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When to Refer to a Spine Provider | The Penn Medicine Spine Center

In this podcast, Patrick Connolly MD shares how and when to refer to a spine specialist at Penn Medicine. He discusses diagnosis that require Neuro and Ortho specialists, how Penn specialists work with primary care physicians and the benefits of referring to the experts at the Penn Medicine Spine Center.
When to Refer to a Spine Provider | The Penn Medicine Spine Center
Patrick Connolly, MD
Dr. Patrick K Connolly, MD is the Neurosurgery Chief at Virtua Memorial Hospital, a partner of Penn Medicine and Clinical Associate of Neurosurgery at Penn Medicine. He attended medical school at the University of Maryland School of Medicine. He completed his residency at Indiana University Hospital and his fellowship at the Hospital of the University of Pennsylvania.


Melanie Cole (Host):  Welcome to this episode From the Experts at Penn Medicine. Today we’re discussing when it’s important to refer to a spine provider at the Penn Medicine Spine Center. Joining me is Dr. Patrick Connolly. He’s the Neurosurgery Chief at Virtua Memorial Hospital, a partner of Penn Medicine and a Clinical Associate of Neurosurgery at Penn Medicine. Dr. Connolly, it’s a pleasure to have you join us today. What are some of the most common conditions that you see at the Penn Medicine Spine Center?

Patrick Connolly, MD (Guest):  As a surgeon I see at the Spine Center is what you would call degenerative spine disease. As we age and all of us and walk on two legs, our spine can develop arthritis in time and the spinal column that is supposed to be protecting the nerves ends up pinching them and causing pain. And that’s most of what patients come and see us for.

Host:  So, tell us about some of the services that you offer for other providers that are looking to the Penn Medicine Spine Center. 

Dr. Connolly:  The Penn Spine Center is a full spectrum service that we’re offering to the community. We are all thing spine. So, we have all different kinds of physicians who – we all work together. We have physical medicine and rehabilitation physicians, we have pain medicine specialists, we have orthopedic spine surgeons and neurosurgeons all working together to provide the best care for the patients in the most timely way.

Host:  Tell us a little bit how advances in radiologic imaging have significantly augmented your diagnostic and therapeutic capabilities for spine disorders.

Dr. Connolly:  MRI has been around and that’s kind of the gold standard for us and that’s been around for about 30 years in clinical use. But the technology keeps getting better in terms of how specific we can be for diagnosing patients. It really is the whole clinical picture though because a lot of times what happens is that you’ll have patients who show up with an MRI and there’s all kinds of bad things and we really have to connect that to what the symptoms and the physical findings that people have to put it all together for them.

 As a surgeon, that’s what I’m looking for. I need symptoms and physical findings and imaging findings that all fit together to explain the patient’s pain syndrome.

Host:  Well then Dr. Connolly, tell us a little bit about how Penn specialists work with the primary care physicians and when you feel it’s important that they refer.

Dr. Connolly:  We want to make sure that the patients and the primary care physicians are getting the things that they need for their patients. Garden variety back pain, most of the time, that gets better on its own with maybe a little bit of like a nonsteroidal anti-inflammatory medication and maybe a little bit of physical therapy. If the patient has tried those two things and they still have symptoms, we would want to see a patient sooner. 

Host:  Dr. Connolly, what symptoms might suggest that there’s something more serious going on?

Dr. Connolly:  Most of the time, episodes of back pain tend to be self-limited and tends to get better in time. But there are a few scenarios that make us think there’s something more serious going on. So, for instance a history of cancer, particularly breast, lung, kidney cancer, sometimes prostate; those patients can develop metastases and they can manifest as back pain in the spine. Other things would be what we would call constitutional symptoms. So, for instance so it you are losing weight and you are not trying, then that concerns us, loss of appetite, night sweats, chills, or fevers along with back pain. That can be also something more serious going on.

If you have a history of immunosuppression so if the patient has a history of HIV or is on active chemotherapy for cancer and they develop back pain; that can be something more serious. Also a history of trauma or neurological deficits. So, for instance, weakness in the leg or presence of bladder or bowel dysfunction, losing control of your urine stream or having abnormality with it; then that can be a sign that there’s something more serious going on. 

Host:  So, then tell us about any innovation. Do you have an clinical trials or technology you’d like to mention? How are you staying in touch with all the innovation coming out today?

Dr. Connolly:  There’s a number of people in our group who are working on doing things less invasively. So, we have Dr. Neil Malhotra is a Neurosurgeon and he’s doing endoscopic disk surgeries so through a tiny incision with scopes that’s a different approach than a traditional open kind of spine surgery. Another thing that we’re using pretty commonly is spinal navigation and what that is is we’ve had brain navigation, sort of a brain GPS for about 20 years in the operating room but there have been some technical limitations for spine. Little by little, we solved a lot of that so we’re brining a lot of the spinal navigation technology into the operating room.

And for us, that’s great because it helps us to confirm the location of any screws or rods that we’re putting in and it’s really confidence inspiring when I can walk out of the operating room and say well, I have a scan, and everything looks great and your loved one should do really well.

Host:  And what can a referring provider expect from your team in so far as communication with the referring physician and your team approach. 

Dr. Connolly:  We try hard to get letters to everybody just to make sure that everybody is in the loop and then in terms of contact time, so if they put an order in for a spine consultation, particularly in-house, those patients will usually hear from our nurse navigator within a day or two. So, we’re calling the patient to kind of get them set up and to navigate them, which is really nice, so the patient is not on the hook for making a bunch of phone calls and they don’t have to worry that they are calling the right number, getting voicemail. We’ve solved a lot of that in terms of ease of access.

Host:  And how do you see this program and the way that your comprehensive approach helps patients and navigates them through their situation? 

Dr. Connolly:  We’ve got a great number of spine attendings that are on the cutting edge of spine technology in terms of surgery and other injection therapies. We’ve got ease of access. Patients are able to call. We have nurse navigator who is helping them navigate a legitimately pretty complex system. We’re trying to make it easy for folks. And then the type of care that they’re getting is really our on the edge in terms of the technological things that we can do. And we also have human touch too. The people that I work with are great people and I’d be happy for them to take care of me or my family. We’re all just very human and very decent people. So, I think that that’s something that patients are – they generally seem to appreciate that when they meet me or one of my partners and they find an actual person talking to them.

Host:  Thank you so much Dr. Connolly for coming on and sharing your expertise with us today. And that concludes this episode From the Experts at Penn Medicine. To refer your patient to Dr. Connolly at the Penn Medicine Spine Center, please visit our website at or you can call 877-937-PENN for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Penn Medicine Podcasts. I’m Melanie Cole.