Our Practice
Kevin R. Teal, MD
Neurosurgeon
Distinctive Features of Immanuel Brain, Spine and Nerve Surgery P.A.
1. Listening to patients and shaping treatment to their needs. 3. Kyphoplasty for Osteoporosis Compression Fractures and some Spinal Column Tumors. During your initial visit you will be seen by our staff who will ask you about your medical history and your symptoms. A focused neurological examination will then be made by your doctor. While many patients want to discuss in great detail the exact event which may have caused their injury, the most important information your health care team needs involves your symptoms (such as where you have pain, weakness, numbness, etc.) and what limitations these symptoms place on your every day activities. Please take the time to write down this information. After reviewing your medical history and diagnostic tests, you will be presented with a number of treatment options. We will inform you of the risks and benefits of each option and will assist you in making the final decision concerning which option is best for you. If you have an emergency after normal office hours, you will be directed to go to the nearest hospital emergency room where you will be evaluated by the emergency room physician. They will be in direct contact with your doctor or the on-call doctor from our office. The Patient's Role You are the only one who can decide which treatment is best for you. It is important that you recognize that you have a responsibility to participate in, and take ownership of, any decisions involving your health care. You will be asked to make the final decision about what is best for you, so ask questions about anything you do not understand. Your family and close friends are an important part of the collaborative process. We encourage you to include them in any education sessions we provide concerning your condition. If you choose to have surgery, we will make every effort to keep family members informed of your progress and to involve them in your recovery process. Deciding which treatment option is best for you involves weighing the risks and benefits associated with each option. If you eventually choose to have surgery, your physical condition and your mental attitude will determine your body's ability to heal. You must approach your surgery with confidence, a positive mental attitude and a thorough understanding of the anticipated outcome. You should have realistic goals — and be willing to work steadily to achieve those goals. Back Pain, neck pain and symptoms caused by a spinal condition are a common problem for many adult Americans. The different parts of the spine are normally well balanced and able to handle the movements, stresses, and strains of the body gracefully. However, when parts of the neck or back are injured or start to wear out, it can be a significant source of pain and discomfort. When describing symptoms to your doctor use adjectives like dull, aching, hot, or throbbing and make sure to include the duration of these symptoms. Below are some common symptoms. To learn more, click on the symptom that you have been experiencing: If any of the following symptoms occur, contact a doctor immediately: These important symptoms could signal nerve damage or other serious medical problems. There are many other conditions that could be causing these problems, but an early and accurate diagnosis is vital for successful treatment. Spinal Anatomy The spinal column is one of the most vital parts of the human body, supporting our trunks and making all of our movements possible. Its anatomy is extremely well designed, and serves many functions, including: All of the elements of the spinal column and vertebrae serve the purpose of protecting the spinal cord, which provides communication to the brain and mobility and sensation in the body through the complex interaction of bones, ligaments and muscle structures of the back and the nerves that surround it. The normal adult spine is balanced over the pelvis, requiring minimal workload on the muscles to maintain an upright posture. Loss of spinal balance can result in strain to the spinal muscles and spinal deformity. When the spine is injured and its function impaired, the consequences may be painful and even disabling. Humans are born with 33 separate vertebrae. By adulthood, we typically have 24 due to the fusion of the vertebrae in the sacrum. When viewed from the front or back, the normal spine is in a straight line, with each vertebra sitting directly on top of the other. Curvature to one side or the other indicates a condition called scoliosis. When viewed from the side, the normal spine has three gradual curves: These curves help the spine to support the load of the head and upper body, and maintain balance in the upright position. Excessive curvature, however, may result in spinal imbalance. The elements of the spine are designed to protect the spinal cord, support the body and facilitate movement. A. Vertebrae B. Intervertebral Disc C. Facet Joint D. Neural Foramen E. Spinal Cord and Nerves The spinal cord is covered by a protective membrane called the dura mater, which forms a watertight sac around the spinal cord and nerves. Inside this sac is spinal fluid, which surrounds the spinal cord. The nerves in each area of the spinal cord are connected to specific parts of the body. Those in the cervical spine, for example, extend to the upper chest and arms; those in the lumbar spine the hips, buttocks and legs. The nerves also carry electrical signals back to the brain, creating sensations. Damage to the nerves, nerve roots or spinal cord may result in symptoms such as pain, tingling, numbness and weakness, both in and around the damaged area and in the extremities. Many muscle groups that move the trunk and the limbs also attach to the spinal column. The muscles that closely surround the bones of the spine are important for maintaining posture and helping the spine to carry the loads created during normal activity, work and play. Strengthening these muscles can be an important part of physical therapy and rehabilitation. All of the elements of the spinal column and vertebrae serve the purpose of protecting the spinal cord, which provides communication to the brain, mobility and sensation in the body through the complex interaction of bones, ligaments and muscle structures of the back and the nerves that surround it. The true spinal cord ends at approximately the L1 level, where it divides into the many different nerve roots that travel to the lower body and legs. This collection of nerve roots is called the cauda equina, which means "horse's tail," and describes the continuation of the nerve roots at the end of the spinal cord. What's causing my back or neck pain? It's a common question, and a visit to your doctor is an important first step to get an answer. You should know that the diagnosis of back, neck, leg or arm pain isn't always easy. The human spine is very complex, so it can be difficult for your doctor to pinpoint the exact cause of low back pain or other symptoms. Below are some common spinal conditions. Learn more by clicking on a diagnosis: Degenerative Disc Disease (DDD) The history of the pain and any activities that may have triggered your symptoms are important factors in diagnosis and treatment. An x-ray is a painless, non-invasive imaging process that utilizes photographic film to absorb electromagnetic radiation transmitted through a material body. These images, also known as radiographs or roentgenograms, are used to diagnose and monitor the treatment of various disorders. Forward and backward bending x-rays may help your doctor assess potential instability. Read More ...
2. Minimally invasive lumbar fusion.
4. Minimally Invasive / Small incision Lumbar Disc (Sciatica) and Cervical Disc (Arm Pain) Surgery.
5. Pain Management Surgery for Chronic Leg or Back Pain.
6. Adequate Counseling on Non-surgical and Surgical Options for Neck/Arm and Back/Leg Pain.
7. Carpal Tunnel release surgery.
8. Counseling on Alternatives to Spinal Fusion.
9. Referral Options for Spinal Injections and Physical Therapy for Neck and Back Pain.
10. Microscope used to perform Brain, Cervical, Thoracic and Lumbar Surgery for safer tumor or disc removal.
11. Image guidance for minimally invasive brain tumor removal.
12. Dr. Teal speaks Spanish.
Your visit to our Office ....
Emergencies
Understanding your responsibilities Symptoms
Regions of the Spine
Spinal Curvature
Elements of the Spine
The vertebrae support the majority of the weight imposed on the spine. The body of each vertebra is attached to a bony ring consisting of several parts. A bony projection on either side of the vertebral body called the pedicle supports the arch that protects the spinal canal. The laminae are the parts of the vertebrae that form the back of the bony arch that surrounds and covers the spinal canal. There is a transverse process on either side of the arch where some of the muscles of the spinal column attach to the vertebrae. The spinous process is the bony portion of the vertebral body that can be felt as a series of bumps in the center of a person's neck and back.
Between the spinal vertebrae are discs, which function as shock absorbers and joints. They are designed to absorb the stresses carried by the spine while allowing the vertebral bodies to move with respect to each other. Each disc consists of a strong outer ring of fibers called the annulus fibrosis, and a soft center called the nucleus pulposus. The outer layer (annulus) helps keep the disc's inner core (nucleus) intact. The annulus is made up of very strong fibers that connect each vertebra together. The nucleus of the disc has a very high water content, which helps maintain its flexibility and shock-absorbing properties.
The facet joints connect the bony arches of each of the vertebral bodies. There are two facet joints between each pair of vertebrae, one on each side. Facet joints connect each vertebra with those directly above and below it, and are designed to allow the vertebral bodies to rotate with respect to each other.
The neural foramen is the opening through which the nerve roots exit the spine and travel to the rest of the body. There are two neural foramen located between each pair of vertebrae, one on each side. The foramen creates a protective passageway for the nerves that carry signals between the spinal cord and the rest of the body.
The spinal cord extends from the base of the brain to the area between the bottom of the first lumbar vertebra and the top of the second lumbar vertebra. The spinal cord ends by diverging into individual nerves that travel out to the lower body and the legs. Because of its appearance, this group of nerves is called the cauda equina - the Latin name for "horse's tail." The nerve groups travel through the spinal canal for a short distance before they exit the neural foramen.
Spinal Muscles
Nervous System
Diagnosis
Diagnostic Exams
There are a variety of diagnostic exams that may be used to determine the cause of your back and/or neck pain, as well as the type of treatment that may be appropriate for you. Your doctor may recommend one or more of the following:
X-ray
CAT/CT Scan
A CAT (computed axial tomography) scan, also known as a CT (computed tomography) scan, is a painless imaging technique that utilizes a computer to produce detailed three-dimensional images of a body from a collation of cross-sectional x-rays taken along an axis. Of all the imaging techniques that are currently available, the CAT scan is best able to produce images of bone and metal devices. Read More ...
MRI
MRI stands for magnetic resonance imaging. It is a non-invasive technique for imaging the spine that involves rotating a magnet around the body and exciting its hydrogen atoms. A scanner is then utilized to detect the energy emitted by the excited atoms. Because the human body is composed primarily of water, which is two parts hydrogen, an MRI provides exceptional detail of the spine's anatomy and is the single most useful test available for diagnosing spinal disorders. Read More ...
Myelogram
A myelogram involves injecting a radiographic contrast dye into the sac (dura) surrounding the spinal cord and nerves, and then taking x-rays of the spine. This allows the radiologist to specifically x-ray the nerve roots. Any abnormalities within the spinal canal can potentially be identified to aid in the diagnosis of certain spinal problems, such as nerve compression or a disc rupture. Read More ...
Discogram
A discogram can determine whether a spinal disc is the cause of back or radicular pain. Using a fluoroscope for guidance, the doctor inserts a spinal needle into the disc and injects radiopaque dye into the nucleus (center) of the disc. In a healthy disc, the dye will remain contained within the central nucleus. If the dye leaks out of the nucleus into the surrounding tissue, the disc is considered abnormal if concordant symptoms during the injections replicate the complaints usually noticed by the patient. Read More ...
Bone Scan
A bone scan involves intravenously injecting a small quantity of a radiographic marker into the patient and then running a scanner over the area of concern. The scanner detects the marker, which concentrates in any region exhibiting high bone turnover. A bone scan is utilized when there is suspicion of tumor, infection or small fractures, i.e., conditions that all result in high bone turnover. A bone scan does not replace the above tests, but may provide additional information by eliminating other serious problems. Read More ...
DEXA Scan
A DEXA (Dual Energy X-ray Absorptiometry) scan measures bone mineral density to check for possible bone loss. During the test, the patient lies fully clothed on a padded table while the DEXA scanner beams x-rays from two sources towards the bone being examined (usually the lower spine or hip). A radiation detector device is slowly passed over the examination area, producing images that are projected onto a monitor. A computer then analyzes the images and calculates bone density based on the amount of radiation absorbed by the bone (the denser the bone, the more radiation it absorbs). The test, which may take up to 30 minutes, is performed by a physician or technician and requires no injections, sedation, special diet or any other advance preparation. Read More ...
Technology
With the advent of Minimal Access Spinal Technologies (MAST™), spine surgeons are now able to remove herniated intervertebral discs in the lumbar spine that are putting pressure on the spinal nerve roots and causing pain, in a minimally invasive fashion for the first time. Minimally invasive technologies also are allowing spine surgeons to stabilize the posterior aspect of the spine with smaller incisions and less damage to the ligaments, fascia, and muscles of the spine than with a traditional "open" posterior spinal fusion. This minimally invasive revolution has impacted virtually every surgical field. In the case of lumbar discectomy, the primary objective is to decompress the affected nerve root. The compressed nerve must be left fully decompressed and freely mobile. This may require extensive bony decompression, nerve root manipulation, and/or removal of herniated nucleus pulposus.
Minimal Access Spinal Technologies have been developed out of advances, in the field of orthopedic minimal access surgeries over the past two decades. Many surgical sub-specialties use fiberoptic video cameras, endoscopes, catheters, and specially designed tools to assist in performing surgery with much smaller incisions. Today, some of these procedures have become the standard of care in orthopedics, cardiology, and gastro-intestinal medicine. Most people are familiar with this type of technology in the form of "arthroscopic" surgery, which allows orthopedic surgeons to look inside joints like the knee and operate through very small incisions. Many people have also become familiar with this type of technology through cardiac catheterizations that are used to treat coronary artery disease, and endoscopies that are used for the diagnosis and treatment of problems of the digestive tract.
The development of Minimal Access Spinal Technologies continues to push and promote the advancement of spinal surgery.
