Category: 2024

Primary care physicians are familiar with diagnosing back pain. But when it comes to discerning the source of the pain and how to treat it, a referral to the physicians at Syracuse Orthopedic Specialists (SOS) and New York Spine & Wellness Center (NYS&WC) is often the next step. The medical groups are in partnership to provide a continuum of care, creating the most complete musculoskeletal group in Central New York and helping patients navigate through their back pain.

Chronic back pain, defined as lasting at least three months, accounts for the most common pain complaint among American adults, according to a 2019 study by the Centers for Disease Control and Prevention, afflicting 39 percent of patients. In 2023, the World Health Organization outlined these key points about low back pain:

• It is the single leading cause of disability worldwide and the condition for which the greatest number of people may benefit from rehabilitation.
• It can be experienced at any age, and most people experience it at least once in their life.
• Prevalence increases with age up to 80 years, while the highest number of low back pain cases occurs at ages 50 to 55, and more prevalently with women.
• Non-specific low back pain is its most common presentation (about 90 percent of cases).

Providers at both SOS and NYS&WC offer initial consultations to patients experiencing back pain. “It’s really important having a trusted partner because there are many sides to pain management,” said Jessica Albanese, MD, a spine surgeon with the SOS Neck and Back Team. “Between our two practices, we offer the full spectrum of interventions. Patients can begin care at either practice and providers will diagnose and navigate patients to the most appropriate specialist to support their treatment and recovery.”

“The best first step for a patient with back pain is to seek treatment and guidance from their primary care provider” shared Dr. Brendan McGinn a specialist in Anesthesiology and Interventional Pain Management at NYS&WC. “By having an initial consultation with their PCP, patients can most effectively take first steps to help manage their pain by trialing a nonsteroidal anti-inflammatory drug (NSAID) or an oral steroid, physical

 therapy, and then if it’s indicated, a referral to SOS or NYS&WC”.

Patients are also welcome to contact SOS and NYS&WC directly to request appointments. Both practices accept nearly all insurance types and do not require referrals unless the patient’s insurance company requires it.

Dr. Ryan McConn a specialist in Anesthesiology and Interventional Pain Management at NYS&WC shares, “The benefit of the close partnership between our two organizations is that patients have seamless access to both groups and the services they provide once within our doors. Each practice will consult patients and ensure care is given by the most appropriate provider.”

Upon initial consultation at either organization, patients may meet with a physician assistant, nurse practitioner, or physician. Each clinical team is highly trained, working in tandem to deliver specialized medical care to every patient.

Together, from initial consultation through treatment, clinicians focus on patient education. “A lot of time is spent with our patients, in both practices, educating them and having a discussion about what is going on, the options they have, and the risks and benefits of each option,” Dr. McConn continued. “I refer to it as ‘getting organized’ because when they first come in, they’re in distress, they don’t know exactly why and they’re not sure how this ends for them and they’re nervous.”

After an initial consultation, conservative treatment options are discussed at both practices. Because of the partnership and symbiosis of SOS and NYS&WC, providers can discuss all options from the musculoskeletal perspective to make people feel better. Between the two practices, services include: physical therapy, behavioral therapy, diagnostic and prescriptive services, electrodiagnostic lab, X-ray and MRI Imaging, and ultimately surgery if all conservative measures fail.

Conservative Approach to Spine Care

When pain is reported, figuring out where it hurts is the first step. “We are able to identify the source of the pain using technologies such as X-rays, MRIs and electrodiagnostics to narrow down the diagnosis,” said Dr. Albanese. New York Spine and Wellness Center has the only accredited electrodiagnostic lab in Central New York.

A conservative approach works best, especially with any spinal issue. “We always maximize non-surgical care first,” Dr. Warren Wulff, a spine surgeon with the SOS Neck and Back Team, said. “Only the smallest percentage of patients where that doesn’t work do we consider for surgery. In our toolbox of surgical procedures, we always select the least invasive way that works. We match the procedure to the problem, giving the best chance for a good outcome.”

Still, the first order of business is reducing the pain, and there’s the expertise of Dr. McConn and Dr. McGinn. “Surgery is never the first line treatment for pain unless the patient has neurological deficits.” Dr. McGinn said. “When pain is the issue, there are many interventions along the continuum of care before reaching the surgery option.” 

Some patients ask for a cortisone shot, thinking that will solve the problem. “But that injection is intended to be more of a bridge toward a faster recovery as the body heals and gets stronger with exercise,” Dr. McGinn added. “It’s supposed to allow for improved functionality and to get patients moving again above all. An injection is part of a multi-modal approach to recovery that can also include chiropractic care, acupuncture, physical therapy, and surgical intervention.”

Importance and Impact of Physical Therapy

Physical therapy is one of the most common treatment choices. “Motion is what makes people feel better, and we typically start treatment with PT,” Dr. Albanese said, “and having patients relearn how to move. They may have some mechanical dysfunction, so they work with the therapy team on strength and mobility.”

Physical therapy includes therapist-guided strengthening, stabilization, and stretching, re-training functional movements, hands-on joint and tissue mobilization, and patient education. At SOS, the therapists pride themselves on individualized, personalized care. SOS offers Orthopedic & Sports Therapy at 5 locations surrounding Central New York, as well as offering remote physical therapy (RTM). RTM is offered to patients living outside the area, to those with limited access to transportation, as well as to patients who prefer online care.

One of the greatest benefits of the Orthopedic & Sports Therapy department within SOS is the close relationship built with the physicians. This direct connection enhances communication amongst the entire care team to expedite patient recovery.

On average, SOS patients achieve superior outcomes with fewer visits and shorter treatment durations compared to national averages. This is consistently shown through the outcomes and patient satisfaction data measured by FOTO Inc. (Focus on Therapeutic Outcomes, Inc.). FOTO has 26 million patients, which is the largest database of outpatient orthopedic therapy patients to compare and the greatest participation by therapy providers.

Non-Operative Interventions 

If pain persists, other interventions remain, which is a huge benefit to starting with conservative treatments. “That’s where New York Spine & Wellness Comes in. They can prescribe medications that may be appropriate and perform minimally invasive procedures – options that are still non-surgical,” Dr. Albanese said.

“While we specialize in spine pain and back disorders, we treat all types of acute and chronic pain” said Dr. McGinn. “Some of our interventions can help patients avoid surgery by working through injuries and healing while others can be used as maintenance therapy for chronic arthritic or disc-based pain in the spine for which there is no real surgical option. Other procedures can involve temporary or permanent implants that can treat debilitating nerve pain that may be severely affecting quality of life. We also perform minimally invasive surgeries in patients with spinal stenosis who may be poor candidates for more invasive surgery due to their age or medical comorbidities.”

Surgical Innovation

“Given enough time and attention, many painful spinal conditions will resolve with non-surgical measures only.” shared Dr. Warren Wulff. In instances when surgical intervention is recommended, we use the latest technology and newest techniques such as neuromodulation and minimally invasive surgery at our orthopedic focused surgery center”.

Neuromodulation, through the use of a spinal cord stimulator, is a recent trend in pain management, and Wulff is expert in the procedure. The International Neuromodulation Society defines it as “the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body.” The goal is to re-establish normal function of the nervous system.

Neuromodulation itself is nothing new. Cardiologists have been using the technology for more than 90 years. “People whose hearts don’t beat regularly, most often get a pacemaker, which is a neuromodulator,” said Wulff. “Similar systems are being investigated to treat tremors, epilepsy, limb ischemia, obesity and eating disorders, and even depression—stimulating the brain with painless magnetic pulses.”

Again, that approach begins conservatively. “We can attach an external version of the neurostimulator for a week,” Wulff said. “If the patient has a good reaction, a permanent device is implanted. This is a 1-2 hour procedure that requires an overnight stay. The benefits can be lifelong.”

“These patients may have been highly medicated for years, taking higher doses of opioids with all the negative consequences,” Wulff continued. “Once you get patients off opioids, they feel better and think clearer. It also leads to reduced need for spinal procedures, and medications, which results in long term savings to the healthcare system.”

Reducing a patient’s pain is the ultimate goal, and both practices advocate for attempting the least invasive, most conservative treatments first. “With everybody being unique,” said Dr. McConn, “there is no one modality that is going to relieve symptoms long-term. It’s actually a combination of all these modalities. I tell patients I don’t know what’s going to work for you but we have the access to all options and we’re going to find a combination that’s going to make the pain more manageable and enhance your quality of life.”

By: William Ecenbarger

Like most other organizations, healthcare facilities have moved toward total digitization. The major benefit of this change is that it has provided an efficient way of sharing patient records among healthcare professionals. Compared to paper-based records, electronic health records require less workforce, time, and physical storage.

However, this shift has created a new and growing risk: cyber-attacks that are compromising patient information, delaying patient procedures and tests, and rerouting ambulances to alternative emergency rooms.

“The health care sector is experiencing a significant rise in cyberattacks, putting patient safety at risk,” warns Andrea Palm, deputy secretary of the U.S. Departent of Health and Human Services. “These attacks expose vulnerabilities in our health care system, degrade patient trust, and ultimately endanger patient safety.”

The HHS Office for Civil Rights said the medical information of some 88 million Americans was exposed in the first 10 months of 2023. HHS also reported a 93 percent increase in large, healthcare-related cyber breaches between 2018 and 2022.

Much of the official concern is focused on breaches of patient privacy.

Healthcare institutions are a gold mine for cyber attackers. They hold huge amounts of information on patients–not just medical records, but also financial information, Social Security numbers, names and addresses. Moreover, unlike most businesses, they are open all the time–meaning, as the Seattle Times pointed out in a recent article, “they might be more likely to prioritize avoiding disruptions and, therefore, more likely to pay a hacker’s ransom.”

Geetha Thamilarasu, an associate professor of computing and software systems at the University of Washington and a specialist in health care security, said patients’ health information is valuable to cyber-attackers, who can use stolen medical records to buy bogus prescriptions, sell identity information online and file fraudulent insurance claims.

“There is a huge underground market on the dark web,” Thamilarasu told the Seattle Times. “Research shows that if a compromised credit card sells for about $1 to $5 each, a compromised medical record can sell anywhere from $400 to $500 — sometimes even $1,000.”

Moreover, anyone concerned about stolen Social Security numbers can enroll in a credit-monitoring agency, but patients have little recourse if their personal health information is stolen.

There are often hundreds of Internet-connected devices in a hospital, each of which may require a different type of security. “While an X-ray machine itself might not carry any patient data, it can act as an entry point for attackers trying to break into an organization’s broader network,” Thamilarasu said.

The American Hospital Association recently warned: “Health care organizations are particularly vulnerable and targeted by cyberattacks because they possess so much information of high monetary and intelligence value to cyber thieves. The targeted data includes patients’ protected health information (PHI), financial information like credit card and bank account numbers, personally identifying information (PII) such as Social Security numbers, and intellectual property related to medical research and innovation.”

John Riggi, the AHA’s Senior Advisor for Cybersecurity and Risk, said hospitals and other healthcare organizations constantly face attacks that can put patient safety at risk. “That’s why I advise hospital senior leaders not to view cybersecurity as a purely technical issue falling solely under the domain of their IT departments. Rather, it’s critical to view cybersecurity as a patient safety, enterprise risk and strategic priority and instill it into the hospital’s existing enterprise, risk-management, governance and business-continuity framework.”

Riggi, a former FBI cybersecurity specialist, urges hospitals to adopt “a culture of cybersecurity” that would result in staff members seeing themselves as “proactive defenders of patients and their data.”

“The cyber bad guys spend every waking moment thinking about how to compromise your cybersecurity procedures and controls. The best defense begins with elevating the issue of cyber risk as an enterprise and strategic risk-management issue. If possible, you should also dedicate at least one person full time to lead the information security program, and prioritize that role so that he or she has sufficient authority, status and independence to be effective. Furthermore, you and your team should receive regular updates on your organization’s strategic cyber risk profile and whether adequate measures are dynamically being taken to mitigate the constantly evolving cyber risk.”  

According to the healthcare news publication HealthcareDive, cyber-attacks exposed 385 million patient records from 2010 to 2022. though individual patient records could be counted multiple times. The HIPAA Journal says the number of healthcare data breaches has been increasing over the past 14 years. In 2023, 5,887 data breaches of 500 or more records were reported to the federal officials. In 2023, more than 540 organizations reported healthcare data breaches to HHS, affecting more than 112 million people.

Riggi said hospitals have been working to put in place better safeguards and more backup systems to prevent such attacks and respond to them when they occur. But he said it is almost impossible to make them completely safe, especially because the systems need to rely on Internet and network-connected technologies to share patient information among clinicians involved in a patient’s care. “Overall, that’s a good thing,” he said. “But it also expands our digital attack surface.”

The HHS recently released a cybersecurity strategy for the healthcare sector that includes these actions:

 –Publish voluntary healthcare sector cybersecurity performance goals to “help healthcare institutions plan and prioritize implementation of high-impact cybersecurity practices.”

 –Provide resources to “incentivize and implement cybersecurity practices.” HHS said it would work with Congress to obtain new authority and funding to administer financial support and incentives for domestic hospitals to implement high-impact cybersecurity practices.

–Implement an HHS-wide strategy to support greater enforcement and accountability. HHS will propose new enforceable cybersecurity standards.

–Expand and mature the one-stop shop within HHS for healthcare sector cybersecurity. This will “deepen HHS and the Federal government’s partnership with industry, improve access and uptake of government support and services, and increase HHS’s incident response capabilities.”

The AHA’s Riggi offered his expertise. “I am available to assist your organization in uncovering strategic cyber risk and vulnerabilities by conducting an in-depth cyber-risk profile, and by providing other cybersecurity advisory services such as risk mitigation strategies; incident response planning; vendor risk management review; and customized education, training and cyber incident exercises for executives and boards. Please contact me for more information at 202-626-2272 or jriggi@aha.org.