Disney Dreamer’s Academy invited Dr. St Louis  to mentor and spend time with students who wish to pursue a career in the medical field.  He and his team of medical suppliers allowed the students to interact with instruments used in the operating room, while giving them advice on how to make their dreams a reality.  Click the link to read more.

Check out the Florida MD – December Edition

Frontline Outreach is an excellent organization which provides a profound foundation for young men. The organization allows young men to explore career routes, while promoting higher education through the ministry of Christ.

Dr. St Louis and his surgical team demonstrated top of the line surgical tools, while allowing the young men to operate the machinery in a test run.

They enjoyed experimenting with the same tools Dr. St Louis would use in surgery to remove brain tumors.

They also toured the Neuro Critical Intensive Care Unit and were able to learn how the nurses and doctors care for the patients.

The gentlemen asked many intelligent questions, as many were interested in medicine.

One of the young men stated, ” I thought I want to become a neurosurgeon, now I know that I want to become one!”

Featured Surgeon: Phillip G. St. Louis, M.D., F.A.C.S.

Microdiscectomy and Anular Repair

Lumbar microdiscectomy is the most common surgical procedure performed in the spine with over 750,000 microdiscectomies performed worldwide each year.  Although a relatively straight forward procedure, complications can arise after surgery, such as continued pain, further disc degeneration, or re-herniations.

Educate Yourself:  What does a Herniated Disc look like on MRI?

*Notice the herniated disc rupture putting pressure on the nerve root in the left side image.  Then notice the same area free after the ruptured disc was removed during the discectomy and anular repair.

What can help prevent Re-herniations (additional surgeries)?

It has long been accepted by most surgeons that there is a 10-15% re-herniation rate after a discectomy procedure.  Several studies indicate the number could be as high as 25%, depending upon the surgeon.  This occurs when a slit is created in the anulus to relieve the herniated portion of the disc in the initial operation. That initial hole (anulotomy) in the disc is not repaired or closed.  Patients then resume normal activities with no tissue offering resistance to more nucleus of the disc rupturing out of the anulotomy.  This often results in a re-herniation.  However, in a two-year follow-up study with 254 patients, Anular Repair was shown to help reduce the re-herniation rate by up to 68%.¹

What Costs are Associated with Re-herniations?

In a recent study conducted by surgeons at Johns Hopkins Hospital (Neurosurgery 65:574–578, 2009), the average cost of treatments for patients who required re-operations for recurrent herniations at one year follow up was $39,836.

So, what can physicians do to ensure patients that undergo surgery for a herniated disc don’t have the greater possibility of re-herniation and additional medical costs associated with a re-do surgery?

The answer!
Consider anular repair at the end of the discectomy procedure.  The initial cost of an anular repair is a fraction of the cost of a re-herniation and can be performed during the first discectomy procedure.  Potential better outcomes and more cost effective surgery – adjuster and case managers should require it.

Over 25 surgeons in Florida have utilized the Xclose™ Tissue Repair System (Anulex Technologies, Inc.) to perform the anular repair procedure. Reduced re-herniation rates help to drive down the overall cost of workers’ compensation insurance.

Dr. St. Louis has been utilizing anular repair and has seen the positive results with his patients.  If you have a patient that has pain and is a possible surgical candidate for a discectomy procedure, refer the patient a surgeon who utilizes anular repair.  Think Anular Repair!

For more information go to www.anulex.com, or contact Dr. Phillip St. Louis (contact information below)

Who is Dr. St. Louis?

Dr. St Louis is a Fellow of the American College of Surgeons and is certified in Neurological Surgery by the American Board of Neurological Surgeons. He has been active in the practice of Neurosurgery (Spine and Brain Surgery) in Orlando since 1983 and retains active privileges at Orlando Regional Medical Center and Florida Hospital Orlando, where he currently serves as the Director of the Neuro Critical Care Unit.
Dr. St. Louis completed his internship and neurological surgery residency at the Cleveland Clinic Foundation. During his training, he received the William E. Lower Fellowship prize for the most outstanding thesis presented on a clinical subject.  He obtained special training in pediatric neurosurgery as a fellow at the Hospital for Sick Children in Toronto, Canada.  He received his medical degree from Hahnemann Medical College in Philadelphia.

For more information about Dr. St. Louis’ accomplishments, please visit his website at:  www.ain.md

Phillip G. St. Louis, M.D., F.A.C.S.

Associates in Neurosurgery

532 Virginia Drive

Orlando, FL 32803

Office: (407) 898-8644

Fax:  (407) 898-8646

www.ain.md

John Orlando, Anular Repair Specialist  -   PH (813) 766-2656  –    jorlando@anulex.com

¹Cauthen JC. Chapter 11. Microsurgical Anular Reconstruction (Anuloplasty) Following Lumbar Microdiscectomy: 155-177. In: Spinal Arthroplasty; A New Era in Spine Care, Guyer RD, editor. St. Louis, Missouri; Quality medical Publishing, 2005

ORLANDO – OCTOBER 2010 – Alicia Harper, 76, has always been a strong woman — a leader both at
home and in her community. She worked hard and raised four children in the Dominican Republic, Puerto
Rico, Mexico and eventually the United States, and made sure they each received a college education. She’s
devoted to her church, her community and her husband of 56 years.

But all that was almost taken away from her, when starting at age 69, symptoms including difficulty
walking, incontinence and dementia, gradually robbed her of her mind and body over the
next six years.

“My wife was always fiercely independent and resourceful. So when she became completely
withdrawn and didn’t even recognize her surroundings, it made no sense to me,” said Nildo, 80, her husband.
“She couldn’t even recognize her own bedroom and we’ve been living in the same house for 25 years. It was
heartbreaking. She’s the love of my life and I saw a little piece of her go every day.”

Family members would visit Alicia and say that although she was physically present, she was
mentally and emotionally distant and unresponsive to what was going on around her.
“The last few years before I received treatment were just a blur for me. I feel like I lost years of my
life during that time,” said Alicia, who retired from secretarial work about 15 years ago.

Unbeknownst to Alicia, Nildo and various doctors over the course of six years, she was suffering from
a little-known neurological condition called normal pressure hydrocephalus (NPH), an excess build-up of fluid
in the brain that causes symptoms similar to Alzheimer’s and Parkinson’s disease. Experts say as many as 5
percent, or 375,000, of those diagnosed with Alzheimer’s, Parkinson’s or some other form of dementia may
actually have NPH and not even know it.

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Early diagnosis of NPH is key because the condition is treatable and potentially reversible. It was for
Alicia, though for several years her symptoms were attributed to advancing age, Type 2 diabetes and possible
Alzheimer’s disease.

It wasn’t until 2009 that tests revealed Alicia had NPH and could benefit from treatment with a shunt,
a thin device placed underneath the scalp to drain excess fluid from the brain and redirect it to the abdomen
where it is reabsorbed into the body.

Today, Alicia is back to going to church, traveling and doting on her eight grandchildren. She’s no
longer in a wheelchair, her mind is once again sharp and her incontinence has improved.

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The three primary symptoms of NPH are: a magnetic gait or walking like one’s feet feel glued to the
floor, memory loss or unclear thinking, and urinary urgency or incontinence.

For Alicia, the first symptom to develop was incontinence, which was relieved temporarily by
medication, but soon returned. Next her family noticed that Alicia was becoming increasingly confused and
disoriented, something that was attributed to just being a part of the aging process. Then several months later,
Alicia went from walking normally to walking like her feet were stuck to the floor. She had to use a walker
and eventually a wheelchair.

In 2008, while getting her Type 2 diabetes checked, Alicia’s doctor noticed how sluggish and
unresponsive she had become since her last appointment three months earlier and urged Nildo to bring Alicia
to a neurologist, who prescribed an Alzheimer’s medication. When the medication did not seem to help, Alicia
was referred to Orlando neurosurgeon Phillip G. St. Louis, MD, director of the Normal Pressure
Hydrocephalus Program at Florida Hospital Neuroscience Institute.

Dr. St. Louis and the multidisciplinary team of experts with Florida Hospital’s NPH Program
suspected NPH immediately and began the unique testing process offered through the comprehensive program.
After the team completed the initial evaluation and the temporary shunt had been implanted for 48-72 hours,
Alicia’s improved symptoms indicted she would benefit from a permanent shunt.

“She had all the classic symptoms, but because NPH is not a well-known condition, patients and their
families often struggle to get a diagnosis,” said Dr. St. Louis. “Fortunately, in Alicia’s case we were able to
treat it in time so we could reverse the symptoms.”

In 2009, Alicia had a programmable shunt implanted to treat her NPH. The procedure takes less than
one hour.1 Sometimes after implantation, the shunt needs to be adjusted because removing too much or too
little fluid can be problematic. The newer programmable shunts allow doctors to painlessly adjust the shunt in
seconds using a magnetic device held up to the head and over the shunt. For other shunts, changing the flow
of fluid requires further surgery.

“In less than two weeks I could walk and think clearly again,” said Alicia. “It feels so good to
reconnect with my family. Every day, I feel like I am reclaiming pieces of who I was before the NPH
was treated. All I have is gratitude—for my doctors, husband and family who all helped me get to where I
am today.”

Last December was a momentous month for the Harper family. Alicia, Nildo, their four children and
eight grandchildren traveled from near and far to celebrate Nildo’s 80th birthday and Alicia’s recent recovery,
marking the first time in years that the whole family has been able to come together and enjoy a family
vacation. At home, Alicia is reading, playing cards and enjoying her new Apple iPad™. She and Nildo are
also traveling again. This year they spent time visiting family and friends in both Mexico and Tennessee—
their first trips in years.

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“Her improvement has been dramatic, and every day things just keep getting better,” said Nildo.
“When I look at Alicia now, I can see her again for who she really is —my wife, a strong woman and the glue
that holds our family together. She’s even telling me what to do again!”
For more information about NPH, visit www.lifenph.com.

Individuals should discuss their health situation with their health care provider to determine if the
possible benefits of surgery for NPH outweigh the risks.
About Codman & Shurtleff, Inc.

This public and health professional education effort is supported in part by Codman & Shurtleff, Inc., a
company that develops and markets a wide range of diagnostic and therapeutic products for the treatment of
central nervous system disorders including NPH.