The Spine Biomechanics Laboratory at Texas Back Institute: Cutting Edge Research on Spine Conditions
Since its founding in 1977, Texas Back Institute has been recognized around the world as a state-of-the-art clinic for spine and neurological treatments. Along with recruiting the best and the brightest spine surgeons and clinicians, the practice has been an important contributor in the development of medical innovations such as artificial disc replacement, treatment for scoliosis, disc fusion and for the testing of many other medical devices on behalf of the Federal Drug Administration.
The practice is now earning accolades for its spinal research with the launch of the Spine Biomechanics Laboratory at Texas Back Institute. According to a recent article in the online medical site “Spine Universe,” this team and facility, located in Plano, Texas is “helping patients understand exactly how spine conditions affect their movements and muscle activities, and quantifies how much improvement they have made following spine surgery and other treatments.”
One of the leaders of this research effort is Dr. Scott Kutz, a neurosurgeon at Texas Back Institute. He explained why this research is important to both TBI patients and spine specialists around the world.
“From a research perspective, this process is extremely valuable because it allows us, as physicians, to understand what we are accomplishing with surgery. The subjective reporting from patients is not as conclusive. While it is certainly wonderful to have a patient return for follow-up and report that they are feeling better, we need objective measures to prove that what has been done is improving the patient’s health. This research is also important for our practice here at the Texas Back Institute and when it is documented in publications, we can share these results – both good and bad – with other spine specialists around the world.”
Walking Through the Process of the Research
As with all research, when a patient is admitted to the Spine Biomechanics Laboratory, the first order of business is to establish a baseline. Dr. Kutz explains how this occurs and what happens after the surgery.
“Before admitting the patient to the lab, we make their diagnosis clinically, based on radiographic imaging (x-ray),” he said. “Once we have identified an appropriate candidate, we schedule an appointment for them to come in and have a gait assessment performed. Dr. Ram Haddas, who is the Director of Research at the TBI Research Foundation, will then connect the patient to the monitoring devices and run them through the steps of the process while videotaping the patient’s gait. When data is fed into a complex computer algorithm, it allows us to quantify the patient’s pre-operative gait. This is useful data, particularly when we perform the post-operative analysis.”
The article in Spine Universe gives additional detail of this gait assessment process. “As part of the biomechanics assessment, small electrodes are taped to the skin over back and leg muscles. Participants are asked to walk 10 feet, stand for one minute, lift a box, move from a seated to standing position and then climb stairs. Cameras are positioned around the room that record leg, back, and joint motion and the electrodes measure muscle activity.”
What is Gait and Why is it so Important?
“Simply put, one’s gait is how they walk,” Dr. Kutz said. “It takes into consideration a person’s stride length and it also takes into account the pressure a person places on the floor as they walk. It shows evidence of a limp, or lean, one way or another. And finally, it reveals if the person is off-balance as they walk.
“All of this is useful information and some of the traits are indicative of certain spinal conditions. Being able to identify those characteristic patterns prior to surgery and then seeing it improve and return to a more normal movement after surgery, is what we are looking for.“
Patient Education has become an Important Aspect of Care
More and more often, patients are becoming involved in their treatment. They want to know “what is happening to them” and why certain procedures are being employed. Dr. Kutz believes this patient education aspect of healthcare is positive and leads to better medical outcomes.
“This process allows us to quantify an abnormality and explain this to the patient,” he said. “Rather than our saying ‘you walk with a limp’ or ‘you have this or that irregularity’ we can actually collect the data (which quantifies the condition) and show it to the patient. It allows us to explain the spectrum of normal patient gait and how that of the patient might differ. After surgery, we can show the degree to which the patient is returning to the normal spectrum.
“This is useful information to the patients, but it is also useful to their insurance companies who are paying for this surgery. The companies who are funding this surgical intervention want to see real results and if we can document this, it is very beneficial to the TBI patients.”
Not every patient at Texas Back Institute goes through this Spine Biomechanical Lab. Dr. Kutz explains why.
“We are still in the initial stages of establishing which patients can best benefit from gait research. At this stage, we have chosen to focus our research on certain disease states. Although, I suspect that in the not-to-distant future, all of our patients will go through this process.
“We are now focused on cervical myelopathy and sacroiliac joint dysfunction. Patients with these two conditions typically have noticeable changes in their gait and research among these patient groups can have immediate research value.
“I believe we will soon be using this gait analysis for diagnostic work on patients who have certain lumbar radiculopathies. In the future, we would like to be able to have a patient come into the lab and through this process identify which nerve root is being compressed. Ultimately, this will help us determine which kind of surgery should be employed.”
Leveraging This Data for Worldwide Consumption
The research compiled at the Spine Biomechanical Lab at Texas Back Institute will enhance the worldwide body of knowledge for treating spine conditions. These are exciting times for the spine specialists at TBI.
“We are already taking the research on patients with cervical myelopathy and sacroiliac joint dysfunction and following them out on the longer term. This allows us to assess the effect of their treatment and build a ‘norm.’ This data will then be shared with other spinal institutions around the world, allowing them to compare our data with theirs.”
To hear the complete interview with Dr. Scott Kutz, click on SpineTalk.
If you are interested in learning more about the work of The Spine Biomechanics Laboratory at Texas Back Institute, click here for more information on the Texas Back Institute Research Foundation.