Care & Treatment

The neurologists and neurosurgeons of St. Vincent’s Spine and Brain Institute treat a wide variety of neurological ailments. From headaches and back pain to epilepsy and brain tumors--- our physicians care for patients with varying neurological issues.

Neurology

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Angiography

A medical imaging technique used to visualize the inside the arteries of the heart, brain, kidney and other parts of the body. It is usually done by injecting a radio-opaque contrast agent into the blood vessel and taking an X-ray. This procedure is performed in order to see how blood moves through the arteries and to check for any blocked or damaged arteries.

Brain Scans

Brain scans allow physicians and researchers to view activity or problems within the brain without performing invasive procedures. These techniques include magnetic resonance imaging (MRI), computer tomography (CT), positron emission tomography (PET), electroencephalography (EEG), magnetoencephalography (MEG), and near infrared spectroscopy (NIRS).

Cerebrospinal Fluid Analysis

A group of laboratory tests that measure proteins, sugar and other chemicals in the fluid that surrounds and protects the brain. A spinal tap is the most common way to collect this sample. This procedure can help detect certain conditions and diseases.

Computed Tomography

An imaging method that uses X-rays to create cross-sectional pictures of the body. A CT Scan rapidly creates detailed pictures of the body in order to guide a surgeon to the right area during a biopsy, to identify masses and tumors, and to study blood vessels.

Discography

Discography

This procedure is used to determine whether the disc is the source of pain in patients with predominantly axial back or neck pain. During the procedure, a contrast medium is injected into the disc and the patient's response to the injection is noted. A CT Scan is usually performed afterward to assess any changes.

Electroencephalography

EEG testing measures and records the electrical activity of the brain. Special sensors are attached to the head and hooked by wire to a computer, which records the brain's electrical activity. Seizures are detected and seen by changes in the normal pattern of the brain's electrical activity.

Electromyography

EMG testing involves the electrical activity of muscles. It is often performed with another test that measures the conducting function of nerves. EMG may aid with the diagnosis of nerve root injury and other problems of the muscles or nerves.

Evoked Potentials

An evoked potential test measures the electrical signals sent by the brain when nerves are stimulated. These are called evoked responses. The most common types of evoked potential tests are visual, auditory and somatosensory, which refers to the pathway of nerve impulses between the limbs and the brain.

Fluoroscopy

An imaging technique used to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope, or X-ray source.

Lumbar Puncture

Also known as a spinal tap, this procedure is performed in order to collect a sample of cerebrospinal fluid for analysis, and very rarely as a treatment to relieve increased intracranial pressure.

Magnetic Resonance Imaging (MRI)

A noninvasive way to take pictures of the body. This type of imaging does not use radiation, it instead uses powerful magnet and radio waves. An MRI is usually performed with other imaging methods in order to help the physician make a more definitive diagnosis.

Muscle, Brain and Nerve Biopsies

This testing involves the removal of cells or tissues for examination. It is performed in order to determine the presence or extent of a disease. The tissue is generally examined under a microscope to make a diagnosis.

Myelography

A type of radiographic examination that uses a contrast medium to detect pathology of the spinal cord. This procedure often involves injection of the medium into the cervical or lumbar spine followed by several X-ray projections. This exam can help find the cause of pain that could not be found with a MRI or CT scan.

Neurological Examination

This exam is divided into several parts, each focusing on a different part of the nervous system: mental status, cranial nerves, motor system, sensory system, the deep tendon reflexes, coordination and the cerebellum, and gait.

Neuro-Opthalmology

Neuro-ophthalmology is a subspecialty of ophthalmology that deals with the visual pathways from the eye to the visual cortex of the brain. The optic nerves carry the message of vision from the retina to the occipital cortex of the brain as an electrical current. This pathway, if damaged, results in visual loss. Many processes can affect this visual pathway.

If visual loss cannot be explained with a routine eye exam, it is often the job of the neuro-ophthalmologist to determine if there is a problem with the nerves and visual pathway behind the eye and within the brain. This is a challenging specialty and unique within the domain of ophthalmology.

Neuro-ophthalmologists also diagnose and treat the diseases that affect the nerves that control the eye muscles, eyelids and pupil.

Common conditions treated by neuro-ophthalmologists include:

  • Double vision
  • Blepharospasm
  • Eye-movement disorders
  • Eye-related migraines
  • Myasthenia gravis
  • Multiple sclerosis
  • Optic neuritis
  • Papilledema
  • Pseudotumor cerebi
  • Pupil abnormalities
  • Thyroid eye disease
  • Visual system neoplasia and tumors

Positron Emission Tomography (PET)

An imaging test that uses a radioactive substance to look for disease in the body. Unlike a MRI and CT scan, a PET scan shows how organs and tissues are working. The scan is typically performed to check brain function, diagnose cancer, heart problems and brain disorders, to see how far cancer has spread, and to show areas in which there is poor blood flow to the heart. The amount of radiation injected is safe.

Single Photon Emission Computed Tomography (SPECT)

This imaging technique uses gamma rays and is very similar to conventional nuclear medicine planar imaging, however it is able to provide 3D information. The basic technique requires injection of a gamma-emitting radioisotope into the bloodstream of the patient. Occasionally the radioisotope is a simple soluble dissolved ion, such as a radioisotope of gallium(III), which happens to also have chemical properties which allow it to be concentrated in ways of medical interest for disease detection.

Spinal Tap

Also known as a lumbar puncture, this procedure is performed in order to collect a sample of cerebrospinal fluid for analysis, and very rarely as a treatment to relieve increased intracranial pressure.

Ultrasound Imaging

This type of imaging involves the use of high-frequency sound waves to create images of organs and systems within the body.

X-Rays

A form of electromagnetic radiation that sends particles through the body. A computer or special film is used to record the images in order to detect abnormalities.

Neurosurgery

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Anterior Lumbar Interbody Fusion (ALIF)

Anterior Lumbar Interbody Fusion (ALIF)

This procedure is similar to the posterior lumbar interbody fusion except that the disc space is fused by approaching the spine through the abdomen instead of the through the lower back.

A three- to five-inch incision is made on the left side of the abdomen. Some ALIF procedures can even be done using only one very small incision or with a scope that allows the surgery to be done through several one-inch incisions.

To begin, the surgeon uses MRI and CAT scans to determine what size implant(s) the patient needs. Once this is completed, the surgeon must prepare the disc space. The surgeon then carefully removes the lamina to be able to see and access the nerve roots. The surgeon then removes the affected disc and surrounding tissue and prepares bone surfaces of adjacent vertebrae for fusion.

Anterior Cervical Corpectomy

Anterior Cervical Corpectomy

This surgical approach is similar to a discectomy; however, the patient is placed in a position with the head in a slight extension and a larger vertical incision is made in the neck to allow more extensive exposure. A discectomy is performed at either end of the vertebral body to be removed. The area must then be reconstructed with a special fusion technique.

Anterior Cervical Discectomy and Fusion

Anterior Cervical Discectomy and Fusion

This procedure is performed on the upper part of the spine in order to relieve pressure on nerve roots or the spinal cord. Through a small incision on the neck, the intervertebral disc and bone spurs are removed. A bone graft is placed in the disc space and will begin to fuse the vertebrae. Although fusion is done with a bone graft, occasionally metal plates are added for stability and to aid the healing process.

Artificial Cervical Disc Replacement

Artificial Cervical Disc Replacement

An artificial cervical disc is a device inserted between two cervical vertebrae after an intervertebral disc has been removed. The device is put in place to preserve motion at the disc space as an alternative to a bone graft or plates and screws. This procedure is typically done on patients with cervical disc herniations that have not responded to non-surgical treatment. The advantages to this procedure are that the patient can maintain normal neck motion and has a faster recovery time.

Brain Biopsy

This procedure involves the removal of a small piece of brain tissue to find a diagnosis of abnormalities of the brain including Alzheimer's disease, tumors, infections and inflammation. After this invasive procedure, the patient is monitored in a recovery room for several hours and usually required to spend a few days in the hospital.

Carpal Tunnel Release

This surgery is performed to treat carpal tunnel syndrome. The surgeon cuts through the affected ligament to make more space for the nerve and tendons. Easing the pressure on the median nerve. Although this outpatient procedure will help decrease pain, nerve tingling and numbness to restore muscle strength, it does not guarantee you will be completely free of symptoms after recovery.

Cervical Laminaplasty

Cervical Laminaplasty

This procedure is intended to relieve pressure on the spinal cord while maintaining the stabilizing effects of the posterior elements of the vertebrae. The surgeon "hinges" one side of the posterior elements of the spine and cuts the other side to form a "door." The door is opened and held in place with wedges. The goal of the procedure is to stop the progression of damage to the spinal cord and allow for recovery.

Cervical Posterior Foraminotomy

Cervical Posterior Foraminotomy

This surgery widens the opening in your back where the nerve roots leave your spinal column. This takes pressure off of a nerve in your spinal column allowing it to move more easily. An incision is made in the middle of the back of the spine. Disc fragments and other bone may be removed to make room. Spinal fusion may also be necessary. This procedure often provides full or partial relief of symptoms.

Craniotomy

This surgical procedure is performed in many cases, including to repair a fracture, remove a tumor or lesion, remove a blood clot, treat an area of infection, stop bleeding, implant electrodes to monitor seizures or treat an aneurysm.

After surgery, the patient is monitored closely in an intensive care unit. The sutures will be removed in about a week and you will be given intravenous fluids for the first few days. The medical team will also monitor intracranial pressure.

Deep Brain Stimulation

A surgical treatment involving the implantation of a medical device called a brain pacemaker. This pacemaker sends electrical impulses to specific areas of the brain. The procedure has been known to provide remarkable therapeutic benefits for chronic pain, Parkinson's disease, tremors and dystonia. It directly changes brain activity in a controlled manner and its effects are reversible.

Disc Replacement, Lumbar

Disc Replacement, Lumbar

This fairly new treatment option is done for some types of lower back pain and may become the standard treatment. It is similar to other types of joint replacement in that the surgeon removes a damaged joint and replaces it with a metal and plastic implant. This implant is designed to move just like a normal disc. The advantages are that the new disc allows motion at the damaged level and does not transfer stresses to adjacent levels.

Epilepsy Surgery

Surgery for those with epilepsy is an alternative for those with seizures that cannot be controlled by medications. The benefits outweigh the risks, however, there is no guarantee that it will be successful at controlling seizures. This surgery is especially beneficial to those who have seizures associated with structural brain abnormalities, such as benign brain tumors, malformations of blood vessels and strokes.

Interspinous Process Decompression

Interspinous Process Decompression

A minimally invasive procedure where an implant is placed between the spinous processes of the symptomatic disc levels. This procedure was developed for those with Lumbar Spinal Stenosis and who are only able to relieve their symptoms by bending forward or flexing the spine. The implant is designed to limit pathologic extension of the spinal segments and maintain them in a neutral or slightly flexed position allowing patients to resume their normal posture.

Intraoperative Monitoring (IOM) of the Nerves

Intraoperative Monitoring (IOM) of the Nerves

The use of specific methods to monitor the functional integrity of the nerves during complex surgery, especially during manipulation of the spinal cord. This method greatly reduces the risk of surgery-related nerve damage.

Intrathecal Catheter Placement

This catheter creates a pathway for medication flowing from a pump to the drug delivery site in patients with spinal cord injuries.

Kyphoplasty

Kyphoplasty

This minimally invasive spinal procedure is done to treat small fractures in the spinal column due to osteoporosis. It can also help prevent weak vertebra from becoming fractured by strengthening the bones in your spinal column.

The procedure involves the use of balloons and the injection of a fast-hardening glue into the regions that are fractured or weak. Two small incisions are made in the back where the balloons are placed and inflated to widen the areas affected. This method has shown to be safe and effective, and because the glue hardens within 15 minutes, there is little or no healing process. Pain from the procedure is usually gone within two weeks.

Laminectomy

Laminectomy

This surgery removes the lamina, two small bones that protrude from a vertebra, or bone spurs in the back taking pressure off the spinal nerves or spinal column. This procedure opens up the spinal canal so the spinal nerves have more room. Once the procedure is complete, a medical professional has the patient walk around as soon as the anesthesia wears off. Most patients are allowed to go home one to three days after surgery.

Lateral Lumbar Interbody Fusion

Lateral Lumbar Interbody Fusion

This is a relatively new, minimally invasive approach performed on the anterior spine. This procedure avoids an incision that traverses the abdomen and also avoids cutting or disrupting the muscles of the back. In this fusion technique, the disc space is accessed from a very small incision on the patient's side a couple of inches in length, occasionally with another small, one-inch incision just behind the first.

Special retractors are utilized, in addition to a fluoroscopy machine, which provide real-time x-ray images of the spine. In addition, special monitoring equipment is used to determine the proximity of the working instruments to the nerves of the spine. The disc material is removed from the spine and replaced with a bone graft, along with structural support from a cage made of bone, titanium, carbon-fiber or a polymer.

This technique typically allows a shorter hospital stay and may be less painful than traditional approaches to the spine, however it also has limitations. Only those vertebra of the spine that have clear access from the side of the body can be approached using this technique. Also, only one or two levels can usually be accessed via this method.

Lumbar Corpectomy

Lumbar Corpectomy

This procedure is performed to fuse two vertebral bodies together due to a fracture of the lumbar vertebral body, or for significant compression of the dura mater from the vertebral body. The goal is to position a graft in order to eventually join and fuse with the vertebrae above and below it.

Lumbar Disc Microsurgery

Lumbar Disc Microsurgery

There are two types of this procedure, Microcompression and Microdiscectomy. Microdecompression is the removal of bone from the spine and Microdiscectomy is the removal of the disc. Both procedures are a way to perform lower-back surgery through a small incision and take pressure off nerves to reduce symptoms.

Lumbar Interbody Fusion (IBF)

Lumbar Interbody Fusion (IBF)

This procedure is a less invasive way to fuse the spine and is generally used for the treatment of back pain caused by degenerative disc disease. The damaged disc is partially removed to eliminate the inflammatory proteins within the disc. Temporary spacers are inserted into the empty disc space to realign the bones and lift pressure from the pinched nerve roots. They are then replaced by threaded metal cages packed with bone graft, which are then screwed into place.

Lumbar Laminotomy

A surgical procedure used to relieve pressure off the spinal canal for the exiting nerve root and spinal cord. It increases the amount of space available for the neural tissue, releasing the nerve. This procedure is done in order to treat bone spurs, pinched nerves, spinal stenosis, herniated discs, bulging discs and arthritis of the spine.

Lumbar Pedicle Screw Fixation

Lumbar Pedicle Screw Fixation

This system is used for spinal stabilization and has become fairly common in spine surgery. The screws traverse all three columns of the vertebrae allowing rigid stabilization of the ventral and dorsal aspects of the spine. The fixations do not require intact dorsal elements, so they can be used after a laminectomy or traumatic disruption of laminae.

Micro Discectomy

Micro Discectomy

Before this procedure an X-ray is done in order to assure the surgeon is entering the correct part of the spine. A small incision is made on the back of the neck to remove the effected parts of the disc. For better visualization, an operating microscope is used. The major advantage of this approach for a cervical disc herniation is that a fusion does not need to be performed resulting in shorter healing time. One major disadvantage is that since the disc is not completely removed, re-herniation is possible.

Posterior Cervical Discectomy

Posterior Cervical Discectomy

Performing a cervical discectomy from the back of the neck is often considered for large soft disc herniations that are to the side of the spinal cord. The key advantage to this approach is that there is no need for a spinal fusion after removing the disc. This preserves the normal motion of the cervical spine and could shorten healing time. However, since this approach does not completely remove the disc, there is a chance of it re-herniating in the future.

Posterior Lumbar Interbody Fusion (PLIF)

Posterior Lumbar Interbody Fusion (PLIF)

The PLIF procedure involves three basic steps. First is pre-operative planning and templating where the surgeon uses MRI and CAT scans to determine what size implant(s) the patient needs.

Once this is completed, the surgeon must prepare the disc space and remove the affected disc and surrounding tissue. The surgeon then prepares the bone surface of the adjacent vertebra for fusion. Once the disc space is prepared, a bone graft, allograft, or BMP with a cage (a biomechanical spacer implant) is inserted into the disc space to promote fusion between the vertebrae. The implant may be made of bone, metal, carbon fiber or other material. Additional instrumentation, such as rods or screws, will also be used at this time to further stabilize the spine.

Spinal Cord Stimulator Implant

Spinal Cord Stimulator Implant

This implant is used to exert pulsed electrical signals to the spinal cord to control chronic pain. This is currently the most used treatment of failed back surgery syndrome, complex regional pain syndrome and refractory pain due to ischemia.

Spinal Fusion

Spinal Fusion

This surgical procedure fuses, or permanently places together, vertebrae that cause back pain. It is usually done along with other spinal surgical procedures. Patients normally have to stay in the hospital for three to four days after surgery in order to be monitored and to be kept in the right position to maintain alignment.

TLIF: Transforaminal Lumbar Interbody Fusion

TLIF: Transforaminal Lumbar Interbody Fusion

This type of spinal fusion is a surgical technique to stabilize the spinal vertebra and the disc between the vertebra. This procedure is designed to create solid bone between the adjoining vertebra to eliminate movement between the bones. The overall goal is to reduce pain and nerve irritation.