Bone and Joint Franklin thrives on team approachFeb. 8, 2018, 10:30 AM
Spine surgeon Byron Stephens, MD, works closely with physiatrists who treat patients with nonsurgical options at Vanderbilt Bone and Joint Franklin.
It’s a coordinated approach to care at the clinic at 206 Bedford Way. Stephens works side by side with physiatrists Aaron Yang, MD, and Byron Schneider, MD.
“We’re providing seamless, uninterrupted spine care at Vanderbilt Bone and Joint Franklin,” said Stephens, who recently moved his practice to Williamson County. “We are a comprehensive spine care clinic. What I mean by that is I work alongside our physiatrists and our physical therapists to provide the full spectrum of spine care, starting with conservative care all the way to surgery.”
Yang is board certified in both pain medicine and physical medicine and rehabilitation treatments. He is also board certified in electrodiagnostic medicine, measuring and evaluating nerve conduction to diagnose neuromuscular disorders.
Schneider is board certified in physical medicine and rehabilitation. A specialist in non-operative management of the spine, he did his fellowship in interventional spine at Stanford.
Stephens said many patients are likely to benefit more being treated by Yang and Schneider.
“The truth is the vast majority of people with spine ailments don’t need surgery, and surgery isn’t where we want to start with almost any patient,” Stephens said. “The team approach working right alongside my physiatry and physical therapy partners is a unique advantage that we offer at Vanderbilt Bone and Joint Franklin.”
Although he performs surgeries from the occiput — the bone at the back and base of the skull where the spinal cord begins, to the sacrum where the spinal canal ends — Stephens has specialized training and a clinical interest in movement-preserving cervical surgeries.
“There are certain inherent downsides to spinal fusion,” he said. “Oftentimes, it is necessary, but there can be inevitable consequences following a fusion. Two of the surgeries that I do that are perhaps unique are a cervical disc arthroplasty — a disc replacement surgery in the cervical spine — and cervical laminoplasty.”
Laminoplasty, a procedure that creates more space for the spinal cord and relieves pressure without fusion, was first developed in Japan. Stephens did fellowship training with a physician who was one of the first to pioneer the surgery in the United States.
“An advantage of laminoplasty is that it decompresses the cervical spinal cord and spinal nerve roots without a fusion,” he said. “It allows a patient to have a faster recovery, not have to wear a cervical collar and not have to worry about the downstream effects of cervical fusion. It is a quicker surgery and a shorter hospital stay.”
However, in many cases fusion is the best option. Stephens performed a fusion, a posterior occipital to C5 fusion, in October 2016 on a patient whose breast cancer had metastasized and eaten away her C2 vertebra, leaving her in incapacitating pain. The patient, Sharon Edwards of Fairfield Glade, Tennessee, was able to travel to Rome three months later to sing with her choir at the Vatican.
Vanderbilt Orthopaedics also maintains a registry that scientifically monitors patient outcomes.
“In spine, our outcomes are above national averages,” Stephens said. “I think a lot of that is reflective of our conservative care. We only operate on people who truly need surgery, and we offer alternative options for people who would do better without surgery. The truth of the matter is a lot of spine surgery, especially fusion surgery, is over utilized. We have a real problem throughout the country with overutilization of spinal fusion surgery. Our philosophy is to avoid fusion surgery whenever possible, and we have the outcomes data to support what we are doing.”