Posts filed under 'Surgery'
July 7th, 2017
Neurosurgeons perform surgery to treat some strokes. Strokes can be treated in various ways. Doctors decide on a course of action by considering a patient’s age, health and the type of stroke they had. Every surgery has benefits and risks that doctors and patients need to weigh.
Surgery to Treat an Ischemic Stroke
An ischemic stroke is when plaque, a fatty substance, accumulates and narrows arteries, cutting off the blood supply to the brain. This condition is called atherosclerosis. The plaque slows blood flow and can cause clots to form.
If the carotid arteries, those in the neck, are blocked, a surgeon may recommend surgery to clear the blockage. During this procedure, the neurosurgeon removes the plaque that has built up.
Ischemic strokes have other causes besides atherosclerosis. They include:
- Heart attack
- Injury to blood vessels in the neck
- A problem with blood clotting
- Heart valve problems
- An irregular heartbeat
Ischemic strokes may be one of two types:
- Thrombotic strokes are when a blot clot forms in an artery that sends blood to the brain.
- Embolic strokes are are caused by a clot that originates somewhere else in the body then moves through vessels to the brain stopping the flow of blood.
Some symptoms of ischemic strokes are:
- Sudden weakness and numbness in the leg, arm or face. These symptoms may affect only one side of the body.
- Double vision or loss of vision
- Dizziness, trouble walking or with balance or coordination
- Trouble speaking or comprehending speech
Surgery to Treat Hemorrhagic Strokes
A hemorrhagic stroke is when bleeding in the brain causes damage. An aneurysm, a weak spot in a blood vessel, that breaks is sometimes the cause of these types of strokes. Another cause of hemorrhagic stroke are abnormal blood vessels, also called arteriovenous malformation.
Bleeding may happen between the brain and the skull. When that happens, it is called a subarachnoid hemorrhage. During an intracerebral hemorrhage the bleeding is inside the brain.
Treatment for these types of strokes include:
- Draining the blood around or in the brain
- Repairing the brain aneurysm
- Removing or blocking abnormal vessels that caused the bleeding
Symptoms of hemorrhagic stroke are often severe and sudden. They include:
- An intense headache
- Loss of consciousness
- Vision problems
- Light sensitivity
Strokes are a serious and life-threatening condition. If you think you are having a stroke, call 911. Speak to your primary care physician to discover if you have risk factors for stroke.
Dr. Todd Kuether is a neurosurgeon in Portland, Oregon. He helps patients who need brain surgery or spinal surgery. His expertise includes endovascular aneurysm and stroke treatment. To make an appointment, please contact his office.
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October 24th, 2016
You want the best when you’re choosing a back surgeon. That goes without saying. But, how do you know if a surgeon is the best doctor for you? Most cities, including Portland, have several neurosurgeons from which to choose.
Your primary care physician may refer you to a back surgeon. You may have the option of traveling to another city for your operation. Ultimately, it’s you who will decide who to trust with your surgery.
How to Choose a Back Surgeon
Start by learning more about your diagnosis. Speak with your primary care physician and research online or at the library. If you are already seeing a neurosurgeon, ask the doctor lots of questions. Get more than one opinion if you want to. When evaluating a doctor, ask yourself these questions:
• Are you at ease speaking with the surgeon?
• Does the doctor and office staff answer your questions fully?
• Does someone from the medical office respond to your calls and questions promptly?
To get proper care, you need to have a good relationship with your healthcare providers. Patients and doctors are partners in medical care. Your surgeon will gather information from you about your condition. It’s vital to feel comfortable and confident when you speak with your physician.
Learn About the Surgeon’s Experience
Choose a doctor whose specialty is spinal surgery. Ask the surgeon what types of procedures they have performed and how many times they have performed a particular operation. Dr. Kuether treats various back and brain problems and specializes in noninvasive procedures. You can learn more about his experience and training here.
Is the Surgeon Board Certified?
Look for a neurosurgeon who is board certified and works at a reputable facility or hospital. Dr. Kuether is board certified in neurosurgery. At Legacy Emanuel Hospital he is the Director of Neurotrauma, where he works in the nationally recognized neurosciences department.
Does the Surgeon Practice Near Your Home?
When all else is equal, it’s nearly always preferable to have surgery near your home. Your care will be more convenient if you don’t have to travel out of town for an operation or pre-and post-operative appointments. Dr. Kuether works in several locations in the Portland-metro area. He has offices at Meridian Park and Emanuel Hospital. He operates at Legacy Good Samaritan, Legacy Emanuel and Wilshire Surgery Center.
What If There Isn’t a Neurosurgeon in My Town?
Some patients must travel for medical care. Patients in rural areas or small towns don’t usually have access to a neurosurgeon. Some people simply prefer a surgeon who lives in another city. In some cases, you can complete tests and paperwork remotely. Speak with your doctors to find out more.
Are you looking for a back surgeon? Contact us for information about our services.
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May 13th, 2016
The prospect of undergoing brain surgery is scary. You’re facing the unknown. You probably feel vulnerable. Questions, important and trivial, fill your thoughts. Preparing for your procedure will empower you. By taking charge of those things you can control, you feel calmer and better able to cope.
Communicate openly with your neurosurgeon. Research your condition. Ask lots of questions. Arm yourself with information. If you have a thorough understanding of the surgery, you can partner with your medical team. A patient isn’t a passive subject. Actively participating in your care helps you stay strong through the procedure and during recovery.
Getting Cleared for Your Operation
Before brain surgery, patients complete a tried-and-true procedure to ensure they are medically fit for surgery. You will speak with your doctor about medications you take. You may be required to see an internist or specialist who will check your ability to withstand the stress of surgery.
If you have medical conditions that could complicate brain surgery, these may need to be resolved. For instance, those with heart disease may need further tests or treatments before undergoing brain surgery.
Coping With the Risks
Only you and your doctors can decide if surgery is right for you. If you’re undergoing elective surgery, you’ll have time to weigh the benefits against the risks. Every surgery has side-effects.
Ask your surgeon about the dangers of your procedure. Find out how many times the surgeon has successfully completed the same operation. You may get peace of mind by having legal documents, such as a living will or advanced directive, in place.
It may not be easy, but speak with family members about worst-case scenarios. Let key members know that you have an advanced directive. If it’s not possible to speak with those close to you, consult your lawyer and draw up the documents.
Find Comfort In the Familiar
Hospitals can be less than soothing. They are filled with strange equipment. Monitors beep when you’re resting. Compression sleeves suddenly inflate around your legs. Technicians come to poke, prod and peer. You’re tethered to poles with bags of blood and fluids.
Counteract the unfamiliar routines and contraptions by bringing a little bit of home to the hospital. Pack your favorite slippers, pillow, blanket or pajamas. Maybe you find comfort in a book, music or a photo of someone you love. Perhaps you have a lucky talisman, or a symbol of your faith. Whatever it may be, bring it with you if it helps you relax.
Your medical team will give you additional instructions to prepare for your procedure. Rely on your caregivers to help you while you’re in the hospital. Follow their recommendations for recovery.
Dr. Kuether is a skilled brain surgeon. If you have questions about your diagnosis, contact him at 503.489.8111. He is accepting new patients.
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March 24th, 2016
Do you know the symptoms of a brain tumor? Some tumors produce no signs, and some common brain tumor symptoms are shared with other conditions. Tumors sometimes, but not always, require brain surgery.
Dr. Kuether is an experienced brain surgeon. He is always accepting new patients. Please contact our office at 503.489.8111 to schedule an appointment.
What Is a Brain Tumor?
A brain tumor is a mass of abnormal cells growing in the brain. Tumors grow at an uncontrollable rate. Normal cells age and die before new cells form to replace them. Tumor cells don’t die.
Tumors continue to increase in size as more tissue is added to the mass. There are benign and malignant tumors. Benign tumors are those that do not contain cancerous cells though they may cause health problems. Malignant tumors are those that are cancerous. Cancerous tumors generally grow faster than noncancerous ones.
Common Symptoms of Brain Tumors
A diagnosis usually begins with a doctor asking a patient to describe symptoms. If the signs are consistent with a brain tumor, the physician may recommend making an appointment with a neurosurgeon. The surgeon may advise brain surgery or another type of treatment.
If you have any of the following indications or suspect you have a brain tumor, see a doctor immediately.
Headaches: Pain is caused by pressure from the tumor on the brain’s nerves. The pain from a tumor is persistent, continuous and may be worse at night. Pain from a tumor may not respond to medication. Pain may be more severe during physical activities.
Seizures: A seizure is a sudden convulsion caused by abnormal electrical activity in the brain. Seizures usually happen quickly. Victims lose control of their bodies during an episode. A person suffering from a seizure may lose consciousness and be unable to control movements. After a seizure, pain, numbness or weakness may linger.
Drowsiness: As a tumor grows, a patient may feel drowsy and sleep more. As the tumor progresses, the sufferer may find it difficult to stay awake. Sometimes these tendencies progress until the person falls into a coma.
Memory Loss: Loss of memory, particularly of short-term memory, is a common symptom of tumors.
Vision or Hearing Problems: A tumor may cause blurred or double vision. A sufferer may see flashing lights or experience deteriorating sight. Changes in pupil size or the appearance of the eyes can occur. Some people lose hearing on one side or hear ringing.
Mood Changes: Brain tumor patients often suffer from depression which tends to grow as the tumor progresses. Insomnia, low energy and thoughts of suicide may also be present.
Behavior Changes: In addition to anxiety, a brain tumor may cause significant changes in behavior. For instance, patients may get irritable and have trouble with written and spoken language.
Don’t ignore these health problems if you have any of them. These signs may be an indication of a brain tumor.
A tumor isn’t something you can identify yourself. If you suspect something is wrong, make an appointment to see a doctor. If you’re diagnosed with a brain tumor, consult a neurosurgeon who will advise you on a course of treatment.
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March 7th, 2016
Are you considering a spinal fusion? A surgeon may recommend spinal fusion to relieve pain and restore a person’s ability to perform day-to-day activities. Only you and your doctor can decide if this operation is right for you.
How Does a Spinal Fusion Work?
Spinal fusions stabilize the spine. During surgery, vertebrae are fused with a bone graft. The affected vertebrae heal into a single unit. In addition to relieving pain, a fusion prevents abnormal movement of the bones. It may prevent nerves, ligaments and muscles from stretching.
There are several variations of the surgery. No matter which type of procedure is chosen, they all have a few things in common:
– Bone is grafted to problem vertebrae.
– After surgery, the bone graft grows and connects the vertebrae.
– The fusion stops the vertebrae movement that caused pain.
What Conditions Can Be Treated With Spinal Fusion?
Various conditions can be improved with a spinal fusion. If you have pain in the lower back, a doctor will attempt to determine the source of the condition. Your doctor may order an imaging test such as an X-ray, CT scan or MRI scan.
Some of the conditions treated by a spinal fusion are:
– Degenerative disc diseases
– Spinal Stenosis – abnormal narrowing of the spinal canal
– Scoliosis – abnormal curvature of the spine
What Types of Procedures Are Available?
Surgery may be open, or it may be minimally invasive. A surgeon may perform the operation through an incision in the abdomen, in the side of the body, or in the back. Minimally invasive procedures involve smaller incisions and shorter recovery times.
A bone graft is required in all types of spinal fusions. During the graft, small pieces of bone are placed between the vertebrae. The bone for the graft may be taken from the patient’s hip or from a cadaver bone. Manufactured or artificial materials are sometimes used instead of bone.
What Does Recovery Involve?
Recovery time varies depending on the type of procedure and a patient’s health. The graft may take several months to grow. While healing, the spine needs to be immobilized. Some patients wear a back brace. Internal devices may be used to keep the graft in place. For instance, plates, rods or screws may be implanted. A doctor may recommend physical therapy to teach safer ways of moving during recovery and beyond.
What Are the Complications From Spinal Fusion?
Spinal fusion is not a new type of surgery. Many decades of experience have tested the effectiveness and safety of the treatment. Still, before any surgery, it’s important to discuss the potential complications of the procedure. Here are some of the possible side effects of a spinal fusion:
Loss of flexibility – This is true for most patients, though the loss is considered minor.
Infection – As with any surgery, there is a risk of infection.
Pain at the surgery site – Some patients have experienced pain where the bones were grafted.
Recurring symptoms – The original symptoms may recur after surgery.
Nerve damage – During the operation, patients’ nerves or blood vessels may be damaged.
Blood clots – Blood clots in the legs may form.
Dr. Kuether specializes in minimally invasive spinal surgery. If you are experiencing back pain, call us to discuss your treatment options.
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March 1st, 2016
Endoscopic carpal tunnel surgery is a minimally invasive procedure for treating the symptoms of carpal tunnel syndrome. Endoscopic surgery uses small incisions and recovery is generally faster than from open surgery.
What Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a painful condition of the wrist, hand and fingers. It is caused by the compression of the median nerve at the front of the wrist. Symptoms include pain, tingling, numbness and a loss of grip.
The carpal tunnel is between the transverse carpal ligament and the bones of the wrist. The median nerve, which controls the thumb and first three fingers, runs through the tunnel.
Repetitive movements over a long period or fluid retention can cause or exacerbate the condition. Pregnancy, diabetes or a genetic predisposition, may increase a person’s risk of developing carpal tunnel syndrome.
How Does Endoscopic Surgery Work?
Surgeons use an endoscope, a thin tube containing a camera and light, during the procedure. The endoscope is inserted into a small incision at the wrist or on the palm. The camera allows the surgeon to see inside the patient’s wrist.
The surgeon performs the procedure using tiny cutting tools. These tools may be attached to the endoscope, or they may be inserted through a separate small incision.
The surgeon cuts the transverse carpal ligament, releasing pressure on the median nerve. The gap in the ligament eventually grows together with more space for the nerve.
The operation is usually an outpatient procedure done under a local anesthetic. Many people can return to work in a day or two.
What Are the Advantages Endoscopic Surgery?
Open surgery requires 4-inch incisions. Incisions for endoscopic surgery are about ½ inch. Less invasive techniques mean patients generally recover faster and have fewer complications. Other advantages include:
– Less pain during recovery and beyond.
– Quicker return to daily activities.
– Less time away from work.
– Smaller, less noticeable scars.
– Reduced need for rehabilitation and physical therapy.
– Faster recovery time is an important advantage for those who depend on crutches, a wheelchair or need surgery on both hands.
Are There Nonsurgical Alternatives?
Some people find relief through rest, acupuncture or physical therapy. If symptoms are caused by repetitive motions at work, a splint and more frequent breaks may help. Medications may provide temporary relief from pain and swelling.
Why Hire a Brain Surgeon for a Wrist Operation?
Endoscopic carpal tunnel release is most successful when performed by a surgeon with experience in these specialized techniques. The wrist contains vital nerves, located close to the carpal ligament. Proper division of the ligament reduces the chance of complications and a second surgery.
Dr. Keuther has more than 14 years of experience performing minimally invasive procedures. He has successfully used endoscopic techniques in carpal tunnel release, brain and spine operations.
Contact him in Portland, Oregon at (503) 489-8111.
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November 9th, 2015
A brain aneurysm diagnosis can be terrifying. Even though a ruptured aneurysm is somewhat infrequent, it can still signify a very serious illness that can lead to disability and even death.
Here is an overview of what a brain aneurysm is and what the surgical treatment entails. Information about this condition can help ease fears and bring a sense of support during a challenging time.
What is a brain aneurysm?
Otherwise known as a cerebral aneurysm, this condition occurs when there is a bulging spot on the wall of a brain artery, which can be likened to a thin balloon. As time goes on, the blood flow within the artery will hit against the thin portion of the wall and aneurysms can form, causing significant wear on the arteries.
Once the artery wall becomes thinner, the blood flow causes the weakened wall to swell. The pressure can cause the aneurysm to burst and blood will flow around the brain. If this happens, surgery is often needed to fix it.
What are the symptoms?
Brain aneurysms that are unruptured often will not cause any symptoms. But, if the aneurysm is large enough, it can sometimes press on the brain or nerves which can cause neurological symptoms, including dilated pupils, blurred or double vision, pain above and behind the eye, nausea/vomiting, stiff neck, loss of consciousness, difficulty speaking, localized headache, weakness, or numbness.
What does the brain aneurysm surgery involve?
There are two common surgical approaches to repairing an aneurysm. The first method is when the doctor clips the aneurysm, which is completed through an open craniotomy. Here, the physician creates a hole in the skull to attend to the area where the aneurysm is located. The other way it can be treated is through endovascular repair, which is a less invasive method that involves inserting a coil or stent.
Patients who undergo the aneurysm clipping will be put under general anesthesia with a breathing tube. Then the scalp, skull, and coverings of the brain are opened. A metal clip is inserted at the neck of the aneurysm to prevent it from bursting.
Patients who have the endovascular repair will either have general anesthesia or a medicine to sedate them without putting them to sleep. A catheter is guided through the groin to an artery, then the blood vessel where the aneurysm is located. A contrast dye is injected through the catheter which allows the physician to look at the arteries and the aneurysm on a monitor.
Once it is located, thin metal wires are put into the aneurysm, which then coil into a mesh ball. Sometimes, mesh tubes are also put in to keep the coils secure. If blood clots form around the coil, it will prevent the aneurysm from bursting.
After the surgery is completed and deemed successful, it isn’t common to have a bleeding aneurysm again in the same area. Patients will likely need to be seen by a doctor every year to discuss progress and prognosis, but most of the time these surgical repairs can prevent further brain aneurysms.
For more information contact the office of Dr. Todd Kuether. Dr. Kuether performs brain surgery at Legacy Emanuel Hospital and Legacy Good Samaritan Hospital both located in Portland, Oregon. Dr. Kuether sees patients at his Emanuel Hospital location and also in Tualatin at Legacy Meridian Park.
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November 5th, 2015
Major surgery raises questions, such as concerns about your diagnosis and treatment. New patients may worry about paying for your care. You may be uncertain what your insurance covers. Most patients want to know what to expect from their insurance company before going into surgery.
Dr. Kuether’s staff can help you understand your benefits. We accept most private insurance and worker’s compensation claims. No matter what your level of coverage, we can help you. We may be able to arrange discounts and payment plans.
Some types of brain and spine surgery are scheduled well ahead of time. If Dr. Kuether is treating you for carpal tunnel syndrome, neck pain or back problems, you’ll likely have time to investigate your coverage and get pre-approvals.
Speak with your insurance company to learn about your benefits. Your insurer will let you know what portion of your treatments are covered and what portion is your responsibility. If you have disability coverage, you may be able to collect benefits while you recover from surgery.
Ask your medical or disability insurance company the following questions before you schedule a surgery:
* What is my policy’s maximum payout? Does this procedure fall within that limit?
* Does my policy pay for post-surgery home health care or rehabilitation? What is my prescription drug benefit?
* What is my disability benefit? How much will I receive each week?
* How long after surgery until my disability coverage starts?
There are three basic types of health coverage. Each type handles patient care differently. Most plans require copayments and some have deductibles. Here’s an overview of how each type of insurance handles referrals.
* Health maintenance organizations: An HMO pays for medical care when you visit a doctor within the network. Most require a referral before seeing a specialist. You’ll have to pay your expenses if you visit a provider outside the network.
* Preferred provider organization: A PPO allows you to choose your doctors. If the doctor you see is not a preferred provider, you’ll pay more than if you see in-network physicians.
* Point of service: A POS generally requires a referral to see a specialist. You can visit an out-of-network doctor, but you’ll be responsible for a higher portion of your expenses.
A ruptured brain aneurysm is a life-threatening crisis that requires prompt treatment. If you have a health crisis, you won’t have time to query your insurance company. Insurance companies handle payment for emergency care differently.
We understand no one wants to worry about medical expenses when they need an operation. We’ll do our best to make it easier by helping you understand your plan and coverage.
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March 27th, 2015
Clinical innovation moves at breakneck speed, and this year saw a number of ‘firsts’ in spine surgery. Here are four that could potentially change the spine industry:
First ever spine surgery with 3D-printed vertebral body
In August, spine surgeons made history when they performed the first spinal disc replacement implanting a 3D printed vertebra. Three-dimensional printing technology uses digital models of a patient’s anatomy to construct a “printed” customized implant in almost any material. The technology isn’t new per se, however applying it to the orthopedic device space is cutting-edge.
The spinal procedure in China using a 3D-printed vertebra replaced the second vertebra in a 12-year-old boy’s neck. After the procedure, the patient’s head was framed with pins and will remain that way for three months. Dr. Liu Zhongjun performed the procedure and said the customized 3D printing technology made the surgery stronger and more convenient than other procedures.
The 3D printing in medical applications market is expected to reach $0.9 billion by 2019, according to a new report from Transparency Market Research. North America held the largest market share for 3D printing in medical applications in 2012, and several device companies are looking to this technology. Medicrea offers 3D-printed UNiD ALIF customized cages, which are part of the company’s entire patient-specific spine implant offerings. In August, Oxford Performance Materials was honored by the New Economy Magazine for developing an additive manufacturing technique with ultra-high performance PEKK to print patient-specific functional and biocompatible prosthetic implants. OPM is the only company with FDA clearance to manufacture 3D polymeric orthopedic implants.
It may be years before spine surgery with 3D printed implants becomes the standard of care, however, it has the potential to change the spine industry as we know it.
First U.S. fetoscopic spina bifida repair successful at Texas Children’s Hospital
The first two-port fetoscopic procedure to repair spina bifida in-utero in the United States was performed this year by surgeons at Texas Children’s Fetal Center and Baylor College of Medicine, both located in Houston. Michael Belfort, MD, obstetrician and gynecologist-in-chief at Texas Children’s Hospital, and William Whitehead, MD, a pediatric neurosurgeon developed the procedure. The team also worked with Dr. Jose Luis Peiro and Dr. Elena Carreras of Vall D’Hebron Hospital in Barcelona, Spain.
The surgery features an in-utero, single layer, suture repair through two different four-millimeter incisions in the uterus. Physicians use a carbon dioxide gas technique during the procedure to repair the spina bifida.
Years of preparation and training went into developing the program both nationally and internationally. Before performing the procedure, Drs. Belfort and Whitehead performed more than 30 simulated procedures using the simulator including two full simulations, gowned and gloved under actual operating room conditions with a full support team.
While the procedure was successful, the final outcome remains to be seen. “While we have had a technical success with this procedure, we will only be able to truly know the outcome once the baby has been delivered and we are able to assess the spina bifida repair,” says Dr. Whitehead.
Spinal cord stimulation results in voluntary movement for paralyzed patients
In April, a study was published in Brain showing that paralyzed spinal cord injury patients may be able to regain voluntary movement in their legs and feet. The study was conducted by researchers from the University of California, Los Angeles and the University of Louisville (Ky.), who implanted spinal-cord stimulators made by Medtronic into the three paralyzed individuals, according to a Wall Street Journal report.
Neuromodulating the spinal circuitry with epidural stimulation combined with physical therapy has resulted in three individuals being able to wiggle their toes, flex their legs and even stand independently for moments at a time. Two of the three individuals had complete paraplegia and previously could not move at all.
Spinal cord stimulation currently does not allow a paralyzed individual to walk again, however, the researchers found that in addition to standing, the therapy does help improve a number of other bodily functions, such as bowel and bladder function, according to a CBS News report.
The research was partially funded by the National Institutes of Health and the Christopher & Dana Reeve Foundation, the CBS report notes.
Stem cell transplant reverses spinal paralysis
An Anglo-Polish team of physicians in Britain pioneered the new technique that has reversed spinal paralysis for the first time. The medical team implanted harvested cells — known as olfactory ensheathing cells, which repair damage to nasal nerves — into an 8mm gap in the spinal cord of Darek Fidyka, a Bulgarian who was confined to a wheelchair after being stabbed in the back in 2010.
Physicians reported that the cell implants on the two “stumps” of the spinal cord slowly restored the nerve fiber connections between both sides, returning feeling and movement to Mr. Fidyka’s legs. Around 10 months after the surgery in 2012, Mr. Fidyka was able to walk with the aid of braces and a walking frame.
The new technique has thus far only been applied to Mr. Fidyka. The medical team and other experts emphasize further testing.
Professor Geoff Raisman, chair of neural regeneration at University College London’s Institute of Neurology, who led the research team in Britain, told BBC News that what had been achieved was “more impressive than man walking on the moon.”
More articles on spine:
Two-level spine surgery economic analysis: Disc replacement vs. ACDF
How does obesity impact lumbar spine treatment? 5 key findings
3 trends in ASC spine care
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April 10th, 2011
Dr. Kuether achieves “America’s Top Surgeon” award for 2011 in Neurosurgery: Consumers’ Research Council of America, a Washington, D.C. based research organization, provides consumers information guides for professional services throughout America. Consumers Research Council of America helps educate and assist consumers in obtaining the finest professional services. Surgeons are selected based on a criteria including level of training, level of experience, professional associations, and board certification.
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