News Archives - 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 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 or call 248-784-3667.


Dr. Tejpaul S. Pannu

Tejpaul S. Pannu, M.D.

The cervical vertebrae are the part of the spine we use the most on a daily basis to go about our normal lives, and are made up of the top seven bones in your spinal column. Understanding these vertebrae, including what can go wrong with them and how problems can potentially be avoided, can help you decide if your cervical vertebrae may benefit from specialized care due to chronic pain or injury.

The Function of Cervical Vertebrae

In addition to protecting the spinal cord, which contains nerves that send signals throughout the body from the brain, the cervical vertebrae play a key role in flexibility and mobility.

The two uppermost cervical vertebrae connect to the skull and are critical for turning our heads side to side and up and down. The cervical vertebrae also serve as a conduit for the nerves that go into your hands and arms, so when there’s pain or disfunction from your cervical vertebrae, there’s a good chance you’ll feel it in your extremities, too.

In general, these seven vertebrae flex and move more and differently than any other part of the spine. Just sitting and having a conversation with a friend, you’re going to use your cervical spine much more than the rest of your spinal column.

What Can Go Wrong with Cervical Vertebrae?

Problems with the cervical vertebrae can be congenital, meaning a person is born with them, or they may arise as a result of degeneration due to injury and/or the general wear and tear caused by aging.

Sometimes people don’t know they have a congenital spinal issue until later in life, when they start having pain or other symptoms. As you get older and your skeleton starts to age, issues come to the forefront that may have never bothered you before. Other congenital conditions that affect cervical vertebrae, such as congenital cervical spinal stenosis, may never cause any symptoms.

Due to gravity and upright walking and sitting, we all experience some degeneration of the cervical vertebrae. Injuries to the spine can also add up over the course of a person’s lifetime, exacerbating degeneration. And an accident or fall can cause sudden and acute damage to the cervical vertebrae.

Cervical issues tend to be more problematic than those affecting other parts of the spine because the cervical vertebrae are closest to your brain. All inflammation starts in the brain and works its way down through the spinal cord, so compression of the cervical vertebrae can cause problems as varied as hand numbness, bladder urgency and gait instability.

Managing Neck and Spine Issues

Whether the damage happens gradually or all at once, problems in the cervical vertebrae can be effectively addressed in several different ways.

The first thing a neurosurgeon will want to do is assess your symptoms, including levels of pain, weakness, and numbness as well as ability to perform tasks such as grasping and walking. Depending on the type and severity of your symptoms, your provider will work with you to decide on a course of treatment.

For mild to moderate symptoms affecting the cervical vertebrae, non-invasive treatments can work quite well. These include physical therapy, acupuncture, chiropractic adjustments, pain injections and laser therapy.

For more serious cases — if your pain is so bad that it affects your ability to function, or if you’re having trouble walking, with or without falling — a specialist may recommend surgical intervention. Surgery may also be considered if you’ve tried less invasive treatments without success. Cervical vertebral surgeries, many of which are minimally invasive, tend to have a very high success rate.

When to See a Specialist

You may not give your cervical vertebrae much thought until they start to trouble you, but this small set of bones does a big job.

Because the cervical vertebrae are so critical for spinal and overall health, it’s a good idea to check with your general practitioner if you have neck pain that lasts for more than a couple weeks, or if you’re experiencing any type of weakness, numbness (also called neuropathy) or difficult grasping or holding objects.

You can also go directly to a specialist who can perform a thorough evaluation and design a treatment plan for your specific needs.

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



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.



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 or call 248-784-3667.



<div class="at-above-post-cat-page addthis_tool" data-url=""></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-cat-page addthis_tool" data-url=""></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 or call 248-784-3667.


Every year, about 80,000 people are treated by neurosurgeons with a tool called the Leksell Gamma Knife®, which treats small and medium-sized brain tumors.

Understanding Gamma Knife treatment, including how and when it is used, can help you determine if you may be a good candidate for this highly effective, non-invasive procedure.

Contrary to its name, the Leksell Gamma Knife® doesn’t involve a knife or blade, and the surgeon makes no incisions. The treatment is a type of radiation based on the concept of concentrating beams of radiation into a very small point. It was invented by a Swedish neurosurgeon, Professor Lars Leksell, in 1967, and is also called radiosurgery or stereotactic radiosurgery.

The Gamma Knife functions similarly to a magnifying glass that, when held up in the sun, concentrates the sun’s rays into a tiny, powerful beam. The Knife is used to deliver focused radiation to small areas of the brain in a very exact way.

Gamma Knife treatment can be used for:

  • Small to medium-sized brain tumors that arise from the brain itself
  • Malignant (cancerous) brain tumors that have spread from other parts of the body such as the breast, lung or kidney
  • Small blood vessel abnormalities such as arterio-venous malformations.

Benefits of Gamma Knife Treatment

If the Gamma Knife is like a magnifying glass, conventional radiation treatment is like being at the beach — when you get a sunburn, you get it over your whole body. And when conventional radiation is used to treat brain lesions, it also irradiates (and damages) otherwise healthy brain tissue surrounding the lesion.

Because Gamma Knife treatment uses highly focused radiation to very exact points of the brain, it minimizes damage to the brain while maximizing the positive outcomes for the patient.

What Does Gamma Knife Treatment Involve?

Gamma Knife treatment is a painless, outpatient procedure that only needs to be performed once. On average, the procedure takes around two hours.

Patients remain awake throughout the procedure and are generally able to go home and return to normal activities a few hours after treatment. Within a few months, tumors may begin to shrink. In many cases, the tumor shrivels down and disappears.

Are You Eligible for Gamma Knife Treatment?

Many brain abnormalities that can be treated with conventional radiation may also be treatable with Gamma Knife radiation, if they are small enough.

For example, a woman with a brain tumor that came from her breast could be an excellent candidate for Gamma Knife treatment, provided the tumor is less than one inch in diameter. After using an MRI to pinpoint the tumor’s location, a neurosurgeon trained to use the Gamma Knife would work with a radiation oncologist to devise a treatment plan.

Working together, the neurosurgeon and radiation oncologist would perform the Gamma Knife treatment to eventually eliminate the tumor.

If you or a loved one are dealing with a small brain tumor or other abnormality, consider reaching out to a Gamma Knife specialist who can help you determine if this noninvasive, highly effective treatment is an option for you.

If you or a loved one is seeking treatment for a brain tumor, are interested in Gamma Knife radiosurgery, or to schedule an appointment with Dr. Diaz or any of our MHSI experts, visit 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