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Types of Arthrodesis


Arthrodesis pic


A graduate of the University at Buffalo School of Medicine and Biomedical Sciences, Brian Klagges, MD, leverages nearly two decades of medical experience to serve as the director of interventional pain management at Elliot Hospital and an anesthesiologist and pain interventionist at Amoskeag Anesthesia. In addition to his clinical work, Dr. Brian Klagges trains physicians in arthrodesis techniques as a consultant for Vertos Medical and MinSURG.

Arthrodesis of the spine, also known as artificial ankylosis or spinal fusion, addresses joint pain due to injury or degenerative conditions by bonding two affected joints together. This procedure not only stabilizes the affected part of the vertebra but also eliminates the root cause of pain and nerve compression (i.e., bone-on-bone friction).

Although arthrodesis of the spine can be accomplished using traditional open back surgical procedures, there are currently two common minimally invasive options that can be done on an outpatient basis. The first of these, intra-articular arthrodesis, involves exposing the joint prior to fusing it. The other, extra-articular arthrodesis, fuses bone blocks on the outside of the joint. This procedure is commonly used for children or in patients with infections.


Using HydroCision Technology for Surgical Procedures




An experienced physician, Brian Klagges, MD, works at Elliot Hospital in his capacity as director of interventional pain management. Furthermore, Dr. Brian Klagges holds the roles of pain interventionist and anesthesiologist at Amoskeag Anesthesia. Dr. Brian Klagges performs various procedures, including minimally invasive discectomies using technology that the Massachusetts-based company, HydroCision, has developed.

HydroCision technology employs a high-pressure stream of sterile saline and suction to incise and remove tissue. The HydroCision system consists of a power unit with adjustable settings and a single-use handpiece that can be customized for orthopedic and spinal procedures.

The main benefit of the HydroCision system is that it can distinguish between different densities and types of tissue. The device can selectively incise tissue without harming neighboring vital structures and healthy tissue. Moreover, unlike radio frequency or laser technologies, the system cannot cause thermal damage to neighboring tissue. HydroCision’s products have undergone clinical studies to confirm their clinical efficacy.

ASRA Releases New MIPS Fact Sheets

American Society of Regional Anesthesia and Pain Medicinepic

American Society of Regional Anesthesia and Pain Medicine

An award-winning physician, Brian Klagges, MD, is the director of interventional pain management at Elliot Hospital’s Interventional Spine Center and an anesthesiologist and pain interventionist at Amoskeag Anesthesia, both in Manchester, New Hampshire. When he isn’t working, Dr. Brian Klagges maintains membership in professional associations such as the American Society of Regional Anesthesia and Pain Medicine (ASRA).

In December 2017, ASRA released two updated fact sheets for anesthesiologists to reference as they navigate Medicare’s Merit-based Incentive Payment System (MIPS), now in its second full year of implementation. Under the MIPS program, Medicare looks at a provider’s performance in the areas of quality, cost, practice improvement, and advancing care, scoring the clinician and using the results to determine whether a payment adjustment (positive or negative) is warranted.

The two new MIPS fact sheets are aimed at chronic pain management providers as well as clinicians who work in regional anesthesia and acute pain medicine. Further, the sheets provide a look at some of the ways that Medicare measures quality in each of the scoring areas and the most efficient ways to submit data for each of them. To view the newly updated fact sheets, visit

Anatomy of an Intervertebral Disc


Intervertebral Disc pic

Intervertebral Disc

As an anesthesiologist and pain interventionalist at Amoskeag Anesthesia in New Hampshire, Dr. Brian Klagges assesses and treats patients with a variety of pain conditions. Particularly experienced in the use of minimally invasive treatments for the lower back, Dr. Brian Klagges draws on a detailed knowledge of spinal and intervertebral disc anatomy.

Between most pairs of vertebrae in the spine, a structure known as the intervertebral disc provides protection from the shock of everyday impact. It is a fibrocartilagenous structure that includes a strong exterior, known as the annulus fibrosus, and a gel-like interior or nucleus.

Both parts of the intervertebral disc are made of up of collagen, water, and proteoglycans, also called PGs, which are specialized proteins found in extracellular matrices, connective tissues, and cell surfaces. Able to attract and organize water molecules, the PG functions as a key component of the intervertebral disc’s nucleus.

Together with collagen fibers, the PGs and water within the nucleus form a mucoprotein gel. The percentage of water within this gel can change according to the amount of pressure placed on the disc. As a person ages, and there is less moisture available to the disc, the amount of shock that the disc can bear begins to decrease.

The ring-shaped outer layer of the disc deteriorates over time as well. This deterioration can ultimately lead to a rip in the disc’s core, which in turn can cause the material of the nucleus to herniate and press on the nearby nerves.

ASA Study Finds Fentanyl Epidurals Do Not Affect Breastfeeding


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Fentanyl Epidurals

Dedicated physician Dr. Brian Klagges serves as both the director of interventional pain management at Elliot Hospital and an anesthesiologist and pain interventionist with Amoskeag Anesthesia. With an MD from the SUNY Buffalo School of Medicine and Biomedical Sciences, Dr. Brian Klagges belongs to the American Society of Anesthesiologists (ASA), a research, education, and scientific organization for anesthesiologists.

In November 2017, the ASA released a study on the effects of fentanyl on breastfeeding. This study was published in the ASA’s peer-reviewed medical journal, Anesthesiology.

Led by Robert J. McCarthy, a Northwestern University Feinberg School of Medicine research professor, the study involved 345 women who were at least 38 weeks pregnant and planned to breastfeed. These women were randomly assigned to receive an epidural solution of either bupivacaine; bupivacaine and 1 microgram per milliliter of fentanyl, an opioid; or bupivacaine and 2 micrograms per milliliter of fentanyl. The doses that included fentanyl are commonly used during labor.

According to the results, breastfeeding rates at six weeks post-partum were 97 percent of those who received a dose of bupivacaine alone; 98 percent of those who received 1 microgram of fentanyl; and 94 percent of those who received the 2-microgram dose of fentanyl. Based on these results, researchers concluded that breastfeeding was not negatively affected by epidurals containing fentanyl. Further, fentanyl does not appear to have any negative effect on infants’ nervous systems.

A Brief Overview of the Three Types of Knee Arthritis


Knee Arthritis pic

Knee Arthritis

Dr. Brian Klagges studied medicine at the State University of New York at Buffalo. For the past decade, Dr. Brian Klagges has worked as a physician and anesthesiologist at Elliot Hospital in Manchester, New Hampshire. In this role, he performs many procedures, including genicular nerve ablation for patients dealing with severe knee arthritis.

The knees may be impacted by three distinct types of arthritis. Osteoarthritis (OA), the most prevalent form of knee arthritis, is a progressive condition that typically begins in middle age. People dealing with OA must address the issue as soon as possible, as untreated OA will continuously wear away at joint cartilage.

Rheumatoid arthritis (RA), meanwhile, can affect individuals at any age and involves episodes of severe inflammation. RA is an immune system disorder, and its cause is unknown.

The third form is post-traumatic arthritis, which is a direct result of blunt force trauma to the knee. Post-traumatic arthritis is most common following an injury that leads to a torn meniscus, ligament damage, or broken bones. However, knee arthritis does not always occur immediately after an injury; the condition may take years to develop.

What Is a Lumbar Microdiscectomy?


 Lumbar Microdiscectomy pic

Lumbar Microdiscectomy

Over his more than 15-year career working as a physician, Brian Klagges, MD, has focused his practice on anesthesiology, providing pain relief to patients during surgery. As an experienced medical practitioner, Dr. Brian Klagges’ expertise is sought after by a number of medical firms such as Vertos Medical and Mini SURG. He offers his services as a consultant on specialized surgical procedures, such as minimally invasive lumbar decompression.

Decompression surgery is aimed at relieving pain caused by pinched lumbar nerves. The most common cause of this condition is disc herniation or discs that have moved from their initial alignment in the spine, but cysts and cancers can also cause it. In the case of disc herniation, there are a number of procedures that can relieve the pain. Due to advances in surgical technology over the years, there are minimally invasive decompression procedures available.

The lumbar microdiscectomy is among the least invasive, requiring just a 1-to-1 ½-inch incision into the spine. The portion of bone that is pinching the nerve is then removed. Between 90 and 95 percent of patients undergoing this procedure report significant alleviation of pain. Furthermore, due to its minimally invasive nature, this surgery can be performed as an outpatient procedure, allowing patients to return to their normal lives quickly.