The spine faculty includes:
Keith Bridwell, MD (chief of service)
Jacob Buchowski, MD
Timothy Kuklo, MD, JD
Larry Lenke, MD
K. Daniel Riew, MD
The Washington University Spine Service offers one of the nation's largest clinical experiences in the surgical management of:
• Pediatric spinal deformity
• Adult spinal deformity
• Complex cervical reconstruction
• Complex lumbar reconstruction
Members of the spine service have presented more papers at the Scoliosis Research Society within the last 15 years than any other center within North America. Over the last fifteen years, the service has edited two major textbooks and published over 100 papers in peer-reviewed journals. Our faculty are active members of the Scoliosis Research Society (SRS), North American Spine Society (NASS) and Cervical Spine Research Society (CSRS).
Resident Educational Experience
At any given time the Spinal Service at Barnes-Jewish Hospital and St. Louis Children's Hospital consists of four fellows (PGY-6), one senior resident (PGY-4) and one junior resident (PGY-1). The Spine Service also staffs two or three days a week at the Shriners Hospital for Children.
On the Barnes-Jewish South-Children's Service, the senior resident (PGY-4) and fellows (PGY-6) have somewhat similar roles. Each is assigned one of the attending surgeons. Each serves as a first assistant on all surgical procedures. Each sees clinical patients with the attending physician. In the outpatient offices, the senior resident and fellows see all the new patients as well as the majority of the return patients with the attending. Participation in ongoing publications is highly encouraged for the PGY-4 resident and is mandated for the PGY-6 fellows.
The senior resident and two fellows serve as first assistants in the operating room. Their level of primary participation is dependent on the skill of the resident/fellow and the degree of difficulty of the technical task at hand. Operative participation is quite active but is always supervised in a hands-on manner by the appropriate attending.
The junior level resident is principally an assistant in the operating room for certain appropriate surgical steps such as obtaining bone graft, performing a laminectomy as well as managing patients and problems on the floor.
A didactic session is conducted each Saturday morning for a one-hour period. There is a specific spine core curriculum, which is independent of the resident core curriculum. There is also a one-hour teaching conference each Friday morning which reviews the surgical cases that have been performed in the past week and the surgical cases which will be performed in the upcoming week by the members of the Spine Service. Most visitors from North America or other parts of the world who attend this conference come away amazed by the breadth and complexity of spinal problems that are managed operatively by the Service. The conference is conducted and narrated by the fellows and senior resident and is attended by the fellows, senior resident, junior resident, four spinal attending surgeons, four clinical spinal nurses, two research spinal nurses, and members of the Radiology Department and Physiatry Department. Quarterly on a Saturday morning, a 90-minute interactive case discussion conference is held in conjunction with the Neurosurgery Department. Didactic lectures on Tuesday mornings and interactive sessions on Thursday mornings are held with the Orthopaedic residents. There is approximately one didactic lecture per month and one interactive lecture per month. The Spinal Service/fellows/residents on the Service also participate in the once-a-month Journal Club and once-a-month Morbidity & Mortality Grand Rounds.
Clinical interests of the Spine Service include:
• both adult and pediatric spine pathologies
• all anatomic regions; namely, the cervical, thoracic and lumbar spine, both posteriorly and anteriorly
• Pathologies include the following etiologies: degenerative, deformity, fracture, tumor, and revision pathologies
• Both operative and nonoperative management are of interest
The ten most commonly-performed surgical procedures for this services include:
• Pediatric spinal deformity
• Revision adult spinal deformity
• Primary adult spinal deformity
• Lumbar stenosis
• Cervical stenosis
• Lumbar disc herniation
• Spondylolisthesis
• Spinal fractures (cervical and thoracolumbar)
• Spinal tumors (cervical and thoracolumbar)
Average annual totals for the Spine Service:
• Surgical procedures - inpatient: 800
• Surgical procedures - outpatient: 0
• General office visits: 8,000
• Average of new patients seen in a fiscal year: 2,000
Current Research Efforts of the Spine Service include:
• Biomechanical evaluation and fixation of the lumbosacral joint
• Spinal cord injury repair
• Functional analysis of pediatric patients following spinal reconstruction
• Functional analysis of adult patients following spinal reconstruction
• Outcome analysis of pediatric spinal deformity patients
• Outcome analysis of adult spinal deformity patients following reconstruction
• Bone formation with adenoviral vector-carrying BMP-2 gene
• The use of allograft, bone morphogenic proteins in long fusions
• Endoscopic thoracic fusions