The recent expansion of Brain & Spine Surgeons of New York (BSSNY) unites the high-level expertise of a growing cadre of specialists in a single practice, significantly widening BSSNY’s geographic reach and making it the largest neurosurgical provider in the Hudson Valley.
BSSNY is furthering its regional impact by making an extensive array of state-of-the-art technology available to its experienced clinicians and by laying the groundwork for participation in clinical research to enhance patient outcomes.
For more than half a century, BSSNY has developed a reputation for advanced care. The merger of Neurological Surgery & Spine Associates and Scoliosis & Spinal Surgery, PC, with BSSNY builds on the foundation laid in 1958, when the practice began with just two members.
With these additions, BSSNY has assembled a diverse group of highly trained specialists, allowing providers to make referrals to one practice that can address virtually any adult or pediatric neurosurgical need and relieving patients of the burden of traveling significant distances for comprehensive care. Members of the practice now provide care in facilities stretching from Poughkeepsie and Westchester County in New York, to Stamford and Greenwich in Connecticut.
John M. Abrahams, MD, President of Brain & Spine Surgeons of New York (BSSNY) and Chief of Neurosurgery at Northern Westchester Hospital, reviews an MRI of cervical spine of a patient who needs surgery.
Dr. Abrahams uses the latest technology to show patients their results so they understand the plan moving forward.
“Referring physicians know about our group, our reputation and the physicians we have,” says John M. Abrahams, MD, President of BSSNY and Chief of Neurosurgery at Northern Westchester Hospital. “Because our physicians have such a wide range of expertise, essentially any neurosurgical or spine condition can be handled by at least one member of the group. We not only have a clinical-minded practice that can handle the full spectrum of neurosurgical issues, but we can now provide this excellent care in facilities that are close to patients’ homes.”
Each year, BSSNY sees nearly 5,000 patients and performs approximately 2,200 procedures — nearly double the volume the group saw just a few years ago, says Dr. Abrahams, who is also Co-director of the spine section of the Orthopedic Spine Institute, President of the Westchester Neuroscience Research Foundation and Associate Professor of Neurological Surgery at New York Medical College.
“I attribute the growth we’ve seen to the longevity of our team,” he says. “Most of the people in the practice have been here a long time. They not only have established solid reputations and referral patterns, but they have also made us the predominant neurosurgical group through all the procedures they’ve mastered.”
The scope of those procedures ranges from the common to the complex. Among the more common procedures BSSNY surgeons perform is anterior cervical decompression for patients suffering from severe neck and arm pain resulting from a herniated disc that is in direct contact with a nerve. Physical therapy is the first line of treatment, but for patients for whom therapy is unsuccessful, anterior cervical decompression yields significant, immediate pain relief.
Surgeons create a small incision in the neck, remove the herniated disc, and replace the disc with either a fusion device or replacement disc. Patients may return home the same day and promptly resume normal activities, Dr. Abrahams notes. That not only enhances the patient experience after surgery but also encourages patients to seek the care they need in the first place, he adds.
“The fear of spine surgery is lessened when patients find out it’s an ambulatory procedure,” he explains. “In fact, a good portion of the procedures we perform allow patients to go home the same day. In the past, any discussion of a patient having a bone fusion procedure had a negative connotation, so referring physicians were reluctant to offer this as a solution. Now, because of the evolution of techniques such as disc replacement, lateral fusion and anterior fusion, patients and referring physicians feel more comfortable with the procedures and realize the outcome will be better.”
Lumbar spine model with fusion device to show patients prior to surgery
BSSNY’s specialists also perform extremely complicated procedures. For example, at their Northern Westchester Hospital location, they are capable of treating complex brain tumors minimally invasively with the Gamma Knife. The Gamma Knife uses collimated beams of ionizing radiation to treat tumors with tremendous precision, sparing normal tissue. According to the International RadioSurgery Association (IRSA), the device has been supported by more than 2,500 peer-reviewed articles.
“The Gamma Knife is a very complex device that allows us to treat tumors without surgery, and thanks to its minimally invasive nature, patients are frequently able to go home the same day,” Dr. Abrahams says. “In the Hudson Valley, we are one of the few organizations that have this device.”
The Gamma Knife offers a myriad of advantages. Some of the most notable, as outlined by IRSA, are:
- Precision — The accuracy of the device ensures patients can receive a high dose of radiation with minimum risk to nearby tissue.
- Reduced expense — The procedure often costs 25 to 30 percent less than traditional neurosurgery.
- Protection from infection — Lack of incisions eliminates the risk of infection or hemorrhage.
- Broader application — The Gamma Knife allows treatment of lesions that were formerly considered inoperable and of patients who previously could not be treated or faced very high risk from open skull surgery.
- Rapid recovery — Gamma Knife procedures generally are performed on an outpatient basis or with only an overnight hospital stay. In either case, patients typically may resume normal activities immediately.
An Emphasis on Technology
Use of the Gamma Knife is one way BSSNY demonstrates the priority it places on incorporating technology to enhance patient outcomes. However, the practice also utilizes a range of other advanced technologies and techniques for precision treatment of an array of brain and spinal conditions.
The entire team reviews a patient’s MRI to develop the most effective treatment paradigm.
Dr. Abrahams with his Executive Assistant, Lisa Carretta
The O-arm is an additional example. This device allows surgeons to acquire a real-time scan of the patient’s spine during fusion surgery. The high-quality 2-D and 3-D images help the surgeon navigate during an operation — resulting in improved accuracy and radically reduced complication rates, Dr. Abrahams notes.
The O-arm provides significant advantages over conventional X-ray methods traditionally used during posterior fusion procedures. The patient undergoes a CT scan. Pedicle screws and rods are then placed, and another CT scan is performed after the procedure to confirm the placement is correct.
“This process does not increase operative times,” Dr. Abrahams says, “and the outcomes are better because there are certainly fewer complications.”
According to a 2014 review in Surgical Neurology International, the mobile O-arm scanner increased the accuracy of instrumentation placement during minimally invasive spine surgery. The review cited one study which noted that of 290 pedicle screws placed using the system, 280 — or 96.6 percent — were in an acceptable position. No vascular or neurological complications were observed, and no revision surgery was required. Another study found O-arm use significantly reduced the time required for pedicle screw placement during scoliosis surgery.
“The O-arm has been one of the most dramatic technological improvements we’ve incorporated over the past few years,” Dr. Abrahams says. “That’s why we’ve integrated it into the process at our Northern Westchester Hospital, White Plains Hospital, Vassar Brothers Medical Center and Westchester Medical Center locations.”
Some of the other advanced techniques BSSNY surgeons utilize include:
Deep brain stimulation (DBS)— DBS uses a surgically implanted, battery-operated neurostimulator to treat a variety of disabling neurological conditions, such as Parkinson’s disease. The neurostimulator delivers electrical stimulation to targeted areas in the brain that control movement. These signals block irregular nerve signals that can trigger Parkinson’s disease symptoms.
Endoscopic surgical techniques — These minimally invasive techniques use thin surgical instruments and video images to perform intricate procedures with little or no trauma. Surgeons can resect or destroy tumors or abnormal tissue and remove that material through tubes.
Sodium fluorescein — This yellow dye, traditionally used in tests involving the eye, has more recently been adapted to help physicians identify tumors in the brain. It is injected into the body but is not absorbed by normal brain tissue. Under a blue light, the tumor — which does absorb the dye — glows the color of a green highlighter, allowing the surgeon to remove more of it without harming normal brain tissue.
Scoliosis surgery — The team has two prominent spine surgeons who specialize in the treatment of scoliosis, both in pediatric patients (younger than 17 years old) and in adults.
A Focus on Research
A further goal of BSSNY’s expansion is to engage in clinical research. In recent months, the practice has taken a number of concrete steps toward achieving that objective. Among them is hiring a full-time research associate, Dr. Abrahams says. Additionally, in order to track patient outcomes against a national cohort, BSSNY has joined the Quality Outcomes Database (QOD), formerly the National Neurosurgery Quality and Outcomes Database.
“This database is supported by the American Association of Neurological Surgeons and is considered the gold standard of data collection for our field,” Dr. Abrahams explains. “We can only get better if we know where we stand.”
“Each of the three practices that are now part of BSSNY had certain specialties that made it a strong presence in the area. We have united all these strengths in one organization, providing excellent, comprehensive care. We cover the whole spectrum of neurosurgical and spine care.”
— John M. Abrahams, MD, President of Brain & Spine Surgeons of New York and Chief of Neurosurgery at Northern Westchester Hospital
In addition, in an effort to increase efficiency and reduce healthcare spending, BSSNY has adopted an outcomes database for its own surgical patients to determine which ones benefit from physical therapy versus a home exercise program. This information is then used to extrapolate to both operative and non-operative patients in order to develop better treatment algorithms for spine patients, according to Dr. Abrahams.
Finally, BSSNY is involved with the genomics program in conjunction with the Department of Pathology at New York Medical College. This allows the practice to support a research project that evaluates brain tumor genomics and helps determine any pertinent receptors that can be used for treatment in the future.
“We have been able to grow the practice by adding research and clinical trials,” Dr. Abrahams says. “That is much easier in a larger group.”
To learn more about Brain & Spine Surgeons of New York or to refer a patient, visit www.bssny.com.