At Spine & Brain Neurosurgery Center, each neurosurgeon is specialized and fellowship trained in one or more of the following: spine surgery, neurosurgery, neuroendovascular surgery, neurosurgery trauma and critical care, reconstructive and complex spine surgery, and neurosurgical oncology. All of our neurosurgeons are either board certified or eligible for board certification.
Neurosurgeons have one of the longest medical training of any medical specialty. In addition to the lengthy education, our neurosurgeons are also specialized through additional fellowships. Because neurosurgeons understand the nervous system, which is the center of any pain issue, we are better prepared to deal with the pain as it affects the entire body.
NEUROSURGEONS:
Nizam Razack, MD, JD, FAANS, FACS
Deep Brain Stimulation
By combining Dr. Gonzalez's training and experience with neurosurgeons experienced in surgical procedures for movement disorders, our practice offers complete neurological treatment for Parkinson's, Dystonia, tremor and other movement disorders. We are the only practice in the Central Florida area that offers patients complete care in movement disorders.Please see our Movement Disorders Clinic.
Our spine neurosurgeons utilize minimally invasive procedures to reduce recovery time. We are most proud of the fact that we offer a multidisciplinary team from which our patients can benefit. By selecting our practice, you will be seen by a physician that best fits your needs. Your physician will be specialized in the area of treatment you require.
Treatment of:
Spinal FracturesSpinal Mass, Cysts
Cervical Radiculopathy
Disc Disease
Disc Herniation
Sciatica
Metastic Cancer
Myelopathy
Stenosis
Spondylolisthesis
To view our video library of the surgeries we perform, please click here.
At Spine & Brain Neurosurgery Center, our cranial surgeons are trained in:
- Tumors - Malignant, Benign, Metastasis, Neoplasms, Brain Masses
- Endovascular - Strokes, Brain Aneurysms, Arterial Venous Malformations, and more.
- Movement Disorders - Deep Brain Stimulation
- Trauma - Sports injuries, accidents
Brain Tumors
Our neurosurgeons understand the emotional, psychological and physical toll that a brain tumor diagnosis has on an individual and their family. Our physicians and support staff will see you through this ordeal, explain each step to you and your family, answering all of your questions along the way. We utilize the most advanced surgical procedures and work with the latest technologies to ensure shortest recovery times, and optimal medical care. Endovascular
Our neurosurgeons are trained in the most advanced neuroendovascular surgery techniques. These techniques have been proven effective for strokes, brain aneurysms, arterial malformations, intracranial atherosclerosis, and blocked carotid, vertebral and subclavian arteries, from inside the blood vessel. These procedures often result in shorter hospital stays and reduced recovery periods.Movement Disorders
Deep Brain Stimulation (DBS) is the most advanced technology available for surgical treatment of movement disorders. This procedure involves implanting a pacemaker-like device beneath the skin which sends electrode stimulation to the electrodes in the brain. Electrodes control messages from the brain to the body. Your neurologist will assess your movement disorder. When diagnosed, he will determine whether you are a candidate for DBS. Surgery becomes an option only after medications have proven ineffective or have caused unacceptable side effects.At Spine & Brain Neurosurgery Center, our neurosurgeon and our neurologist work in tandem to provide you with effective and timely treatment of your disorder. Please click here for our Movement Disorders Clinic.
Trauma
Sports related injuries and vehicular accidents are the two most prevalent causes of head trauma. Our neurosurgeons partner with Orlando Health to provide the Central Florida area with the only Level 1 Trauma Center.
WHAT ESI IS
An Epidural Steroid Injection is an injection of a steroid into the affected area in an attempt to decrease pain and inflammation. The injection given can be highly effective because the steroid which decreases inflammation is injected directly to the source of the pain.
Many types of spinal conditions may be improved including: herniated disc, spinal stenosis, or degenerative disc disease. Approximately fifty percent of patients show improvement following ESI procedures. If a patient shows improvement, further therapeutic injections may be indicated.
WHAT TO EXPECT
1. The physician will cleanse the area of injection with a sterile solution and inject a local anesthetic into the appropriate area, which may cause momentary discomfort and a slight burning sensation.
2. After the area is numb, the physician will insert a needle and inject the steroid. A patient will feel pressure but should not feel pain while the steroid is being injected.
3. The assistant will then place a small adhesive bandage on the injection site.
4. A patient may experience some soreness at the injection site for the first 24 hours after receiving the injection. If so, applying ice will help reduce the discomfort.
A patient may be asked to remain in the office for some time after the procedure for monitoring. A patient may drive home, although some patients are more comfortable allowing someone else to do so. A patient may resume normal activities following the procedure.
We want to welcome you to our Movement Disorders Clinic. Spine & Brain Neurosurgery Center offers the only center in the Central Florida for complete treatment of Parkinson's and Movement Disorders. We have partnered Neurosurgeons and Neurologists in order to offer our patients University caliber treatment at a local level. Dr. Manuel Gonzalez, neurologist, and Drs. Nizam Razack and Glen Manzano, neurosurgeons, will see you through your treatment. Their goal is to find the treatment that maximizes both quality of life and independence. Treatments include medications, surgery and rehabilitation.
Movement Disorders are degenerative in nature. Once determined that Deep Brain Stimulation is an option, timing of the procedure is critical. If a surgical candidate delays, it is possible that the disorder will degenerate beyond the window of opportunity for surgery. At this point, surgery is no longer an option.
At Spine & Brain Neurosurgery Center, we are able to offer you a minimal wait time from the time you become a surgical candidate to the time of your surgery.
Most common among the Movement Disorders are Parkinson's, Dystonia and Essential Tremors.
Parkinson's
Parkinson's is a neurodegenerative disease which affects up to 1.5 million Americans. An estimated 40,000 to 60,000 new cases are diagnosed each year. Although the cause is unknown, we do know that substantia nigra, cells in a small deep area of the brain, begin to die. These cells produce dopamine. Dopamine is a chemical messenger which allows ease of movement of our body parts, both internally and externally. As more cells die, less dopamine is produced. The body loses capacity to move easily: muscles begin to shake or slow down. Many symptoms related to Parkinson's are not correlated to the disease until after a patient's capital Parkinsonian symptoms emerge. Depression, anxiety, urinary incontinence, sleep disturbance and constipation are all symptoms of Parkinson's, yet the diagnosis will not be considered until the patient exhibits the 3 capital symptoms: rigidity, tremors and slowness of movement and thinking.
The condition of Parkinson's is a continuum due to its progressive nature. But, it can be classified into 3 stages: mild, moderate, and severe.
- In the mild stage, medications work well in order to minimize symptoms.
- During the moderate stage, symptoms are directly addressed and attempted to be minimized through physical therapy. During this stage, medications continue to be used, and Deep Brain Stimulation (DBS) surgery is considered. DBS is not for everyone; your physician will determine if you are a surgical candidate.
- During the severe stage, medications and therapy may become less effective and symptoms will worsen. Deep Brain Stimulation surgery may still be an option. DBS is not for everyone; your physician will determine if you are a surgical candidate.
Dystonia
Dystonia is characterized by sustained muscle contractions which often cause involuntary twisting and repetitive movements and/or abnormal postures or positions. Symptoms for Dystonia can become apparent during any stage of life. The areas of the body that are most commonly affected are the neck, hands and eyelids.
Some dystonias are task specific, for example, an attempted task, such as writing, playing the piano, and walking forwards, will cause contractions, tremors, or sustained positions. Other dystonias are non-task specific. A patient will suffer from contractions, tremors, or sustained positions while the body is at rest.
Stress typically exacerbates dystonic spasms, while rest or sleep generally mitigates them.
Treatment for dystonia includes medication, botox and deep brain stimulation.
Essential TremorEssential Tremor is sometimes confused with Parkinson's disease and with Dystonia. While it can occur at any age, it is most common in older adults.
Essential Tremor generally affects the hands first, but it can also affect the neck and can impair an individual's speech. It is an action tremor manifested by simple tasks, such as tying shoes, writing or drinking. These activities can become difficult and even impossible. The tremor is often associated with purposeful movement. It minimizes when the body is at rest and disappears when the body is asleep.
Our Movement Disorders Clinic has been established in order to provide those suffering from Parkinson's, Essential Tremor and Dystonia complete care. Complete care includes a neurologist specialized in Movement Disorders and Neurosurgeons highly trained and experienced in DBS. Dr. Gonzalez, our Movement Disorders specialist who will be able to diagnose and treat your condition. Should you become a surgical candidate, you will be treated by Dr. Razack or Dr. Manzano, our neurosurgeons experienced in DBS.
Below you will find a comprehensive listing of symptoms for movement disorders. If you are experiencing one or all of the symptoms listed below, do not delay in visiting your doctor. Treatments for Parkinson's, Dystonia and Essential Tremor include medication, physical therapy, or surgery. Deep Brain Stimulation (DBS) is the most common surgical procedure when a patient qualifies for surgery.
Movement Disorder SymptomsA medical evaluation is recommended if you have any of the following symptoms:
- Tremors
- Slowed Motion: Walking, getting up, other basic actions may become difficult and time consuming.
- Muscular Tightness or Stiffness
- Posture and Balance Impairment
- Automatic Movement Loss: Eye blinking, smiling and swinging of arms are diminished or lost.
- Automatic Involuntary Movements: Twitching, twisting, or compulsive phrases.
- Speech Changes: Slurred, soft, monotone speech, slurring or word repetition may occur.
- Dementia: Mental clarity and memory problems.
For information on Deep Brian Stimulation, please click here.
Deep Brain Stimulation has been proven as effective in the treatment of Movement Disorders. Surgery becomes as option after medication has proven ineffective in controlling the disease.
What It Is
Deep Brain Stimulation(DBS) is an invasive, none destructive reversible, FDA approved procedure. DBS is used to treat certain movement disorders including, but not limited to Parkinson's Disease, Essential Tremors, and Dystonia. Deep Brain Stimulation is only considered after medication has proven ineffective or causes side effects that outweigh the benefits of the medication. It is important to consult an expert team. You need the consultation of a neurologist and a neurosurgeon to determine whether this procedure is for you. Not all those who suffer from movement disorders qualify for DBS.The Procedure
DBS is a procedure which requires a 2 part instrumentation: 1) deep inside the brain and 2)just below the skin in the chest area. A thin wire with electrodes at the end is guided to a specific target deep inside the brain. This wire connects to another wire which travels outside the skull, below the skin, down just past the collar bone and connects to the stimulator and battery.It is not perfectly clear how DBS regulates unwanted messages. The stimulator sends electrical pulses to the brain decreasing tremor, reducing rigidity and improving body movement.
For more information about Deep Brain Stimulation, please visit http://professional.medtronic.com/therapies/deep-brain-stimulation/.
We have incorporated MRI services into our practice for patient convenience. Our patients that require high-resolution brain and spine scans can have their scan on the same day as their appointment with their physician.
Technology
At Spine & Brain Neurosurgery Center, we utilize a GE1.5 Tesla for our scans. We selected this machine with our patients and our specialty in mind; it is a closed MRI used in surgical planning and in assessing surgically implanted hardware. A closed MRI is necessary for optimal brain and spine scanning; it provides 3-D images that can be viewed from different angles. Also, when scanning implanted hardware, the 1.5 Tessla creates an image with less artifacts than other scanners. We are pleased to offer you the convenience of the MRI and the confidence that the scan will provide our specialists what they need to assess your situation. What to Expect
MRI scans can range from 20 minutes to 1 hour. No special preparation is needed for MRI scans without contrast unless you have difficulty with enclosed places. Should you have difficulty, please advise your physician and necessary measures will be taken to ensure your comfort.Some scans are with contrast and some are without contrast. An MRI with contrast is not an unpleasant experience. Depending on your age or certain medical conditions, you may be required to have blood work prior to your scheduled appointment. It is possible to have an allergic reaction to contrast, however it is extremely rare. Most allergic reactions can be treated with medication. Should you have any itching or difficulty, please let the technologist know so that we can help alleviate the reaction.
Before you enter, you will be asked to remove any item that may disrupt the magnetic field. These valuables, along with your belongings will be in a locked compartment outside the MRI room. You may be asked to remove dentures, belt buckles or clothing. Hospital gowns are available if necessary.
During the scanning process, several images will be taken. It is important that you lie as still as possible and to breathe gently. At certain times during the process, you may be asked to hold your breath. The better you are able to follow the technologist's instructions, the better the quality of the scan. The machine is noisy. You will hear loud knocking sounds or buzzing at different times. You will be given earplugs for comfort.
Generally, you will be able to leave after your scan. If you have been given any type of sedative because of difficulty with enclosed spaces, you will need to arrange for someone to drive you home. It is preferable that you are not alone for 24 hours following the use of the sedative.
Medical implants and other similar items must be evaluated prior to your scan. If you are pregnant, please notify your physician. You will be asked to complete a screening form in order to evaluate each patient prior to scanning.
If you have scheduled to have an MRI done at our facility, please click here to view, complete and print your form prior to your scheduled visit.