Dr. Tharin is a fellowship-trained Spinal Neurosurgeon with particular interests in cervical spondylotic myelopathy, spondylolisthesis, degenerative deformity, and tailored approaches to the treatment of spine tumors. She offers cutting edge and minimally invasive technologies including XLIF, percutaneous spinal instrumentation, and intraoperative image-guidance. She considers it her tremendous privilege to care for veterans.
Multidisciplinary Spine Care at the VA Palo Alto Health Care System
At the VA Palo Alto, we offer the full spectrum of Spine Care services including Physiatry, Pain Management, Physical Therapy, Neurology, Neuroradiology, and Spine Surgery. Dr. Tharin has recently brought these together under one roof in the Multidisciplinary Spine Clinic, where patients may receive consultations from Physiatry, Pain management, Physical Therapy, and Spinal Neurosurgery all in the course of one visit, eliminating the extra wait and travel that can be associated with multiple referrals. We treat spinal disease, deformity, and trauma in every part of the spine.
Dr. Tharin also offers veterans, at Stanford, cyberknife treatment of tumors of the brain and spine, either in conjunction with surgical treatment or as an alternative, depending on the best treatment option for the individual patient.
MR Guided High Intensity Focused Ultrasound for Lumbar Back Pain
The primary purpose of this protocol is to assess the ExAblate 2100 MR guided high intensity focused ultrasound device as an intervention for treatment of facetogenic lower back pain
This study is currently recruiting participants.
This is a single group, single arm, open/nonblinded, non-randomized study. The primary outcomes are safety and preliminary efficacy. The InSightec ExAblate 2100 MRgHIFU system is a non-invasive thermal ablation device fully integrated with an MR imaging system and used for the ablation of soft tissue and bone.The study will reach primary completion 12 months from the time the study opens to accrual.
|Ages Eligible for Study:||21 Years and older|
|Genders Eligible for Study:||Both|
|Accepts Healthy Volunteers:||No|
- Men and women > 21 years of age and who are skeletally mature
- Body mass index ≤ 30 kg/m2
- Patients who are able to understand and willing to sign a written informed consent document and able to attend all study visits
- Patients with at least 6 months of chronic lower back pain (LBP) localized to the midline or axial low back, with symptoms attributed to the facet joints on physical examination that have persisted despite conservative therapy. Conservative therapy is defined as systemic pain medications and anti-inflammatory medications, as well as physical therapy, such as massage, heating, hydrotherapy, and strengthening exercises.
- Patients with Numerical Rating Scale worst lumbar back pain score of at least 4 out of 10 over the 24 hours preceding the time of rating.
- Patients must have chronic LBP attributed to facet joints as demonstrated by MRI consistent with at least grade 2 facet joint arthritis, with corresponding abnormal activity at the facet joint on 18F-sodium fluoride PET-CT.
- Patients must have an analgesic response to either prior local anesthetic injection to the facet joint or to radiofrequency ablation of the facet joint, with relapse of pain.
- The targeted facet joint must be deeper than 10 mm from the skin
- Patients with severe lumbar lordosis
- Patients with contraindication for MR imaging such as implanted metallic devices that are not MRI-safe, size limitations, claustrophobia. etc
- Patients with known intolerance or allergy to MR contrast agent (gadolinium chelates) including advanced kidney disease (GFR <30 mL/min/1.73 m2) or on dialysis
- Pregnant and nursing patients will be excluded from the study because of a contraindication to administering MRI contrast agents to these patients
- Patients with known intolerance or allergy to medications used for sedation (midazolam), analgesia (fentanyl), and local and regional anesthesia (lidocaine, bupivacaine, and ropivacaine)
- Patients with evidence of lumbosacral radiculopathy on MRI or physical exam findings, including radicular leg pain, or any neurologic deficit at or below the segmental level of the highest facet to be treated, including subjects with impaired sphincter control
Patients with pain at another location that
- cannot be distinguished from lumbar back pain
- does not rate at least 2 points less in worst pain score compared to lumbar back pain
- requires the use of analgesics
- Patients with gross spinal instability on imaging
- Patients who have lumbar spinal stabilization hardware in place
- NOT visible by non-contrast MRI, OR
- NOT accessible to ExAblate device
- Individuals who are not able or willing to tolerate the required prolonged stationary position during treatment (can be up to 5 hrs of total table time)
- Patients with acute medical condition (e.g. pneumonia, sepsis) that is expected to hinder them from completing this study
Patients with unstable cardiac status including:
- Unstable angina pectoris on medication
- Patients with documented myocardial infarction within six months of protocol entry
- Congestive heart failure requiring medication (other than diuretic)
- Patients on anti-arrhythmic drugs
- Patients with severe hypertension (diastolic BP > 100 on medication)
- Patients with severe hematologic, neurologic, or other uncontrolled disease (e.g. platelets < 50,000/microL, INR > 1.5)
- Patients who are taking anti-thrombotic medication
- Severe cerebrovascular disease (multiple CVAs or CVA within 6 months)
- Patients with inflammatory arthritides.
- Patients unable to communicate with the investigator and staff
- Patients seeking compensation for disability or work injury.
- Patients who are part of another trial testing other Investigational Agent
Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.
Please refer to this study by its ClinicalTrials.gov identifier: NCT02291978
|Contact: Kara Richardsonfirstname.lastname@example.org|
For Spine surgery referrals, have your referring (usually Primary Care) provider place a Neurosurgery Consult to the VA Palo Alto Health Care system. Please help them to ensure that your imaging studies, including any from non-VA facilities, have been uploaded into the system. Patients and Providers interested in referrals to Multidisciplinary Spine Clinic should note this in the consult request and can contact Hansni Prasad, Program Assistant in Neurosurgery at (650) 493-5000 x65709 or Jan Elliott, Nurse Practitioner in Anesthesia Pain Management at (650) 493-5000 x65519 for further information.
NEW POSITION--VA Palo Alto and Stanford University Combined Neurosurgery Orthopedic Spine Fellowship
VA Palo Alto and Stanford University Combined Neurosurgery Orthopedic Spine Fellowship
Number of Positions: 1
Suzanne Tharin, Ph.D, MD, Fellowship Director
Serena S. Hu, MD
Ivan Cheng, MD
Veterans Administration Health Care System
Department of Neurosurgery
3801 Miranda Avenue, MC 112
Palo Alto, CA 94304
Phone: (650) 852-3450; Fax: (650) 849-1265
Attention: Hansni Prasad
Scope of Work:
Percent of Fellowship devoted to Operative Care: 50%
Non-Operative Care: 10%
Research/Publication obligation: 40%
Approximate percentage of exposure to the Spine by region:
Approximate percentage of Fellowship exposure to the Spine by diagnostic category:
This is a one year fellowship at Veterans Administration Palo Alto Health Care System and Stanford University Medical Center open to both Orthopedic and Neurosurgery applicants. The fellow will obtain a comprehensive experience in adult spinal problems with emphasis on diagnostic techniques as well as surgical and non-surgical treatment. Optional experience in stereotactic radiosurgery to spine tumors is also available. Research is required for completion; there are opportunities for clinical and basic science research.
Upon completion the fellow will be experienced in the multidisciplinary and surgical treatment approach to spinal problems. Fellows will be trained in anterior approaches to the spine and minimally-invasive techniques, as well as traditional methods of fusion.
The fellow will be involved in teaching residents. An unrestricted California medical licensure is required.