Mark M. Mikhael, M.D.

Mark M. Mikhael, M.D.

Mark M. Mikhael, M.D.

Profile

Personal Bio

Treatment Philosophy

I believe that the needs of the patient come first and I will work with them to appropriately explore all reasonable conservative measures prior to pursuing surgical intervention. I specialize in the surgical treatment of cervical (neck) and lumbar (mid/lower back) spine disorders, such as disc herniations (causing sciatica or radiculopathy) and spondylosis (stenosis and arthritis). My interests include minimally invasive spine surgery, microsurgery of the spine, nerve compression, and spinal reconstruction (stabilization and fusion).

Conditions & Procedures

Conditions

Adult Spinal Deformity, Cervical Disc Disease, Disc Herniation, Lumbar and Cervical Radicular Pain, Lumbar Degenerative Disc Disease, Myelopathy, Pars Defects, Radiculopathy, Sciatica, Spinal Stenosis, Spinal Stenosis: Cervical, Thoracic, Lumbar, Spine Injuries, Spine Instability, Spondylolisthesis, Spondylosis, Synovial Cysts

Procedures

Cervical and Lumbar Surgery, Cervical And Lumbar Total (Artificial) Disc Replacement, Cervical Laminoplasty, Complex Spine Reconstruction, Laminectomy and Laminoplasty, Microdiscectomy, Minimally Invasive Approach, Minimally Invasive Spine Surgery, Nerve Decompression, Pars Repair/Reconstruction, Spinal Fusion, Spine Surgery, Synovial Cyst Excision

General Information

Gender

Male

Affiliation

Independent Practitioner

Expertise

Spine Surgery

Academic Rank

Clinician Educator

Languages

English

Board Certified

Orthopaedic Surgery

Clinical Service

Spine Surgery

Education, Training & Fellowships

Medical School

University of Illinois at Chicago, 2005

Residency

Mayo Clinic

Fellowship

UCLA Medical Center

Locations

A

Illinois Bone and Joint Institute, LLC

2401 Ravine Way
Suite 200
Glenview, IL 60025
847.832.1695
847.998.6365 fax

This location is wheelchair accessible.
B

Illinois Bone and Joint Institute, LLC

2350 Ravine Way
Suite 600
Glenview, IL 60025
847.832.1695
847.998.6365 fax

This location is wheelchair accessible.
C

Illinois Bone and Joint Institute, LLC

521 Green Bay Rd.
Wilmette, IL 60091
847.832.1695
847.998.6365 fax

This location is wheelchair accessible.

Insurance

For information on the insurance plans this provider accepts:
  • Call: 847.832.1695

Publications

  • Number of recent inpatient admissions as a risk factor for increased complications, length of stay, and cost in patients undergoing posterior lumbar fusion.

    Spine 2014 Dec 15

    Authors: Eleswarapu A,
    Abstract
    Retrospective cohort study.
    To identify risk factors for increased complication rate, hospital charges, and length of stay in patients undergoing posterior lumbar fusion.
    A better understanding of risk factors for perioperative complications in patients undergoing posterior lumbar fusion can aid with patient selection and postoperative monitoring. Previous studies have assessed the impact of factors such as body mass index, age, and American Society of Anesthesiologists physical status classification on complication rate.
    Data were acquired from the institution's quality improvement data set. Preoperative demographic factors included sex, age, number of inpatient admissions in the prior year, body mass index, Charlson comorbidity score, American Society of Anesthesiologists physical status classification, number of levels fused, operative duration, and medications on admission. Complications recorded included pneumonia, myocardial infarction, venous thromboembolic event, hardware failure, readmission, or unplanned return to the operating room. Multivariate regression was used to identify predictors of increased complication rate, hospital charges, and length of stay.
    A total of 462 patients were included. A history of more than 1 admission in the prior year was the only variable significantly associated with increased complication rate (odds ratio 10.56, P < 0.0001). History of more than 1 admission in the prior year (+1.92 d, P < 0.0001), operative duration more than 5 hours (+0.81 d, P = 0.008), and American Society of Anesthesiologists physical status classification 3 or greater (+0.75 d, P = 0.01) were associated with increased length of stay, whereas history of more than 1 admission in the prior year (+$27,798, P < 0.0001), fusion of 4 or more levels (+$38,043, P < 0.0001), and operative duration more than 5 hours (+$40,298, P < 0.0001) were associated with increased total charges.
    The number of inpatient admissions in the prior year was found to be a more powerful predictor of perioperative risk after lumbar fusion than metrics evaluated in prior studies, such as age, body mass index, and comorbidities.
    3.
    PMID: 25271515 [PubMed - as supplied by publisher]
  • Calcium pyrophosphate dihydrate crystal deposition disease (pseudogout) of lumbar spine mimicking osteomyelitis-discitis with epidural phlegmon.

    American journal of orthopedics (Belle Mead, N.J.) 2013 Aug

    Authors: Mikhael MM,
    Abstract
    Calcium pyrophosphate dihydrate crystal deposition disease (pseudogout) of the axial spine is rare. To our knowledge, there are few reports of the disease presenting with a presumed diagnosis of infection in the lumbar spine. As reported here, the diagnosis of osteomyelitis-discitis with epidural phlegmon was presumed before intervention. We present the case of a 60-year-old man with radiographic imaging and worsening clinical presentation at 2 consecutive hospitalizations. Axial magnetic resonance imaging originally showed increased signal intensity at the L5-S1 disk, which suggested an infectious rather than inflammatory process. Aspiration and biopsy at the time were nondiagnostic and showed no evidence of organisms. Two months after conservative treatment, the patient was readmitted with intractable low back pain and radiating bilateral leg pain. Repeat imaging showed increased interval signal in the L5-S1 disk, as well as enhancing soft-tissues that now extended to adjacent levels with extensive erosive changes. After surgical intervention for suspected infection, all cultures and stains for organisms were negative. Final pathology showed granulation tissue with focal inflammatory changes and calcium pyrophosphate crystal deposition. Although pseudogout is rare, physicians should add the disorder to the differential diagnosis for low back pain with radiculopathy and presumed infection.
    PMID: 24078961 [PubMed - as supplied by publisher]
  • High-grade adult isthmic L5-s1 spondylolisthesis: a report of intraoperative slip progression treated with surgical reduction and posterior instrumented fusion.

    Global spine journal 2012 Jun

    Authors: Mikhael MM,
    Abstract
    Adult isthmic spondylolisthesis most commonly occurs at the L5-S1 level of the lumbar spine. Slip progression is relatively rare in adults with this condition and slippage is typically associated with advanced degeneration of the disk below the pars defect. When symptomatic, radiculopathy is the typical complaint in adults with isthmic spondylolisthesis. When considering options for surgical treatment of adult isthmic spondylolisthesis, the surgeon must consider several different options, such as decompression, fusion, instrumentation, reduction, and type of bone graft to be used. All of these decisions must be individualized as deemed appropriate for each particular patient. This report presents a case of intraoperative slip progression of a L5-S1 adult isthmic spondylolisthesis to a high-grade slip, which was treated with complete surgical reduction and posterior instrumented fusion. This case demonstrates the potential instability of this condition in adults and has not been previously reported. The case details and images are reviewed and the intraoperative decisions, treatment options, and patient outcome are discussed.
    PMID: 24353957 [PubMed - as supplied by publisher]
  • Cervical spine surgery: cervical laminaplasty.

    Instructional course lectures 2012

    Authors: Mikhael MM,
    Abstract
    Multilevel cervical spondylosis resulting in myelopathy is a complex condition to treat surgically. Several anterior and posterior procedures have been described. Cervical laminaplasty is a procedure that provides multilevel posterior cord decompression while attempting to eliminate the postoperative development of instability and kyphosis by retaining the posterior elements. Because laminaplasty does not involve arthrodesis, more postoperative motion is preserved and early range of motion is encouraged to avoid stiffness. Although laminaplasty is a relatively straightforward procedure, understanding several key points can help avoid common technical challenges and ensure the best possible outcomes for patients. A variety of fixation techniques, each with advantages and limitations, are available to keep the laminaplasty door open. The surgeon should be aware of the complications associated with cervical laminaplasty.
    PMID: 22301254 [PubMed - as supplied by publisher]
  • Minimally invasive approaches to the cervical spine.

    The Orthopedic clinics of North America 2012 Jan

    Authors: Celestre PC,
    Abstract
    Minimally invasive approaches and operative techniques are becoming increasingly popular for the treatment of cervical spine disorders. Minimally invasive spine surgery attempts to decrease iatrogenic muscle injury, decrease pain, and speed postoperative recovery with the use of smaller incisions and specialized instruments. This article explains in detail minimally invasive approaches to the posterior spine, the techniques for posterior cervical foraminotomy and arthrodesis via lateral mass screw placement, and anterior cervical foraminotomy. Complications are also discussed. Additionally, illustrated cases are presented detailing the use of minimally invasive surgical techniques.
    PMID: 22082636 [PubMed - as supplied by publisher]
  • Minimally invasive cervical spine foraminotomy and lateral mass screw placement.

    Spine 2012 Mar 1

    Authors: Mikhael MM,
    Abstract
    This technique article describes accomplishing multilevel posterior cervical decompression and lateral mass screw placement through a tubular retraction system.
    Multilevel foraminotomy and instrumented fusion using lateral mass screw fixation can be achieved through a minimally invasive technique using specialized retractors and intraoperative fluoroscopic imaging.
    Minimally invasive surgical techniques have been adapted to the cervical spine with good results. These techniques have the theoretical advantages of reducing morbidity, blood loss, perioperative pain, and length of hospital stay associated with conventional open posterior spinal exposure.
    Minimally invasive access to the posterior cervical spine was performed with exposure through a paramedian muscle-splitting approach. With the assistance of a specialized tubular retraction system with a deep soft tissue expansion mechanism, multilevel posterior cervical decompression and fusion can be accomplished.
    Minimized access to perform multilevel posterior cervical foraminotomy and fusion can be safely accomplished with tubular retraction systems. Complications associated with these techniques can include inadequate decompression, improper instrumentation placement, or neurologic injury due to poor access and visualization.
    Multilevel foraminotomy and instrumented fusion using lateral mass screw fixation can be safely achieved using these techniques. Complications associated with these strategies are typically due to inadequate visualization, incomplete decompression, or poor placement of instrumentation. As with all minimally invasive spine techniques, the surgeon must ensure that goals of the surgery, both technical and clinical outcomes, are comparable to those of a conventional open procedure.
    PMID: 22024895 [PubMed - as supplied by publisher]
  • Postoperative culture positive surgical site infections after the use of irradiated allograft, nonirradiated allograft, or autograft for spinal fusion.

    Spine 2009 Oct 15

    Authors: Mikhael MM,
    Abstract
    Retrospective chart review.
    We report the rate of postoperative infection at our institution following the use of irradiated allograft, nonirradiated allograft, or autograft for spinal fusion procedures.
    Infection after a spinal fusion procedure is a devastating complication. It has not been defined whether spine bone graft preparation has any correlation with postoperative infection in spinal fusion procedures.
    We retrospectively identified 1435 patients who underwent spine fusion procedures with a minimum 1-year follow-up. Irradiated allograft was used in 144 patients, nonirradiated allograft was used in 441 patients, and autograft was used in 850 patients. Postoperative spinal infection was based on documented positive spine cultures at the time of re-exploration for presumed infection. Infection rates were estimated using the method of Kaplan and Meier; estimates were calculated out to 1-year postsurgery, and rates were compared using log-rank tests.
    No significant difference in the rate of surgical site infection at 1 year was observed after the use of irradiated allograft (1.7%), nonirradiated allograft (3.2%), or autograft (4.3%), P = 0.51.
    There is no significant difference in the rate of infection following spine fusion using irradiated allograft, nonirradiated allograft, or autograft. The selection of bone graft to aid in spinal fusion should be based on the requirements of surgical technique and availability of the desired tissue and not on a perceived association with postoperative infection.
    PMID: 19829261 [PubMed - as supplied by publisher]
  • Multilevel diskitis and vertebral osteomyelitis after diskography.

    Orthopedics 2009 Jan

    Authors: Mikhael MM,
    Abstract
    Diskitis is a rare but serious complication following diskography. The signs and symptoms may be easily confused or attributed to patients' preexisting chronic axial degenerative conditions. Unrecognized, it can progress to deep-seated infection with vertebral osteomyelitis. This article presents a case involving a 4-level destructive vertebral osteomyelitis following multilevel diskography despite prophylactic antibiotics and a double-needle technique. A 38-year-old man with radicular symptoms underwent a microdiskectomy at L4-5. Due to only minimal improvement in pain postoperatively, the patient underwent a diagnostic lumbar diskography at L2-3, L3-4, L4-5, and L5-S1 at an outside institution in consideration for repeat surgical treatment. Following this procedure, the patient continued to have debilitating symptoms and presented to our institution, where evaluation revealed elevated inflammatory biomarkers. Magnetic resonance imaging (MRI) suggested diskitis and vertebral osteomyelitis with compression fractures at the 4 levels where the diskography was performed. The patient was successfully treated with parenteral antibiotics targeted at Staphylococcus saccharolyticus, which was isolated in the culture from an open biopsy specimen after an initial percutaneous biopsy was inconclusive. Magnetic resonance imaging is the best radiologic modality for early diagnosis of this complication. This case demonstrates that early changes on MRI should warrant immediate workup and treatment. Treatment involves at least 6 weeks of parenteral antimicrobial therapy.
    PMID: 19226022 [PubMed - as supplied by publisher]
  • Failure of metal-on-metal total hip arthroplasty mimicking hip infection. A report of two cases.

    The Journal of bone and joint surgery. American volume 2009 Feb

    Authors: Mikhael MM,
    Abstract
    Infectious disease transmission through the use of human donor allografts can be a catastrophic complication in an otherwise straightforward surgical procedure. The use of bone allograft in reconstructive orthopedic surgeries is increasing, yet severe complications, including death, can result if the transplanted tissues transmit a communicable disease to the tissue recipient. The BioCleanse tissue sterilization process is a fully automated, low-temperature chemical sterilization process that renders allograft tissue sterile. The purpose of this study was to evaluate the effect of a chemical tissue sterilization process on the mechanical strength of cortical bone allografts prior to implantation. Cylindrical cortical bone specimens were harvested from seven human cadaver donors and treated either by: chemical sterilization alone; chemical sterilization and terminal sterilization by gamma irradiation; chemical sterilization, lyophilization, terminal sterilization by STERRAD and rehydration; or untreated. The specimens were tested to failure in axial compression, diametral compression, shear, or bending. There were no significant differences in ultimate stress, strain, or fracture energy between the chemically sterilized and control groups in any of the testing modes.
    PMID: 19181991 [PubMed - as supplied by publisher]

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