Posts filed under 'Spine'

What is Spinal Fusion Surgery?

On August 3rd, 2017

The spine is the core of the human body. If you suffer from severe spine pain, you’ll have to do whatever it takes to recover as quickly as you can.

Sometimes, surgery tends to be a necessity for many people who put off their spinal issues for considerable amounts of time. One form of this surgery is spinal fusion.

Older woman with back pain

What happens during spinal fusion surgery?

Spinal fusion is a welding process that essentially fuses vertebrae together into a single bone. Doctors will recommend this type of surgery when they know exactly where the source of your pain is. Spinal fusion may be used to treat:

  1. Spinal stenosis
  2. Degenerative disk disease
  3. Spondylolisthesis
  4. Scoliosis
  5. Tumor
  6. Infection

Spinal fusion eliminates motion between vertebrae, ultimately alleviating the pain. With that, there will be a slight loss of spinal flexibility, which is a minor trade-off for an extremely necessary procedure.

How does spinal fusion surgery work?

The doctor will approach your spine from either the front or the back and insert a bone graft in between the vertebrae. This facilitates the fusion.

Bone grafts help the vertebrae heal together into one bone, and there are several different artificial bone graft materials that are widely used today including:

  1. Demineralized bone matrices (DBMs), which are cadaver bones with the calcium removed. This causes the bone to be changed into a gel-like substance, and DBMs are used many times with other grafts.
  2. Other synthetic bone-forming proteins that help with spinal fusion are called bone morphogenetic proteins. These are FDA-approved only under certain circumstances.
  3. Another common bone graft material is ceramics, which have a similar shape and consistency to real bone.

How long is the recovery process after this surgery?

Following the bone grafting and spinal fusion procedure, immobilization is crucial to let the fusion happen and to allow the spine to properly align. Even afterwards, we usually recommend just light activity, like walking.

Every surgery will result in some pain, and that’s why it’s crucial to continually work with your doctor post-surgery to successfully facilitate the healing process.

Medication is sometimes a controversial aspect of the recovery, as opioids are commonly used to help manage pain. The public health issues in the United States with opioids are a crucial epidemic, and alternative medications have become widely used in recent years.

Needless to say, this entire process requires a lot of endurance from the patient and trust in your doctor. That’s why, when you are in the initial planning of a spinal fusion surgery, you are going to want to do your research and find the best doctor for you.

Dr. Todd Kuether is one of the most knowledgable and experienced neurosurgeons based in Portland, Oregon. If you have any questions or concerns at all you should reach out to his office through this contact form.

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Why Does My Back Hurt?

On December 10th, 2016

Is back pain treatable? Many people live in pain because they believe there’s no cure for an aching back. Sometimes, these fears are validated by a physician. While back pain and injuries can be difficult to treat, there are ways to lessen and prevent problems.

Why Does my Back hurt.

An integrative approach, involving doctors and therapists, may increase your chances of curing a back-related ailment. Spinal surgery is sometimes an option, but only after you and your doctors have exhausted all the nonsurgical treatments.

Small Incisions Speed Healing

Back surgery techniques have improved over the years. Dr. Kuether, a Portland, Oregon spinal surgeon, can perform many procedures using minimally invasive techniques. Rather than open surgery, Dr. Kuether operates via a small catheter. Patients heal faster and with less pain because incisions are minuscule.

Typically, doctors, therapists, and patients work jointly to formulate plans for recovery and care. A team-based approach is the most efficient way to back pain recovery. Doctors bestow the benefit of powerful medical prescriptions. Therapists put together plans that guide their patients to recovery.

Together, doctors and therapists can cure or reduce the ailments associated with back pain. The road to recovery can be arduous. But, with guidance, you can work your way to recovery.

Why Does My Back Hurt?

The majority of back related issues surface as lumbar spine (lower back) symptoms. These symptoms may begin abruptly or gradually.

The underlying causes vary. In some cases, the acute onset of pain may stem from traumatic injuries. For example, a car accident, a direct blow to the lower back, or a fall, may trigger the onset of lumbar spine symptoms.

Lower back pain is also associated with non-traumatic causes. These include reduced flexibility, physical and mental stress and improper posture and movements.

Prevent Back Pain

You can take measures to avoid back pain. Improving your posture may lessen your pain or prevent it altogether. Sit and stand properly to reinforce healthy habits. Your head and shoulders should remain upright and straight. Avoid prolonged sedentary behavior as this can complicate back pain.

Improving our body’s movement or mechanics may also reduce or prevent back pain. For example, people who lift objects incorrectly are more likely to have back pain. When lifting things, it is important to use the body’s stronger, lower muscles, rather than upper body muscles. This means your knees and using your glutes and legs. Twisting while lifting is also not recommended.

Stress management is imperative to prevent back pain. The onset of stress can lead to unbearable bouts of inflammation. Therefore, simple stress management techniques, including meditation or visualization, can decrease your chances of lumbar pain. Strength training is key to fortifying your back. Regular exercise, three to five times per week, can improve both strength and flexibility.

These techniques may improve back health, but if you experience pain for more than a few days, consult a physician.

Speak With a Back Surgeon in Portland, Oregon

Kuether Brain and Spine helps those who need back surgery. Contact us for information about our practice.

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Water Workouts for an Aching Back

On November 28th, 2016

Pain makes it difficult to do what you want to do. When your back aches, you may not be able to exercise. Water workouts for an aching back can be a gentle alternative for those who have pain. Before you begin a new exercise program, check with your primary care physician.

water workouts

If you have chronic back pain, your doctor may recommend you see a spinal surgeon. Surgery has helped many people with back pain and problems. Medications, physical therapy and alternative medicine are options for some people.

Dr. Todd Kuether is a back surgeon in Portland, Oregon. He performs minimally invasive endoscopic surgeries that help patients live without pain. He has successfully treated spinal stenosis, disc degeneration and other spinal conditions that commonly cause pain.

The Benefits of Exercising in Water

Whether you’ve had surgery or not, exercise can help keep your back stronger. Some people also find relief from discomfort when they perform regular low-impact activities. Working out in water offers an aerobic workout without the pounding.

If you’re a fan of soaking in a warm tub, you’ve felt the comfort of floating in the water. When you’re in a pool or tub, you may feel less pressure and pain in your back, hips, knees and feet.

Water’s buoyancy allows some people to move with less pain. They can work on strength, flexibility and cardiovascular fitness with less pressure on the spine and other joints. When you’re immersed up to the neck, water supports most of your weight. Even waist-deep water offers relief from pressure.

Pool workouts or therapy describe a variety of activities. A doctor or physical therapist may recommend a particular type of exercise. While water activities are easy on your joints, they can still be vigorous. The resistance of the water makes moving more difficult. Pace yourself, and don’t do anything that hurts.

Water Workouts for an Aching Back

Swimming is an excellent way to stay in shape, but it’s not your only option. Here are a few more ideas:

Walking: Walking in water is one of the easiest ways to start working out in the pool. You can walk lanes in the shallower sections of a pool. This is an effective cardiovascular workout that also strengthens lower-body muscles.

Aerobics: Many community centers offer water aerobics classes. Group exercise is often more fun than solo pursuits. A well-designed class includes a range of movements, including exercises for flexibility, strength and cardiovascular fitness.

Running: Injured runners sometimes take to the deep water to continue training. If you want to try water running, start out by wearing a flotation belt. Move your legs as if running on land. Your feet shouldn’t touch the bottom of the pool.

Zumba: Water Zumba is similar to classes in a studio. Upbeat music and dancing keep your enthusiasm and energy high.

Spinal Surgery in Portland, Oregon

Dr. Kuether is a Portland neurosurgeon. He is board certified and is the Director of Neurotrauma at Legacy Emanuel Hospital. Learn more about Dr. Kuether and his practice here. To become a patient, contact his office.

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How to Choose a Back Surgeon

On 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.

How to choose a back surgeon

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.

Entry Filed under: Spine,Surgery Comments

What Is Spinal Stenosis?

On June 10th, 2016

Spinal stenosis, a narrowing of the channel occupied by the backbone, places pressure on the nerves and spinal cord. The narrowing can occur anywhere along the spine, but most often happens in the low back.

What is Spinal stenosis?


The condition causes low back and leg pain. When the nerves are pinched, sufferers may have numbness, tingling and hot or cold sensations in the legs. Some people lose control of their muscles, causing falls and difficulty with walking.


Diagnosis usually begins when a patient complains of leg or low back pain. The doctor may order an imaging test such as an X-ray, MRI or CT scan.


Sometimes rest or physical therapy can relieve pain. Changes in posture or performing certain stretches may open space for pinched nerves. Other treatments include:

Medication: Pain may be relieved with anti-inflammatories. NSAIDS, aspirin and ibuprofen are sometimes recommended for back-pain.

Exercise: A physical therapist may recommend certain changes as mentioned previously. In addition, exercises to improve the general strength of the spine may help with pain.

Surgery: If pain persists after other treatments are tried, surgery may be needed. A spinal surgeon will operate to relieve the pressure on the nerve roots. This operation is sometimes done in conjunction with a spinal fusion. Surgery is generally done to lessen pain, weakness or numbness in the legs.


Spinal stenosis usually develops later in life. Here are some of the most common reasons people develop spinal stenosis:

Age: A host of problems can contribute to spinal stenosis as people grow older. Connective tissues between bones may thicken. Disks that normally cushion the vertebrae often break down. Bone spurs sometimes develop in the spinal canal.

Tumors: A tumor may cause inflammation in the spinal canal. Tumors also cause problems by growing into the space around the spine. These growths may displace bone or result in bone loss.

Instability: Also called spondylolisthesis, this is a condition where one vertebra migrates onto another vertebrae, causing a narrowing of the spinal canal.

Trauma: Injuries that dislocate that spine or cause fractures can release bone fragments that create pain.

Arthritis: Both osteoarthritis and rheumatoid arthritis can cause back pain. Osteoarthritis is a joint disease characterized by the breakdown of cartilage. Cartilage cushions joints and bones, but when it’s damaged, bones don’t slide past one another as they should. Rheumatoid arthritis is a disorder of the immune system which causes swelling and pain in joints.

Heredity: Some people or born with spinal stenosis and begin to suffer symptoms early in life. Some birth defects may also cause the spinal canal to narrow.

Dr. Kuether is a neurosurgeon practicing in Portland, Oregon. He has treated many patients with spinal stenosis. Please contact his offices to make an appointment.

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What Is Spinal Fusion Surgery?

On 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. 

A spinal fusion uses bone grafts to stabilize the vertebrae.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:

– Fractures

– Degenerative disc diseases

– Infections

– Tumors

– 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.


Entry Filed under: Spine,Surgery Comments

Risky Business: On the Job Back Injuries

On December 1st, 2015

Does your job put you at risk for a spine injury? Some occupations are associated with higher rates of musculoskeletal injuries. If your job requires heavy physical work, you’re no doubt familiar with the dull ache of over-used muscles in the low back.

A back injury, however, goes beyond temporary muscle soreness. An injury can cause you to miss time at work and may result in lasting damage to your spine.

Three Common Causes of Back Injuries

Back Injuries from WorkMany on-the-job back injuries result from repetitive movement, using force to move objects or poor posture. The lower back is the most common area of pain and injury.

Repetition often leads to muscle fatigue, but in some cases can cause muscle strains, carpal tunnel syndrome and other injuries. If your work uses the same movements hour after hour, you could be at risk.

Force injuries can be caused by lifting and pushing heavy objects. If you’re bending from the waist to lift, you’re placing too much strain on your spine and back muscles. A single episode of force can fracture vertebrae, but injuries may also develop gradually from overuse.

Slouching, the habitual posture of many office workers, causes fatigue and muscle strain. Sitting for hours can also lead to pain in the low back.

Treatment and Prevention

The first course of treatment for many injuries is rest. Your doctor may prescribe pain medication or recommend an over-the-counter drug. Physical therapy helps some patients strengthen muscles and learn better spinal-health habits. Acupuncture may also be an effective treatment to lessen pain. In some cases, if less invasive cures are ineffective, your doctor may recommend spinal surgery.

Some types of injuries can be prevented. Maintaining a healthy weight puts less strain on your back. Quitting smoking and using other nicotine products has been shown to reduce back pain. Learning to lift with your legs and glutes protects your back. If you work in an office, make sure your desk, chair and other equipment are arranged to promote good ergonomics.

High Risk Occupations

Working in construction places you at a higher than average risk for injuries. Construction often involves using force, pushing, lifting or twisting. These types of movements can strain muscles and damage the spine. Back injuries are among the most common types of injuries suffered by construction workers.

Do you work in healthcare? Rates of overexertion injuries among healthcare workers are some of the highest in the U.S. according to the Centers for Disease Control. Nursing home workers have three times the average rate for these types of injuries which include back injuries.

Warehouse workers, long-distance truck drivers, landscapers, and grocery clerks also have a higher than average risk for spine injuries.

If you’ve been hurt at work, speak with your primary care doctor about your treatment. You can also call our office to learn more about options for treatment. Kuether Brain and Spine accepts most insurance, including Worker’s Compensation.

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Will Insurance Cover My Surgery?

On 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.

Insurance Coverage for SurgeryDr. 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.

Entry Filed under: Brain,Spine,Surgery Comments

Spine Updates in 2014

On 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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