Allegheny General Hospital Pioneers Innovative Spine Imaging Technology
Physicians at Allegheny General Hospital (AGH) are the first in Pennsylvania and among the first in the nation to introduce a groundbreaking new technology that standardizes the imaging process and yields more precise images of the spine in motion.
The Vertebral Motion Analysis (VMA) technology uses fluoroscopy to capture real time images of the spine while the patient is guided through a pre-set range of motion. The technology is ideal for assessing patients with suspected instability of the lower lumbar spine.
The VMA features a patented Motion Normalizer device which provides powered passive trunk bending both while the patient is standing and lying down. Patients grip handle bars during the test and the motion normalizing technology gently moves them through a specified range of motion to capture a true picture of the spine’s ability to flex and bend.
The most widely-used method for measuring spinal instability currently is static end-range bending x-rays. But such x-rays provide limited information about the patient’s spine function and can yield highly variable results.
“If you’re in pain, you bend differently,” said Boyle Cheng, PhD, Director of Research for the Department of Neurosurgery at Allegheny General Hospital. “In the Spine and Biomechanics Laboratory at AGH’s Neurosciences Institute, we have conducted spine studies that demonstrate a difference between healthy and treated spines. You get voluntary bend angles based on how the patient is feeling that day.”
Dr. Cheng says the controlled patient positioning of the VMA system greatly reduces test variability and eliminates differences in tests conducted by different radiologic technologists.
Additionally, the use of fluoroscopy in place of x-rays means that physicians receive video consisting of hundreds of individual still images when a VMA test is performed versus just three still images of flexion, extension and center from the standard x-ray procedure to evaluate the lower spine.
Image recognition software locates the vertebrae on each frame and plots the degree of trunk bending for each level of the spine. A set of biomechanical measurements is overlaid on the video images to provide physicians with expansive data at a glance.
“It gives us more information as a baseline pre-operatively to help physicians determine if patients are good candidates for various surgical procedures,” said Paul Kiproff, MD, Chair, Department of Radiology, West Penn Allegheny Health System. “Post-operatively, we can really see if mobility has improved in conjunction with pain relief.”
The VMA requires about 30 percent less radiation than the current standard of care of end-range x-rays. This level of radiation is well below that associated with other commonly-prescribed diagnostic procedures, Dr. Kiproff said.
VMA testing takes approximately 30 minutes and can assess patients in a weight-bearing or non-weight-bearing posture. Patients who participated in trials of the device at AGH said the VMA delivers an unexpected benefit in addition to capturing images and information about the spine.
“It felt great,” said Patrick Overking, 65, of Bruceton Mills, WV. “I drove to the hospital that day wearing a back brace and it had been just two months since my surgery so I was a little worried. But, it felt good and it kind of loosened me up a bit so that I realized that my surgery was pretty good and I didn’t have to be afraid to do a lot of things anymore.”
AGH was among six facilities in the country to participate in clinical trials of the VMA technology from 2010 until it received approval by the Food and Drug Administration in 2012, according to the hospital’s principal investigators, neurosurgeons Donald Whiting, MD and E. Richard Prostko, MD. Allegheny General is the only hospital in Pennsylvania and currently one of just five facilities nationwide to offer the now commercially available technology to patients.
Helping to bring this new technology from concept to reality is the latest achievement in Allegheny General’s long-standing history of research to improve comprehensive spine care. The Neurosciences Institute at AGH integrates world-renowned experts in the subspecialties of neurology, neurotology, neuroradiology, neuro-critical care, and neurosurgery to offer world class care for patients. Recognized as both a Neurosciences Center of Excellence and a Spine Center of Excellence, the program serves as a national and international referral center for treatment of all types of neurological conditions and conditions impacting the spine.