5 Reasons Why Outpatient Spine Surgery Is Here To Stay From Dr. Kern Singh

human spine

Dr. Kern Singh, co-founder of the Minimally Invasive Spine Institute at Rush in Chicago, recently penned an article on the safety of outpatient spine surgery for Vertebral Columns, a publication of the International Society for the Advancement of Spine Surgery.

The article responds to a USA Today and Kaiser Health News article highlighting the risk of cervical hematoma after outpatient spine surgery, among other potential complications after outpatient surgery. Here are five key points.

1. As technology advances, it has become safe to perform more complex spine surgeries in the outpatient setting, which is typically a lower cost setting. “Outpatient surgery centers are more easily accessible than large facilities, and the streamlining of services allows for maximum efficiency and minimal wait times,” he wrote. “These advantages have led to outpatient surgery centers achieving an overall patient satisfaction rate of 92 percent.”

2. Spine-focused ASCs have staff who are trained in outpatient spine surgery and focused on providing the high quality care for patients.

3. Complications are a concern for surgeons regardless of the operative setting, but especially for the outpatient setting because the staff are not equipped to handle a life-threatening complication. ASCs and surgeons should have an action plan to transfer patients to the hospital quickly if there are signs a complication occurred.

“Though rare, a cervical hematoma can develop in the first few hours after surgery,” wrote Dr. Singh. “For this reason, patients in the outpatient setting are monitored closely during the immediate postoperative period so emergent treatment can be initiated if needed.”

4. Dr. Singh cited an article published by McClelland et al., showing complication rates among outpatient cervical fusion patients from 1996 to 2016. The complication rate was 1.8 percent and mortality rate was 0.1 percent, much lower than up to 5 percent rates that have been associated with hospital-performed cervical fusions.

5. According to Dr. Singh, most ASCs where surgeons perform outpatient spine procedures are owned and operated by hospitals or health systems; however even among centers owned by surgeons, the surgeons have an obligation to prioritize patient safety.

“Surgeons must rigorously assess a patient’s eligibility for outpatient surgery, as pre-existing conditions may put patients at a higher risk for complications,” he wrote.

He argues that surgeons who are proficient in outpatient spine techniques and responsible patient selection can safely perform the appropriate procedures in the ASC and achieve high patient satisfaction as well as positive outcomes.

5 Ways Movement Enhances A Parkinson’s Disease Diagnosis

By Erica Hornthal, MA, LCPC, BC-DMT; CEO Chicago Dance Therapy

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I’m not here to tell you why exercise or a certain type of activity like dance or yoga, is beneficial.  Anyone can type “PD and exercise” into Google and read one of 63 million results. What I would like to share are the psychosocial implications that arise from engaging in movement.  How movement enhances our emotional, social, and cognitive well-being is imperative following a diagnosis of Parkinson’s disease.

Movement, our earliest form of communication, seems to be taken for granted only until we see it deteriorate or are faced with a degenerative disease that reminds us that our movements are so much more.  They are a connection to ourselves and our environment. Engaging in movement is not just about maintaining our physicality, but about preserving our existence.


Assists in symptom management: Research has shown that movement can help manage problems with gait, balance, tremors, flexibility, and coordination.  Improved mobility has been shown to decrease the risk of falling as well as other complications from PD. This often occurs because the brain is learning to use dopamine more efficiently.  

Promotes self-awareness and identity: Every person has a different way of moving and certain affinities toward movement.  It is those differences that promote a capacity for introspection and the ability to stand out as an individual.  Muscle memory even has the ability to tap into memories stored in the brain. Movement has the ability to retain our memories and create new ones.  

Maintains a sense of control: Connection to our breath, the most primitive form of movement, enables us to control our pulse rate, circulation, and even our thoughts.  This is so important for when we feel like things are out of our control or when our body is not functioning the way we would like, we have the power through our own breath to take back a sense of control.  

Builds psychological resilience: Movement has the ability to actually increase our adaptability to stress and adversity.  Reinforcing our own connection to the body empowers our psyche and encourages inner core strength.  This core I’m referring to isn’t your abdominals, but rather your identity. Connecting to the muscles in your chest, torso, and pelvis tap into your belief system, identity formation, and personality.

Maintains social connections: From early on in human existence, there is documentation of celebration and rejoicing through song and movement.  Movement has the ability to connect us with others without verbal communication. We can join in someone’s experience just by witnessing and empathically embracing their body language.


These 5 ways in which movement enhances our mind body connection are just the tip of the iceberg.  Movement is more than just exercise and physical fitness. Movement is body language, expression, and creativity.  Movement is an innate part of being human and just because that ability changes when diagnosed with PD, that does not mean that we should give up all that it entails.  It is even more imperative that we engage in movement to preserve that very part of who we.

Erica Hornthal is a licensed professional clinical counselor and board certified dance/movement therapist. She received her MA in Dance/Movement Therapy and Counseling from Columbia College Chicago and her BS in psychology from University of Illinois Champaign-Urbana.  

Erica is the founder and president of North Shore Dance Therapy and Chicago Dance Therapy. As a psychotherapist in private practice, Erica specializes in working with older adults who are diagnosed with dementia and movement disorders. Her work has been highlighted nationally in Social Work Magazine, Natural Awakenings, and locally in the Chicago Tribune as well as on WCIU and WGN.  


Parkinson’s Awareness Month: #StartAConversation

Every April, the Parkinson’s Foundation engages the global Parkinson’s community to support Parkinson’s Awareness Month. When we raise awareness about Parkinson’s and how the Foundation helps make lives better for people with PD, we can do more together to improve care and advance research toward a cure.

How Stem Cells Will Shape Tomorrow’s Health Care

Experts discuss stem cell treatments for cancer, neurosurgery, orthopedics, pediatrics:

The use of stem cells in medical treatments already is yielding exciting results and may yield greater medical advances in the future. At a recent event hosted by Rush University Medical Center, experts at Rush discussed the role of stem cells in neurosurgery, orthopedics, pediatrics and oncology and how their breakthrough research may dramatically improve the lives of people afflicted by disease and severe injury. An edited transcript of that discussion appears here: https://www.rush.edu/news/how-stem-cells-will-shape-tomorrows-health-care.

Larry Goodman, MD, CEO of Rush University Medical Center and the Rush system, moderated the conversation. The panelists included Brian Cole, MD, MBA, professor in the Department of Orthopedic Surgery and section head of the Center for Cartilage Restoration at Rush; Richard G. Fessler, MD, PhD, professor in the Department of Neurological SurgeryTimothy M. Kuzel, MD, chief of the Division of Hematology, Oncology and Cell Therapy; and Anna Spagnoli, MD, the Woman’s Board Chair of the Department of Pediatrics.

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TISSUE BANK EMPLOYEE BECOMES TISSUE RECIPIENT

RECIPIENT OF: PATELLA LIGAMENT ALLOGRAFT

H.C. Martensen works in the AlloSource tissue processing core where he is faced with the powerful realities and possibilities of tissue donation and transplantation every day. He also has the utmost confidence in the allografts that he and his tissue bank colleagues produce, so much so that he recently requested one for his own transplant.

Over the summer H.C. returned to his former university, Colorado College in Colorado Springs, for an alumni soccer game. He played on the team in college, and since then remained very athletic, participating in triathlons and skiing. However, at the time of the game, it had been a while since he’d played soccer. Following a cutting motion on the field he felt his leg let go below the knee. H.C. instantly knew what had occurred, not only because of his work, but also because a close friend had sustained a torn ACL just
three days prior.

Shortly thereafter a surgeon confirmed it – H.C.’s ACL and lateral meniscus were torn
and he needed surgery and an allograft transplant. Although the surgeon did not
historically use allografts from AlloSource, H.C. made a special request to have his
graft come from the tissue bank. His surgery required a patella ligament bone-tendon-bone graft, which he received from a 33-year-old male donor.


“Just a few years older than me,” H.C. said. “It added to the perspective that I’ve had.

I’m presented with the reality of the business we’re in everyday. Seeing young donors come in is hard. Now that I’ve personally benefitted I’m further grateful for the gift of donation and even more aware of what we do.”


Since his surgery in June, H.C.’s recovery has been progressing very well and he just
completed his final functional evaluation in physical therapy. Although his knee isn’t yet 100%, he knows it shouldn’t be back to normal this soon after the injury, and his road to recovery has been swifter than other patients with similar injuries. Of course, H.C. intends to make the most of his gift of life – he will be training for triathlons.

The Importance of Strengthening the Gymnast’s Elbow

By Tara Hackney, PT, DPT, OCS, KTTP for Atletico Physical Therapy

strengthening gymnasts elbowGymnastics offers a unique perspective, even allowing some athletes to see the world upside down!

Very few sports involve supporting the entire body weight with the arms like gymnastics. Due to these special considerations, gymnasts are more prone to certain injuries, such as Osteochondritis Dissecans of the elbow (OCD), and should take care to strengthen the entire arm to decrease injury risk.

What is OCD Elbow?

Osteochondritis Dissecans (OCD) lesions can be found in the elbows of adolescent athletes. The exact cause of OCD in the elbow is unknown, but repetitive microtrauma and decreased blood flow to the subchondral bone are believed to play a role. As the underlying bone weakens, a segment of the articular cartilage separates from the subchondral bone, forming a lesion. OCD lesions in gymnasts may be caused by repetitive weight bearing on the hands with the elbow in extension.

Presentation of elbow OCD is very vague. A patient can have pain, tenderness and swelling over the lateral aspect of the elbow. There may be limitation in how straight the elbow can go and there may be locking or catching if the injury has progressed. However, tendinitis of the elbow can have a similar presentation. More often OCD is suspected in specific patient populations including pre-teen and teenage gymnasts as well as young baseball pitchers with elbow pain. Diagnosis is through imaging such as x-ray or MRI.

Treatment for OCD Elbow

Non-operative treatment for elbow OCD consists of rest and sports restriction. For a gymnast that means no weight bearing on arms and no hanging from bars or rings as the latter puts traction stress through the elbow. Muscle strengthening exercises and possibly a short period of immobilization are also usually a part of treatment.

There are some cases where the lesion is unstable and surgery is the best option. After surgery, physical therapy is performed to reduce pain, swelling and restore range of motion. Resistance strengthening is also incorporated into the rehabilitation after bone healing has occurred, usually around 8 weeks after surgery.

What Can Athletes Do While Resting Their Elbow?

If a gymnast has been diagnosed with an OCD lesion, they are not allowed to do any weight bearing on the arm, which includes performing skills on the bars. So what can the gymnast do as they allow their elbow to heal? Core strengthening is one option, as core strength is vital to a gymnast and is important during all events. Leg strengthening can also be performed while adhering to the restrictions on the elbow. An overall conditioning program can be designed for the athlete that will incorporate cardio, core strengthening, leg strengthening, shoulder and wrist strengthening, and flexibility stretching. Staying active and in shape is vital to the gymnast during this time to assist in returning to the sport when the elbow restrictions are lifted.

Arm Strengthening for Gymnasts

The elbow is the middle joint of the arm with the shoulder and wrist on either side. While the gymnast’s elbow is healing, it is important to strengthen both of the surrounding joints to provide extra stability for the arm for when return to weight bearing is allowed. Prior to initiating any activities, ensure the gymnasts’ physician has cleared them for return to these exercises.

            Shoulder strengthening examples:

  • Resistance band exercises including rows, shoulder extension, diagonals, internal/external rotation
  • Sidelying shoulder external rotation
  • Tricep extension with band or hand weight
  • Bicep curls with band or hand weight
  • Prone I, T, Y exercises – exercises can be performed using a swiss ball for added core activation, hand weights can be added for resistance
  • Gradual return to weight bearing exercises, like push-ups, planks and handstands, can be added when the athlete is cleared from restrictions

            Wrist strengthening examples:

  • Wrist curls in both directions with a weight or resistance band
  • Gripping exercises for the hands
  • Wrist rotation exercises, such as hand weight rolling
  • Supination/Pronation with a hand weight

Arm Stretching for Gymnasts

  • Wrist flexor stretch
  • Wrist extensor stretch
  • Cross body shoulder stretch
  • Tricep stretch
  • Shoulder flexion stretch on foam roller, wall, or mats
  • Shoulder circles – lie on your side on the floor and draw a circle on the floor with your top arm by rotating your upper body
  • Doorway stretch

Strengthening the Upper Body

Gymnasts have special considerations due to the nature of their sport with weight bearing on the arms. This can lead to injuries of the elbow such as OCD lesions. Strengthening of the entire upper body, including shoulder and wrists, should be incorporated into a conditioning program for both healthy gymnasts and gymnasts recovering from an elbow injury.

For more information, contact an Athletico clinic close to you for a complimentary injury screening.

Schedule a Complimentary Injury Screen