New Technologies Archives - Michigan Head & Spine Institute Blog


Dr. Richard D. Fessler

Richard D. Fessler, M.D.

Someone in the United States has a stroke every 40 seconds, and strokes are a leading cause of death and disability for Americans. One of the best ways to lower your risk of having a stroke is to know your risk factors so that you can work to reduce them. Now, innovations in healthcare and technology — like wearables such as smartwatches — are improving the way stroke victims, and those at risk for stroke, are monitored.

What Are the Main Risk Factors for Stroke?

Stroke risk factors can be divided into two categories: non-modifiable and modifiable. Non-modifiable risk factors are those that can’t be changed, such as sex and age. (Women are more likely than men to have a stroke, and your chance of having a stroke about doubles every 10 years after age 55.)

Some of the most common modifiable risk factors include health conditions such as high blood pressure, diabetes and cardiac disease. In terms of modifiable factors related to lifestyle, cigarette smoking is a big one — it doubles a person’s risk of having a stroke.

The Pitfalls of Traditional Stroke Risk Monitoring

For many people, preventive healthcare means seeing their doctor once a year for a check-up. At this appointment, a nurse checks your blood pressure and other vital signs, the doctor gives you an exam, and you’re on your way. But what if your appointment is at 8:00 a.m. and, unbeknownst to you or your doctor, your blood pressure goes up every afternoon between noon and midnight? There’s no way this stroke risk factor would be detected at your morning appointment.

Although better than nothing, this type of infrequent monitoring simply doesn’t gather enough information to be truly meaningful.

Wearable Technology Enhances Stroke Monitoring

In the same way that wearable technology such as fitness trackers and smartwatches have made it easier to track our activities, these tools can also help healthcare providers monitor risk factors for stroke around the clock. Instead of having their blood pressure checked once a year, people can have it monitored constantly, without needing to leave the house.

Wearable technology can also look for other possible stroke risk factors, such as sleep apnea, that may be affecting a patient without them realizing it — something that an annual check-up would never detect. And it can constantly monitor things like body temperature that, when elevated, may trigger a stroke. The patient’s provider has access to all of the information gathered by the wearable, and can reach out to the patient if they see anything that needs to be addressed.

Aside from the sheer quantity of health data that can be gathered by wearables to help detect stroke risk factors, their biggest advantage is convenience. All a patient needs to do is charge the device and put it on their wrist.

The Future of Stroke Prevention

The remarkable advances in healthcare technology currently happening have made it possible for us to achieve something we all want — peace of mind. Whether for yourself or older loved ones, wearables can be an invaluable tool for monitoring stroke risk, no effort required.

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



Approximately 50 million people in the United States — one in five adults — report struggling with pain on most days or every day. This type of chronic pain can interfere with every aspect of life, making even the simplest of tasks unmanageable.

Fortunately, recent advances in technology have resulted in a new tool for treating chronic pain called neuromodulation. Understanding this treatment, including what it involves and how it works, may help you decide if neuromodulation is right for you.

What is Neuromodulation?

Neuromodulation refers to altering or modulating the function of the nervous system using targeted electrical stimulation or drug delivery. This can be accomplished using non-invasive devices such as transcutaneous electrical nerve stimulation (TENS) units or implantable devices such as spinal cord and deep brain stimulators.

The nervous system can be targeted anywhere along its course, including the brain, spinal cord or peripheral nerves.

How Does Neuromodulation Help With Chronic Pain?

In simple terms, Neuromodulation alters or blocks pain signals as they travel to the brain. Depending on a patient’s pain pattern, the device can be placed at different locations in the spine or on certain nerves to block pain.

Chronic pain can be described as aching, sharp, stabbing or burning sensations. Neuromodulation devices override these sensations, instead providing a soothing or gentle tingling feeling in painful areas.

Can My Pain Be Treated With Neuromodulation?

Ideal candidates for neuromodulation for pain are those with chronic (not acute) pain, usually defined as pain lasting more than 3 months. This is typically pain that affects the neck, back or extremities, although there are options for facial pain and other pain patterns as well.

These patients have usually tried different medications or injections and continue to experience pain. Many have had back or neck surgery and continue to have pain, and others don’t qualify for surgery or don’t want to have additional or more invasive surgery.

What Happens During the Procedure?

For spinal cord stimulation, patients require a “trial” before the permanent device is implanted to ensure that the therapy is effective and worthwhile. A trial of spinal cord stimulation typically involves placing thin electrodes through two needles into the back, similar to an epidural injection. These are threaded to the appropriate region that matches the patient’s pain pattern.

These electrodes are then connected to an external device and patient’s “trial” the therapy at home for about a week. If the trial is successful, meaning pain severity is reduced by at least 50%, the temporary electrodes are removed in office and the permanent implant is planned.

This next step involves placement of the same electrodes in the same location, although now they are anchored into the back and connected to a small battery which is also implanted into the back or buttocks through two small incisions in the back. For some patients, a small laminotomy (opening in the spinal vertebra) is necessary to place the electrode.

Deciding which devices are used and where they are implanted requires an individualized approach based on each patient’s unique needs and anatomy.

What Does Recovery Look Like?

These are almost universally outpatient surgeries, and patients tend to experience some slight post-operative discomfort which resolves after a few days.

Patients should limit twisting, bending and lifting more than 5-10 pounds for the first two weeks after implantation to allow for healing, and for the electrodes to scar or “set” into place.

Once patients are seen at their first post-operative visit, we typically discuss a gradual return to activity and lifting of restrictions. Patients also have their devices programmed at that time, during which we map their pain distributions with the stimulation.

Are There Risks Associated With Neuromodulation?

Infection is the most common complication, particularly with implantable devices; on average this risk is 2% for any infection. Important risk factors that can contribute to infection are diabetes, smoking and obesity.

The risk of a spinal fluid or cerebrospinal fluid (CSF) leak is approximately 1%. The risk of a devastating complication such as spinal cord injury is very rare, occurring in much less than 1% of cases.

Although almost all neuromodulation devices currently manufactured and implanted are MRI-compatible, certain precautions must be taken in terms of what type of MRI machine can be used.

Who Else Can Benefit From Neuromodulation?

In addition to chronic pain, neuromodulation devices are often used for movement disorders such as tremors, Parkinson’s disease and dystonia. Additional conditions that can be treated with neuromodulation include obstructive sleep apnea and urinary incontinence.

Neuromodulation also has a long history of use for psychiatric disorders, including obsessive compulsive disorder and depression.

Pain Relief is Possible

Patients with complex regional pain syndrome tend to do very well with spinal cord stimulation, and my last patient was a young woman who went from being unable to walk on her own feet to regaining full strength and having greater than 90% pain relief.

For deep brain stimulation, it’s very gratifying to test the stimulator in the operating room with the patient awake—one of my more recent patients started crying when she realized that her tremor was completely gone for the first time in decades.

If you or a loved one are dealing with chronic pain and feel like you’ve tried everything, talk to a healthcare provider about neuromodulation. You may be only one outpatient procedure away from finally finding relief.


Dr. Richard D. Fessler
Richard D. Fessler , M.D. Neurosurgeon

In 2013 Dr. Richard Fessler predicted the use of telehealth would become the norm as technology was in place to create visits for patients via a smart phone. Fast forward to 2020, Dr. Fessler saw his prediction become reality. The pandemic of a lifetime gave the entire healthcare industry a push into telehealth. Insurance companies expanded coverage for this type of visit with a push from Center for Medicare Service or CMS to cover costs.

“At MHSI we were ready to offer our patients this option when COVID caused concerns about safety for our patients and staff.  With the insurance barrier removed, it brought reassurance we could deliver the telehealth option and patients didn’t have to be concerned about unnecessary out-of-pocket-costs,” said Dr. Fessler. “We are thankful that our patients accepted the technology and the new way we are able to provide care.”

For example, when Tony couldn’t take his back pain any longer, he met with Neurosurgeon Dr. Ratnesh Mehra virtually and had trust that his surgical experience would be equally the same and relieve his back pain. Dr. Mehra recalls the day they met online, “Tony was able to effectively communicate with me about his pain and what he was feeling. At that point we decided that surgery for Tony was the right course of treatment and I met Tony in pre-op in person for the first time.” Tony says, “One week after surgery I was walking…dancing.”


Watch how intense pain stopped Tony in his tracks!:


To schedule a telehealth appointment with an MHSI neurosurgeon, call 248-784-3667 or visit


Michigan Head & Spine offers Telehealth appointments through Zoom Cloud Meetings. The following tips will help you prepare for a Telehealth visit.

Schedule an appointment
Your appointment can be scheduled through the office where you see your MHSI provider. On the day of your appointment you will receive a Zoom link and passcode. If you need to reschedule your appointment, please contact us within 24 hours of the appointment via the patient portal or by calling 248-784-3667.

Find the right location
Find a quiet place to communicate with your physician. Make sure this is a location where you won’t be disturbed by others coming into the room or background noises like the television, radio, pets, or noisy appliances. Be sure to have plenty of space around you – you may be asked to move around during your appointment so your physician can see your movements. DO NOT hold your Telehealth visit while you are driving or sitting in a vehicle – MHSI will reschedule your appointment as a result. Make sure there is plenty of light in the space where you hold the meeting so your provider can see you clearly.

Prepare your personal details
Come prepared to discuss your medical history or any pre-existing conditions you have. Be sure to mention any symptoms you may be experiencing since your last appointment. Check your prescriptions so you can discuss refills if they are needed. And, be sure to write down any questions or concerns you may have so you don’t forget to ask during the appointment. 

Set up technology
Telehealth appointments require an internet-connected device and use of a video source from a smartphone, computer with camera, or tablet. Make sure that your equipment is fully charged or plugged in and reliably connected to the internet before your appointment. Headphones or earbuds provide the best sound quality and can help reduce feedback or background noise.

Our virtual appointments are available through the Zoom Cloud Meeting application. Be sure that you have downloaded the most current program from the App store for your phone, tablet or computer. The application is free to download.

Test your software in advance of your scheduled appointment by visiting the Zoom website at https// 

Get connected
Be sure to be connected to the internet and locate the meeting link. Follow these steps to connect:

  • Click the Zoom link in the email or text to launch the Zoom application. 
  • Enter the Meeting ID and Passcode from the email appointment to join the meeting. 
  • You will see a preview window and a button that states “Join with Video,” click the button to begin. 
  • You may be asked by Zoom to allow permissions or enable video and audio.
  • Join the audio by selecting “Call via device audio” or “Call via internet”
  • Please be patient with your provider if they do not arrive precisely at the appointment time.

For more assistance a short video on How to Join a Zoom Meeting can be viewed here.

We will try to assist you in getting connected the best we can – but we cannot provide IT support. Please have assistance available with you at your appointment time if you have difficulties connecting. If you are unable to get connected, your appointment may be rescheduled.

Click here to download our connection tips sheet and keep it for future reference during your scheduled appointment.


Downriver Communities Now Have Neurosurgery Expertise

When looking for a neurosurgeon, you want someone you can trust with head, neck and spine conditions. Someone who has expertise with a good reputation. Someone close to home.

MHSI opened a new office, conveniently located on the campus of Beaumont Hospital, Trenton. Staffed by neurosurgeons Ratnesh Mehra, D.O., Pradeep Setty, D.O.  and Jeffrey Jacob, M.D., we offer the caliber of care and treatment you expect, only closer to home.

Neurosurgery is delicate, and you want the best, most experienced surgeons. The team at MHSI – Trenton has a complex set of skills including minimally invasive and robotic surgery, superior knowledge of brain tumors, and leading-edge experience with skull base and spine surgery.

Patients have long traveled to MHSI to be seen by specialists who provide the full spectrum of care for head, neck and spine conditions, because we provide a range of treatment and diagnosis options that are unparalleled in Southeast Michigan. And with the new Trenton office so close to home, receiving our care just got easier.

This is our tenth location and our first Downriver. Opening another office cements our mission to you: Provide the best, most experienced care. Spine, neck and head conditions are complex, and you want the best surgeon. With the team at MHSI working for you, helping you make the best decisions for your health, you know you have the professionals you want on your side.

The new location on Fort Street, on the campus of Beaumont Hospital, Trenton, opens up conveniences for patients as well. Imaging, testing, therapies and more are within arm’s length at the hospital, while the doctors you trust are right there with you.

We are accepting new patients, seeing post-op patients and continuing to provide care for those in the follow-up stage of care. You can call 248-784-3667 for an appointment, or request one online.

Expertise makes a difference, and the difference is MHSI.