At Northwell Health, putting their backs into it

Striking a cord: This was a big week for spine-related innovations at Northwell Health and its Feinstein Institute for Medical Research.
By GREGORY ZELLER //

Potential triggers for crippling backaches and revolutionary cancer treatments marked a big week for the human spine at Northwell Health.

First, on Nov. 14, the health system announced that North Shore University Hospital had become the first center in the eastern U.S., and second nationally, to perform combined kyphoplasty intraoperative radiation therapy – a cutting-edge treatment for spinal metastasis, a common development for all patients with systemic cancers.

The Feinstein Institute for Medical Research, Northwell Health’s R&D arm, followed that breakthrough announcement Nov. 15 with word that researcher Nadeen Chahine has received a $1.8 million National Institutes of Health grant to study how inflammation affects degenerative disc diseases of the spine.

Nadeen Chahine: Disc drive.

Nadeen Chahine: Disc drive.

Chahine, director of Feinstein’s Bioengineering-Biomechanics Laboratory and an associate professor of molecular medicine at the Hofstra Northwell School of Medicine, earned the five-year R01 grant from the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Her study, “Mechanobiology of Inflammation in Intervertebral Disc,” will hunt down the triggers of degenerated intervertebral discs, a condition that causes debilitating pain that starts in the lower back, buttocks and thighs and often radiates to other areas.

Contemporary treatments for degenerated IVD – in which rubbery spinal discs shrink and lose integrity – include physical therapy, pain medication and surgery, though none is known to completely eliminate the pain.

Specifically, Chahine – who is also an associate investigator at the Feinstein Institute’s Center for Autoimmune and Musculoskeletal Diseases – will observe interactions of the “high mobility group box 1” molecule, a protein released by dying or distressed cells.

The biomedical engineer’s focus: whether the HMGB1 molecule triggers inflammation and disc degeneration. It’s a question of potentially enormous importance – Chahine references studies showing 40 percent of U.S. adults are affected by some level of degenerated IVD, with annual treatment costs spiraling past $100 billion.

Better understanding how inflammation hampers a disc’s ability to bear load could create alternate treatments that slow down – or possibly reverse – worsening conditions like degenerated IVD.

Calling the condition “understudied,” Chahine said she was “extremely grateful” to NIAMS for funding her unique mechanobiological research, which will involve a team of bioengineers, clinicians and biologists.

“It is our hope that this study will get us closer to a treatment of disc degeneration,” Chahine said in a statement.

Further along the developmental path is the groundbreaking spinal metastasis treatment performed Nov. 3 at North Shore University Hospital, only the second time a Kyphoplasty IORT has been attempted in this country.

According to Northwell Health, the patient – battling a Stage 4 colon cancer that had metastasized to his spine – suffered debilitating pain even after undergoing traditional external radiation therapy.

That’s a fairly common story: spinal metastases develop in 40 percent of cancer patients, and one in five of those will require a kyphoplasty, a surgical intervention used primarily to mitigate spinal-fracture pain, stabilize bone and treat vertebrae after compression fractures.

Following a spine-stabilizing kyphoplasty, most spinal metastasis patients are prescribed a short course of conventional external-beam radiation therapy. But that has not proved out as a long-term solution, according to NSUH radiation oncologist Maged Ghaly, who noted “short-term pain control and low rates of complete response to pain.”

“Furthermore, approximately 20 percent of patients will suffer pain progression following cEBRT, requiring treatment,” Ghaly said.

In this case, the patient, who suffered from a painful vertebral fracture caused by the spinal tumor, risked progression of his spinal fracture if he underwent a second course of external radiation.

So Ghaly joined neurosurgeon Ahmad Latefi Nov. 3 to perform a Kyphoplasty IORT, a minimally invasive joint procedure that originated with a German biotech. The Kypho-IORT is meant to offer the stabilization benefits of a kyphoplasty with a single dose of intraoperative radiation – a “novel approach,” according to Latefi, just right for “potentially unstable spinal cord metastases” in a patient with risks related to prior spinal radiation.

Though minimally invasive, the procedure was complex. Latefi made a small spinal incision and inserted an Intrabeam “needle applicator” manufactured by German biotech Carl Zeiss Meditec, while Ghaly performed the IORT, delivering precision radiation treatment directly into the tumor, sparing the spinal cord and surrounding tissue.

Latefi also inserted a tiny spinal catheter to “restore the height of the vertebrae,” Northwell Health said, while the team injected “a cement-like substance” into the spine to fortify the vertebrae against future collapse.

The patient was discharged the same day and, while still battling his colon cancer, was “able to resume his daily activities,” according to the health system, which is permanently adding the Kypho-IORT to its treatment options.

“This integrated palliative treatment option improves the patient’s quality of life with quicker pain relief,” Latefi said. “And without interrupting their systemic therapy.”


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