COMPREHENSIVE MANAGEMENT OF BRAIN & SPINE DISORDERS

We offer a compendium of therapies including non-surgical, minimally invasive and traditional surgical treatments for an array of conditions. In addition, we provide onsite therapy services, collaborating with several physical therapy clinics and radiology services.

WE MANAGE THE FULL SPECTRUM OF NECK & BACK DISORDERS WITH PARTICULAR EXPERTISE IN MINIMALLY INVASIVE THERAPIES.

Back and neck pain are common complaints in the general population, with an estimated 80% of adult Americans experiencing either condition over the course of their lives.  An estimated 10% of people will experience chronic back pain (pain that lasts 3 months or longer), with an estimated economic cost of almost $300 billion to the US economy.  The causes of back and neck pain are varied - and the vast majority of patients will not require surgical intervention.  Our goal is to help identify the root cause of your symptoms and find the most effective therapy.  Most patients will require little more than time, therapy and a short course of medical management.  Patients experiencing intractable pain due to a spinal instability, neurologic injury due to nerve/spinal cord compression or select patients who fail reasonable attempts at conservative treatment may need to consider operative intervention.  Our role is to help patients and their families understand the options available and make the best decision for their specific condition.    

CONDITIONS

Cervical Disc Herniation

Cervical Spinal Stenosis

Thoracic Disc Herniation

Thoracic Stenosis

Lumbar Disc Herniation

Lumbar Stenosis

Lumbar Spondylolisthesis

Spine fractures

Spinal Cord Tumors

Spinal Metastatic Tumors

Sacroiliitis (Sacroiliac Joint)

What Is Degenerative Disc Disease?

Discs are soft, gelatin-like pads located between the hard bones or vertebrae that make up the spinal column, which encases the spinal cord and nerves. Discs function as shock absorbers when you flex, rotate, or bend your back or neck, and they begin to degenerate as we age. The gel-like substance called the nucleus may thin to the point where there is insufficient padding between vertebrae.

Another common spinal condition is herniated nucleus pulposus, often referred to as a “ruptured” or “slipped” disc. It occurs when the disc, the shock absorber between the bones of the spine spills over into the spinal canal, causing compression of one of the spinal nerves. It may be caused by trauma, stress to the area or degenerative changes over time. In general, disc herniation symptoms may intensity with coughing, sneezing, or sitting.

A cervical or neck disc herniation may cause pain, tingling, numbness, weakness in the neck, arms or hands if compressing a nerve. If it compresses the spinal cord it can cause weakness in the legs as well. A lumbar disc herniation in the lower back may send pain shooting pain into the buttocks or down the leg, local severe back pain, burning in the back, weakness in one leg or both legs, changes in bowel or bladder activity, and lack of sensation or pins-and-needles tingling in one or both legs. Thoracic disc herniations, which affect the upper spine are less common than cervical or lumbar disc herniations, and often discovered as a secondary diagnosis. Often asymptomatic, they may be tricky to diagnose and could be a ticking time bomb if the herniation progresses to compress the spinal cord itself which could lead to paralysis of the legs.

Treatment Options

Surgical treatment includes a microdiscectomy, a minimally invasive procedure, to remove the disc. Another option is implanting an artificial disc, made of metal and plastic, to maintain mobility of the spine. In the past couple of years, it has become more frequently utilized in cervical spinal surgery, but your spine surgeon will help you determine if that is the best option for you. Sometimes spinal fusion is the best choice. New techniques in spinal fusion surgery make it less traumatic and recovery may be significantly shorter.

In older patients, spondylolysis is caused by degeneration of the joints and discs in a part of the vertebrae known as the pars, usually involving the fourth or the fifth lumbar vertebra in the lower back. Spondylolysis may allow the vertebral bones to slip, one over the other, throwing the spine out of alignment. This is a condition called spondylolisthesis and may result in severe localized pain in the back as well as pain in the legs. In young people, spondylolysis may be a result of a stress fracture most commonly seen in active athletes, such as gymnasts, weightlifters, football players, and dancers. It can be congenital or be caused by trauma.

Patients with spondylolysis may feel slight to severe back pain, particularly across the lower back, muscle spasms, back stiffness, tightening of the hamstrings, nerve compression, and changes in posture.

Treatment options include rest, physical therapy, medication, chiropractic care, steroid injections or surgery, such as discectomy, laminectomy or spinal fusion. Cardiovascular exercise, maintaining a healthy weight and a regimen to improve strength and flexibility in the area of herniation may help relieve symptoms and prevent muscle spasms in the future.

"I HAVE A BRAIN TUMOR...."

The finding of a brain tumor can be an overwhelming experience for patients and their loved ones.  Questions such as "Is it a cancer? How long have I had it? What can we do about it?" often arise.  We understand and empathize with this sentiment because we've lived through this with our own family and friends.  We offer advanced surgical therapies and integrate with some of the finest specialists in Oncology, Neurology and Radiation Oncology to provide an unparalleled benchmark level of care for both benign and aggressive brain tumors. Ultimately, it is all about YOUR health and well being.  Your healthcare goals become our goals & we will help you to understand what is going on within your body.  Just because you have a disease process does not mean we overlook that you are a person with feelings, pain and questions which need honest and direct answers. We strive to always deliver compassion and care needed to put you at ease, we are here to help.

BRAIN TUMORS

Glioma/Astrocytoma

Glioblastoma

Metastatic Brain Tumors

Meningioma

Schwannoma

Pituitary Tumors

Craniopharyngioma

Ependymoma

Choroid Plexus Papilloma

HYDROCEPHALUS

Hydrocephalus (a.k.a. "water on the brain) is a frequently seen condition where spinal fluid accumulates in the ventricles of the brain, causing symptoms from increased local pressure.  Hydrocephalus has many causes. While it is most commonly seen in children, adult patients may also develop hydrocephalus after a brain hemorrhage, infection or certain congenital causes.  It is important to understand that hydrocephalus is a diagnosis made on clinical grounds, not just based on CT or MRI scan findings.  Management options will vary based on severity of symptoms and the root cause.  

Communicating Hydrocephalus

Normal Pressure Hydrocephalus

OTHER

We also manage a spectrum of other brain related conditions including Chiari malformation and facial pain related to trigeminal neuralgia (a.k.a. tic-doloreaux).  We have special expertise in managing among the more complex Chiari malformations in the Mid-Tennessee area and have seen patient referrals from all across the United States.

Chiari Malformation

Trigeminal Neuralgia

Carpal Tunnel Syndrome

Ulnar Nerve Entrapment

Peripheral nerve disorders (a.k.a. "pinched nerve" in the extremities) are a common source of pain and dysfunction, affecting almost 10% of the general population. Carpal tunnel syndrome and cubital tunnel syndrome are both disorders of nerve compression in the arm/hand that results in numbness, weakness, tingling and loss of function.  

We have extensive expertise in the surgical and non-surgical management of the most common peripheral nerve disorders.

SI joint pain symptoms may include:

• Lower back pain

• Sensation of lower extremity: pain, numbness, tingling and/or weakness

• Hip / groin pain

• Disturbed sleep patterns due to pain

• Feeling of leg instability (buckling or giving way)

• Disturbed sitting patterns (unable to sit for long periods, sitting on one side)

• Pain going from sitting to standing

• Sciatica like symptoms

Treatment for SI joint pain

Non-surgical Management goals include reducing symptoms and improving patient function. Options may include:

• Oral pain medications (NSAIDs, opioids, etc.)

• SI belting

• Physical therapy

• Therapeutic SI joint injections

Surgery is SI Joint Fusion

If a patient experiences ongoing or recurrent pain, this may be due to an underlying disruption. For chronic lasting pain greater than 6 months due to a sacroiliac joint disruption, fusion of the sacroiliac joint may be an option. We utilize the SI Bone iFuse Implant System for our patients here at our practice

Watch this video to hear Dr. MacGregor explain SI-Joint pain

Send us a message

If you have specific questions for Dr. MacGregor please send us a quick message. Know that e-mails are usually returned after clinic hours and may take up to 24 hours for a typical response. You may always call us at (615) 467-4633 if you prefer. We have after hours answering service where you may leave a message.