Two new neurosurgeons/spine surgeons have recently joined Duke in Wake County, expanding access to treatments for patients with peripheral nerve damage, extremity weakness, degenerative disc disease, and adult degenerative scoliosis.
Clifford L. Crutcher II, MD, neurosurgeon and spine surgeon, cares for patients with complex spine conditions, including multilevel degenerative disorders and adult degenerative scoliosis. One of Crutcher’s main areas of expertise is minimally invasive spine surgery, which reflects his conservative approach to surgery.
“I think there are a lot of opportunities at Duke for treatment using aquatics, physical therapy, physiatry, and epidural injections, so I tend to think of surgery as the last resort,” he says. “If surgery is indicated, I try to use minimally invasive techniques to minimize the disruption to the patient's life.”
Crutcher and his team are also working with anesthesiologists to incorporate different modalities of regional anesthesia into a program for enhanced recovery after spine surgery. Duke is one of only a few centers in the area to offer one of the newest techniques—the erector spinae plane block (ESPB). Crutcher explains that ESPB is a preoperative nerve block that can reduce perioperative narcotic utilization by 30% in some patients.
“The more traditional technique is either no local anesthetic, or a surgeon injects a local anesthetic at the end of surgery. This regional anesthesia before surgery provides greater coverage over a larger area and greater pain relief for the patient,” he says.
Brandon W. Smith, MD, neurosurgeon and spine surgeon, specializes in peripheral nerve surgery, including adult and neonatal brachial plexus surgery, nerve transfer surgery, denervation surgery for cervical dystonia, and nerve-related extremity weakness. Fellowship trained in both peripheral nerve and brachial plexus surgery as well as spine surgery, Smith can assess adults and children from a spine or a nerve standpoint.
Patients with weakness in the arms or hands can be referred quickly to Smith and his team in Wake County, where they will be evaluated to determine the source of the weakness. When patients have a weakness from a trauma, tumor, or another disease, Smith explains that they can sometimes be “rewired” with a nerve transfer. The procedure involves taking nerves from muscles that still work and giving them to more important ones based on the individual patient’s needs.
“I have to think really carefully about each specific patient and what they're willing to trade,” Smith explains. “For example, if a patient doesn’t want to take a nerve that goes to the pointer finger and the thumb because they’re a writer or they like to sew, I could take the one that goes to the pinky instead.”
Smith credits a multidisciplinary approach to patient care that differentiates the Duke program from others, combining expertise in neurology, neurosurgery, orthopaedics, and plastic surgery to evaluate and treat patients. “If a referring provider has a patient with any nerve problem, they can just send them to Duke and their patient will get taken care of,” he says.