Editor’s Message Lumbar Spinal Stenosis CINN in the News Could your employees be at risk for STROKE? Events

Physiatrists Brian Couri, M.D. Daniel Hurley, M.D. Howard Robinson, M.D. Christine Villoch, M.D. Surgeons Thomas Brown, M.D. Kenneth Heiferman, M.D. Dean Karahalios, M.D. Martin G. Luken, III, M.D. Noam Stadlan, M.D.

CINN has specialists available to evaluate job requirements and susceptibility to back injuries. If you are interested in this service, please contact Lisa Dombro at ldombro@cinn.org

Editor’s Message The issue of The Discussant before you is yet another example of our commitment to provide you with information on some of the more prevalent neurosurgical and neuromedical issues facing people today. In this issue, we look at the issue of Lumbar Spinal Stenosis (LSS), a disease impacting over 1 million people in the United States. LSS is a narrowing of the spinal canal which compresses the nerves traveling through the lumbar spine into the legs. It causes pain that can manifest both in the lower back and buttocks as well as radiate into one of both thighs and legs. Conservative and surgical solutions are available to treat this debilitating condition. Deviating from The Discussant’s typical focus on spine, this issue brings you more information about the factors that may put you, your employees, patients or clients at risk for stroke. Stroke is the third leading cause of death in the United States and a leading cause of significant disability. CINN is committed to educating our communities on the risk factors and treatment options available to prevent stroke. In fact, as our understanding of the underlying disease expands, and our adoption of advanced diagnostic technologies increases the opportunities for early detection, physicians at CINN are aggressively shifting the paradigm of stroke treatment to prevention and management of risk. We at CINN urge you to join us in our campaign to reduce the burden of this disease by educating yourselves, employees, clients and communities on the risk factors of stroke. Leonard J. Cerullo, M.D. Guest Editor

Leonard J. Cerullo, M.D. Neurosurgeon Leonard J. Cerullo, M.D., is the founder and medical director of the Chicago Institute of Neurosurgery and Neuroresearch (CINN), Chicago, Illinois. A board-certified neurosurgeon with over 20 years of experience, Dr. Cerullo is widely recognized as one of the nation’s leaders in the field of neurosurgery. He is highly regarded for his skill in the diagnosis and treatment of brain tumors and spine disorders.

The Path to Proper Diagnosis and Treatment of Lumbar Spinal Stenosis

Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal, which compresses the nerves traveling through the lumbar spine and into the legs.

Diagnosis of lumbar spinal stenosis is based largely on a complete clinical history and physical examination. Physical examination of patients with suspected lumbar stenosis should begin with a thorough assessment of the back. As the exam progresses, the following common symptoms should warrant concern and need for further analysis:

• Dull to severe aching pain in the lower back or buttocks that develops with walking or other activity
• Pain that radiates into one or both thighs and legs
• Relief of symptoms by sitting or lying down, and/or by bending forward at the waist
• Loss of motor function in legs, bowel or bladder (rare)
• Evidence of an increasingly sedentary lifestyle in an effort to control pain

If any of the above symptoms are observed or if there is otherwise suspicion of lumbar spinal stenosis, it is highly recommended that radiographic confirmation be obtained through MRI, myelogram or CT myelogram.

The characteristic syndrome associated with lumbar stenosis is neurogenic intermittent claudication. Its presence is typically indicated by lower back pain, pain numbness and tingling in the lower extremities that worsens with prolonged standing or walking.

Treatment

The compression that occurs with LSS is caused by an overgrowth of bone. Though pain and discomfort associated with this condition may be alleviated through conservative treatments, the only option that will open the lumbar canal and ultimately correct the problem is surgery. A study conducted in 2000 suggests that patients with moderate stenosis might improve after receiving only conservative treatment. However, a separate study from the same year suggests that after one year of conservative treatment, patients who still have moderate pain will benefit more from surgery than from continued conservative treatment.

Conservative treatments include NSAIDs, physical therapy, epidural steroid injections, lumbar bracing and bed rest. Non-surgical treatments such as these may be attempted to manage the condition initially in patients with mild symptoms of short duration.

If conservative treatments fail, surgical options should then be explored. The most commonly performed surgical procedures include laminectomy, laminectomy plus fusion, partial laminectomy, and fusion and instrumentation. Additionally, a foraminotomy is used to treat foraminal stenosis. Laminectomy is considered the “gold standard” of LSS surgical procedures and is available in micro-endoscopic form. Decompression must be performed in conjunction with any of the aforementioned procedures, and additional procedures may be necessary depending on individual circumstances. Procedural decisions are influenced by the severity of the disease as well as the patient’s risk acceptance level.

CINN in the News

Recently, several CINN physicians have been highlighted in local and national press. Respected as experts, TV, radio and newspaper reporters have sought out opinions on stroke, the future of spine surgery, brain tumors and the importance of faith in healing, from CINN. Following is a summary of these reports:

Future of spine surgery

ABC7 News: Dean Karahalios, MD, fellowship-trained spine surgeon at CINN, was asked to provide his opinion on new technologies under development to relieve back pain. Dr. Karahalois commented that one such technology being researched “is referred to as nucleus replacement, where we can place artificial or synthetic material into the disc space to reconstitute that nucleus. That will be coming down the road very soon.”

Stroke

NBC5 News & NBC2 News: Dr. Leonard J. Cerullo commented on the prognosis of patients suffering from stroke. Dr. Cerullo stressed that everyone, and especially those over 50 years old, should know the warning signs of stroke.

War on Cancer

WGN9 News: This piece focused on the prevalence of brain metastases from lung, breast and melanoma skin cancer. Up to 40% of patients with these cancers develop brain metastases, and currently it is not common practice to use MRI scans to detect such tumors at an early stage. Dr. Leonard J. Cerullo was quoted as urging all physicians and patients to include MRI scans in the routine diagnostic workup and monitoring of cancer patients.

Facing Pain, Finding Hope

Vibrant Life/Relavent Radio/Spirit Radio: Dr. Dan Hurley, CINN physiatrist and author of Facing Pain, Finding Hope, has been interviewed by numerous radio programs nationwide and has given many public appearances to discuss his perspective on suffering and dealing with pain. The book is published by Loyola Press and available at Barnes and Noble, or through Amazon.com.

Doctors Urge Brain Scans for Cancer Patients

Associated Press article; nationwide newspaper and Internet coverage: Dr. Leonard J. Cerullo was quoted as urging cancer patients to seek out brain scans to detect brain mestases.

Radiation with sharp aim

Chicago Tribune article: Dr. Leonard J. Cerullo explains that Gamma Knife radiosurgery may be the best option for patients suffering from brain metastases, as it produces fewer side effects than whole brain radiation, including less depression, fatigue and memory loss.

Could your employees be at risk for STROKE?

Kirby Pucket, beloved baseball player, who died in March at the age of 45 had every sign that a tragic stroke was possible, including high blood pressure, excess weight and a family history of heart disease and stroke. John Stroeger, Jr., Cook County Board President, was also at high risk for stroke given his history of heart disease and diabetes. Are you also at risk for stroke? If you are over 55 and struggle with weight problems, have had a prior stroke, have a family history of heart disease or stroke, have high blood pressure or cholesterol, are afflicted with diabetes, smoke, or consume high levels of alcohol, you are at increased risk for stroke.

Experts now believe that stroke is as preventable as heart attack. In addition to primary prevention tactics such as quitting smoking, drinking only in moderation, and exercising, there are medical solutions and minimally-invasive surgical interventions that can decrease your risk of stroke. Several of the CINN physicians specialize in performing these stroke-preventing procedures.

A stroke occurs when blood circulation to the brain fails due to either a blocked or ruptured blood vessel. The resulting lack of oxygen to brain cells can impair brain function. Stroke is the third leading cause of death in the United States. Of the roughly 700,000 new and recurrent cases of stroke each year, 160,000 are fatal. Stroke prevention remains the most important treatment strategy for reducing the burden of this disease.

Free stroke screenings are being offered at CINN’s home on the north side of Chicago — The Neurologic & Orthopedic Institute of Chicago, 4501 N. Winchester, on the “sixes” in the month of June – Tuesday, June 6th, Friday June 16th and Monday, June 26th from 9:00 a.m. – noon. Each screening will take about 20 minutes and will include a blood draw, a carotid ultrasound, as well as consultation with a stroke specialist.