A Team Approach

UConn Health’s new Brain and Spine Institute offers comprehensive, world-class patient care

April 12, 2021
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Article By Carol Latter

Health issues involving the head or back – anything from headaches, blurry vision, and dizziness to back pain or gait problems – can be not only concerning but alarming, depending on how suddenly or unexpectedly the symptoms occur.

And when the root cause is unknown, patients often don’t know the best person to call for help. This can lead to consultations with multiple providers and specialists – and an extended period of discomfort and worry – before they receive a diagnosis and treatment.

Now, with the launch of its Brain and Spine Institute, UConn Health has made it easier for patients with symptoms like these to get the advice and treatment they need.

Located at UConn’s Outpatient Pavilion in Farmington, the institute formally brings together more than two dozen world-renowned experts in the fields of neurology, neurosurgery, neuroradiology, nonoperative spine care, spine surgery, and more, to offer patients comprehensive, personalized care.

Dr. Hilary Onyiuke, who founded UConn’s Comprehensive Spine Center in 2005, says the newly minted institute is committed to providing prompt, state-of-the-art clinical care for all disorders involving the brain and spine.

“The central nervous system includes the brain and the spine, and there’s a lot of cross-linkage between the two,” he says. “By providing individualized care to our patients through our unique multidisciplinary approach, we not only optimize patient outcomes but continue to shape the future treatment of brain and spine disorders.”

Dr. Onyiuke notes there is a wide variety of medical conditions involving the brain, the spine, or both. These include degenerative arthritis (one of the most common), traumatic injuries suffered in accidents, benign or cancerous tumors, vascular malformations (abnormal blood vessel development), and congenital, degenerative, or acquired deformities.

Dr. L. John Greenfield, Jr., a neurologist who chairs the Department of Neurology, says symptoms often dictate where a patient ends up being seen first. “But our goal as an institute is to simplify the process.”

Dr. Onyiuke adds, “If a patient has a central nervous system problem, all they have to do is make one call to the Brain and Spine Institute at UConn Health, and we’ll be able to triage them in a very effective way, to actually get them an answer to whatever question they have regarding their medical issues.”

Collaborative care

The Brain and Spine Institute was launched in October 2020, as a way of formalizing a cooperative, consultative approach that already existed informally among providers. The goal was to provide the most seamless and effective care for patients, according to Dr. Isaac L. Moss.

Dr. Moss is a fellowship trained orthopedic spine surgeon, chair of the Department of Orthopedic Surgery, director of the UConn Spine Surgery Fellowship, and co-director of the Comprehensive Spine Center, which has now become part of the Brain and Spine Institute. He says he has worked closely with UConn Health providers who have expertise in the spine and brain for years, including Dr. Greenfield and neuroradiologist and chairman of the Department of Radiology, Dr. Leo J. Wolansky.

“We were already functioning in a very collaborative manner; this is just the way we are, naturally getting opinions from each other,” Dr. Moss notes, adding that providers’ insights about a patient’s condition may be different, based on their various areas of expertise. “And so, when I’m looking at an MRI and there’s something that just doesn’t make sense, I’ll call our neurology friends. There’s no such thing as competition between us.”

Dr. Wolansky agrees, saying in addition to participating in the same conferences several times a month, “we frequently correspond via text and emails, based on the findings that we have, and call each other all the time. It’s a very tight group – I think in many ways because UConn Health is not too huge. It really works to our advantage that we always know who’s involved. We know who to talk to, and so it makes us very nimble. As an institution, our size is a big advantage, since it allows us to integrate very easily with each other. The patient is the winner.”

Dr. Ketan Bulsara, chief of neurosurgery, is among an elite group of dual fellowship trained neurosurgeons in cerebrovascular/skull base microsurgery and endovascular neurosurgery. His clinical practice involves both spinal and cranial work, he says the institute “embodies a lot of what we were already doing but brings it under one umbrella. We gave all of these previously siloed capabilities a common identity.”

Dr. Moss – who often performs surgeries alongside Dr. Onyiuke, allowing patients to benefit from their combined expertise – says the institute offers “a huge advantage for patients because they’re not just getting a consult from one doctor. They’re actually getting a consultation from all of us.”

Dr. Greenfield says in addition to improving patient access and convenience, the new set-up will promote seamless communication between the medical aspects and surgical aspects of patient care.

“Let’s say we’re dealing with a condition called normal pressure hydrocephalus,” says Dr. Greenfield. “Often, it starts out as a radiologic diagnosis because the patient has enlarged ventricles and other signs that suggest this diagnosis, rather than Parkinson’s Disease or whatever else the patient might have been referred for. But it takes a careful evaluation to figure out whether this patient is going to benefit from shunting surgery or not.”

Dealing with the issue from a cohesive, multidisciplinary approach “allows us to take a systematic approach to patient care – create some standardized approaches and standardized referral patterns – so that a patient doesn’t go immediately to neurosurgery, without going through the pathways to find out what is really going on. Maybe a surgery can be avoided, or perhaps we find that surgery is what is really needed.”

State-of-the-art APPROACH

What also makes the care provided at the institute so special are the innovative techniques, equipment, and resources it employs.

For example, when a patient has a brain tumor, Dr. Wolansky says, “one of the concerns is to remove as much of the tumor as you can, without hurting the patient’s ability to function neurologically.” To ensure the surgery is both safe and effective, “it’s very valuable oftentimes to do a functional MRI – an MRI scan where we can actually see the brain thinking.”

He says this makes it possible to identify areas that control certain functions. “Let’s say that the tumor is somewhere near the area of the brain that controls your right hand. Obviously, you don’t want to injure the ability to use the right hand. That’s such a crucial thing for quality of life. So we can do an MRI while the patient is moving their fingers, and we’re able to see exactly what part of the brain is controlling the function of the right hand.”

In the operating room, this personalized “brain map” allows the surgeon to see exactly where he or she can safely cut. “Dr. Bulsara will often rave about how rapidly and how accurately we’re able to do that,” Dr. Wolansky says.

Dr. Bulsara says the institute also has “an amazing collaboration” with Jackson Laboratories, a genomic medicine facility located on the same campus.

“Many times, patients with a tumor or other invasive growth are offered traditional treatments. But because we have Jackson Labs on our site, we can send the tissue to them immediately. They’re able to sequence the DNA, and then tell us what the appropriate treatments are for that specific tumor. Usually, this whole process takes about a week to 10 days, max, so you can see exactly what you’re dealing with and how to treat it in the best way possible. This is truly the Holy Grail of precision medicine.”

Using this information, Dr. Kevin Becker, the director of Medical Neuro-Oncology, has been able to devise effective personalized treatments for patients with brain and spine tumors.

Dr. Moss notes that UConn has also built a minimally invasive surgery program that makes it possible to perform spine surgery with less collateral tissue damage. “The spine is in the center of our body and, as a result, is surrounded by vital structures, including muscles that are important for our everyday function. Some traditional approaches in spine surgery can lead to unwanted consequences,” he says.

“Now, with a variety of technology and techniques, we can access the spine with smaller incisions, allowing us to achieve the same results, in terms of relief of neurologic compression and pain, while minimizing the damage to the surrounding structures.”

This is achieved through specialized training and the use of state-of-the-art technology, including surgical robots, operative microscopes, and specialized tissue retractors.

“Minimally invasive surgery was once used only to address minor problems, but now, I can address both straightforward and complex issues, including conditions like scoliosis, a major curvature of the spine. We can realign and stabilize the patient’s spine through a series of small incisions, which has many advantages, including a faster recovery and reduction in complications such as infections,” says Dr. Moss.

Dr. Bulsara notes that UConn Health is the first in New England to use a Mazor robot for spine surgery. “We were also the first in the country to have the augmented reality microscope. We were one of the first in the country to integrate this with novel ultrasound capabilities. And all of these are state-of-the-art treatment options that we have committed ourselves to making sure that we get, because it translates into improved patient outcomes.”

Dr. Moss says another huge advance that has improved care for UConn Health patients is motion-sparing technology. In the past, if a patient’s spine was not functioning properly because of a herniated disc in the neck, for example, surgeons would perform a fusion, which would stabilize the disc but limit range of motion.

“Now, we are able to offer some patients disc replacements,” he says. “These are mechanical devices that, just like artificial hip or knee joints, restore motion to the affected region.” While not all patients are candidates, “these technologies can accomplish the goals of surgery while preserving near-normal range of motion. That’s a big deal.”

These advances not only promote better long-term patient outcomes but reduce the amount of time spent in the hospital, allowing patients to recover at home. “And it turns out that they’re happier and safer there,” Dr. Moss says.

Dr. Greenfield says newer medicines in neurologic subspecialties “have really changed the game in a variety of ways. For instance, when I was finishing my neurology residency training in the early 1990s, there were exactly zero drugs for multiple sclerosis. And so we could make the diagnosis very easily, but in terms of medicine that could affect the disease, we had zip.”

Since then, he says, “there’s been an entire revolution in how we care for these patients, initially with the interferons, and then in the last five to 10 years, there have been these immunosuppressive antibodies that are very targeted at specific cell populations. They have dramatically reduced the relapse rate and really modified the disease course.”

The Brain and Spine Institute also has a multiple sclerosis program headed by Dr. Jaime Imitola – an MS expert who not only manages all of the patients but also is conducting research involving stem cell biology from these patients and has access through its infusion center to state-of-the-art treatments.

“Dr. Imitola also runs a multidisciplinary clinic, with social work and physical therapy, and a variety of other resources that patients need in order to cope with their illness,” Dr. Greenfield explains.

Word is spreading

He says that while UConn Health may not be a huge healthcare system, “we have a disproportionate amount of expertise for our size.”

As Dr. Bulsara points out, “Only 2% of hospitals in the United States have neurosurgery residencies. The University of Connecticut/UConn Health is home to one of only two such training programs in the state. So we’re among an elite group that has a neurosurgery residency program. We also have residents in neurology and orthopedics. We have fellowships. And so we have a lot of learners at the medical school, residency, and fellowship levels. And in each of these structures, the learning initiative is headed by world-class physicians who have a long track record and tremendous experience – and who not only assume the care of any patient who comes into the Brain and Spine Institute but, through the trainees, shape the future of our specialties.”

Word of that expertise has spread far and wide, with patients from across the state, from other states, and from other countries seeking consultations or care, and physicians from other healthcare institutions regularly referring patients to UConn Health.

Says Dr. Bulsara, “Through the multidisciplinary operations that we have within the Brain and Spine Institute, we have a tremendous amount of experience and a tremendous track record in terms of improving care for patients. We take pride in the fact we offer state-of-the-art care in terms of brain and spine pathologies. We believe that no one does it better. And we would be grateful for the opportunity to earn the trust of patients who would like to be treated here. It would also be great to partner with physicians – locally, regionally and nationally – as we pave the way for better treatments for brain and spine pathology.”

He adds, “The status quo for the treatment of brain and spine disorders in the world still needs further improvement. We want to lead the charge in changing that, through a brain and spine institute that has many, many talented people, in multiple specialties, at a world-class academic medical center.”

Photography courtesy of UConn Health

Carol Latter is the editor of Seasons magazines and lives in Simsbury.

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