Treatments & Services Archives - Michigan Head & Spine Institute Blog


Neurosurgeons at Michigan Head and Spine Institute have begun using Optune for the treatment of newly diagnosed and recurrent glioblastoma (GBM). Richard Veyna, M.D., is certified to prescribe this wearable and portable medical device, the first FDA-approved therapy in more than a decade for newly diagnosed GBM.

“Our goal at Michigan Head & Spine Institute is to treat cancer patients with the latest, approved therapies available, so we welcome the opportunity to provide Optune as part of a combination treatment for those fighting GBM,” said Richard Veyna, M.D. “We want our patients to have the best possible quality of life. With Optune as a therapy patients are able to go about their daily activities with minimal disruption to their lives.”

For newly diagnosed patients, Optune is used with the chemotherapy temozolomide (TMZ) after surgery and radiation with TMZ. In a clinical trial, adding Optune to TMZ was proven to delay GBM tumor growth and extend survival in newly diagnosed patients compared with TMZ alone. For recurrent patients, it can be used alone when surgery and radiation treatment options have been exhausted. Optune is approved for the treatment of adult patients (22 years of age or older) with GBM. In a clinical trial, adding Optune to TMZ provided an unprecedented five-year survival advantage in patients with newly diagnosed GBM.

About Glioblastoma Multiforme

Glioblastoma, also called glioblastoma multiforme, or GBM, is the most aggressive type of primary brain tumor. While GBM is rare, it is the most common type of primary brain cancer in adults. Approximately 12,500 new cases of GBM or brain tumors that may progress to GBM are diagnosed in the United States each year. (Watch Pamela’s story)

How Optune WorksOptune-Device-500x500

Optune creates low-intensity electric fields—called Tumor Treating Fields (TTFields)—which potentially slow or stop cell division leading to cancer cell death. Because TTFields do not enter the bloodstream like a drug, they did not significantly increase TMZ-related side effects for newly diagnosed patients. In clinical trials the most common device related adverse events were scalp irritation from device use and headache.

For the treatment of recurrent GBM, Optune is indicated following histologically–or radiologically–confirmed recurrence in the supratentorial region of the brain after receiving chemotherapy. The device is intended to be used as a monotherapy, and is intended as an alternative to standard medical therapy for GBM after surgical and radiation options have been exhausted.

Guidelines for Use of Optune

Optune should not be used if the patient has an active implanted medical device, a skull defect (such as, missing bone with no replacement), or bullet fragments. Use of Optune with implanted electronic devices has not been tested and may theoretically lead to malfunctioning of the implanted device.

Use of Optune together with skull defects or bullet fragments has not been tested and may possibly lead to tissue damage or render Optune ineffective. Do not use Optune if you are known to be sensitive to conductive hydrogels. In this case, skin contact with the gel used with Optune may commonly cause increased redness and itching, and rarely may even lead to severe allergic reactions such as shock and respiratory failure.

Warnings and Precautions

Optune should only be used after receiving training from qualified personnel, such as your doctor, a nurse, or other medical personnel who have completed a training course given by Novocure™ (the device manufacturer).

Optune should not be used if the patient is pregnant, or thinks she might be pregnant or are trying to get pregnant. It is not known if Optune is safe or effective in these populations.

The most common (≥10%) adverse events involving Optune, in combination with temozolomide, were low blood platelet count, nausea, constipation, vomiting, fatigue, scalp irritation from device use, headache, convulsions, and depression.

The most common (≥10%) adverse events seen when using Optune alone were scalp irritation from device use and headache.

Scalp irritation from device use, headache, malaise, muscle twitching, fall and skin ulcer is considered an adverse reaction related to Optune when using the device alone.


All servicing procedures must be performed by qualified and trained personnel, like Dr. Veyna.

Do not use any parts that do not come with the Optune Treatment Kit, or that were not sent to you by the device manufacturer or given to you by your doctor.

Do not wet the device or transducer arrays.

If you have an underlying serious skin condition on the scalp, discuss with your doctor whether this may prevent or temporarily interfere with Optune treatment.


Advancing treatment options for patients takes a great deal of innovation, energy and funding. Mick Perez-Cruet, M.D., neurosurgeon at MHSI, has begun sharing the results of his most recent research focused on the use of a device that uses stem cells as a way to regenerate intervertebral discs, which can degenerate and cause back pain as one ages.  Currently there is no biologic method to restore a degenerated disk.

Back pain has a very high price tag.  Direct and indirect costs associated with low back pain is estimated to be $50 to 100 billion annually in the United States.  These costs come from lost work days, with an average of loss of activity coming in around 297 million days – that work and personal activities.

In his presentation, Dr. Perez-Cruet explains the research, how it could ultimately reduce back pain, returning patients to daily functional activity based on the results of this research. “It’s now time to move the research to the next phase, and hopefully those who have the ability to financially support this effort, will to so,” he says.

Stem Cell Based Intervertebral Disc Regeneration


Mick Perez-Cruet, M.D., was recently featured in Becker’s Spine Review discussing how spine treatment is evolving.

“Q: Where do you see the biggest opportunities for spine surgeons? How is the field evolving?

Dr. Mick Perez-Cruet: The biggest opportunities for spine surgeons are that we will continue to be extremely busy due to the growing aging population. Because patients expect to recover quickly and fully, minimally invasive spine surgery is growing in leaps and bounds with new MIS innovations and options continuing to expand.

I am particularly excited about the future of biologic treatment of spinal disorders. This remains a challenge but new and exciting research may, in the future, allow us to regenerate the intervertebral disc and restore natural function and motion to the degenerated vertebral segment. Our group is currently very active in this research using disc distractive device mechanisms in conjunction with cultured nucleus pulposus human stem cells to achieve this goal.”

Originally posted here: Becker’s Spine Review 


Lumbar Spondylolisthesis occurs when a lumbar vertebra slips out of place. One vertebra slips forward, distorting the shape of the lumbar spine, and may compress the nerves in the spinal canal. The nerves that exit the foramen (open spaces on the sides of your vertebrae) may also be compressed. These compressions can cause pain and other problems.  But, there’s hope for relief.

Mick Perez-Cruet, M.D., presented recent studies and shows how lumbar spondylolisthesis is being treated.  To schedule an appointment with Dr. Perez-Cruet, please call 877-784-3667, or online.


Patients arrive at Michigan Head & Spine Institute with many different conditions and injuries.  We hear from our patients that learning about conditions other than what you might be experiencing often helps family members or friends. So this month the MHSI Health Education Series will discuss trigeminal neuralgia.

Robert Johnson, M.D., MHSI neurosurgeon explains, “Pressure or damage to the trigeminal nerve can cause malfunction of the nerve which leads to the pain in the face known as trigeminal neuralgia.” Trigeminal neuralgia usually affects more women than men, and those over 50 years of age. Doctors may use medications, and sometimes surgery to relieve the pain and release the pressure on the nerve.

Some Possible Causes:

  • Contact between a normal blood vessel and an artery/vein
  • Aging
  • Multiple Sclerosis or other movement disorders
  • Brain lesion
  • Stroke or facial trauma
  • Abnormal position of blood vessel related to the nerve

Symptoms of Trigeminal Neuralgia

There are many symptoms of trigeminal neuralgia which could include one of these patterns:

  • Extremely painful, sharp electric-like spasms that may last a few seconds to a few minutes.
  • Spontaneous attacks of pain while doing regular daily activities such as talking, brushing your teeth, or chewing.
  • Pain that is triggered by sounds, wind or touch.
  • Pain that affects one side of the face, rarely does it affect both sides of the face.
  • Constant aching or burning pain.
  • Pain is usually in the areas that are supplied by the trigeminal nerve: cheek, jaw, teeth, gums, or lips. Pain in the eyes and forehead are less common.
  • Attacks become more frequent and increase in intensity.
  • Pain, for an unknown reason, isn’t usually felt while sleeping. Knowing this may help physicians pinpoint if it could be a migraine or toothache rather than trigeminal neuralgia.
  • In atypical trigeminal neuralgia, a severe migraine in addition to the sharp electric like spasms may be present.

Treatment for Trigeminal Neuralgia

Medication, which may include muscle relaxers, anti-seizure drugs, and antidepressants to target the inflamed nerve, may be prescribed to those diagnosed with trigeminal neuralgia. In some cases, surgery may be needed to relieve the pressure that is causing the nerve disruption. These surgical options may include:

  • Microvascular decompression – relocating or removing a blood vessel that is in contact with the trigeminal nerve. This is done with a small incision behind the ear on the side of your pain
  • Tumor Removal
  • Gamma Knife Radiosurgery
  • Glycerol injection – the sterile glycerol damages the trigeminal nerve and blocks pain signals
  • Balloon compression

Robert Johnson, M.D., Jeffrey Jacob, M.D., and Daniel Michael, M.D., are all MHSI neurosurgeons who specialize in treating trigeminal neuralgia.  If you identified these symptoms as those you may be experiencing, please call MHSI for an appointment, 1-877-784-3667.


Pain — you know, the kind that feels like a burning sensation deep beneath the skin causing never-ending waves of aches and discomfort — has been experienced by nearly everyone at some point in their lives. Pain is real and although it’s felt differently by each person, it can be relieved. The physiatrists at Michigan Head & Spine Institute (MHSI) strive to return their patients with chronic or injury-related pain back to living their lives again.

Physiatrists, or physical medicine and rehabilitation specialists, use conservative, nonsurgical tools as well as minimally invasive techniques to get patients back on track. “Pain can keep a person from the simple activities of life like bending down to tie a shoelace, or lifting a child or groceries, while neck pain can prevent turning one’s head while driving in traffic — a very dangerous situation,” explains Carrie Stewart, M.D., a physiatrist who specializes in helping patients return to activity without surgery.

Some of the most advanced medical tools and techniques are used to reduce pain. This can include epidural injections, trigger point or peripheral joint injections and manual medicine. Also available are spinal cord stimulators, special wires that are surgically implanted in the spine to provide relief, something like a “pacemaker” for pain which disrupts pain signals.

For some, minimally invasive injections might be a last resort, or might even be used for postsurgical pain relief. “Medications may relieve pain for a while, but our goal is to determine the source of the pain and help our patients get back to their functional lives,” says John Marshall, M.D. “We avoid loading patients up on drugs that only mask their pain, and work to identify and treat the cause of the pain.”

“A multidisciplinary approach leads to less medication usage. It helps the patient maximize his or her return to their best function and is optimal for pain management,” adds Ingrid Chua-Manalo, M.D., who spent eight years as an anesthesiologist before shifting into physiatry.

Each patient is treated as an individual, looking at the whole person. A thorough patient history is taken and a physical exam is conducted. If necessary, X-rays, MRIs, electromyograms (EMGs), or physical therapy are ordered. Counseling is also offered to help patients cope with the emotional aspect of pain.

“Some patients may require surgery,” explains Robert P. Farhat, D.O., who specializes in nonsurgical evaluation and minimally invasive procedures. “Because we are part of the MHSI team, we have the resources of the country’s most renowned neurosurgeons — experts in minimally invasive and traditional spine procedures — right in the same office. We can discuss a patient’s individual situation and collectively come to the best treatment plan possible.”

The physiatry team at Michigan Head & Spine Institute continues to grow to meet the needs of the increasing number of patients who experience acute and chronic pain from disease, injury, and auto accidents.

There are 10 locations in southeast Michigan for the convenience of our patients. Our Physiatry team includes:

Robert P. Farhat, D.O.

Specializes in nonsurgical evaluation, minimally invasive procedures, and management of back and neck pain.

Karl Freydl, D.O.

Specializes in pain management and interventional treatments to manage pain for patients.

Natalia V. Glisky, M.D.

A fellowship-trained pain medicine physician who diagnoses and treats pain using a creative, multidisciplinary approach.

Sophia Grias-Radwanski, M.D.

Manages patients who require nonoperative treatments for musculoskeletal and neurological conditions.

Ingrid Chua-Manalo, M.D.

Moves patients from medication relief for pain back to their optimum functionality using minimally invasive pain procedures.

John M. Marshall, M.D.

Treats musculoskeletal and neurologic conditions using nonsurgical and conservative techniques.

Carrie Stewart, M.D.

Treats musculoskeletal pain, including neck and back pain, to nonsurgically return functionality to her patients.

Henry C. Tong, M.D., M.S.

Specializes in nonsurgical evaluation, minimally invasive procedures, and management of low back and neck pain, plus shoulder and hip pain.


The two main blood vessels in the neck that supply blood to the brain are called the carotid arteries. When these arteries narrow, blood flow to the brain is reduced. This is called carotid artery stenosis. The gradual buildup of fatty substances and cholesterol deposits is called plaque.  Plaque occurs as we age, engage in unhealthy lifestyles and don’t manage risk factors, like high cholesterol.

Often, there are often no symptoms until a stroke occurs. So it is important to seek regular physical exams. If your doctor hears an abnormal sound in these arteries a carotid duplex or Doppler ultrasound may be required to examine the blood flow and look for plaque or blood clots.

Medication may be prescribed if less than 50% of the artery is blocked. If more than a 70% blockage is present a carotid endarterectomy or a carotid angioplasty / stenting procedure can improve blood flow to the brain.  Both procedures are usually conducted by a neurosurgeon. In the carotid endarterectomy, an incision is made in the neck and the plaque and diseased portions of the artery are removed to increase blood flow to the brain.

Richard Fessler, M.D., an endovascular neurosurgeon at MHSI explains, “In a carotid angioplasty, a catheter is inserted into the groin, through the aorta (the main blood vessel of your heart) in an attempt to clear the blockage and open up the artery. Sometimes a stent is inserted into the artery to keep the artery open and the blood flowing.”

For all patients, “These are much less invasive procedures than open surgery for all patients, but especially elderly patients,” adds Dr. Fessler.

If you find yourself in an emergency situation, like having a stroke that requires a carotid endarterectomy or angioplasty, or your doctor says you need one of these procedures ask for an MHSI neurosurgeon. To schedule an appointment, call 1-877-784-3667 or online at


Dr. Veyna
Dr. Veyna

Everyday, the neurosurgeons at Michigan Head & Spine Institute see patients who arrive with head injuries at area hospital Emergency Departments. For Dr. Richard Veyna, it may have all been in a day’s work, but for 13-year-old Drew Pelkowski and his parents it was a life-changing event when Drew was involved in a golf cart accident.

See the entire story on WXYZ-TV as told by Drew’s parents at Beaumont Hospital in Royal Oak.

A GO FUND ME account has been set up to help the Pelkowski’s with medical expenses.


Do you suffer with headaches that interrupt your work and lifestyle? Do they last for more than four hours at a time? Are they as frequent as 15 days each month? If so, you could be a candidate for relief with an FDA approved therapy called Botox®. That’s right, the same Botox® used for cosmetic enhancements also relieves headaches.

Headache Relief

Natalia Glisky, MD
Dr. Glisky

Natalia Glisky, M.D., an interventional physiatrist at Michigan Head & Spine Institute, says, “Any person who experiences painful, long lasting headaches that change their lifestyle can be relieved of pain in about 10 minutes.” She uses a very fine needle to inject 155-200 units of Botox® into 31 sites in the muscles of the forehead, temples, neck and shoulders and promises her technique is painless. “Most patients are a little anxious the first time, but few ever mention discomfort from the needle. When they realize how quickly the headache pain is gone, they are very pleased,” says Dr. Glisky.

“This procedure is safe. Some patients experience a little bruising which is easily covered with makeup,” says Dr. Glisky. She suggests no exercise that increases the heart rate, plus avoiding massage and saunas for about 24 hours. Most insurances cover the treatment and the results last about 12 weeks.

Dr. Glisky is also using Botox® to relieve pain and discomfort in the muscles caused by chronic muscle spasms in disorders like cervical Dystonia, spasticity after strokes and spinal cord injury. Most insurances cover the treatment.

Relief for TMJ

And for those suffering from TMJ, or if you grind or clench the teeth, adding Botox® injections to the use of a night guard, can greatly relieve muscle tightness in the jaw and neck. “About 50% of patients with headaches also have TMD (temporomandibular disorders) including TMJ,” explains Dr. Glisky. Botox® treatment for TMJ is not covered by most insurances, but is a fee-for-service which is dependent on the amount of Botox® used. The TMD/TMJ injections range between $300 and $600. (note: the cost includes doctors fee and the facility cost).

For any of the conditions treated, Dr. Glisky says patients have no down time. Botox® is safe and FDA approved for these treatments. For the conditions not covered by insurances there’s a fee per Botox® unit formula.

To make an appointment with Dr. Glisky, call 877-784-3667 or request an appointment online.