Baylor Scott & White - Texas Brain and Spine Institute

Cerebrovascular disease evaluation and treatment

We treat all vascular problems in the brain and spine. Most common among them are aneurysms, stroke, arteriovenous malformations and cavernomas.

We work closely with neuroradiologists to deliver advanced care for these issues, whether it’s surgery, endovascular treatment (minimally invasive treatment that avoids an open surgery) or radiation therapy.

Neck and lower back pain

Because every patient is unique, we formulate neck and lower back treatments based on a thorough evaluation, which we perform using some of the latest technological advancements.

Conservative, non-surgical treatment is the foundation for the treatment of spine pain, including physical therapy and other less invasive options.

We believe in evaluating patients promptly and educating them on their diagnosis so they can play an active role in the decision-making and treatment process to reduce their lower back and neck pain.

Stroke care

A stroke is a medical emergency that occurs when a blood vessel in the brain becomes blocked (ischemic stroke) or breaks (hemorrhagic stroke). During a stroke, nearly two million brain cells die every minute, which makes getting the proper care fast critical to limiting long-term disability or even saving lives.

Radiosurgery

Radiosurgery, defined as treatment using powerful beams of precisely focused radiation, is a crucial tool in the fight against difficult tumors.

We work in conjunction with radiation oncologists to develop precise plans to deliver radiation to the tumor while sparing the important structures nearby as part of our radiosurgery treatment for difficult tumors and other neurological disorders.

Cervical disc herniation

A disc herniation is the same in the cervical region as in the remainder of the spine, but surgical treatment is very different. Initially, treatment starts with medications—usually anti-inflammatories and muscle relaxants—and physical therapy. The next tier of treatment is advanced imaging—usually an MRI—and pain management injections. Finally, the last level of treatment is surgery, which is generally an anterior cervical discectomy and fusion (ACDF). The ACDF technique has been performed for decades, and research shows it is one of the most successful surgeries.

Cervical stenosis

Stenosis, or pinching or compression of the spinal nerves and spinal cord in the neck region of the spine, is called cervical stenosis. It is the same stenosis we see in the lumbar and thoracic spine, but the neck or cervical region of the spine is shaped quite differently than the other regions. Due to the different shapes and locations of other organs, the techniques for addressing stenosis in the cervical spine are usually different. For example, someone with lumbar stenosis would likely undergo surgery from the back to decompress the nerves; however, in the cervical region, that surgery done from the front of the neck.

Lumbar disc herniation

The disc is a combination of soft tissue and cartilage that acts as a shock absorber between the spine's vertebral bones. The outer annulus holds in the inner nucleus like a bag; the inner nucleus acts as the shock-absorbing substance. When a disc herniates, the inner nucleus out from the annulus that contains it. The part that has bulged nerves and cause stenosis and symptoms.

Most disc herniations will not require surgery, but in some severe cases, surgery is necessary. Treatment with surgery involves removing the part of the disc that has been damaged and is pressing on nerves. The technical name for this is discectomy or micro lumbar discectomy in the lower back region. Before surgery, medications, physical therapy, and injections can be beneficial.

Revision spinal surgery

The need for revision spine surgery generally has three causes: a previous spine surgery that did not heal correctly, new or worsening problems at a site of prior surgery, and problems above or below an old spine surgery. For surgeries that did not heal correctly, there could be a lack of fusion, loose or broken screws and rods, or the spine could be fused in a bad position. Worsening or new problems at a site of previous surgery could be instability or spondylolisthesis that has developed after a decompression-type surgery. In the case of pinched nerves, often, decompressing the nerves surgically without fusing can lead to a good result. However, further degeneration of the disk and facet joints can lead to recurrent stenosis and instability over time. Lastly, most problems that require spine surgery in adults have a significant, if not sole, etiology from degeneration. When surgery is done and that spine level is addressed, the degenerative processes still occur at the other spine levels. If those other levels progress to needing surgery, it is expected that the new and old surgery levels will need to be joined together during surgery.

Treatments for revision spine surgery are varied and must be tailored to the problem and the person. Revision cases are more challenging than operating on a spine without surgery; it takes experience and skill. Most importantly, it takes willingness, not just from the surgeon but also from the patient. Patients facing revision spine surgery are often looking at a more extensive surgery than they had previously. They have experienced recovery once before, and sometimes, that may have been a trying experience. Ultimately, the patient must have courage and realize that revision spine surgery can significantly improve symptoms and quality of life.

Spinal instability and spondylolisthesis

The technical term for spinal instability caused by degeneration is spondylolisthesis, and the different types are discussed in the spondylolisthesis section. There can be spinal instability from trauma that causes injury to the spinal ligaments, discs and soft tissues or fractures of the spinal bones. In general, it takes a significant amount of force to cause trauma that would destabilize the spine; almost all of these patients are first evaluated in the Emergency Department.

Spondylolisthesis is a term used to describe instability and malalignment between two vertebral bodies and the disc in between them, usually in the lumbar or lower back region. These three parts, the disc and the spine bone above and below it, are often referred to as a motion segment and are named by the bone above and below, for example, L4-5. L4-5 is the most common level for degenerative spondylolisthesis. It means there is enough degeneration or arthritis at the L4-5 level that the L4 bone on top of the L5 bone is sliding off L5. Commonly, it will slide forward, called anterolisthesis, but it can slide to the side (laterally) or the back (retro). With degenerative spondylolisthesis, there is usually significant pinching or stenosis of the nerves at that level. With the instability from the sliding out of place of the bone and the nerve pinching, spondylolisthesis usually causes significant back pain, leg pain, and numbness. Isthmic spondylolisthesis usually occurs at L5-S1, the bottom disc in the spine. This happens when there is a stress fracture in part of the spine bone called the pars. The fracture commonly occurs in childhood and adolescence but can be years or decades before spondylolisthesis occurs. Once it happens, the symptoms are very similar to degenerative spondylolisthesis with components of back pain and leg symptoms.

Several symptoms drive the treatment of spondylolisthesis. Still, ultimately, definitive treatment involves stabilizing the bones so they do not continue to slide out of place and unpinching the nerves. This surgery is called a decompression and fusion, where laminectomy and foraminotomies are performed, and implants hold the two bones together, allowing the bone to grow between them, fusing them into one bone. Before symptoms are severe enough for surgery, physical therapy, medications and epidural steroid injections can be helpful to lessen the symptoms.

Stenosis

Stenosis is pinching, pressure or compression on the spinal cord or nerves. The cervical and thoracic regions of your spine, the neck and chest area, contain both your spinal cord and spinal nerves that branch off and spread to your body. The lumbar region, or low back, contains only spinal nerves. Stenosis of spinal nerves can cause pain, numbness and weakness in the arms and legs; the symptoms can be episodic or constant and can range in severity from mild to excruciating and debilitating.

Treatment for significant stenosis usually involves surgical decompression of the pinched nerves to relieve the pinching and provide the best environment for the nerves to heal. The technical name for these types of decompressive surgeries is laminectomy, foraminotomy, and discectomy. These surgical techniques can be done in addition to other methods used simultaneously. Milder forms of stenosis can be treated with non-surgical techniques, such as physical therapy, medications, and injections.