Brain and Spine Services
The fellowship-trained neuroradiologists of Mecklenburg Radiology Associates provide consistently outstanding pediatric and adult patient care through expertise in the performance and interpretation of imaging studies of the brain, neck and spine including the careful use of MRI, CT, ultrasound, x-ray, and angiography. With early, accurate imaging diagnosis, we are committed to helping patients achieve the best outcomes in stroke/TIA, brain tumor, epilepsy, back pain, multiple sclerosis and headache as well as a variety of other processes in the fields of neurology, neurological surgery, and otolaryngology. Our interventional neuroradiologists perform carotid stenting, aneurysm coiling, vertebroplasty and kyphoplasty, and a range of minimally invasive treatments for vascular malformations and other neurological disorders.
The human spine is a complex, flexible system made up of vertebrae, sacrum and tailbone. Between the vertebrae are pads called discs that take the shock from daily activities. The spine is the support system for the body, but its delicate design can result in many problems. The most common issue for adults is herniated or "slipped" discs, which happens when there is a tear in the disc. The rupture can cause pain, numbness, and weakness. While a herniated disc most often occurs in the lumbar spine, it can also happen in the cervical and thoracic areas. Other spinal problems include arthritis, called spinal stenosis, osteoarthritis, degenerative disc disease, osteoporosis, spondylolisthesis, scoliosis, kyphosis and trauma resulting in breaks in the vertebrae.
Mecklenburg Radiology Associates' specialty trained musculoskeletal radiologists can diagnose and treat many conditions through minimally invasive procedures and pain management therapies.
Bone loss from osteoporosis can lead to a painful vertebral compression fracture (VCF). More than 750,000 older adults are diagnosed with a VCF each year. Often a patient notices acute back pain and in 90 percent of the cases, conservative therapy of medications and bed rest is successful. In some cases, patients do not heal properly and are left with chronic pain. Those patients can benefit from two minimally invasive procedure performed by an interventional radiologist.
Kyphoplasty is a technique that allows for the restoration of vertebral height. Using fluoroscopy guidance, a balloon is inserted into the affected vertebral site and is inflated to the height of the fractured bone. The balloon is removed and replaced with bone cement, which in injected into the site. This procedure stabilizes the vertebrae and usually brings immediately pain relief to the patient.
Vertebroplasty is similar to kyphoplasty as cement is injected directly into the vertebral space, but does not use a balloon to restore the height of the bone.
Myelograms are an effective way to examine the spinal canal and spinal cord. The test is especially helpful to determine is there is a herniated disc, lesion, tumor, bone spur or nerve root problem that is causing back pain in a patient. While the procedure is traditionally performed using an injected dye into the patients back and following it with fluoroscopy, CT scan is often used to get a cross-sectional view of the spine.
If a patient continues to have back pain and an MRI does not show signs of a herniated disc, a physician can order a discogram. This examination of the back uses dye to highlight the discs. Radiologists use either x-ray or CT to look for structural damage, such as a tear in the outer portion of the disc, and if it is the cause of a patient's pain. Myelograms are done frequently prior to surgery to help physicians pinpoint the problem and determine the best type of surgery to repair the problem.
Facet Joint Block
Facet joint blocks diagnose and treat pain in the facet joint at the same time. Using fluoroscopy (x-ray in motion), an interventional radiologist injects a small amount of anesthetic medication and/or cortisone into the facet joint or the nerves surrounding the joint. The injection is given to temporarily reduce pain and inflammation in the joint. If the patient's pain is relieved, then it is a good indication that the facet joint is causing the pain. Facet joint blocks are typically done after a patient has undergone CT or MRI for diagnosis
Nerve Root Block
Selective nerve root blocks can bring relief from pain and help diagnose the primary site of low back or leg pain. A compressed nerve root can become inflamed and result in moderate to severe back and leg pain. MRI is normally used to find the source of the pain, but if the test does not definitely identify the site, a nerve root block can pinpoint the site and relieve the pain simultaneously. The block is also used for treating a disc that ruptures outside of the spinal column. Pain relief injections can be administered up to three times a year.
Epidural Steroid Injection
Patients who present with lumbar disc herniation, often have nerve root irritation and swelling. This swelling can be the source of the patient's pain. An injection, which is delivered directly into the epidural space in the spine, can help reduce the inflammation. Along with injecting steroids into the region, an interventional radiologist can also use a solution, such as lidocaine or saline, to remove the inflammatory proteins, which are usually the source of the pain.
According to the American Heart Association, more than 750,000 people had a stroke over the past year. Strokes are the leading cause of disability and third leading cause of death in the world. While younger women are at less risk than men, a woman's risk increases with age. Overall, about 46,000 more women than men have a stroke. The majority of strokes – 87 percent – are ischemic, which is caused by a reduction in blood flow to the brain. Most often, the reduction is due to a blockage or narrowing in an artery that supplies blood to the brain or when the blood flow is reduced because of a heart condition. A hemorrhagic stroke, a bleed inside the brain, is not as common. It develops when an artery in the brain leaks or bursts.
The key to surviving a stroke is quick, accurate diagnosis, followed by aggressive treatment. With an ischemic stroke, patients may have warning signs or what is called transient ischemic attacks (TIAs), or mini-strokes. TIA symptoms normally don't last more than 20 minutes, but some can last for up to 24 hours. It's important for patients to report these symptoms immediately to their doctor:
- Numbness, weakness or paralysis of the face, arm or leg, especially on one side of the body.
- Vision problems in one or both eyes, such as double vision or loss of vision.
- Confusion, trouble speaking or understanding.
- Trouble walking, dizziness, loss of balance or coordination.
- Severe headache.
Patients are diagnosed with a stroke, using a series of tests and a CT scan to determine the type of stroke. Diagnosing whether the stroke is ischemic or hemorrhagic is critical as the medications and treatments are different, and can be life-threatening if not treated appropriately.
Radiologists at Mecklenburg Radiology Associates are fellowship trained to diagnose and treat stroke patients. These neuroradiologists and interventional radiologists have a thorough understanding of how the brain and circulatory system work and how they function. This specialty team provides the latest in state-of-the-art stroke care from diagnosis to treatment at Presbyterian Hospitals and Lake Norman Regional Medical Center.
Stroke Thrombolysis/MERCI Retrieval System
Since an ischemic stroke occurs due to a clot that is restricting blood flow to the brain, it's critical to remove the clot as quickly as possible to restore blood to the brain and reduce the likelihood of long-term effects. Neuroradiologists will often administer thrombolitic therapy to dissolve a clot. Using CT to guide the catheter, the radiologist is able to deliver medicine directly to the clot, causing it to dissolve. Another more recent method to restore blood flow is performed using a mechanical device called the MERCI Retrieval System. This corkscrew-type device is delivered to the clot site via catheterization, where it engages the clot and removes it from the brain. These two methods of stroke therapy help improve without the need for more invasive surgery. They are also performed in veins to remove clots due to immobility, infection, diabetes and fatty deposits. The procedures are also used to treat deep vein thrombosis and embolisms.
When the carotid arteries, which run on either side of the neck and supply blood to the brain, become narrowed or blocked by a condition known as atherosclerosis, a patient is at risk for a stroke or brain dysfunction. Our interventional radiologists can insert a stent – a small wire mesh tube - into the blocked artery. The stent, which is left in place to keep the artery open, restores blood flow to the brain. This minimally invasive procedure is especially helpful in patients who are not candidates for surgery.
Stents are also placed to treat other blocked arteries in the body, such as the legs, arms and kidneys.
An aneurysm, or bleeding in the brain, is a serious condition that can cause a stroke or result in death, if not diagnosed and treated quickly. Patients with an aneurysm normally present with paralysis, constant headache and pressure, and neck and back pain. The condition is normally diagnosed through CT, MRI or angiography. If a patient has had a hemorrhagic stroke, an aneurysm or arteriovenous malformation (a congenital condition of tangled, dilated blood vessels that disrupts normal blood flow in the brain), a coil can be inserted to help stop the bleeding. The coil is inserted through a catheter in the patient's leg and guided to the site of the bleed. The coil, along with a specialized glue to hold it in place, is positioned at the site. A clot forms around the coil and stops the bleeding. These coils are a newer, minimally invasive way of treating bleeding in the brain and in other parts of the body.
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January 31, 2013
Dr. Kevin Carroll explains how the new High-Field True Open Magnetic Resonance Imaging machine works.