Skip to Content

Mark M. Mikhael, M.D.

Mark M. Mikhael, M.D.

Mark M. Mikhael, M.D.

Spine Surgery
  • Locations

    Illinois Bone and Joint Institute, LLC

    2401 Ravine Way
    Suite 200
    Glenview, IL 60025
    847.998.5680 847.998.6365 fax Get Directions This location is wheelchair accessible.

    Illinois Bone and Joint Institute, LLC

    2401 Ravine Way
    Suite 103
    Glenview, IL 60025
    847.998.5680 847.998.6365 fax Get Directions This location is wheelchair accessible.

    Illinois Bone and Joint Institute, LLC

    2350 Ravine Way
    Suite 600
    Glenview, IL 60025
    847.832.1695 847.998.6365 fax Get Directions This location is wheelchair accessible.

    Illinois Bone and Joint Institute, LLC

    521 Green Bay Rd.
    Wilmette, IL 60091
    847.998.5680 847.998.6365 fax Get Directions This location is wheelchair accessible.
  • Publications
    • Use of Allogenic Mesenchymal Cellular Bone Matrix in Anterior and Posterior Cervical Spinal Fusion: A Case Series of 21 Patients.

      Asian spine journal 2017 Jun

      Authors: Divi SN
      Retrospective case series.
      To report our early experience using allogenic mesenchymal cellular bone matrix (CBM) products in cervical spine fusion.
      Multi-level cervical fusions have historically yielded lower fusion rates than single level fusions, especially in patients with high risk medical comorbidities. At this time, significant literature in cervical fusion outcomes with this cellular allograft technology is lacking.
      Twenty-one patients underwent either multilevel (3 or 4 level) anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, or posterior cervical fusion. ViviGen (DePuy Synthes Spine, Raynham, MA, USA), an allogenic bone matrix product, was used in addition to standard instrumentation. Radiographic evaluation was performed at 2 weeks, 12 weeks, 24 weeks and 1 year postoperative. Visual analog scale (VAS) and neck disability index (NDI) scores along with return to work and leisure activity were recorded.
      At 6 months postoperative, all patients had radiographic evidence of bone fusion regardless of age or medical comorbidities. All patients reported subjective improvement with a mean decrease in VAS from 8.3 to 1.5 and a mean decrease in NDI from 40.3% to 6.0% at 1 year. All patients also returned to work and/or regular leisure activity within 3 months.
      Twenty-one patients undergoing high-risk anterior and posterior cervical spine fusion, with the use of a commercially available mesenchymal CBM product, went on to radiographic fusion and all had improvement in subjective outcomes. While further effort and research is needed to validate its widespread use, this study shows favorable use of CBM in cervical fusion for high-risk cases.
      PMID: 28670414 [PubMed - as supplied by publisher]
    • Extensive Deep Venous Thrombosis Resulting from Anterior Lumbar Spine Surgery in a Patient with Iliac Vein Compression Syndrome: A Case Report and Literature Review.

      Global spine journal 2015 Aug

      Authors: Reddy D, Mikhael MM, Shapiro GS, Farrell T
      Study Design Case report. Objective Although May-Thurner syndrome or iliac vein compression syndrome is covered in the vascular literature, it remains absent from the orthopedic and neurosurgery literature and has not been previously reported to occur in concordance with spine surgery. We review the salient points of disease presentation, diagnosis, and treatment. Methods A 33-year-old woman was followed postoperatively via clinical and radiographic findings. Her presentation, operative treatment, postoperative extensive deep venous thrombosis (DVT) formation, and management are described. Results We present a unique case of a healthy 33-year-old woman who developed an extensive left iliac vein DVT after anterior lumbar spine fusion. Although she had multiple risk factors for thrombosis, the size of the thrombus was atypical. A subsequent venogram showed compression of the left common iliac vein by the right common iliac artery, consistent with May-Thurner syndrome. Conclusions May-Thurner syndrome or iliac vein compression syndrome is a rare diagnosis that is absent from the spine literature. The condition can predispose patients to extensive iliac vein DVT. The contributing anatomy and subsequent clot often require catheter-directed thrombolysis and stenting to achieve a favorable outcome.
      PMID: 26225289 [PubMed - as supplied by publisher]
    • Rotation effect and anatomic landmark accuracy for midline placement of lumbar artificial disc under fluoroscopy.

      European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2017 03

      Authors: Mikhael M, Brooks JT, Akpolat YT, Cheng WK
      Total disc arthroplasty can be a viable alternative to fusion for degenerative disc disease of the lumbar spine. The correct placement of the prosthesis within 3 mm from midline is critical for optimal function. Intra-operative radiographic error could lead to malposition of the prosthesis. The objective of this study was first to measure the effect of fluoroscopy angle on the placement of prosthesis under fluoroscopy. Secondly, determine the visual accuracy of the placement of artificial discs using different anatomical landmarks (pedicle, waist, endplate, spinous process) under fluoroscopy.
      Artificial discs were implanted into three cadaver specimens at L2-3, L3-4, and L4-L5. Fluoroscopic images were obtained at 0°, 2.5°, 5°, 7.5°, 10°, and 15° from the mid axis. Computerized tomography (CT) scans were obtained after the procedure. Distances were measured from each of the anatomic landmarks to the center of the implant on both fluoroscopy and CT. The difference between fluoroscopy and CT scans was compared to evaluate the position of prosthesis to each anatomic landmark at different angles.
      The differences between the fluoroscopy to CT measurements from the implant to pedicle was 1.31 mm, p < 0.01; implant to waist was 1.72 mm, p < 0.01; implant to endplate was 1.99 mm, p < 0.01; implant to spinous process was 3.14 mm, p < 0.01. When the fluoroscopy angle was greater than 7.5°, the difference between fluoroscopy and CT measurements was greater than 3 mm for all landmarks.
      A fluoroscopy angle of 7.5° or more can lead to implant malposition greater than 3 mm. The pedicle is the most accurate of the anatomic landmarks studied for placement of total artificial discs in the lumbar spine.
      PMID: 25971356 [PubMed - as supplied by publisher]
    • 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, Mikhael MM, Koh JL
      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.
      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, Chioffe MA, Shapiro GS
      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, Shapiro GS, Wang JC
      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, Wolf CF, Wang JC
      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, Pazmiño PR, Mikhael MM, Wolf CF, Feldman LA, Lauryssen C, Wang JC
      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 01

      Authors: Mikhael MM, Celestre PC, Wolf CF, Mroz TE, Wang JC
      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, Huddleston PM, Nassr A
      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]
  • In the News
    In the News

    Dec 2018

    Sep 2018

    Apr 2018

    Feb 2018

  • Social Media
    Social Media