Twin Cities Spine Center: Leading Spine Care for Generations

By Conner Armstrong
Tuesday, May 16, 2017

Twin Cities Spine Center provides a lifetime of care for patients, and the practice continues to offer the most advanced spine care available.

(l-r) Benjamin Mueller, MD, PhD, Joseph Perra, MD, Amir Mehbod, MD, Kevin Mullaney, MD, Ensor Transfeldt, MD, Manuel Pinto, MD, James Schwender, MD, Christopher Alcala, MD, Timothy Garvey, MD

As Twin Cities Spine Center approaches its 70th anniversary as a practice, one of its team members recalls how the organization helped her early in life.

“When I was a child, I was diagnosed with scoliosis,” says Lisa Butler, RN, with Twin Cities Spine Center. “Back then, treatment meant wearing a Milwaukee brace, and I wore that from the time I was 11 until I eventually had surgery in 1978, when I was 20. We were just starting to develop scoliosis screening at that time; and treatments were starting to evolve.”

Because Twin Cities Spine Center treats patients of all ages, from pediatrics to geriatrics, Ms. Butler was able to receive care from the same team members who cared for her in childhood well into her adult years. She benefited from the practice’s focus on early research, education, leadership and the values the practice’s founder, John H. Moe, MD, instilled when he established the sub-specialty orthopedic spine practice in 1947. Countless other patients could share similar stories about the positive impact this progressive practice has had on their spine health over the years.

Her experience as a scoliosis patient inspired Ms. Butler’s choice to become a nurse. Her goal was to work for the spine specialty practice that had helped her, and, by doing so, assist other spine patients. After 27 years in her role as a nurse with Twin Cities Spine Center, she can attest that, “The physicians and staff are still striving for excellence with new treatments today.”

Pioneering Techniques and Technology

The work of Dr. Moe and his colleagues contributed to the development of the Scoliosis Research Society, as well as the first modern textbook about spinal deformity. The practice has grown substantially over its 70 years, expanding to include nine surgeons, all of whom are board-certified and fellowship-trained, as well as more than 80 professional and support staff. Continuing Dr. Moe’s legacy, Twin Cities Spine Center houses a full research department and a world-renowned fellowship program that has trained surgeons from across the United States, Puerto Rico and 19 other countries.

Lisa Butler, RN, and Manuel Pinto, MD, have worked together for 27 years.

“Our primary focuses are patient care, education and research, and while patient care must always come first, our emphasis on advancing spine care for the next generation is what sets us apart,” says Timothy A. Garvey, MD, orthopedic surgeon, and President of Twin Cities Spine Center. “Providing a fellowship for new surgeons keeps all of us on the leading edge of our procedures. We embrace the latest advances in the field, and the up-and-coming physicians with whom we work can and do benefit from our dedication to that.”

Recent fellow, Eiman Shafa, MD, who will join the practice in July, agrees with Dr. Garvey.

“A strong fellowship program encourages an environment where all patients receive care based on the highest level of clinical evidence and the most advanced, up-to-date treatment options,” Dr. Shafa says. “The academic setting ensures patients are treated with the highest of ethical standards.”

Lisa Butler, age 12, wearing her Milwaukee brace

Advances in scoliosis care over the years also illustrate Dr. Garvey’s point. The treatment for scoliosis that Ms. Butler underwent in the 1970s included nine months of wearing a cast that covered her torso. Over the years, Twin Cities Spine Center surgeons sought methods that would improve the treatment and recovery experience for scoliosis patients, introducing growing rods and, most recently, utilizing magnet-driven growth rods that help stretch the spine when bracing no longer works. In the 1990s, these surgeons were early adopters of pedicle screws, which allowed them to rigidly attach to the spine so as to stabilize and realign the spine. Minimally invasive spine surgery techniques using screws and rods are now possible as well. With these advances and others, including using smaller surgical equipment and incisions, patients who undergo surgery for issues similar to Ms. Butler’s are typically in the hospital for less than a week, and, frequently, for only three to four days.

“Spine care has changed so much, certainly from when I was a child, but even from when I started as a nurse here in the 1990s,” Ms. Butler says. “The research we do at Twin Cities Spine Center and the communication that takes place with our colleagues throughout the nation have allowed us to consistently deliver very high-quality, leading-edge services and care.”

Building on a Strong Foundation

Research conducted by the first- and second-generation physicians of Twin Cities Spine Center has helped advance the practice to the point that 85 to 90 percent of their pediatric scoliosis patients now do not require surgery.

“When surgery is required, we can now use internal fixation with very small children, even in 2- or 3-year-olds, and those capabilities extend to the elderly, as well,” says Joseph Perra, MD, Program Director of Orthopedic Spine Services at Gillette Children’s Specialty Healthcare and surgeon with Twin Cities Spine Center. “We pride ourselves on being abreast of changes in technology and often get involved on the ground level with their development, because we see needs that we can help fill.”

James Schwender, MD, performs minimally invasive spine surgery.

Among those areas of need are additional care options for patients with spinal conditions other than scoliosis. Twin Cities Spine Center treats spine issues ranging from pinched nerves, bone spurs, herniated discs and fractures to degenerative disc disease, tumors, kyphosis, spondylosis, spondylolisthesis and Scheuermann’s disease. The team’s inclusion of therapies to treat these conditions exemplifies its mission “to be an international leader in spine surgery by providing optimal patient care, publishing research that advances clinical practice, providing a leading U.S. training program and making lasting contributions to the field of spine surgery.”

This means no facet of spine surgery is overlooked. In cases when discectomy or spinal fusion surgery is ultimately performed, Twin Cities Spine Center patients have been found to have less pain as well as better function and mobility than those from other centers in the state, according to outcomes data from Minnesota Community Measures.

“Several of us have different areas of subspecialty and interests in special populations. When a patient with a very specialized need arrives, we can direct that patient to the best person to take care of the problem,” Dr. Perra says. “My mentor, Robert Winter, MD, was one of the top two world experts in congenital scoliosis, so I continue to see a large population of people with congenital scoliosis. We also have a special expertise in skeletal dysplasias, such as achondroplasia, or dwarfism, so we are equipped to handle the special medical challenges people in this group face. Ensor Transfeldt, MD, is an expert in cervical thoracic osteotomies for ankylosing spondylitis and related conditions. This is one of the unique aspects of our group.”

Dr. Shafa chose to do his fellowship at Twin Cities Spine Center for both the variety and leadership that Dr. Perra describes.

“I wanted to be exposed to multiple surgeons, the most challenging spinal pathology and a wide variety of surgical cases,” Dr. Shafa says. “At Twin Cities Spine Center, I could learn from the innovators in minimally invasive spine surgery as well as complex pediatric and adult deformity correction.”

For all the lasting changes Twin Cities Spine Center is making in the field of spine care, the basic philosophy remains the same as that of Dr. Moe: Patient care is at its best when technically skilled providers work with a growing knowledge base of conditions and treatments. The team likes to say it focuses on “decisions, not incisions.”

Ensor Transfeldt, MD, has been with Twin Cities Spine Center for 30 years.

Research Promotes Better Decision-making

Surgeons at Twin Cities Spine Center have participated in a variety of research projects focusing on care plan decision-making. Using this information, the team is better equipped to map out individualized treatment programs and help patients meet their care goals. The following are examples of past and ongoing studies:

  • The question of whether pain, deformity or spinal imbalance motivates patients to seek a spine surgeon, a topic addressed in a recent publication by Timothy A. Garvey, MD
  • An examination of short-term complication rates among patients receiving surgery for low-grade spondylolisthesis, reported upon by Joseph H. Perra, MD
  • The relationship between obesity and post-operative complications among patients with degenerative spondylolisthesis, recently presented by Eiman Shafa, MD, at the North American Spine Society annual meeting
  • The relative benefits of various surgical approaches to fusion of the low back, an effort led by Manuel R. Pinto, MD
  • The question of how best to repair a nonunion after a transforaminal lumbar interbody fusion procedure, answered by Kevin J. Mullaney, MD, and other Twin Cities Spine Center surgeons
  • The relative rates of revision surgery following open versus minimally invasive transforaminal lumbar interbody fusion, being studied by Christopher Alcala-Marquez, MD, and others
  • The comparative effectiveness of nonoperative management of spinal fractures compared to surgery among neurologically intact patients, initially studied by Dr. Garvey; Amir A. Mehbod, MD, completed a 22-year follow-up on some of these patients
  • The clinical factors that should be considered to reduce the risk of complications among patients receiving low back surgery, part of a stratagem developed by Dr. Mehbod and Ensor E. Transfeldt, MD
  • The value of minimally invasive surgery (MIS) to improving patient experiences and shortening hospital stays, by James D. Schwender, MD, a past president of the Society for Minimally Invasive Spine Surgery and leader in the development of new instruments for MIS
  • The validity of EuroQOL-5D (a newer way to measure quality and cost effectiveness) compared to other outcome tools among patients with degenerative disease of the low back, a topic of interest to Benajmin Mueller, MD

For more information about research, call 612-775-6233 or visit

“Providing care is not as simple as looking at an X-ray and saying, ‘We’ll do X or Y,’” Dr. Garvey explains. “Say your patient is an 82-year-old who wouldn’t benefit from a major operation. You need to listen to the person and know what the goals are. If you can provide what is needed with a minor operation, then the decision-making is more important than the sophisticated operation you could technically perform. There are other patients who might not meet the typical profile of people on whom we would perform surgery, those who might be better served by small interventions and getting a scooter, but if they want to travel and walk around several city blocks, we have to spend time making a decision rather than going with a formula. The personalized care we provide for patients with our individualized consideration and collaborative decision-making are just as important as the sophisticated technology we may utilize. Together, they ensure optimal outcomes.”

The idea of “decisions, not incisions” is why “providing optimal care” is the first item in Twin Cities Spine Center’s mission statement. It’s why people will approach team members at health fairs and say their grandmother came to them for spine surgery decades ago. The Twin Cities Spine Center team has provided leading spine care in the region for generations, and at 70 years, that shows no sign of changing.

For more information about Twin Cities Spine Center, visit