All posts by MISI

Michael Rimlawi Destined for a Career in Health Care

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DALLAS (February 20, 2018)…Approachable, empathetic and compassionate are words patients often use to describe 46-year- old Michael Rimlawi. Dr. Rimlawi is founder of the Minimally Invasive Spine Institute in Dallas. The spine institute was created to provide care for patients who suffer from back and neck pain as well as provide minimally invasive surgery when needed.

Rimlawi grew up in a family of health care professionals who he credits for his love of medicine and helping others. He is the oldest of four children born to an Italian and Lebanese father and American mother. His father is an obstetrician/gynecologist, and his mother a nurse. His parents met while they were in training in Ohio and soon married and started a family.

For Rimlawi, not going into health care was never an option. From a very early age, his mother recalls that he emphatically would state he wanted to fix people. He would shadow his father on rounds and observe surgeries. Rimlawi reflects, “It was a different time back then. He would put me by the anesthesiologist and have me watch surgery. Of course, one would never be allowed to do this today, but I must say this experience, and watching my parents with patients, shaped me to respect the medical profession and to want to be a physician so I could help people the way my parents did. My mother was so kind and understanding with everyone she came in contact with and I saw how she would make people around her feel safe and at ease. My father has an amazing work ethic and never complained about the hours he worked or the family time he missed because of work. He modeled focus and drive for me. He sacrificed so much to take care of our family.”

After graduating high school, Rimlawi headed to the University of Wisconsin – Madison. His mother joined him there as she pursued her undergraduate degree after being a stay-at-home mother for many years. Rimlawi laughs, “My friends would see her in the dorm and thought she was my girlfriend, and I’d have to point out that she was my mom. I don’t know how she had the energy to attend classes and study after taking care of all of us. She’s pretty amazing.”

From Wisconsin, Rimlawi headed to New York College of Medicine. It was here that he changed his focus from wanting to be an OB-GYN to a spine surgeon. It became personal because he suffered a bad back injury. He went to numerous physicians for treatment, but nothing really worked. No one took the time to explain what was causing him pain and why.

“One doctor would send me to another doctor, then to physical therapy, then to a chiropractor, and give me medications,” Rimlawi states. “I dealt with severe back pain for years, and no one explained my prognosis or treatment options to me. My back pain was so bad at one point that I had to take my medical school exams standing up. It wasn’t until later in medical school that I started understanding what was wrong with my back and why I was in so much pain. That’s when I became very interested in becoming a spine surgeon.”

Rimlawi adds that because he lived for so long in pain, he understands patients who come to him frustrated and at the end of their rope. He believes patients need to understand their treatment plans and options. “Spine pain can be scary, so it’s important that my patients know their diagnosis and understand the process we are going to follow to treat their pain. Knowledge helps patients to feel in control and know what to expect.”

When Rimlawi finished medical school, his residency training brought him to the North Texas Health Science Center. And as they say, the rest is history.

Five questions for Michael Rimlawi:

1.     Who is your role model?

“My role models have always been my parents. I witnessed firsthand their work ethic and how family was very important to them. My father was constantly working to provide for us. He missed a lot of games, family dinners and events because he had to work. My mother is an amazing cook, and she insisted we have meals together. We would all sit together, eat and share stories about our day. My mother was always there for us. I realized as I got older just how special she is. She taught us the value of treating others in the way we would want to be treated and the importance of doing the right thing. Those life lessons you never forget.”

2.     What’s one thing about Michael Rimlawi others would be surprised to know?

“The one thing that others would be surprised to know is that I invented two minimally invasive spine surgery instruments. There were a few products available that each did the things I needed in surgery but not one complete instrument that did it all – back then they had deficiencies. I wanted to invent something that had all the superior aspects of each product rolled into one. I sat down with an engineer and gave him all my ideas. We put it into one device that I was able to patent. I also patented a minimally invasive retractor as well. My retractor allows me to get into the spine with very little muscle destruction.”

3.     How do you maintain empathy?

“You know what? It’s the only way I know how to be. If someone is in pain, I recognize that feeling. I can’t sit back and do nothing. I have to help. I know what it is like to be in excruciating pain 24 hours a day. I can relate. It’s funny.

Certain things in my life I’ve gotten used to, like seeing blood, broken bones, pinched nerves, but as far as seeing people in pain, I’m never going to get used to that. If I can help minimize or erase their pain, I have to do it.”

4.     What has been a defining moment in your life?

“One of the biggest defining moments in my life was when my father developed a focal dystonia in his hand. It affected his ability to operate and therefore affected his ability to support the family. It really shook me to see this strong person become vulnerable. Even though I was in training, I started moonlighting to help my family because I knew how stressed my father was. I had to work to help finance my brothers’ and my sister’s education. I’m grateful that I was in a position to give back. My family means everything to me.”

5.     What is one of the most interesting surgical cases you’ve been involved with?

“There’s so many. One of the most interesting or best case I’ve worked on was with a gentleman who came to my office in a wheelchair. He could barely move his arms or legs, and he didn’t know why. We were able to discover the cause of his paralysis. Following surgery, I’d see progress where he slowly got out of his wheelchair, he slowly went to a walker, he slowly went to a cane, and then one day he wanted to surprise me. He told the staff to knock on the door three times before I came in. So they knocked three times, I opened the door, and without saying a word, he performed a short dance in the patient room. That was very touching. He went from a wheelchair unable to move his arms or legs to doing a little dance. There is very little else that feels as fulfilling as positively affecting someone’s life.”

The Minimally Invasive Spine Institute was founded in 2011 on the principle of patient-centered compassionate care where every treatment offered is customized to meet the patient’s specific needs and exceed their expectations. From staff and fellowship-trained, spine specialists to state-of-the-art technology and innovative techniques, the Minimally Invasive Spine Institute in Dallas has brought together the best of the best, where patients can access their team of doctors and specialists all under the same roof. Providing no operative and advanced surgical care for all types of spinal disorders, this 45,851-square-

foot facility has helped more than 20,000 patients and holds a 98 percent success rate. The ambulatory surgery center (ASC) is AAAHC Certified, meaning it maintains the highest standards for ASCs and boasts a zero percent infection rate. The Minimally Invasive Spine Institute’s ASC houses four hospital-grade operating suites and 16 stress-free recovery bays staffed with experienced, specialized nurses. Additional facility features include an on-site imaging center, clinic and procedure rooms, rehabilitation, physician rooms and a hotel lobby-like reception/waiting areas in a quiet, clean environment specifically designed for comfort and care. The Minimally Invasive Spine Institute is noted for the development of the groundbreaking procedure MicroCision, the least invasive option to treat back and neck pain in the cervical, thoracic and lumbar regions with an incision as small as 3 millimeters. For more information on the Minimally Invasive Spine Institute, go to or call 855-466-6741.


The Minimally Invasive Spine Institute offers the unique benefits of a center solely dedicated to using the latest technologies to effectively treat a comprehensive range of spinal conditions. Whether it’s employing a cutting-edge pain mapping process to diagnose or performing minimally invasive back surgery with incisions so small it allows patients to return home the very same day, the Minimally Invasive Spine Institute works to give superior care and lasting results to every person they see. The spine specialists at the Minimally Invasive Spine Institute treat all aspects of spinal disease including degenerative and traumatic conditions of the cervical, thoracic and lumbar spine. More than just back doctors, the Minimally Invasive Spine Institute specialists are leaders in their field, pioneering minimally invasive surgical techniques, helping train spine surgeons all over the world and achieving successful outcomes for their patients. For more information on the Minimally Invasive Spine Institute, call 855-297-7242 or go to Follow on social media: Facebook –; Twitter –; LinkedIn –; and Pinterest –

Severe Headaches: Migraines and How to Treat Them

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Migraines are severe headaches that affect over 30 million Americans per year. Marked by nausea, vomiting and sensitivity to light and sound, migraines are debilitating and disruptive, sometimes with little or no relief for days at a time. Understanding their progression, potential triggers and effective treatments can greatly help those suffering to combat migraines and regain control of their lives.

Characteristics of Migraines

As far as severe headaches go, migraines are in a category of their own. Generally manifesting in childhood, what starts as a localized headache in one area of the head turns into throbbing, pulsating pain that causes nausea, vomiting, sensitivity to light and sound, mood swings, fatigue and even sinus pain and congestion. They are exhausting and debilitating and, for many who suffer, can last anywhere from two to four days.

Migraines follow a four-stage pattern:

  1. The first stage is known as the prodromal stage, and it starts one to two days before the migraine comes on. The individual may notice being thirstier than usual, craving specific foods, yawning more often than usual and going to the bathroom more. He or she may also become irritable and tired.
  2. In the second stage, the aura stage, the visual disturbances that accompany migraines begin to pop up. The individual may experience flickering of lights, areas where he or she appears to lose vision, and has difficulty focusing. He or she may also notice difficulty concentrating or speaking and may feel some numbness or tingling throughout the body.
  3. The third stage, the actual attack, is when the headache begins. Usually starting above the eyes and moving to one side of the head (although sometimes it can cover the entire head), the headache becomes more intense, often throbbing and pulsating. During this stage, nausea, vomiting, lightheadedness and worsening of symptoms during physical activity may also occur.
  4. The last stage is the postdrome stage, the period after the headache when the individual is exhausted, fatigued, lacking in energy and sluggish.

Migraine Headache Relief

Being aware of migraine triggers may go a long way in helping patients prevent migraine attacks. Some common triggers for these severe headaches include:

  • Specific types of foods, especially those containing MSG, caffeine, nitrates or alcohol
  • Missing meals
  • Stress
  • Environmental factors
  • Lack of or too much sleep

Migraine headaches are treated in several ways, depending on history of migraines, severity of symptoms and efficacy of previous treatment. Medication is one of the go-to primary treatments for migraines –from over-the-counter migraine formulas of acetaminophen, aspirin and caffeine, to prescription medications that work to constrict blood vessels and block pain pathways in the brain. In some cases, anti-depressants, opioids and even beta blockers are used to treat migraine headaches. There are also alternative treatment therapies that have proven effective in easing migraine symptoms. These include acupuncture, massage therapy and biofeedback.

If you are suffering from migraines or persistent headaches, contact MISI today at 877-504-9759 to schedule a consultation with one of our migraine specialists.

Insurance Coverage Questions to Ask Before Back Surgery

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When it comes to insurance, most policies (including Medicare) cover back surgery, as long as it is deemed medically necessary by a doctor. But, insurance coverage can be confusing, which is why it’s important for patients to stay informed about their insurance coverage and what it entails.

Each insurance policy differs regarding what is covered and what is not. Additionally, there are a few things that can affect your level of coverage, so it’s important to be familiar with these aspects, to ensure you will have minimal out-of-pocket expenses. Things to keep in mind when reviewing insurance coverage before back surgery:

  • Reason for surgery.

    Some insurance policies will only cover surgery relating to a specific diagnosis, so be sure to read into your policy before scheduling your surgery. If your insurance policy covers back surgery, the surgery will need to be deemed medically necessary for your insurance to cover it.

  • Work-related injury.

    If your back surgery is due to a work-related injury, most insurance companies will require your company’s workers’ compensation coverage to pay for the procedure, rather than your personal insurance.

  • In-network vs. Out-of-network.

    Some insurance policies don not offer out-of-network benefits to members and require diagnosis by a specialist within their network in order for them to cover the procedure. Policies that have both in-network and out-of-network benefits allow their members more flexibility when deciding on where to seek medical treatment for back pain.  Be sure to check with your insurance company whether or not this applies to you.

  • Type of surgery recommended.

    There are certain types of surgeries that your insurance may not cover. Check with the doctor to find out which type of surgery he or she recommends, and then follow-up with your insurance provider to ensure that they cover it. If back surgery is covered by your insurance carrier, your coverage will not change if you choose to have minimally invasive back surgery or traditional open-back surgery.

  • Benefit level covered.

    Depending on your benefit level, some aspects of surgery or postoperative care may not be covered, such as medications and therapeutic medical equipment.

The key to understanding which procedures your insurance will or will not cover is communication. Speak with your insurance company, read the coverage information they send, and follow up with any questions you may have.

Deskercise Tips for Back Pain Relief

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Research shows that a sedentary lifestyle can be harmful to a person’s overall health. Unfortunately, with many people sitting behind a desk for eight hours a day, the risk of cardiovascular disease, varicose veins, obesity, type 2 diabetes or back problems is increased. That is why it’s important to incorporate some stretching or light exercise during the workday.

Exercise Tips While Sitting at Work

Stretching exercises at your desk can boost energy levels, improve mood and offer upper and lower back pain relief. Here are some tips to help develop a deskercise routine and make each day a little healthier.

  • The Posture Perfecter:

    Neck and back problems can occur more quickly due to bad posture, so be sure to sit properly in your chair and avoid slouching. Adjust the chair height to make sure your feet, hips, and arms are at 90-degree angles to the floor.

  • The Headshot:

    Stretch your neck by gently lowering your right ear to your right shoulder, holding in place for 5 seconds. Repeat to the opposite side. With each stretch, you may find yourself more flexible, but don’t go further than what is comfortable.

  • The Leaning Tower:

    Stretch your arms and your upper body by reaching your hands above your head, stretching toward the ceiling. Lean at the waist in this position, first to the right side, then the left. Try to keep your shoulders from rising to your ears in order to protect your muscles from tensing up.

  • The Pencil Pinch:

    Roll your shoulders back until the shoulder blades are pinched together and pretend you’re holding a pencil between the scapulas. Hold for 5 seconds, release and repeat.

  • The Spine Rotator:

    Use your chair to stretch! Sit upright with both hands on the right side of the chair. Gently rotate your shoulders to the right until your spine is twisting slightly. Release your hands and repeat on the left side.

  • The Last Man Standing:

    Be sure to stand up and walk around for a couple of minutes every hour. This gives the body a break from sitting and increases blood flow.

Don’t be embarrassed to work out a little at your desk. Stretching throughout the workday can offer some lower and upper back pain relief while ensuring that you live a more active lifestyle.

What to Ask at a Spine Surgery Consultation

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Just as a surgeon needs to know all relevant patient information before operating, it’s critical for a patient to know about the procedure he or she is about to undergo. That is why it’s important for patients to have a list of questions ready for a spine surgery consultation.


What Type of Questions to Ask

From filling out new patient forms to meeting with a new spine specialist, a spine surgery consultation visit can be a little overwhelming. Having a list of questions ready for the doctor when you arrive will ensure all concerns are addressed and questions answered before undergoing surgery. But what type of questions should be asked?

Questions to Ask About Diagnosis, Treatment and Procedure

Be sure to ask in detail about the condition that brings you to a spine specialist, what their diagnosis is, how they came to that conclusion and the treatment options available. Some questions to ask include:

  • What is your diagnosis of the symptoms?
  • What treatment options are available? Which course of treatment is recommend and why?
  • If surgery is recommended – please describe in detail what the surgery will entail, from start to finish. Who will be performing the surgery and how long will it take?
  • What are the risk factors and possible complications of the surgery? What are the long-term effects?
  • What can I do on my end to prepare for treatment and surgery to ensure it is as successful as possible?

Questions to Ask About Postoperative Care

Just as you asked questions about your diagnosis and the treatment plan it entails, you should ask questions about the postoperative period. Some questions to consider could be:

  • What should I expect my recovery time to be?
  • What does the post-operative process involve? What can I expect during this period of recovery?
  • How long before I can go back to normal activities, including school or work?
  • What are some complications I should look out for during my recovery time?
  • What should I do if I notice any unusual symptoms?
  • What are your expectations for recovery?

Find Out About a Surgeons Professional Background

Patients should never be afraid to ask specialists about their experience or history. When asking questions during your consultation, don’t be afraid to ask about a surgeon’s professional background and experience with the type of treatment that is being suggested. Some questions to ask include:

  • Have you performed this surgery before? What is your success rate?
  • How long have you been practicing? How long have you been performing this kind of surgery?
  • Are you fellowship-trained?

When it comes to spine surgery preparation, a great specialist knows that providing the patient with as much information as possible makes him or her feel at ease and comfortable, which will make the healing process smoother. Don’t be afraid to ask questions.

Pain Relief Struggles: How Do Vices Affect My Orthopedic Health?

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Pain relief from orthopedic conditions greatly depends on the body’s physical condition as a whole. This is why vices can have lasting negative effects on musculoskeletal health. But how exactly do these vices such as smoking, drinking, overeating or leading a sedentary lifestyle affect the way a person heals from orthopedic conditions?

How does smoking affect orthopedic health?

Smoking has been linked to a number of cancers, emphysema, heart disease, diabetes and strokes, among other illnesses. Smoking also increases the risk for osteoporosis as it weakens bones, reducing their blood supply and slowing their absorption of calcium. In addition, it breaks down the estrogen that bones need to stay strong and slows down the production of bone-forming cells. All together it amounts to weak and brittle bones. Based on this information, it is no surprise that studies have found that elderly smokers have a 30-40% greater chance of breaking their hip.

However, the consequences of smoking on orthopedic health don’t just apply in your golden years. Smokers, who are athletic in nature, are affected by shortness of breath and in turn, decreased oxygen delivery to the muscles. In addition, smoking weakens the muscles and joints, increasing the risk for bursitis, arthritis, tendinitis, injury, fractures and tears in tendons and ligaments.

How does drinking affect orthopedic health?

It was once believed that only alcoholics were at a greater risk for health consequences, but now it’s believed that binge drinkers are also susceptible. Alcohol has long been associated with liver disease, pancreatic cancer, heart problems and more. It has also been associated with orthopedic health conditions such as an increase in bone fractures, ultimately slowing down the process of bone healing, making those fractures more difficult from which to recover.

How does overeating and a sedentary lifestyle affect orthopedic health?

Smoking and drinking aren’t the only vices harmful to bone and spine health. If you’re seeking chronic pain relief and you live an inactive lifestyle, or you find yourself eating more than you should and gaining weight, it’s important to understand the correlation between those vices and your health. Weight issues coupled with a lack of exercise can greatly increase the risk of back pain. Inactivity combined with extra weight puts pressure and strain on your joints and spine, putting you at a greater risk for sciatica, herniated discs and pinched nerves.

These vices negatively affect bone and spine health, making chronic pain relief more difficult to achieve. Cutting out harmful vices such as smoking and drinking as well as getting into an active lifestyle will empower you to regain control of your orthopedic health. Take back your health and find your way to lasting pain relief!

Can Popping Your Back or Neck Cause Spine Damage?

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Many people crack their knuckles on a regular basis and, although the rumors have always been persistent that knuckle cracking could lead to rheumatoid arthritis, no evidence has been found to suggest that. But what about “popping” your back or neck? Is there a chance that popping either of those could lead to a spine condition?

Where does the “pop” come from?

The popping sound heard when cracking your neck or spine is believed to come from the same process that makes your knuckles crack. Joints are surrounded by fluid-filled membranes that act as a lubricant and shock absorber so your bones don’t grind together when you move. The gases in the fluid, most notably nitrogen and carbon dioxide, escape when pressure is applied to the joint, which creates the popping sound.

Can popping your back or neck lead to a spine condition?

Cracking your back once in a while should not be a cause for concern, nor does it mean that you will develop arthritis or a spine condition as a result.

However, that doesn’t mean that habitually popping your back or neck is without risks. When you routinely crack your neck or back, you’re putting yourself at risk for hypermotility, which essentially means your joints, tendons, muscles and ligaments lose elasticity. In addition, the urge to pop your neck or back on a regular basis may be a sign of an underlying condition, which should be examined by a specialist.

The Bottom Line

Although popping your back and neck once in a while may not do you any harm, doing so habitually, or even having the urge to do so frequently, may be a warning sign that something else is going on. Habitually cracking your back could wear out your joints and connective tissue, making them lose elasticity and put you at risk for discomfort or worse, chronic pain. So be sure to keep your popping in check!

Pain Relief Mysteries: Does Weather Really Affect Pain?

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Can bad weather make pain relief impossible? You may have come across someone who declared his sinus headache or joint pain was an indicator bad weather was imminent. According to many doctors, when the weather takes a turn for the worse, or rain is on the horizon, patients are able to predict the changes with relative accuracy.

Theories about Weather

While research has been conducted, the current results are too mixed to definitively prove or disprove these claims.

One theory correlates barometric air pressure to chronic pain. Barometric air pressure is how “heavy” or “thick” the air feels. When the pressure is high, it presses against our bodies and prevents joints and tissue from expanding. When the pressure drops, which happens before a storm or wet weather conditions, the lack of pressure on our joints and tissues allows them to become inflamed more easily.

Another theory asserts that nerves become more sensitive due to injury, swelling, scarring or adhesions. As a result, it may appear that changes in weather, or cold weather have a negative effect on chronic pain.

The Truth about Chronic Pain

Whatever the real reasons, sometimes patients erroneously believe that moving to warmer climates may provide them with some chronic pain relief. While a warmer climate may be helpful, the root cause of their chronic pain won’t go away. It’s important for patients to learn how to manage their chronic pain effectively, regardless of weather.

Following a pain management plan that works for the patient is an important part of pain relief. Remaining active is another crucial piece of chronic pain relief. Being mindful of their emotional or mental state and tackling issues of depression or anxiety, in time can be extremely helpful in maintaining a good frame of mind so pain can be properly managed. These are just some of the many steps you can take for pain relief, regardless of the weather changes!

De Quervain’s Disease: What you need to know from MISI

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Named after the Swiss surgeon, Dr. Fritz De Quervain, who first identified the condition, De Quervain tenosynovitis, more commonly referred to as De Quervain’s disease, is a hand condition affecting a patient’s ability to move his or her thumb. This happens when the tendons on the thumb side of the wrist become swollen, causing pain when twisting, grasping or making a fist.

The causes of this painful hand condition include chronic overuse of the wrist, direct injury to the wrist or tendon area, and inflammatory arthritis. One interesting fact about De Quervain tenosynovitis is that women are more likely than men to suffer from this condition, especially after pregnancy. It used to be referred to as washerwoman’s sprain or mother’s wrist.

De Quervain’s Treatment

Treatment for De Quervain’s disease is aimed at reducing inflammation, maintaining movement in the thumb and preventing recurrence. In order to properly diagnose the condition, a hand surgeon will perform a simple test called the Finkelstein’s Test. The patient makes a fist with their fingers closed over the thumb with the wrist angled towards their little finger. If this causes pain on the thumb side of your wrist, chances are it’s De Quervain’s disease.

De Quervain’s treatment options consist of the following:

  • A splint, worn every day and night for 4-6 weeks, to hold the affected area firm and still
  • Ice applied to the affected area in order to reduce inflammation
  • Anti-inflammatory medications, such as naproxen or ibuprofen, to reduce pain and swelling
  • Corticosteroids injections to relieve pain and inflammation

In cases where the condition does not respond to conventional treatment options, surgery may need to be considered. At MISI, our approach involves a 2cm incision over the affected tendons in the wrist area in order to release the pressure and allow more room for tendon movement. This procedure takes as little as seven minutes with an average recovery period of seven days.