the desire to be of service to others was definitely in his genes.

His dad, a hardworking police officer, was in the Marine Corps, and his mom drove a school bus and later worked at a hospital. His brother, Robert, served in the U.S. Army and later followed their father onto the New York City Police Department. The neurosurgeon grew up around folks who had a sense of responsibility to community and country – and a very strong work ethic.

Leonard received his doctor of medicine degree from New York University, and then went on to complete his neurological surgery residency and a spine surgery fellowship at the NYU Medical Center and Bellevue Hospital. He was fortunate enough to get a health professions scholarship through the Air Force, and following his medical training, he served for three years as the director of spine surgery at Wilford Hall Medical Center and retains strong ties to the military.

“When I discovered neurosurgery – the fascinating intricacies of the brain and later the spine – I had no doubts as to my specialty” Leonard declares. “Neurosurgery is absolutely amazing in its complexity. There are endless mysteries to be solved, and that appeals to me.”

Neurosurgical mysteries involve a vast range of brain disorders, as well as conditions that can affect the spine and peripheral nerves. So convoluted and complicated is the field that Leonard believes no one should enter it unless there’s a true passion for the profession, plenty of dedication and a willingness to do some very hard work.

Spinal surgery, which occupies most of his time these days, is especially challenging with new innovations coming along all the time. Perhaps no medical field has changed so dramatically since its infancy in the 1930s when Henry Cushing, a general surgeon, set out to advance the science, thereby becoming one of the founding fathers of neurosurgery.

By the 1960s, concepts that would lead to the first CT scanner came along, and the first advances in fusion surgery were made. Neruroimaging arrived about a decade later, as did other remarkable technological advances.

Today, the buzz is about minimally invasive surgical methods and the revolutionary therapies that the latest advances in biotechnology are providing, like the stem therapy Leonard employs on many of his patients.

Having trained at one of the leading neurosurgical residencies in the country, Leonard brought along many of the field’s newest and most innovative ideas when he arrived in San Antonio at Wilford Hall Medical Center’s Department of Neurosurgery. By 2001, he was staff neurosurgeon and director of spine surgery there, and he continues to be associated with the facility on a consulting basis.

In addition, he serves as a clinical assistant professor of neurosurgery at the University of Texas Health Science Center Department of Neurosurgery, as well as on the clinical neurosurgery staff for the San Antonio VA.

In 2004, Leonard opened Alamo Neurosurgical Institute, his own comprehensive practice that now has two offices – one in North East San Antonio and one in New Braunfels.

The Alamo Neurosurgical Institute offers advanced help for all surgical disorders of the brain and spine, including all of the latest minimally invasive procedures. Being so multifaceted and experienced in such a variety of subjects, Leonard is often called upon for advice by medical colleagues. Dr. Ajeya P. Joshi of the San Antonio Orthopaedic Group especially appreciates Leonard’s assistance and willingness to collaborate.

Joshi and Leonard met quite by chance about four years ago on a challenging non-surgical case involving a hospitalized patient. Leonard’s insight and perspective were very helpful, Joshi points out, and since then, the two have provided second opinions for each other and have often worked together in the OR.

“Dr. Leonard’s demeanor, technical expertise and judgment are always top notch,” Joshi declares. “I’ve learned a lot working with him and value and respect him immensely.” Patients feel the same way.

Cynthia C. Stobaugh, who consulted Leonard when back pain began cramping her running style, says the physician’s expertise is impressive. But in her opinion, his caring attitude is an even greater attribute.

Leonard cared and understood when Stobaugh told him she wanted to stay active; it was very important to her. At first, the 41-year-old athlete (she has three children and works as an assistant librarian) took injections for back pain, eventually switching from running to cycling because it was a bit easier on her back.

She kept on struggling with flair-ups, and one day, the flair-ups became constant. Pain got to be so severe that she could hardly walk. Operating to repair a herniated disc and related damage was the only option.

“It was scary to contemplate such a major surgery,” the patient admits. Leonard, however, helped her cope with her fears. “He’s a busy man but he was so kind – so was the entire clinic staff,” Stobaugh recalls. “They always took the time to talk to me and reassure me. When I went into the operating room, I was ready emotionally, and the whole experience was a very positive one.”

Today, Stobaugh has six titanium screws holding her back firm in the fused section. She has started cycling again and has high hopes that she will soon be back on the track.

“I want to race,” says the determined patient, who is now pain free and quickly regaining physical strength. “What Dr. Leonard has done for me is truly remarkable.”

Dealing with cases such as Stobaugh’s and realizing how much responsibility is in his surgical hands can be stressful for Leonard.

“I want to do my best … I worry about each person who comes in the clinic door, and the people I operate on become friends, not just patients,” he reflects. “I think it’s a good way for a doctor to be, but it can take a toll. You have to get away sometimes and relax.”

His way of winding down is to work on his classic car collection, restoring old favorites such as a vintage 1969 Corvette to peak condition. He belongs to an online car forum where auto restoration fans “talk” with each other about their hobby.

He also loves to attend car shows whenever possible and has fond memories of seeing big, old muscle cars when he was growing up in New York. “Great machines,” he says nostalgically, adding that the auto enthusiasts he has met are great people, too.

When he isn’t “doctoring up” old cars in the garage, Leonard likes to spend leisure moments with his family. He recently observed his 15th wedding anniversary with his wife, Meggan. They have three children: Mikey, 14, Matthew, 9, and Madelyn, 6.

Does he think the kids will go into medicine?

Matthew seems to be showing an interest in medicine and science lately, his proud Dad says.

“Mikey, our 14-year-old, is autistic, and Matthew is both a very compassionate brother and is also very interested in how something like this happens – how Mikey’s brain [is] different from others,” Leonard says. “Madelyn is a little too young to know what might interest her, but she is smart as a whip, so there is no doubt she will be able to do whatever she wants.”

But it’s really too soon to know where life’s roads will take them. All of us have to find our own direction, the physician goes on to explain; all of us have to find our own callings. And no doubt about it, his calling is neurosurgery.

Original Article by: Rose Mary Budge | Photography by: Oscar Williams

With Mazor Robotics Technology, Neurosurgeon Dr. Michael A. Leonard is Advancing the Treatment of Spinal Conditions

Physicians are constantly looking for new and innovative treatments to help them care for their patients. Spine surgeons are no exception to this. We are always interested in new methods to achieve our goals in the operating room, in safer and less invasive ways. Unfortunately, there are many ideas and products that have been previously touted to help surgeons in the operating room, but ultimately were less than advertised. One recent exception to this is Mazor Robotics Renaissance spine surgery system. This system is a recent advancement in spine surgery, and it has enabled many procedures to be accomplished in a less invasive way.

Mazor Robotics Implementation

Mazor Robotics TechnologyI have been fortunate enough to be the first surgeon in San Antonio to have added Mazor Robotics robotic spine surgery system to my practice, and I’m currently the only surgeon in San Antonio certified to perform these procedures. My experience with the benefits provided by robots in treating my patients goes back a long way. I’ve been utilizing robots for over a decade to treat my patients with spinal and brain tumors. One of the most advanced tools for treating these patients is a robot-guided radiation beam that allows for pinpoint delivery of radiation deep into a patient to treat tumors, while safely preserving surrounding tissue. My experience with this system allowed me to see the value in a robot guidance system for many of my other spinal surgery patients who didn’t need radiation, but could otherwise greatly benefit from the precision a robot guidance system can deliver. When I first saw Mazor Robotics Renaissance spine surgery system, I realized it would revolutionize spine surgery as I knew it. I’ve been using this system since 2013, and I’ve currently performed nearly 80 surgeries with it. I have been amazed at how it has helped make my surgical outcomes more successful.

This system uses a patient’s preoperatively obtained CT scan and state-of-the-art 3-D software to plan the perfect surgery, and then the surgical robot assists the surgeon in carrying out that plan with the utmost accuracy. This has resulted in smaller incisions, less time in surgery, less blood loss and quicker recovery for my patients. After using this system for the last two years, I am convinced it is the way of the future, and I’m certain it is only a matter of time before all surgeries will be performed with robotic guidance.

Of course as with any surgical technique, not every patient requires or is a candidate for robotic spine surgery. Nevertheless, the indications and applications for robotic guidance in spine surgery are growing rapidly. Indeed, the Mazor Robotics Renaissance system has recently been used to provide robot guidance to access deep brain lesions, allowing for tumor biopsy in the most accurate and safest way possible.

Robotics have been revolutionizing surgery for some time. Although it has taken a little longer to happen, it has finally arrived to the spine surgery world, and things will never be the same.

The Facts on Laser Spine Surgery

As a neurosurgeon who specializes in spine surgery, I frequently have patients who come to my office and inquire as to whether or not they can be treated with the amazing new therapy they saw on TV or read about on the Internet.

Sometimes they are, in fact, capable of benefiting from this new treatment, and sometimes the treatment they learned about is not applicable to their condition. Often, however, the treatment being promoted to them has little basis in science and medicine and little evidence to support its use.

Recently, numerous patients have been coming into my office with questions on whether they are a candidate for Laser Spine Surgery, and even carrying in advertisements that they have cut out of newspapers and magazines.

Given this recent attention directed to the use of lasers to treat spinal conditions, I thought it would be helpful to have some information on what this type of treatment consists of and whether it holds the answer to helping patients who are struggling with decisions about treatment options for their spinal conditions.

The use of lasers in medicine is not new. Lasers have been used in surgery to treat a variety of conditions for decades. Neurosurgeons use lasers for very specific tasks, usually involving surgery for brain tumors. In this setting, lasers have some distinct advantages. They can be used to make very precise cuts through delicate brain tissue while causing minimal disruption to the surrounding structures. Other specialists use lasers for a wide range of conditions.

Some of the more recent applications for lasers have been in the field of dermatology where they are used for hair removal, tattoo eradication, and to improve the treatment of acne.

The use of lasers for spinal surgery is not entirely new either. Percutaneous laser discectomy has been just one type of less invasive approach that has been tried for a number of years to treat a specific type of disc disorder referred to

as a contained disc protrusion. While the results from this have showed some benefits and one could debate its merits, it is the more recent promotion of laser treatment for almost any spinal condition that is a relatively new phenomenon.

A review of the medical literature on this topic, however, fails to yield significant evidence to support much of these claims. There are no peer reviewed, class I (prospective, randomized, double-blinded) studies to support this expanded use of lasers in spinal surgery. In fact, there are no studies of any type in the current medical literature that supports the broad concept of Laser Spine Surgery.

This lack of evidence in the medical literature does not necessarily mean that this treatment doesn’t work. It only means that there is no evidence to support that it does work.

There are some who would say I am simply casting doubt on a competing treatment for financial reasons by discouraging patients from seeking treatment elsewhere. I would respond to this by saying that I endeavor to provide my patients with the most state-of-the-art treatments possible. When a new treatment becomes available, I investigate it to see if it is capable of delivering on what it promises and if it will improve my patient’s care.

There is nothing secret or magical about the use of a laser in spine surgery. A laser is simply another tool available to the surgeon to achieve his or her surgical goals. If a study were done that convincingly demonstrated that utilizing a laser were helpful, it would be easy for me to incorporate it into the scope of my practice. The addition of this technology would then lead to better outcomes for my patients and, as a result, more patients seeking my services to receive this new and improved treatment.

I have chosen not to provide this service because my decision must be based entirely on whether or not it convincingly improves the care of my patients, and as I have already pointed out, this has not been demonstrated. I’m not alone in my assessment of this surgical tool.

Of the many other spine surgeons I know in this community and throughout the country, none have advocated the routine use of a laser for their patients undergoing surgery.

Please contact the office today to schedule your appointment with Dr. Michael Leonard or complete our Contact  Form.

When is it time to see a doctor about my neck pain?

In today’s blog I want to return to my regular blog series and discuss when to see a doctor for cervical pain. As previously discussed in my blog, Neck Pain 101, neck pain is common and can result from a number of different causes including strained muscles, poor posture and degenerative disc disease.

Today, we are going to discuss signs and symptoms that indicate it is time to see your doctor about your neck pain. Although neck pain is common and can often be treated at home, neck pain may be a sign of a more serious problem.

Schedule a doctor’s appointment if your neck pain continues despite a few weeks of conservative treatments or your neck pain is increasing in severity despite at home treatments. In addition, if you are experiencing pain radiating into your shoulders, arms or hands, it is time to see your doctor. This may be an indication of a problem with a disc in your neck, and, in fact, some people with a disc problem may not even experience neck pain and instead may only have arm or shoulder pain! Another sign that indicates it is time to see your doctor is weakness in your arms or hands. Patients with this symptom often describe this as dropping things, such as their coffee mug.

If your neck pain started after a traumatic injury, such as a motor vehicle accident, is accompanied by a high fever or severe muscle weakness you need to seek immediate care.

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