SPINE DISORDERS VARY, and although causes may differ, the most common symptom is pain. Back pain is a medical issue

that eight out of 10 Americans experi-ence during their lifetimes, according to the National Institutes of Health. With sophisticated new treatments for acute and chronic conditions, Health Quest’s

Northern Dutchess Hospital is expand-ing its care efforts for all spine disorders. Driving the endeavor are board-certified, fellowship-trained physicians Richard Perkins, MD, spine surgeon, and Richard Dentico, MD, pain management specialist. Using a multidisciplinary approach, the Spine Center navigates patients through individualized treatment programs

employing the latest nonsurgical therapies and surgical procedures to accelerate heal-ing and optimize results.

When Dr. Perkins approached leaders at Northern Dutchess Hospital with his vision, they quickly took steps to make the Spine Center a reality — a solution with a tangible community impact that would better the lives of patients throughout the

Backbone of Spine Center at Health Quest’s Northern Dutchess Hospital Is Patient-focused, Collaborative CareBy Carrie FryeWITH THE OPENING OF THE SPINE CENTER AT NORTHERN DUTCHESS HOSPITAL, A COMPREHENSIVE NONSURGICAL AND SURGICAL CARE TEAM DELIVERS A COORDINATED APPROACH TO BETTER SERVE PATIENTS WITH BACK AND NECK PAIN.

Richard Perkins, MD, spine surgeon, and Richard Dentico, MD, pain management specialist, treat Spine Center patients at Northern Dutchess Hospital.

■ A BUSINESS & PRACTICE MANAGEMENT MAGAZINE | ABOUT PHYSICIANS | FROM PHYSICIANS | FOR PHYSICIANS ■

region coping with back and neck pain, herniated disks and diseases of the spine.

“The delivery of spine care includes not only surgery but also nonsurgical treatments for patients with spine-related conditions,” Dr. Perkins says. “We wanted to consolidate our treatment programs and develop a more concise, accessible pathway for patients from imaging and diagnosis to treatment. Patients with pain can be inappropriately referred or unable to see a surgeon for consultation, so the idea was to streamline the process and make the patient experience better by providing faster, more effective spine care.”

As a partner in private practice with Dr. Perkins, Dr. Dentico understood the value of creating a Spine Center.

“Dr. Perkins and I treat the majority of spine cases at Northern Dutchess Hospital and in the greater area, so it made sense for us to join forces and provide

a more comprehensive spine program,” Dr. Dentico says. “This is an opportunity for a private practice and a community institution to collaborate and provide a streamlined service for patients with back and neck pain. Seeking care can be intimidating, considering all of the possible spine treatments and different resources available, and we want to help patients get the most appropriate care for their conditions.”

Expediting Spine CareAn orthopedic-trained nurse navigator coordinates patient care at the Spine Center. The coordinator serves as a direct point of contact for patients referred to or seeking care at the Spine Center for back and neck pain associated with injuries, arthritis, disc herniation, sciatica or other conditions associated with the cervical, thoracic or lumbar spine.

Within the Spine Center program, patient calls are returned within one business day, and appointments with clinicians are set up in a timely manner.

“The nurse navigator conducts the initial interview with patients and records their symptoms, the duration of their back and spine pain and the imaging required,” Dr. Perkins says. “Then all of the patient history and information can be packaged for my or Dr. Dentico’s review to expedite treatment.”

“The spine care algorithm includes nonsurgical and surgical treatments, and we have a full complement of coordinated services at the Northern Dutchess Spine Center to better serve patients of the mid Hudson Valley.”— Richard Perkins, MD, spine surgeon, Spine Center at Northern Dutchess Hospital

PHYSICIAN LEADERSHIP STRENGTHENS SPINE CENTERRICHARD PERKINS, MDBOARD CERTIFIED IN orthopedic surgery

and with more than 10 years experience,

Dr. Perkins performs a wide array of both

minimally invasive and traditional open spinal

surgeries. A former San Francisco Spine

Institute Surgical Fellow, Dr. Perkins is a

partner in private practice with Dr. Dentico at

Orthopedic Associates of Dutchess County.

He focuses on adult spinal disease.

“In orthopedics and spine surgery, you

can really change people’s lives,” he says.

“The results only 24 hours after a procedure

can be tremendously dramatic, and that’s

certainly gratifying.”

RICHARD DENTICO, MDA BOARD-CERTIFIED PHYSICAL medicine

and rehabilitation specialist, Dr. Dentico is a

graduate of New York Medical College. After

completing a sports medicine fellowship at

Atlantic Health System, Dr. Dentico has been

in private practice at Orthopedic Associates

of Dutchess County since 2010. Aside from

his role at the Spine Center, Dr. Dentico also

lectures in the community. His most recent

published work discusses cervical radicu-

lopathy in rehabilitation medicine.

“I have a strong professional relationship

with my fellow clinicians, and that is the

groundwork for a strong Spine Center,”

Dr. Dentico says. “Our collaboration and

communication truly optimize spine care for

our patients.”

Dr. Dentico explains spinal anatomy to a patient at Northern Dutchess Hospital.

“An evaluation by a physician quickly puts patients into therapy protocols,” Dr. Dentico adds. “Having a nurse naviga-tor assist in all of these maneuvers keeps patients progressing instead of struggling to advocate for their own care.”

Advanced radiologic technologies on-site, including MRIs, X-rays, CT and bone scans, as well as X-ray-guided injection therapies, increase the pace by swiftly providing physicians with the imaging required to set a plan of care in motion.

“If a patient throws his or her back out on Sunday, I want to perform an examination as quickly as possible to ease his or her pain, and we will do everything possible to reha-bilitate the patient swiftly and efficiently,” Dr. Dentico says. “Fast turnaround with a nurse navigator facilitates that aspect of care.”

Nonsurgical Pain ManagementA thorough evaluation by clinicians at

the Spine Center at Northern Dutchess Hospital is the first of a two-pronged strategy that, for most patients, begins with nonsurgical treatment options. After ruling out neurological conditions that might require an immediate surgical

consultation, Dr. Dentico tailors a care plan to the patients’ conditions and needs, depending upon the acuity of the underlying back issue.

“Pain management begins with interventional injections, which can provide substantial relief for shorter periods of time,” Dr. Dentico says. “I understand and appreciate the reha-bilitation process for patients and work with them to regain function with several different types of therapies.”

As a physiatrist, Dr. Dentico provides a host of injection interventions in order to diagnose the origin of a patient’s back pain and treat it with an ultimate goal of avoiding surgery. Epidural injections place medication directly into and around the nerves in the spinal discs to reduce inflammation and provide pain relief. These injections may be given in both the cervical and lumbar spine. Dr. Dentico can also use spinal joint injections to treat arthritis pain.

“The Spine Center at Northern Dutchess Hospital provides community physicians with a real resource for back pain via physiatry, therapy and surgery. We give their patients access to expedited, expert spine care to get them feeling better and help them return to functional lifestyle activities, whether skiing or picking up their grandchildren.”— Richard Dentico, MD, pain management specialist, Spine Center at Northern Dutchess Hospital

Alecia Brophy, RN, assists a patient through her CT examination.

Radiofrequency Ablation TherapyRadiofrequency ablation is another

nonsurgical strategy Dr. Dentico uses to treat back pain stemming from arthritis, spinal stenosis or disc herniation. The procedure utilizes radio waves to calm nerves in the spine that are at the root of the patient’s pain and stops the pain signals with a needle and guided X-ray.

“The tiny sensory nerves that are sending pain signals up to the brain are ablated by cauterization technique,” Dr. Dentico explains. “Patients may experience up to 12 to 18 months of pain relief.”

Physical Therapy RegimensOn-site licensed physical therapists are

among the practitioners available at the Spine Center at Northern Dutchess Hospital to enhance the accessibility of nonsurgical therapy offerings to patients with back pain.

The McKenzie Method, a proven physi-cal therapy treatment protocol developed in the 1950s by Robin McKenzie in New Zealand, encompasses a series of exercises customized for patients under the auspices of the physical therapy team to stabilize and strengthen the spine while reducing pain in the neck and back.

“The physical therapists at the Spine Center provide excellent McKenzie proto-cols for lumbar radiculopathy or low-back pain,” Dr. Dentico says. “The key is really a spinal stabilization program, in which the spine is strengthened in many different places to reduce pain and improve function.”

Outpatient physical therapy through the Spine Center is available at Northern Dutchess Hospital’s Rhinebeck main campus as well as its satellite campus in Hyde Park.

“There are many approaches to physical therapy,” Dr. Perkins adds. “They all involve specific exercises and techniques to keep patients from reinjuring themselves. The program is tailored with the highest-quality, licensed therapists in place.”

Complementary TherapiesThe Spine Center at Northern Dutchess

Hospital, in addition to physical therapy, offers alternative and holistic approaches including acupuncture, and makes referrals for chiropractic care. These therapies may

offer another form of pain relief without the risk of harsh side effects often associ-ated with prescribed medications.

Acupuncture, derived from ancient Chinese medicine, is a therapeutic modality in which finely pointed needles are inserted in the soft tissue as a pain reducer, whereas chiropractic care focuses on mechanical manipulation and realign-ment of the spine.

“I do refer patients to chiropractic care, and it is often successful at treating back pain and helpful in spine pathology, depending upon the patient’s underlying problem,” Dr. Dentico says. “Acupuncture is more for chronic back pain conditions or those patients concerned with the long-term efficacy or effects of medications. There are many options other than injections and surgery, as long as there are not underlying

NORTHERN DUTCHESS HOSPITAL SPINE CENTER’S FULL SPECTRUM OF CARE TREATMENTSNONSURGICAL SPINE CARE

+ Acupuncture

+ Bracing

+ Epidural injections

+ Facet block

+ Medial branch block/sacroiliac block

+ Physiatry

+ Physical therapy

+ Radiofrequency ablation

+ Selective nerve root block

MINIMALLY INVASIVE SURGICAL SPINE CARE

+ Direct lateral interbody fusion

+ Laminotomy

+ Microdiscectomy

+ Microforaminotomy

+ Mini anterior lumbar interbody fusion

+ Minimally invasive surgical transforaminal

lumbar interbody fusion

+ Percutaneous pedicle screw placement

+ Vertebral augmentation (kyphoplasty)

OPEN SURGICAL SPINE CARE + Anterior cervical discectomy

and fusion

+ Anterior lumbar interbody fusion

+ Cervical disc replacement (arthroplasty)

+ Corpectomy

+ Laminectomy

+ Laminoplasty

+ Lumbar disc replacement

+ Osteotomy

+ Posterior cervical fusion with

or without laminectomy

+ Posterolateral fusion

+ Sacroiliac fusion

+ Spinal cord stimulator placement

+ Transforaminal lumbar

interbody fusion

Dr. Dentico administers a lumbar epidural steroid injection for a patient with low-back pain.

CONDITIONS TREATED

+ Acute and chronic neck and back pain

+ Arthritis

+ Cervical spine conditions

+ Herniated discs

+ Lumbar spine conditions

+ Osteoporosis

+ Sciatica

+ Scoliosis

+ Spine trauma/injury

+ Thoracic spine conditions

turns the corner for them; however, some patients don’t respond to conservative treatments, and at that point we consult a surgeon, if we haven’t done so previously. The Spine Center provides patients with the opportunity to see multiple experts during the acute phase of their injury, which better educates them and allows them to make an informed decision regarding their care.”

Common conditions that may lead to surgical intervention include arthritic pressure on the nerves, herniated discs, scoliosis, spinal stenosis and spondylo-listhesis — the forward displacement of a vertebra caused by the loosening of bone that may not always require surgery.

Minimally Invasive Spine Surgery

While a last option, surgery may be a necessary treatment for back pain. Most minimally invasive spine surgeries are performed as outpatient procedures with accelerated recovery periods and minimal blood loss. Many may be performed in as few as 30 minutes.

“For patients suffering from spine disease with neck or low-back problems requiring surgery, we want to operate in the least invasive fashion possible,” Dr. Perkins says. “Performed with precise tools, minimally invasive surgery requires a smaller incision, and the vast majority of patients return home the same day.”

Dr. Perkins routinely performs minimally invasive cervical and lumbar procedures, including:

++ Anterior+lumbar+interbody+fusion.+This procedure is typically indicated for patients with degenerative disc disease. The surgeon removes a damaged disc and implants new bone tissue to hinder movement. Minimally invasive lumbar interbody fusion cuts surgical time in half, compared with the traditional open procedure.

++ Bone+fusion.+This procedure joins and realigns two or more vertebrae to halt the slippage associated with arthritis.

++ Cervical+and+lumbar+laminectomy.+This surgical option opens the canal in the vertebrae to stop compression of the spinal cord.

++ Cervical+and+lumbar+total+disc+replace-ment.+In approximately 30 minutes, Dr. Perkins can perform this procedure and replace a disc, which affords the patient enhanced, natural movement. The artificial disc is comprised of tita-nium and a plastic polymer that allows the segment to move, so the patient will have more normal or more physiologic motion when the surgery is over. This procedure promotes continued spine health in the future, notes Dr. Perkins.

neurological issues to be addressed. Any kind of treatment is acceptable that meets a patient’s needs, and should a specific therapy become ineffective, we can always explore other options.”

Surgical Spine CareWhen pain management, physical and

alternative therapies are not producing fast or efficient pain relief, Dr. Dentico continues the team’s multidisciplinary approach by consulting with Dr. Perkins to advance the care protocols.

“Back pain, if left untreated, may take up to nine months to resolve, but if chronic radiculopathy persists, we want to hasten recovery,” Dr. Dentico says. “Every patient is different when it comes to therapies. Some patients have a chiropractic treatment or physical therapy session and find that it

Physical Medicine Director Cathy Leonard helps a patient perform a trunk extension exercise.

Dr. Perkins reviews a spine surgical candidate’s X-ray.

++ Kyphoplasty. The injection of bone cement into a weakened vertebra to restore its strength and function is used to treat compression fractures typically associated with osteoporosis. Real-time X-ray imaging provides a detailed view of the lower lumbar spine. The surgeon places a needle through the skin and into the bone. Then, a balloon placed through the needle is inflated into the bone, restoring the height of the vertebra.

++ Microscopic+anterior+cervical+dis-cectomy+and+fusion. This procedure treats degenerative discs in the neck by removing the affected disc and insert-ing a synthetic spacer. Patients typically require a 24- to 48-hour overnight hospi-tal stay for this procedure, but generally do not have to wear a stabilizing neck collar afterward.

Minimally invasive motion preservation procedures, as they pertain to the cervical disc, are not quicker procedures but yield positive patient outcomes, says Dr. Perkins.

“Motion preservation is a newer trend we’ve adopted that can help people avoid a fusion,” he says. “When patients have a herniated disc in their cervical spine and require surgical intervention, instead of removing the disc and fusing it, we can perform a disc replacement.”

Dr. Perkins and his team are also skilled in traditional open surgical interventions. These procedures may be necessary to meet patient needs in cases such as spinal cord stimulator placement or osteotomy, when a bone is cut to change its alignment.

A Community ResourceRecognizing the need in the mid

Hudson Valley, the Spine Center at Northern Dutchess Hospital seeks to provide a patient population with the full scope of spine care services by partnering with the highest caliber multidisciplinary team of clinicians and practitioners.

“Northern Dutchess Hospital is a true community hospital, and that is where this community reaps the most benefits,” Dr. Dentico says. “Caring for their neighbors, the hospital leadership recruited accomplished physicians and a quality ancillary staff. The Spine Center is a community service that facilitates excellent care.”

Dr. Perkins views Northern Dutchess Hospital’s new Spine Center as a value-added resource for community physicians.

“There are certainly patients with back and neck pain presenting at family care physician offices and in emergency rooms, and now with the Spine Center, we can bet-ter triage these patients,” Dr. Perkins says. “The center provides a one-stop destination for spine care and advanced care therapies. Patients will be treated faster, more effec-tively and by the correct provider.”

“If a patient wants to be seen, we are here to serve them,” Dr. Dentico says. “I am willing to see and treat any patient, whether he or she is an injection or surgi-cal candidate. We take an empathetic approach to patients with back pain, whether acute or chronic, and will do everything in our power to ameliorate their pain and improve their function by providing them with compassionate and appropriate care.”

For more information about the Spine Center at Health Quest’s Northern Dutchess Hospital, call 845-871-3333 or visit health-quest.org/NDHspine. ■

Brophy and Leonard are part of the Spine Center team.

Dr. Perkins stands in one of the operating rooms where he performs Spine Center surgeries.

Reprinted from Mid Hudson MD NEWS