Michigan Head & Spine Institute, Author at Michigan Head & Spine Institute Blog


Congratulations to our MHSI doctors who were recognized by HOUR Detroit as TOP DOCS for 2023.

You can view their respective physician pages by clicking on the links below.


Jeffrey T. Jacob, M.D.
Fredrick S. Junn, M.D.
Ratnesh N. Mehra, D.O.
Tejpaul S. Pannu, M.D.*

Pain Medicine

Karl R. Freydl, D.O.
Kevin R. Lee, M.D.
John M. Marshall, M.D.
Henry C. Tong, M.D., M.S.*

Preventive Medicine

Alison Lee, M.D.*

*denotes top vote getter


MHSI is proud to share the exciting news that Dr. Ratnesh Mehra has received the designation of FACOS; Fellow of the American College of Osteopathic Surgeons. Dr. Mehra has demonstrated a commitment to the practice of surgery, surgical teaching, authorship of professional papers and participation in local, state and national organizations.

The designation was conferred to Dr. Mehra during a ceremonial hooding in Chicago, IL amongst his mentors, peers, students, family and friends last weekend.

Congratulations, Dr. Mehra!!!

If you or a loved one is seeking treatment for neurosurgery, or to schedule an appointment with Dr. Mehra or any of our MHSI experts, visit www.mhsi.com/appointments or call 248-784-3667.


Michigan Head & Spine Institute is proud to share the exciting news that Dr. Holly Gilmer has just been elected Chair of the Michigan Board of Medicine.

She was appointed by Governor Gretchen Whitmer to the Board of Medicine in 2020 and has now been elected as Chair by her colleagues on the Board.

We wish to extend our congratulations to her on such a prestigious accomplishment!

If you or a loved one is seeking treatment for neurosurgery, or to schedule an appointment with Dr. Gilmer or any of our MHSI experts, visit www.mhsi.com/appointments or call 248-784-3667.


Dr. John J. Steele

John J. Steele, M.D., Ph.D.

You may not be familiar with the O-arm™, but this imaging system has revolutionized spinal surgery, along with other surgical procedures. Getting to know the O-arm™, including what makes it superior to other imaging tools and why it’s considered top-of-the line for spinal trauma surgeries, can help you understand why Michigan Head & Spine Institute surgeons sing the praises of this system.

What is the O-arm™?

The O-arm™ system is a mobile X-ray system that provides 2D and 3D images during surgical procedures. It provides visibility that allows surgeons to be ultra-precise, helping them pinpoint problems and take care of them with minimal impact on the patient. It also helps surgeons apply medical devices in a way that uses the smallest and fewest of those devices — yet provides the strongest possible repair. The O-arm™ also exposes patients to less radiation than other surgical imaging tools.

How Does the O-arm™ Help Spinal Surgery Patients?

Surgery is all about precision. Thanks to the imaging provided by the O-arm™, surgeons can be more precise than ever, which often means fewer or smaller incisions and faster recovery time for patients.

The O-arm™ also affords surgeons the ability to precisely navigate complex surgical situations in a way that wasn’t previously possible. Consider, for example, a congenital spinal problem such as a sacral meningocele. To operate in such a “busy” area near the spine, surgeons need to be confident in their ability to be precise. The O-arm™ affords them this confidence.

Another cutting-edge application of the O-arm™ involves the placement of cervical pedicle screws. The pedicle is like the yellow brick road of the spinal column, and pedicle screws help support the weakest part of the spine. The computer precision of the O-arm™ allows surgeons to place pedicle screws accurately and efficiently in a much less invasive way than other, previously used imaging tools. This type of surgery wasn’t possible 10 years ago, or even two years ago.

Yet another major benefit of the O-arm™ is that it allows surgeons to check in real time that they’ve placed devices correctly or take another image after removing something during surgery. If they see something additional that needs to be corrected or removed, they can take care of it while the patient is still under anesthesia, without subjecting them to another procedure.

Other Applications of the O-arm™

As the O-arm™ system becomes more widely available, it is being explored as a tool for many different kinds of procedures. In addition to spinal trauma surgery and procedures to address congenital spine problems, it is also being used to help patients with scoliosis.

Outside of the spine, the O-arm™ is being considered for other types of trauma and orthopedic surgery. As the number of uses for this tool grow, it’s even possible that in the next 10 years the O-arm™ will be used to place deep brain stimulators because it provides such an accurate roadmap.

Much like NASA’s Artemis program is helping us explore space like never before, the O-arm™ is catapulting us into a new neurosurgical universe.

If you or a loved one is seeking treatment for neurosurgery, or to schedule an appointment with Dr. Steele or any of our MHSI experts, visit www.mhsi.com/appointments or call 248-784-3667.



<div class="at-above-post-arch-page addthis_tool" data-url="https://www.mhsi.com/blog/what-seniors-should-consider-before-neurosurgery/"></div>Understanding some of the neurosurgery issues seniors face, including some of the most common surgeries and special considerations for this age group, can help older folks and their families determine if they’re dealing with a health issue that could be helped by surgery of the brain or spine.<!-- AddThis Advanced Settings above via filter on get_the_excerpt --><!-- AddThis Advanced Settings below via filter on get_the_excerpt --><!-- AddThis Advanced Settings generic via filter on get_the_excerpt --><!-- AddThis Share Buttons above via filter on get_the_excerpt --><!-- AddThis Share Buttons below via filter on get_the_excerpt --><div class="at-below-post-arch-page addthis_tool" data-url="https://www.mhsi.com/blog/what-seniors-should-consider-before-neurosurgery/"></div><!-- AddThis Share Buttons generic via filter on get_the_excerpt -->


Every year, around 2.9 million cases of traumatic brain injury (TBI) occur in the United States, and about 5.3 million Americans are currently living with a disability related to a traumatic brain injury.

Understanding traumatic brain injuries —symptoms, treatment options and how to prevent them — can help prepare you in the event you or a loved one sustain this type of injury.

What is a Traumatic Brain Injury (TBI)?

Any injury with an external cause that affects how the brain works is a traumatic brain injury, often abbreviated to TBI. These injuries are typically caused by a blow to the head — like a fall, or a car accident where the head hits the steering wheel at high speed — or a penetrating injury such as a gunshot wound.

A traumatic brain injury can be mild, moderate or severe. Fortunately, about 75 percent of traumatic brain injuries are mild. The most common type of mild traumatic brain injury is a concussion.

Symptoms of a traumatic brain injury may include:

  • Amnesia
  • Confusion
  • Trouble concentrating
  • Difficulty speaking or understanding language
  • Inappropriate expression of emotion, either laughing or crying
  • Aggression and irritability
  • Blurred vision
  • Slurred speech
  • Dilated or unequal pupils
  • Headaches
  • Ringing in the ears
  • Nausea or vomiting
  • Anxiety
  • Problems with balance

People who have suffered a traumatic brain injury may also experience symptoms of post-traumatic stress disorder (PTSD) alongside those of their injury.

It’s important for athletes, fall-prone individuals (like persons with disabilities or who are elderly) or anyone else who may be vulnerable to a traumatic brain injury to know the signs and symptoms, so they can seek care immediately upon noticing them.

Treating Traumatic Brain Injuries

Many people with TBIs — particularly mild ones such as concussion — will be first seen and treated by their primary doctor or an urgent care provider. Then, depending on the severity of the injury, they may be referred to a specialist — like a neurologist or neurosurgeon — for further evaluation and treatment.

In the case of mild traumatic brain injuries, recovery often involves rest and over-the-counter pain relievers, and can be done at home. Moderate traumatic brain injury typically requires more intensive treatment such as surgery.

What to Expect After a Traumatic Brain Injury

Most people who sustain a mild traumatic brain injury will stop having symptoms within days or weeks. However, up to 25 percent of these people may experience lingering effects such as inability to concentrate, head and neck pain, and memory issues for much longer — possibly months after the event that caused the TBI.

For the small percentage of people who do experience long-term effects after a traumatic brain injury, ongoing treatment is key. Ideally this treatment is overseen by a multidisciplinary team that includes a neurosurgeon, neurologist, and rehab doctor or physical therapist, among other specialists.

Preventing Traumatic Brain Injury

While some TBIs might be more mild or less symptomatic than others, there’s no ideal situation with traumatic brain injury. Every situation is unique and presents its own set of challenges to recovery and treatment.

So how do we prevent TBIs entirely? While you can’t prevent the type of TBIs that come from accidents like tackles on the football field or a car accident, the most powerful tool we have is knowledge. The organization ThinkFirst is an excellent source of trustworthy and comprehensive information on preventing traumatic injuries, offering tips for people of all ages on how to protect the brain.

If you or a loved one is seeking treatment for a traumatic brain injury, or to schedule an appointment with any of our MHSI experts, visit www.mhsi.com/appointments or call 248-784-3667.


Congratulations to our MHSI doctors who were recognized by HOUR Detroit as TOP DOCS for 2022.

You can view their respective physician pages by clicking on the links below.


Jeffrey T. Jacob, M.D.
Fredrick S. Junn, M.D.
Ratnesh N. Mehra, D.O.
Tejpaul S. Pannu, M.D.


Pain Medicine

Karl R. Freydl, D.O.*
Kevin R. Lee, M.D.
John M. Marshall, M.D.
Henry C. Tong, M.D., M.S.

*denotes high vote getters


Although it’s relatively new, endovascular neurosurgery is being used to treat an increasing number of health problems — with remarkable results. Through research and collaboration, experts from a variety of fields are coming together to innovate a type of surgery that is helping some of the highest risk patients.

What is Endovascular Neurosurgery? 

Endovascular neurosurgery is a subspecialty of neurosurgery that combines multiple types of expertise. Incorporating both neurosurgery, which treats conditions of the brain and nervous system, and interventional radiology, which uses imaging and minimally invasive techniques to diagnose and treat injuries and health conditions, endovascular neurosurgery uses small catheters to diagnose and treat health problems affecting the brain and spinal cord.

What Conditions Endovascular Neurosurgery Treat?

Endovascular neurosurgery can be used to diagnose and treat a variety of injuries, diseases and health conditions including:

  • Strokes
  • Brain aneurysm
  • Cerebrovascular malformations including arteriovenous malformations (AVMs) and dural arteriovenous fistula (dAVF)
  • Carotid artery disease
  • Atherosclerosis (narrowing) of the vessels of the brain
  • Idiopathic intracranial hypertension (formerly pseudotumor cerebri)

This is merely a partial list of the many health concerns that can be addressed with endovascular neurosurgery — a list that will continue to grow as neurosurgeons, interventional radiologists, and interventional neurologists work together to advance the science surrounding these techniques.

What Are the Benefits of Endovascular Neurosurgery?

The blood vessels of the brain are deep within the brain itself, meaning they’re not readily accessible without open surgery. Because it involves the use of catheters to pass through blood vessels, endovascular neurosurgery is a minimally invasive technique that provides an alternative to more invasive options.

Rather than opening the skull to get into the brain, endovascular neurosurgeons often only need to make a tiny puncture to insert the catheters they use in surgery.

The minimally invasive nature of endovascular neurosurgery means that some patients who receive elective (non-emergency) types of this procedure can go home the same day.

Even in cases where recovery takes a little longer, patient outcomes are generally very good. Many people can go home within one day of surgery and are back at work within a week.

Another major benefit of endovascular neurosurgery is that it offers hope for people with diseases or conditions that would have been otherwise untreatable. These are patients who didn't have a different treatment option — or at least a good treatment option — and these endovascular techniques are allowing neurosurgeons to provide life-altering or even life-saving care for them.

Advancing Technology, Saving Lives 

Endovascular neurosurgery is an exciting field that allows surgeons to greatly improve outcomes for patients who were otherwise at the mercy of their disease.

Treatment options that weren’t available only a few decades ago are now saving people’s lives — and will continue to do so as the field grows and expands through continued collaborative research and innovation.

If you or a loved one is seeking treatment for a condition of the spine, or to schedule an appointment with any of our MHSI experts, visit www.mhsi.com/appointments or call 248-784-3667.



Migraines affect more than 10 percent of the world’s population, and migraine disease is considered to be one of the main causes of disability worldwide.

One study of people with migraine disease in the United States found that over half were unable to engage in day-to-day activities, including work or school, because of migraines.

Women are hit especially hard by migraines; migraine disease is 3 times more common in women than men, affecting around 1 in 5 American women.

Understanding migraines including how they're different from other headaches and what can trigger them and why the triggers might change may help you manage them better.

Symptoms, Phases Set Migraines Apart

Migraine is produced by chemical activity in the brain, nerves and blood vessels surrounding the skull and muscles of the head and neck.

Migraine is different from other headaches because it comes as a cluster of symptoms, and usually occurs with the same triggers and symptoms every time, though triggers can change over time, especially with hormonal changes.

Classic migraine is also unique in that it typically occurs in four phases.

During prodrome (pre-migraine) phase, you might experience:

  • Sensitivity to light, sound and smells
  • Mood changes
  • Pain and/or stiffness in the neck
  • Yawning
  • Food cravings
  • Constipation
  • Diarrhea

Aura phase, which doesn’t happen for everyone, is usually characterized by visual and sensory changes such as:

  • Seeing flashing lights and/or zigzag lines
  • Blurred vision
  • Tingling
  • Numbness
  • Slurred speech
  • Difficulty thinking or writing clearly

Headache phase is characterized by:

  • Intense pain on one or both sides of the head

Postdrome phase is the post headache phase when symptoms generally include:

  • Exhaustion
  • Confusion
  • Feeling unwell

Although not everyone with migraine disease goes through all four phases, the symptoms and phases an individual experiences tend to be the same every time. Recognizing this pattern helps people know they’re having a migraine.

Common Migraine Triggers

While not all migraines are triggered, some people find that certain factors tend to kick off a migraine for them. Common migraine triggers include:

  • Stress
  • Sleep disturbances, including a change in sleeping patterns such as sleeping late on the weekends
  • Hormone changes
  • Foods that contain a compound called tyramine (including fermented foods, certain aged cheeses, red wine, smoked foods and cured meats)
  • Changes in weather/humidity fluctuations
  • Dehydration
  • Altitude changes
  • Strong smells such as perfume
  • Medications

Another surprising (and surprisingly common) migraine trigger? Chewing gum. Up to 50 percent of people with migraine disease also have temporomandibular joint (TMJ) disorders, conditions affecting the jaw joints and surrounding muscles and ligaments that can be aggravated by gum chewing.

It’s a good idea to pay attention to your personal triggers; if you’re able to identify and avoid them when possible, you may be able to lessen the number of migraines you experience.

Why Triggers May Change Over Time

Some people — especially women — may find that their migraine triggers change as they get older, or that they experience fewer or more migraines at certain times (such as during pregnancy or menopause). This is because hormone levels fluctuate throughout a woman’s life, and hormone changes can trigger a migraine.

Other things that might cause triggers to vary over time include nutrient deficiency (such as low vitamin D levels) and thyroid problems. But you shouldn’t assume that these things are triggering your migraines without talking to a healthcare provider.

When to See a Doctor

If you notice a change in the pattern of your headaches — particularly if they become more frequent and you have them more than three times per week — it’s a good idea to talk to your doctor about an evaluation.

More concerning are headaches that occur during physical activity such as exercise or bending over, or if a headache is severe enough to wake you from sleep. If you’re awoken by a headache or suddenly develop a headache more painful than any you’ve had before, it’s an emergency and you should seek care immediately.

Other headache symptoms that necessitate emergency treatment:

  • Neck stiffness with fever and/or rash
  • Shortness of breath
  • Dizziness
  • Neurological symptoms such as loss of balance, slurred speech or paralysis on one side of your body
  • Nausea and vomiting (if severe and you’ve never had it with a headache before)

In general, it’s better to be safe than sorry when it comes to headaches, so don’t hesitate to reach out to your doctor if you’re concerned.

If you or a loved one is seeking treatment for a condition of the brain, or to schedule an appointment with any of our MHSI experts, visit www.mhsi.com/appointments or call 248-784-3667.



Dr. John Steele
John J. Steele, M.D., Ph.D.

Knowing the signs and symptoms of a stroke, and what to do when you spot them, may save someone’s life. The acronym, BEFAST, can help.

Catching Stroke Quickly Increases Chances of Survival

In the last three decades, medicine has made huge strides in stroke management — but the window of treatment is very narrow.

A stroke can get very bad, very quickly, meaning you have a limited amount of time to respond if you hope to have a good outcome.

In most cases, stroke can be treated with either medical or surgical therapy. But stroke remains the fifth leading cause of death and the number one cause of loss of independence, which is why it’s so important that people know the signs and act quickly.

Because of this, experts created the acronym BEFAST to help people remember and recognize the most common stroke symptoms.

  • Balance problems, dizziness, and/or loss of coordination
  • Eye trouble, including blurred vision and difficulty seeing out of one or both eyes
  • Facial drooping or numbness on one side of the face
  • Arm weakness or numbness on one side
  • Speech difficulty, including stuttering and/or slurred speech
  • Time to call 911 if a person shows any of these symptoms, even if they go away

Even with an acronym to remind you of stroke symptoms, you might not recognize the signs right away. It may be helpful to focus on the physical signs; if someone is unable to speak, has a facial droop or can’t move one side of their body, or if their hand flops down when you raise it, there’s a good chance that person is having a stroke.

The Importance of Comprehensive Stroke Treatment

Once you’ve identified signs of a stroke using BEFAST, it’s time to get help.

When you call 911, request that the person be taken to a comprehensive stroke center to ensure the most accurate diagnosis and best possible treatment.

The most crucial step when it comes to diagnosing a stroke is getting an image of the brain with a CT or CAT scan to determine the cause and type of stroke. Ideally, imaging will be followed by a more comprehensive evaluation using the stroke scale developed by the National Institutes of Health (NIH). This 42-point evaluation goes far beyond BEFAST, allowing healthcare providers to learn details about a stroke that help them determine how best to treat it.

Managing Expectations About Stroke Treatment and Recovery

How effectively a stroke can be treated, and how well a person recovers, depend largely on how early the stroke is diagnosed; the earlier the stroke is detected, the better the outcome is likely to be. When blood flow to the brain is blocked, which is what happens during a stroke, there’s going to be a certain amount of damage even after normal blood flow is restored.

This means stroke patients who have been successfully treated can still experience effects such as weakness on one side of the body or problems with speech, but often will recover to the point of independence. Recovery from a stroke usually takes between three and six months, but is highly dependent on the extent of the stroke.

Even better than catching a stroke early is not having one at all. Preventive measures such as maintaining a healthy weight and keeping blood pressure and cholesterol in check can go a long way in keeping your heart healthy and reducing your risk of stroke.


If you or a loved one is seeking treatment for a condition of the brain, or to schedule an appointment with Dr. Steele or any of our MHSI experts, visit www.mhsi.com/appointments or call 248-784-3667.