History of Buffalo Spine and Sports Medicine
The genesis of Buffalo Spine and Sports Medicine began with the founders, Dr. Frederick B. McAdam and Dr. Michael C. Geraci, who had a common interest in treating low back pain and other musculoskeletal disorders while they were still residents in Physical Medicine and Rehabilitation at the University at Buffalo School of Medicine in 1986. During residency, they developed a musculoskeletal clinic at the Veterans Administration Medical Center in Buffalo. They both stayed on as attendings in the department of Rehabilitation Medicine at the Erie County Medical Center where they also created an outpatient musculoskeletal clinic. After a year of mostly inpatient work, they wanted to devote themselves full time to outpatient musculoskeletal medicine. So in 1989, they established the first outpatient physiatric practice in Buffalo, with their first office on Wehrle Drive near Harlem Road.
Conservative or nonoperative spine care was beginning to establish itself as a preferred approach in the late 1980s, particularly catalyzed by the landmark article in 1989 by the Saal brothers entitled "Nonoperative Treatment of Herniated Lumbar Intervertebral Disc with Radiculopathy: An Outcome Study". Our practice embraced the principles of spine stabilization exercises and education in the treatment of our patients with low back disorders. These principles have continued to be the cornerstone of our treatment methods up to this day. In 1989, steps were also taken to deepen our understanding of the biomechanics that are often at the root of the tissue "failure" in patients with low back pain whether the pain generators were disc, facet joint, sacroiliac joint, or other tissue. The partners worked intensively with Philip Greenman, D.O., at the College of Osteopathic Medicine at Michigan State University to develop skills in osteopathic manual medicine to treat various musculoskeletal problems. In fact, it took only a couple of years for the clinicians to master the techniques enough to join the faculty at Michigan State University, where they taught continuing medical education courses for a number of years.
The next revolution in spine care for the practice took place in 1990-91 when we worked with Charles April, M.D., to develop skills and utilizing fluoroscopically guided epidural steroid injections and other spinal injections in the management of back and neck pain. The clinicians introduced the Buffalo area to the merits of fluoroscopic guidance for administering precise placement of medication into the lumbar epidural space and various joints. The paradigm at the time for lumbar epidural steroid injections was a series of 3 blind injections, despite evidence for a missed placement rate upwards of 40% in the literature. The value of well-placed lumbar epidural steroid injections that became apparent was twofold. The need for using surgical methods to alleviate pain was often obviated with the use of epidural steroids. We did a retrospective study of our patients with lumbar disc herniations with radiculopathy in 1993 (and one more time subsequently) and had a surgical rate of slightly less than 10% when the national average was 15-20%. Secondly, lumbar epidural steroid injections and other spinal injections usually afforded patients better pain control which allowed them to participate more actively and hence more successfully in their rehabilitation program. Other influences on our practice came from Vladimir Janda, a Czech physiatrist who taught us about muscle imbalances, and Stuart McGill, a Canadian professor of spine biomechanics, who taught us about the rational use of spine stabilization exercises.
In 1991, our practice became officially known as Buffalo Spine and Sports Medicine. As our clinical experience and expertise grew, so did the realization that nonoperative spine specialists were not being trained by our medical education system. Therefore, we started a fellowship program in Spine, Sports and Occupational Medicine in 1992, which was one of the few programs in the country at the time. Since 1992, we have trained 27 fellows who have gone on to practice musculoskeletal physiatry all around the country. Some of these former fellows have continued to enrich our clinical offerings: We expanded our clinical services in house to include physical therapy in 2000 under the leadership of Walter Brown, PT. Since then, our physical therapy department has grown in depth and breadth to offer in eclectic approach to biomechanical diagnosis and treatment with various manual therapies and the rational use of therapeutic exercise. Initially physical therapy was carried out just in our Williamsville office, but in recent years we developed physical therapy services in the Southtowns in our Orchard Park office for the geographical convenience of our patients. Needless to say, we have utilized other excellent physical therapists in the community when it would better benefit patients.
Over the past 2 decades we have incorporated diagnostic and interventional musculoskeletal ultrasound for diagnosing and managing peripheral joint, tendon and peripheral nerve pathologies. Ultrasound has improved the overall patient experience and allowed us to better target potential pain generators safely and accurately. Furthermore, we incorporated botulinum toxin injections for cervical dystonia, migraine headaches, upper and lower limb spasticity and even hyperhidrosis (excess sweating). We continue to look for new and innovative treatment options for our patient population.
Education of fellows, residents, medical students, physical therapists and physician assistants has been a part of our mission as an institution from the beginning. Besides having clinicians rotate with us in the clinic, we have organized educational activities into the life of our practice with clinical conferences with fellows and physician assistants, lectures for clinicians in the community, and Journal Club for BSSM physicians, physician assistants, physical therapists and physical therapy aides.
Since our inception in 1989, we have sought to build clinical relationships in the community to benefit our patients. We have worked closely with a small group of spinal surgeons with a commitment to understanding what nonoperative care can offer patients in exchange for teaching us reasonable indications for surgical intervention. In the process, we have not only spared many patients from the need of having a spine surgery but also have better prepared those few patients who require surgery for a better surgical outcome. We have also developed solid relationships with a large group of primary care physicians and clinicians, who have entrusted the care of your patients to us. In return, we have offered many of them educational opportunities to learn how to better manage musculoskeletal disorders. In recent years, we have also attempted to promote rational exercise in the community with the help of enlightened personal trainers, who understand biomechanics and spinal loading in particular when helping patients fashion a home exercise program independently.
In the future, we envision developing appropriate, cost effective and clinically effective clinical services to the community with the help of strategic partners such as hospitals, health networks, government, communities, and health insurances.