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Neurology and Neurosurgery Associates, P.A.
50 Second St. S.E., Winter Haven, FL 33880
863-293-2107

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Treatments for Cervical and Lumbar Disc Disease Explained in Series *(con't)* Back
MAKING A DIFFERENCE *(courtsey Lakeland Ledger)* Neurosurgeon to Explain Treatments for Free in Series Monday, March 4, 2002 By DONNA KELLY The Ledger
WINTER HAVEN -- Neurosurgeon Bill Brennan is the type of doctor one sees on television more often than in a real medical facility. He believes part of his job is to make sure patients understand their condition and treatment options long before they enter the hospital. For this reason, he will offer the first of what he intends to be a series of informative presentations about the most common diseases he treats with "Cervical and Lumbar Disc Disease" from 7 to 8 p.m. Wednesday at Schalamar Creek Country Club, 4500 U.S. 92 E., Auburndale.
Refreshments will be served. Admission is free, and reservations are not required. Brennan, 44, performs approximately 200 surgeries a year on patients with cervical and lumbar disc disease. "It's an extremely common problem," he said. Half of Wednesday's program will cover cervical disc disease. "I will talk about the anatomy, what goes wrong and what to do about it," Brennan said. He also will explain what patients can expect if they refuse treatment. The second half of the hour will deal with lumbar disc disease. Brennan will address those who need lumbar fusion and explain stenosis, another type of degenerative change. "The information is designed to be boiled down," he said. "It is a complicated subject that will be given in a short time and an easily understood format." And because he has never experienced these health issues himself, he will have a panel of patients available to add comments and answer questions from the audience. He is including these patients in his program for the same reason he has a list of names and phone numbers of those who have undergone various surgeries to give to patients who are facing the same treatments. "I think that kind of information is invaluable," Brennan said. "Because I don't know how it hurts." Mary Felix, 53, had been experiencing neck pain for years before she found herself in Brennan's office facing the possibility of traction for the rest of her life or undergoing cervical fusion. She chose the latter, and all her questions about the procedure had been answered long before she arrived at the hospital for the surgery. She found Brennan's manner "very businesslike and professional," she said, and yet the information was easy to understand. "He went through it (the surgery and recovery) step by step, and it was on a level I could understand," Felix said. "And I felt like if I hadn't understood it, then he would have taken another approach." Felix was confident when she went in for surgery and hasn't had any surprises in her recovery, either. She knew what to expect. "It was totally remarkable what he did for me," she said, adding that she no longer feels numbness in her arms and hand, as she did before the surgery. Now 60 days into her recovery, Felix plans to be a part of Brennan's panel Wednesday. Having worked for two orthopedic surgeons in the past, she is familiar with patients' reactions to the word "surgery." "The reason some people don't have surgery done is because they are scared," she said. "They've not been told about it on a level they understand." Brennan said he hopes to begin a trend of doctors taking the time and effort to discuss diagnosis and treatment in-depth with patients before scheduling surgery. If this presentation is well-received by the public, Brennan said he'd like to schedule more of them on other topics pertaining to neurology and neurosurgery. "It's something I'd like to do on a regular basis, every few months or so," he said. "It will be fun to do." For more information on the presentation "Cervical and Lumbar Disc Disease," contact Brennan's office at 863-293-2107.
New Hope for Back Surgery *(con't)* Back
Minimally Invasive Techniques for Spinal Fusion Reduce Pain and Recuperation Time *(courtsey Lakeland Ledger)* Sunday, April 25, 2004 By Robin Williams Adams The Ledger
LAKELAND -- Patients with painful degenerative disc disease, narrowing of the spinal canal or misaligned vertebrae that slip over each other may find themselves facing spinal fusion on the vertebrae in their backs. Traditional or open spinal fusion is major surgery, involving several-inch cuts through muscles, up to a week's stay in the hospital and long recuperation.
As with many other procedures, however, minimally invasive techniques have spread into spinal fusion back surgery. Dr. Michael Campanelli and Dr. James Spence Jr. began doing small-incision fusion as a team in October at Lakeland Regional Medical Center. Dr. Mark Greenberg now works with them. All are neurosurgeons. "It's a real revolution in spinal surgery," Campanelli said. "People just do extremely well." Spence and Greenberg are with Watson Clinic. Campanelli is in the Lakeland office of Winter Haven-based Neurology and Neurosurgery Associates. The new method had been done six times at Lakeland Regional by early April. Campanelli, who participated in all of them, said he expects to use it for half of the 40 or 50 fusions he does each year. Patients getting spinal fusion need to have specific conditions causing their back pain. Some conditions, such as osteoporosis-related compression fractures, are better treated with other procedures. (See related article on page 14). Glenn Yarbrough, 54, had the minimally invasive surgery on Jan. 16. His back pain had become so bad he could not continue his job as a truck driver. A magnetic resonance imaging exam, recommended by his family doctor, showed that a disc had worn completely away. "I had the surgery on Monday," he said. "I was up and walking by myself on Thursday." He was at LRMC five days. Their first patient was discharged after two days, Campanelli said, with an average stay of two or three days. Two vertical cuts, less than an inch long, are made parallel to the spine on each side. A third one, shorter and horizontal, goes above the vertebrae that rods and screws will hold together. Tubes of gradually increasing size, from pencil width up to a one-inch diameter, are slid through the incisions into the body, pushing aside muscles to reach the affected area. With traditional surgery, large bands of back muscle are stripped free of the spine and drawn back out of the way. "There was a lot of back pain in the post-operative period and healing took quite awhile," Campanelli said of that method. With minimally invasive surgery, the tubes create tunnels that separate muscles to allow access, which is less invasive. Screw extenders, long metal shafts, deliver and attach the screws to the vertebrae. They extend outside the body to let surgeons join them together. That lines up the screw heads inside the body and lets the rods pass through the heads without being obstructed, he said. Surgeons attach an arc-shaped arm that delivers a pre-cut rod into the heads of the implanted screws, according to Medtronic Sofamor Danek, which makes the system Lakeland doctors use. Although neurosurgeons are the ones doing this in Lakeland, orthopedic spinal surgeons can do it after receiving the training. With either type, it is important to have someone experienced in doing the traditional, open method, Campanelli said. With the small cuts, doctors cannot look directly at the area where they put the screws and rods. A fiberoptic light at the end of a tube illuminates the interior. Continuous X-ray images are transmitted by fluoroscopy onto a TV screen monitor. Two rods and four screws, the same number and size as in the traditional procedure, are used. They keep the vertebrae rigid until enough bony re-growth occurs to create fusion. Robin Williams Adams can be reached at robin.adams@theledger.com or 863-802-7558.
Dr. Fernando Miranda joins Staff *(con't)* Back
Dr. Fernando Miranda joined the practice of Neurology and Neurosurgery Associates, P.A. June 13, 2005. Dr. Miranda is a Board Certified Anesthesiologist with a subspecialty certification in Pain Management. Dr. Miranda completed a general surgery internship at Mount Sinai Medical Center (Miami Beach) and his Anesthesiology Residency at Jackson Memorial in Miami. He also completed a Pain Medicine Fellowship at the University of Iowa Hospitals and Clinics in Iowa City, Iowa.
Dr. Miranda has been a staff Anesthesiologist at Holy Cross for the past six years. During which time he established the pain management program for the Anesthesiology group at Holy Cross Hospital. Dr. Miranda specializes in the diagnosis and treatment of painful spinal disorders. Dr. Miranda is looking forward to becoming a part of the Winter Haven community and serving Polk County.

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