Neurosurgery and Spine Clinic
When back or neck pain disrupts daily life, getting the right care close to home matters. Bozeman Health’s Neurosurgery and Spine Clinic brings together orthopedic and neurosurgical expertise to treat a wide range of spine conditions, from disc problems and spinal deformities to tumors and traumatic injuries. Our team offers personalized surgical and nonsurgical care and coordinated treatment to help patients make informed decisions and work toward better function and quality of life. Patients across southwest Montana can access advanced spine care locally, with referrals to specialized centers when needed.
CRANIAL SURGERY
Expert Brain and Neurological Care
A neurological condition can affect every aspect of daily life — from how you think and move to how you work, sleep and spend time with the people you love. At Bozeman Health Neurosurgery and Spine Clinic, our team provides comprehensive evaluation, treatment and long-term follow-up for conditions affecting the brain, spine and nervous system.
Neurosurgeons Dr. Joseph Sramek and Dr. James Kalyvas work closely with patients, families and care teams to develop personalized treatment plans that prioritize safety, recovery and quality of life. Whether you are experiencing symptoms from a concussion, have recently been diagnosed with a brain tumor, require ongoing monitoring after surgery or are seeking relief from chronic pain, our team is here to guide you through every step of your care.
James Kalyvas,
MD, FAANS
Bozeman Health Deaconess Regional Medical Center
Joseph Sramek,
MD
Bozeman Health Deaconess Regional Medical Center
Virginia Jeppesen,
NP-C
Bozeman Health Deaconess Regional Medical Center
Brain Masses & Brain Tumors
Hearing that you have a brain mass can be overwhelming. A brain mass is an abnormal growth within the brain that may be benign (noncancerous) or malignant (cancerous). Some masses are discovered after symptoms such as headaches, seizures, changes in vision or balance problems, while others are found unexpectedly during imaging performed for another reason.
Our team will carefully review imaging studies and discuss whether observation, additional testing or surgery is the best next step. When surgery is recommended, our team will explain the procedure, expected recovery and any additional treatments that may be needed. Some patients can receive their care entirely in Bozeman, while others with more complex conditions may benefit from care at a specialized tertiary center. When additional expertise is needed, we coordinate those referrals while remaining involved in your ongoing care.
Cranial Surgery Patient Journey
Following surgery, patients recover in either the intensive care unit or an inpatient hospital room depending on the complexity of the procedure and level of monitoring needed. Your care team will closely monitor your recovery, manage comfort and guide each stage of healing. As recovery progresses, patients and families receive education, support and rehabilitation guidance tailored to their specific needs. Follow-up care continues after discharge to help ensure ongoing healing, recovery and confidence moving forward.
Meningiomas
Meningiomas are among the most common types of brain tumors. They develop in the protective layers surrounding the brain rather than in the brain tissue itself. Many meningiomas grow slowly and may not require immediate treatment.
For some patients, careful monitoring with periodic imaging is the safest approach. Others may benefit from surgery if the tumor is growing or causing symptoms. Our team works closely with patients to determine the most appropriate treatment plan and provides long-term follow-up to monitor for changes over time.
Your Care Journey
Following surgery, patients recover in either the intensive care unit or an inpatient hospital room depending on the complexity of the procedure and level of monitoring needed. Your care team will closely monitor your recovery, manage comfort and guide each stage of healing. As recovery progresses, patients and families receive education, support and rehabilitation guidance tailored to their specific needs. Follow-up care continues after discharge to help ensure ongoing healing, recovery and confidence moving forward.
Subdural Hematomas
A subdural hematoma occurs when blood collects between the surface of the brain and its protective covering, often after a head injury. Symptoms can develop immediately or gradually and may include headaches, confusion, balance problems, weakness or changes in mental status.
Treatment depends on the size of the hematoma and the severity of symptoms. Smaller collections may be monitored closely with repeat imaging, while larger hematomas may require surgery to relieve pressure on the brain. Throughout recovery, our team carefully monitors healing and helps patients safely return to daily activities.
Your Care Journey
Following surgery, patients recover in either the intensive care unit or an inpatient hospital room depending on the complexity of the procedure and level of monitoring needed. Your care team will closely monitor your recovery, manage comfort and guide each stage of healing. As recovery progresses, patients and families receive education, support and rehabilitation guidance tailored to their specific needs. Follow-up care continues after discharge to help ensure ongoing healing, recovery and confidence moving forward.
Concussions & Head Injuries
A concussion is a form of traumatic brain injury that can affect memory, concentration, balance, mood and overall well-being. While many people recover fully, some continue to experience symptoms for weeks or months after an injury.
Our team evaluates patients with concussion symptoms and develops individualized treatment plans focused on recovery and symptom management. We work with patients to monitor progress, address lingering symptoms and provide guidance for safely returning to work, school, sports and other activities.
Your Care Journey
Following surgery, patients recover in either the intensive care unit or an inpatient hospital room depending on the complexity of the procedure and level of monitoring needed. Your care team will closely monitor your recovery, manage comfort and guide each stage of healing. As recovery progresses, patients and families receive education, support and rehabilitation guidance tailored to their specific needs. Follow-up care continues after discharge to help ensure ongoing healing, recovery and confidence moving forward.
Advanced Options for Chronic Pain
A spinal cord stimulator uses mild electrical signals to interrupt pain messages before they reach the brain. These devices can help reduce pain associated with certain spine conditions, nerve injuries and chronic pain syndromes.
Our team provides comprehensive care throughout the process, including evaluation, trial stimulation, implantation and long-term device management.
Your Care Journey
Following surgery, patients recover in either the intensive care unit or an inpatient hospital room depending on the complexity of the procedure and level of monitoring needed. Your care team will closely monitor your recovery, manage comfort and guide each stage of healing. As recovery progresses, patients and families receive education, support and rehabilitation guidance tailored to their specific needs. Follow-up care continues after discharge to help ensure ongoing healing, recovery and confidence moving forward.
Pain pumps deliver medication directly into the fluid surrounding the spinal cord. Because medication is delivered precisely where it is needed, patients often require lower doses than they would with oral medications.
We evaluate candidates for pain pump therapy, perform implantation procedures and provide ongoing management, refills and follow-up care.
Precision Technology for Safer Surgery
Modern neurosurgery relies on advanced technology to improve precision and enhance patient safety.
The O-arm system provides high-resolution, three-dimensional imaging during surgery. Rather than relying only on scans obtained before a procedure, surgeons can view detailed images in real time while operating.
This technology helps verify anatomy, confirm implant placement and make immediate adjustments when needed. By providing greater accuracy during surgery, the O-arm supports better decision-making and can reduce the need for additional procedures.
Stealth Navigation functions much like a GPS system for the brain and spine. Using advanced imaging and specialized tracking technology, surgeons can see the exact location of their instruments in relation to critical anatomy throughout a procedure.
This level of precision is especially valuable when operating near delicate structures within the brain and nervous system. It allows surgeons to navigate complex anatomy with confidence while minimizing disruption to surrounding tissue.
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Surgeons
Surgical Team
James Kalyvas, MD, FAANS
Neurosurgery and Spine
Joseph Sramek, MD
Neurosurgery and Spine
Virginia Jeppesen, NP-C
Neurosurgery and Spine
Cranial Patient Testimonials
Hear from patients about their experiences with Bozeman Health’s Neurosurgery and Spine Clinic,
from their first consultation through treatment and recovery.
A Pivotal Moment: Life-Saving Neurosurgery Launches in Southwest Montana
Orthopedic and Advanced Spine Care
Ben Smith,
DO
Bozeman Health Deaconess Regional Medical Center
James Kalyvas,
MD, FAANS
Bozeman Health Deaconess Regional Medical Center
Joseph Sramek,
MD
Bozeman Health Deaconess Regional Medical Center
Scott Grimm,
PA
Bozeman Health Deaconess Regional Medical Center
Danielle Crawford,
PA-C
Bozeman Health Deaconess Regional Medical Center
TOPS: Motion - Preserving Spine Surgery
Spinal fusion stabilizes the spine by permanently joining two or more vertebrae. For some patients, a motion-preserving procedure may be another option. The TOPS (Total Posterior Spine) System is an implant designed to stabilize a specific area of the lower spine while allowing movement at the treated segment. It may be an option for select patients with conditions such as lumbar spinal stenosis and certain forms of spondylolisthesis.
Not everyone is a candidate. Your surgeon will review your symptoms, imaging, spinal stability and overall health to determine whether TOPS, spinal fusion or another treatment is appropriate.
What to Expect
Your surgeon will review your symptoms, medical history and spinal imaging to determine whether you meet the criteria for the TOPS procedure. If TOPS is recommended, your surgeon will explain how the implant works, how the procedure differs from spinal fusion, and the potential benefits, risks and alternatives. You’ll also discuss what recovery may involve before deciding how to proceed. After surgery, your care team will guide you through early recovery, including incision care, safe movement and any activity restrictions. Follow-up appointments and imaging help your surgeon monitor healing and the implant. Your return to daily activities will depend on your procedure and individual progress.
Spine Surgery Care Path
Your journey begins with a thorough evaluation at Bozeman Health Spine + Joint Institute and Neurosurgery and Spine Clinic. During your consultation, your provider will take time to understand your symptoms, review imaging and discuss how pain or mobility issues are affecting your daily life. Many patients come to us hoping to return to the activities they love — working, traveling, hiking, exercising or simply moving comfortably again. Your care team will explain all treatment options, including nonsurgical therapies and surgical recommendations, so that you can make informed decisions with confidence.
Before surgery, you will meet with members of the anesthesia and surgical care teams to prepare for your procedure at the Spine + Joint Surgery Center. During this visit, your medical history, medications and overall health are carefully reviewed to help ensure a safe surgical experience. You will receive detailed instructions about how to prepare for surgery, what to expect on surgery day and how recovery will begin immediately afterward. This is also a chance to ask questions and discuss any concerns.
On surgery day, you will be welcomed by a specialized spine care team focused on your comfort, safety and recovery. Procedures are performed in the Spine + Joint Surgery Center using advanced surgical technology and evidence-based techniques designed to support precision and improved outcomes. Your surgeon and anesthesia team will review the plan with you before surgery begins and keep your loved ones informed throughout the procedure. Every aspect of care is centered on helping reduce pain, restore function and improve quality of life.
Adult Scoliosis
Adult scoliosis is a sideways curve of the spine that develops in adulthood or progresses from a curve that began earlier in life. It can cause back pain, changes in posture, difficulty standing upright or pressure on nearby nerves. Treatment depends on the curve, your symptoms and how the condition affects daily life. Options may include physical therapy, medication or other nonsurgical care. Some patients may benefit from surgery to improve spinal alignment, relieve pressure on nerves or stabilize the spine.
What to Expect
Your surgeon will review your symptoms, medical history and spinal imaging to understand the curve and how it affects your daily activities. Additional imaging may be needed to plan treatment. If surgery is recommended, your surgeon will discuss the procedure, its goals, potential risks and expected recovery. The length of surgery and hospital stay depend on the complexity of your condition and the procedure performed. Recovery may include a hospital stay, gradual increases in activity and follow-up appointments. Physical therapy may also be recommended. Your care team will guide you on managing discomfort, moving safely and returning to daily activities as you heal.
Spine Surgery Care Path
Your journey begins with a thorough evaluation at Bozeman Health Spine + Joint Institute and Neurosurgery and Spine Clinic. During your consultation, your provider will take time to understand your symptoms, review imaging and discuss how pain or mobility issues are affecting your daily life. Many patients come to us hoping to return to the activities they love — working, traveling, hiking, exercising or simply moving comfortably again. Your care team will explain all treatment options, including nonsurgical therapies and surgical recommendations, so that you can make informed decisions with confidence.
Before surgery, you will meet with members of the anesthesia and surgical care teams to prepare for your procedure at the Spine + Joint Surgery Center. During this visit, your medical history, medications and overall health are carefully reviewed to help ensure a safe surgical experience. You will receive detailed instructions about how to prepare for surgery, what to expect on surgery day and how recovery will begin immediately afterward. This is also a chance to ask questions and discuss any concerns.
On surgery day, you will be welcomed by a specialized spine care team focused on your comfort, safety and recovery. Procedures are performed in the Spine + Joint Surgery Center using advanced surgical technology and evidence-based techniques designed to support precision and improved outcomes. Your surgeon and anesthesia team will review the plan with you before surgery begins and keep your loved ones informed throughout the procedure. Every aspect of care is centered on helping reduce pain, restore function and improve quality of life.
Custom Spinal Rods
For some patients with complex spinal deformities, custom spinal rods can help our surgeons address individual differences in spinal shape and alignment. These rods are designed to support a surgical plan tailored to the patient’s anatomy and treatment goals. Your surgeon will use detailed imaging and careful planning to determine whether custom rods are appropriate. During surgery, the rods may be used with screws and other implants to support the spine in its planned position as it heals.
What to Expect
Planning begins with detailed imaging of your spine. Your surgeon uses these images to assess your anatomy and determine whether patient-specific rods are appropriate for your procedure. Before surgery, your care team will explain the surgical plan, how the rods will support your spine and what recovery may involve. After surgery, you may stay in the hospital while your team monitors your progress and helps you begin moving safely. Follow-up visits help your surgeon monitor healing and spinal alignment. Your recovery plan may include activity restrictions and rehabilitation based on the procedure and your progress.
Spine Surgery Care Path
Your journey begins with a thorough evaluation at Bozeman Health Spine + Joint Institute and Neurosurgery and Spine Clinic. During your consultation, your provider will take time to understand your symptoms, review imaging and discuss how pain or mobility issues are affecting your daily life. Many patients come to us hoping to return to the activities they love — working, traveling, hiking, exercising or simply moving comfortably again. Your care team will explain all treatment options, including nonsurgical therapies and surgical recommendations, so that you can make informed decisions with confidence.
Before surgery, you will meet with members of the anesthesia and surgical care teams to prepare for your procedure at the Spine + Joint Surgery Center. During this visit, your medical history, medications and overall health are carefully reviewed to help ensure a safe surgical experience. You will receive detailed instructions about how to prepare for surgery, what to expect on surgery day and how recovery will begin immediately afterward. This is also a chance to ask questions and discuss any concerns.
On surgery day, you will be welcomed by a specialized spine care team focused on your comfort, safety and recovery. Procedures are performed in the Spine + Joint Surgery Center using advanced surgical technology and evidence-based techniques designed to support precision and improved outcomes. Your surgeon and anesthesia team will review the plan with you before surgery begins and keep your loved ones informed throughout the procedure. Every aspect of care is centered on helping reduce pain, restore function and improve quality of life.
Revision Spine Surgery
Some patients continue to experience pain or other symptoms after spine surgery. In other cases, a previous procedure may not heal as expected, or changes in the spine may develop over time. Revision spine surgery addresses problems related to an earlier procedure. Depending on the cause, surgery may involve correcting spinal alignment, relieving pressure on nerves, adjusting or replacing implants, or extending a previous fusion.
What to Expect
Your surgeon will review your symptoms, medical history, previous surgery records and updated imaging to understand what may be causing your symptoms and determine the best approach. Because revision surgery can be more complex than an initial procedure, your surgeon will discuss the goals, potential risks and expected recovery. The surgical approach and length of your hospital stay depend on the problem being treated and the extent of surgery. After surgery, your care team will help you manage discomfort, move safely and follow any activity restrictions. Follow-up appointments and imaging help monitor healing and guide your return to everyday activities.
Spine Surgery Care Path
Your journey begins with a thorough evaluation at Bozeman Health Spine + Joint Institute and Neurosurgery and Spine Clinic. During your consultation, your provider will take time to understand your symptoms, review imaging and discuss how pain or mobility issues are affecting your daily life. Many patients come to us hoping to return to the activities they love — working, traveling, hiking, exercising or simply moving comfortably again. Your care team will explain all treatment options, including nonsurgical therapies and surgical recommendations, so that you can make informed decisions with confidence.
Before surgery, you will meet with members of the anesthesia and surgical care teams to prepare for your procedure at the Spine + Joint Surgery Center. During this visit, your medical history, medications and overall health are carefully reviewed to help ensure a safe surgical experience. You will receive detailed instructions about how to prepare for surgery, what to expect on surgery day and how recovery will begin immediately afterward. This is also a chance to ask questions and discuss any concerns.
On surgery day, you will be welcomed by a specialized spine care team focused on your comfort, safety and recovery. Procedures are performed in the Spine + Joint Surgery Center using advanced surgical technology and evidence-based techniques designed to support precision and improved outcomes. Your surgeon and anesthesia team will review the plan with you before surgery begins and keep your loved ones informed throughout the procedure. Every aspect of care is centered on helping reduce pain, restore function and improve quality of life.
Spinal Vascular Lesions
Spinal vascular lesions are abnormalities involving blood vessels in or around the spinal cord. Depending on the type and location, they may affect blood flow, put pressure on nearby nerves or cause bleeding. Symptoms can include weakness, numbness, difficulty walking or changes in bladder or bowel function. Evaluation may include MRI or other specialized imaging. Treatment depends on the type and location of the lesion and may involve monitoring, a procedure or coordinated care with other specialists.
What to Expect
Your evaluation will include a review of your symptoms, medical history and imaging. Depending on the findings, you may need additional testing or consultations with other specialists to help guide treatment planning. If a procedure is recommended, your surgeon will explain what it involves, its goals and the potential risks and benefits. Preparation, hospital stay and recovery depend on the type and location of the lesion and the treatment required. After treatment, your care team will arrange follow-up visits and imaging as needed. Your surgeon will explain what symptoms to watch for, when you can resume activities and whether ongoing monitoring is recommended.
Spine Surgery Care Path
Your journey begins with a thorough evaluation at Bozeman Health Spine + Joint Institute and Neurosurgery and Spine Clinic. During your consultation, your provider will take time to understand your symptoms, review imaging and discuss how pain or mobility issues are affecting your daily life. Many patients come to us hoping to return to the activities they love — working, traveling, hiking, exercising or simply moving comfortably again. Your care team will explain all treatment options, including nonsurgical therapies and surgical recommendations, so that you can make informed decisions with confidence.
Before surgery, you will meet with members of the anesthesia and surgical care teams to prepare for your procedure at the Spine + Joint Surgery Center. During this visit, your medical history, medications and overall health are carefully reviewed to help ensure a safe surgical experience. You will receive detailed instructions about how to prepare for surgery, what to expect on surgery day and how recovery will begin immediately afterward. This is also a chance to ask questions and discuss any concerns.
On surgery day, you will be welcomed by a specialized spine care team focused on your comfort, safety and recovery. Procedures are performed in the Spine + Joint Surgery Center using advanced surgical technology and evidence-based techniques designed to support precision and improved outcomes. Your surgeon and anesthesia team will review the plan with you before surgery begins and keep your loved ones informed throughout the procedure. Every aspect of care is centered on helping reduce pain, restore function and improve quality of life.
Primary and Metastatic Spinal Tumors
Spinal tumors can develop in the bones of the spine, the spinal cord or surrounding tissues. Primary tumors begin in or near the spine, while metastatic tumors spread to the spine from cancer elsewhere in the body. Symptoms may include persistent back or neck pain, weakness, numbness or changes in movement. Treatment depends on the tumor’s type and location and whether it affects the spinal cord or nearby nerves. Depending on the situation, care may include monitoring, a biopsy, surgery to remove tumor tissue, or surgery to relieve pressure or stabilize the spine. Neurosurgeons may coordinate care with oncology and other specialists.
What to Expect
Your care may include a review of your symptoms, medical history and imaging, along with additional scans or a biopsy to better understand the tumor. If you have a known cancer diagnosis, your neurosurgeon may work with your oncology team and other specialists to coordinate your care. Before surgery, your surgeon will explain the goals of the procedure, which may include obtaining a tissue sample, removing tumor tissue, relieving pressure on nerves or stabilizing the spine. The procedure and hospital stay depend on the tumor’s location, the treatment needed and your overall health. After treatment, your team will monitor your recovery and arrange follow-up appointments and imaging. If needed, your care may continue with oncology or other specialists to coordinate additional treatment and ongoing monitoring.
Spine Surgery Care Path
Your journey begins with a thorough evaluation at Bozeman Health Spine + Joint Institute and Neurosurgery and Spine Clinic. During your consultation, your provider will take time to understand your symptoms, review imaging and discuss how pain or mobility issues are affecting your daily life. Many patients come to us hoping to return to the activities they love — working, traveling, hiking, exercising or simply moving comfortably again. Your care team will explain all treatment options, including nonsurgical therapies and surgical recommendations, so that you can make informed decisions with confidence.
Before surgery, you will meet with members of the anesthesia and surgical care teams to prepare for your procedure at the Spine + Joint Surgery Center. During this visit, your medical history, medications and overall health are carefully reviewed to help ensure a safe surgical experience. You will receive detailed instructions about how to prepare for surgery, what to expect on surgery day and how recovery will begin immediately afterward. This is also a chance to ask questions and discuss any concerns.
On surgery day, you will be welcomed by a specialized spine care team focused on your comfort, safety and recovery. Procedures are performed in the Spine + Joint Surgery Center using advanced surgical technology and evidence-based techniques designed to support precision and improved outcomes. Your surgeon and anesthesia team will review the plan with you before surgery begins and keep your loved ones informed throughout the procedure. Every aspect of care is centered on helping reduce pain, restore function and improve quality of life.
Complex Spinal Trauma
Serious spinal injuries can result from falls, vehicle crashes, sports injuries or other accidents. Some cause fractures or make the spine unstable, while others damage the spinal cord or put pressure on nerves. Treatment depends on the type and severity of the injury. Some patients may need bracing, activity restrictions and close monitoring. Others may need surgery to stabilize the spine or relieve pressure on the spinal cord or nerves. Care may also involve other specialists, depending on the injury.
What to Expect
Evaluation begins with an assessment of the injury, spinal stability and nerve function. Your care team may use X-rays, CT scans or MRI to understand the extent of the damage. Serious injuries may require urgent evaluation and treatment. If surgery is needed, your surgeon will explain its goals and what the procedure may involve. The length of your hospital stay and recovery depend on the severity of the injury, the treatment required and whether you have other injuries. As you recover, your team will help you begin moving safely when appropriate and explain any bracing, activity restrictions or rehabilitation you may need. Follow-up care helps monitor healing and changes in strength, sensation, mobility or function.
Laminectomy
A laminectomy removes part of the bone at the back of a vertebra, called the lamina, to create more space for the spinal cord or nerves. It is often used to treat spinal stenosis, a narrowing of the spinal canal that can cause pain, numbness, tingling or weakness. A laminectomy aims to relieve pressure on nerves and may be performed on its own or combined with another procedure, such as spinal fusion.
What to Expect
Discectomy
A discectomy removes the portion of a damaged or herniated spinal disc that is pressing on nearby nerves or the spinal cord. A herniated disc can cause pain, numbness, tingling or weakness in the neck, back, arms or legs. The goal is to relieve pressure on the affected nerves while preserving as much healthy disc tissue as possible. Depending on the location and severity of the problem, a discectomy may be performed on its own or as part of a larger spine operation.
What to Expect
Your surgeon will review your symptoms and imaging to determine whether a herniated disc is likely causing your symptoms. The procedure is usually performed under general anesthesia. Depending on the location of the disc and the surgical approach, your surgeon makes an incision in the neck or back to reach and remove the portion of the disc causing pressure.
Some patients go home the same day, while others need a hospital stay.
Spine Fusion
Spinal fusion joins two or more vertebrae to create a more stable section of the spine. It may be recommended for spinal instability, certain fractures, spinal deformities or other conditions that cause significant symptoms. During surgery, your surgeon places bone graft material between the affected vertebrae. Screws, rods or other implants may be used to hold the vertebrae in position while the bones heal together.
What to Expect
Surgeons
Surgical Team
Ben Smith, DO
Neurosurgery and Spine
James Kalyvas, MD, FAANS
Neurosurgery and Spine
Joseph Sramek, MD
Neurosurgery and Spine
Scott Grimm, PA-C
Neurosurgery and Spine
Danielle Crawford, PA-C
Neurosurgery and Spine
Spine Patient Testimonials
Hear from patients about their experiences with Bozeman Health’s Neurosurgery and Spine Clinic,
from their first consultation through treatment and recovery.
From Pain to Possibility: Finding Relief with Orthopedic Surgery
Spine + Joint Institute
At the Bozeman Health Spine + Joint Institute (SJI), your health and well-being are our top priorities. Our experienced team focuses on hip, knee, and shoulder joint replacements as well as spine surgery, delivering expert, compassionate care.
We’re proud to be Montana’s first certified Orthopedic and Spine Center of Excellence, a distinction earned through years of refining our approach to prioritize your safety. With the latest surgical advancements and a strong commitment to quality, we’re dedicated to guiding you through every stage of your journey.
