When do you need a neurosurgeon?

Back and neck pain are common patient complaints, and, in fact, they rarely need surgical treatment. They are usually treated with anti-inflammatory medications, physical therapy, or chiropractic care, and resolve within two to eight weeks.  Back pain prevention is very important, and can be helped with core strengthening exercise and by maintaining a healthy weight.

You should consider a consultation with Dr. Darakchiev:

•  if the back pain is persisting and disabling or recurring
•  if the back pain is associated with a buttock pain, and radiates down the leg, known as sciatica
•  if there is a tingling sensation, numbness, or weakness of the leg or the foot
•  if there are new bowel or bladder problems
•  if the neck pain is persistent and travels to the shoulder and the arm
•  if the pain is restricting your regular activities, interfering with your lifestyle and overall well-being

What are the causes for back and neck pain?

• Muscle strain, muscle spasm, are the most common
• Disc– bulging of the gel-like cushions (disc) between the bones of the spine (vertebrae). It can cause a compression of the spinal nerve and might impair its function
• Degenerative Disc Disease, osteoarthritis of the spine – as the disc ages it shrinks, it may tear, it may present as bone overgrowth, known as spurs
• Spinal Stenosis– narrowing of the nerve canal, that can lead to compression of the spinal cord

The above conditions do not always cause symptoms and might not require surgical  treatment. It is also true that some conditions might not cause pain, but it is critical to repair them surgically. For example, patients with osteoporosis of the spine might develop a fracture, without any symptoms, and that puts them in danger for spinal cord injury or paralysis.

Surgical treatment could be minimally invasive in which only the extruded piece of the disc is removed, discectomy.  In some cases, a complete removal of the disc with a fusion may be the best option while sometimes replacing the disc with an artificial disc is a reasonable choice.

Other spine conditions that Dr. Darakchiev treats include spine cysts, spine tumors, spinal infection, spinal fracture, spinal cord injury, cauda equine syndrome.

Every patient is different, and their conditions vary. Dr. Darakchiev will help you choose “what is right” for you.

Dr. Darakchiev is a fellowship trained neurosurgeon in neuro-oncology and SRS, or Stereotactic Radiosurgery (Gama knife, Linac). Treating patients with brain tumors is one of the major aspects of his practice.

Brain Tumors are abnormal growth in the brain. Primary brain tumors are originating from the brain cells and could be benign or malignant. Some more common primary brain tumors are meningioma, glioma (astrocytoma), pituitary gland tumors, acoustic neuroma.

There are also metastatic brain tumors, originating from cancer cells elsewhere in the body (lung, breast, kidney, skin..)  and spreading through the bloodstream to the brain.

Some brain tumors do not present with symptoms. Other times, symptoms may include headaches, seizures or neurological difficulties related to speech, vision, numbness, weakness, loss of balance.

Dr. Darakchiev is also specialized in SRS – stereotactic radiosurgery where a highly focused beam of X-rays is targeting the tumor while  preserving the normal brain.

Treatment options vary depending on the tumor type, size and location; whether the tumor has spread, and the age and health of the person. A brain biopsy might be the first step in order to make an accurate diagnosis and determine the appropriate treatment – surgical, chemotherapy, radiation, or a combination of them.

Hydrocephalus is a condition characterized by the abnormal buildup of cerebrospinal fluid (CSF) within the cavities (ventricles) of the brain. This excess fluid puts pressure on the brain, which can damage it if left untreated. CSF is a clear, colorless fluid that surrounds and protects the brain and spinal cord. It cushions the brain, helps to remove waste products, and delivers nutrients. In hydrocephalus, the flow of CSF is disrupted. This can happen for a number of reasons, including Congenital hydrocephalus, which is hydrocephalus that is present at birth and Acquired hydrocephalus that develops after birth. It can be caused by a number of factors, including head injuries, tumors, strokes, and meningitis. Hydrocephalus is a serious condition that can be life-threatening if left untreated.

Symptoms of hydrocephalus can vary depending on the age of the person and the severity of the condition.

 In infants, symptoms may include:

• rapidly increasing head size
• bulging soft spots on the head
• irritability,
• poor feeding 
• seizures  

In older children and adults, symptoms may include:

• headache
• nausea/vomiting
• blurred vision
• balance problems
• difficulty walking
• urinary incontinence
• personality changes and memory problems
• seizure. 

Traumatic brain injury (TBI) is a sudden injury to the brain caused by an external force. This force can range from a mild bump or jolt to the head to a severe blow or penetration. Any impact to the head can cause a TBI, such as falls, car accidents, assaults, sports injuries, explosions, and penetrating injuries like gunshot wounds. TBIs can be classified as mild, moderate, or severe, depending on the extent of brain damage and the resulting symptoms.Traumatic brain injuries can disrupt how the brain works, affecting various functions like thinking, memory, emotions, movement, and sensation.

Symptoms vary depending on the severity and location of the injury but can include:

• headaches
• dizziness 
• nausea
• vomiting
• confusion
• memory problems
• difficulty sleeping
• speech and language problems
• vision problems
• balance and coordination problems
• emotional changes

Trigeminal neuralgia is a condition of excruciating facial pain. The pain can be triggered by cold air, eating, or brushing your teeth. It might last only moments, but the pain is so severe as to be incapacitating. Typically, it is caused by compression of the fifth cranial (trigeminal) nerve by a blood vessel. It may involve one, two or rarely all three branches of the nerve. It infrequently occurs on both sides of the face. If medications (Tegretol, Trileptal) are not effective, or side effects of the medications are unacceptable, surgical treatment may be considered. The surgical approaches include blocking the  fifth nerve transmission chemically or electrically, or –  by open surgery: microvascular decompression, in which sponge-like material is placed between the trigeminal nerve and adjacent blood vessels to alleviate the pulsatile pressure from blood flow. Stereotactic Radiosurgery has shown excellent results, as an alternative to surgery.

Carpal Tunnel Syndrome (CTS) is a condition caused by compression of the Median nerve in the patient’s wrist.  The actual carpal tunnel structure is a narrow passageway located on the palm side of the wrist. This structure protects the nerve, as well as the tendons tasked with bending the fingers. Patients suffering from carpal tunnel syndrome may experience tingling, numbness, pain and hand weakness.

Patients with mild symptoms may ease their discomfort by avoiding certain activities, taking frequent hand breaks, and using cold packs to minimize swelling. If these techniques are not effective, a physician can advise more intensive non-surgical treatments, such as:

• Wrist Splinting involves the use of a splint to stabilize the wrist and to minimize night time numbness and tingling.
• Non-steroidal anti-inflammatory drugs (NSADs) like Motrin and Advil may be used to alleviate pain.
• Corticosteroids may be injected in the carpal tunnel to reduce the swelling and the inflammation, which alleviates pressure on the median nerve.

Sometimes even in patients who have carefully followed nonsurgical therapy, symptoms can become debilitating and make daily activities more difficult, the nerve damage becomes a concern. Surgical treatment is indicated to transect the ligament and release the median nerve (Carpal Tunnel Release). After surgery the ligament heals back together, but with enough space for the nerve.

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A 26 year old young man jumped head first into a shallow pool and sustained multiple cervical spine fractures causing cord compression and instability:

– unstable C6-7 fracture dislocation with “jumped facets” with complex fragmented C7 body fracture

– herniated traumatic C6-7 disc

– C1-2 unstable fracture

Clinically, the patient had arm pain and weakness but was not paralyzed. He required staged surgeries to decompress his spinal cord and stabilize the spine.

I performed C7 corpectomy and supported the spine with expandable cage, plate and screws, followed by posterior stabilization with lateral mass screws and rods. Patient then underwent a third surgery to stabilize C1-2 from the back.

This young man underwent uneventful recovery and regained his strength and sensation. He went to a short-term rehab facility and 2 months later was able to go back to his full time job.

So glad I was able to bring him back to his life.