Frequently Asked Questions

General Questions

What is a Physician Assistant and/or Nurse Practitioner, and can I see one when the doctor is out?

Physician Assistants and Nurse Practitioners are mid-level providers. They are licensed to evaluate patients independently, order diagnostic testing, diagnose, and establish treatment plans under the supervision of a collaborating physician. You may see a PA/NP without seeing the doctor, but the physician always reviews and approves any treatment protocols. PA’s and NP’s have prescriptive authority to prescribe and renew medications.

Is it necessary to bring reports, previous X-rays and/or MRI films to my first appointment?

These are all very important diagnostic tools and can be helpful for the physician to provide an accurate diagnosis and treatment plan.

Epidural Steroid Injection Questions

When will I notice relief in my back or leg following an epidural steroid injection (ESI)?

Most commonly, pain relief is noticed within 24 to 48 hours. Some patients respond slower and get results within 1 to 2 weeks. Maximum benefit is usually seen by 2 weeks post-procedure.

How long will my ESI last?

It is extremely variable from patient to patient. Some patients receive 1 or up to 3 injections with relief lasting from weeks to years.

What are the risks and side effects associated with ESI’s?

An ESI is one of the safest procedures performed in medicine today. The overall complication rate is far less than one percent. Nonetheless, there is some expectation of risk with any medical procedure. We take numerous precautions to prevent any problems and strongly recommend that all patients fully review their pre-injection instructions. Most complications arise from patients not following these instructions. The primary procedure risks involve bleeding, infection, spinal fluid leakage, and injury to nerve structures. Secondary risks involve the potential side effects of the medications used during the procedure (from the steroid itself). These include temporary weight gain, increase in blood sugar (mainly in diabetics), water retention, and suppression of the body’s own natural production of similar steroids. Long-term effects of chronic steroid use include thinning of the bones, early cataract formation, and avascular necrosis (a condition involving decreased blood supply to the hip bone).

What should I do after my ESI? Can I return to work?

We advise patients to take it easy for a day or so after the procedure. Afterward, patients are allowed to resume normal activities as tolerated. Most patients have no problem returning to work one or two days after the procedure.

What should I expect to feel after an ESI?

Immediately after the injection, some patients may feel a heaviness or numbness in the legs. This is an expected effect of the numbing agent and usually goes away after several hours. Most patients generally experience a “sore back” for a day or two afterward. The full effect of the steroid medication usually takes 24 to 48 hours to begin working. Some patients have a longer period until they feel relief. It is not uncommon for many patients to feel relief for only a week or so after a first injection; this usually will result in long-term pain relief after a repeated injection.

Scoliosis Questions

How can I tell if my child has scoliosis, and does it cause any problems?

Look at your child’s spine to see if it curves. Also, check to see if one shoulder is lower than the other. Your doctor can also check by looking at your child’s stance and ordering an X-ray for a definitive diagnosis. In most people, the curve in the spine is so small it causes no problems. In severe cases, the curve may cause back pain and restrict the amount of space available for the lungs and heart to work properly.

Post-Surgical Procedure Questions

When can I return to work after my surgery?

This varies significantly from patient to patient. We take into account the type of surgery performed, the patient’s line of work, and their post-operative recovery when making this decision. In general, patients who perform sedentary work can return to work as soon as one to two weeks after surgery. Patients who perform heavy-demand work are generally out for a minimum of six weeks. Again, there is no one recommendation; therefore, we suggest you further discuss this during the surgical-planning phase of your care.

Will I need to wear a back or neck brace after my surgery and for how long?

This obviously differs with each of the types of surgeries we perform. For lower back fusions, patients typically stay in a stiff/rigid brace for six weeks, then transition into a softer brace for another four weeks thereafter.

For neck fusions, there is usually more variation in how long bracing is used. This ordinarily depends on how many levels are fused and the patient’s bone quality. Most patients wear a stiff/rigid collar anywhere from two to six weeks, then a softer collar for another three to four weeks thereafter.

Patient’s undergoing non-fusion surgery, such as a microdiscectomy, typically wear a soft brace or corset brace for six weeks after surgery.

Fusion Questions

If my spine is fused, will I have limitation in my motion?

In the majority of cases, patients are left with no significant decrease in motion. One and two level neck and back fusions rarely result in any limitation of “functional” motion. Some patients may notice a slight difference in full motion, but this usually does not affect most activities of daily living. Larger fusions involving three or more motion segments may result in a noticeable difference in some activities, but this is usually not debilitating.

Minimally Invasive Surgery Questions

What are the advantages of Minimally Invasive Surgery (MIS) compared to traditional open surgery?

Minimally invasive procedures typically involve less destruction of normal tissues during surgery. In a traditional open procedure, a wide area of normal tissues (muscles, ligaments and bone structures) are sacrificed during the surgical exposure. These structures typically never return to normal function and will eventually form a large mass of scar that may later cause pain, spasm and dysfunction. During a minimally invasive surgery, special equipment and techniques are employed that allow for the same surgery to be performed with significantly less surgical morbidity. In addition, patients usually have less blood-loss, require shorter hospital stays and encounter less post-operative complications.

What types of minimally invasive spine surgeries are commonly performed?

Minimally invasive spine surgery uses small incisions and special equipment to access the spine and perform the procedure, minimizing damage to the surrounding tissue. Often these procedures can be done with minimal to no muscle damage via a “muscle sparing” approach. Some treatments include:

• Discectomy – If a herniated or bulging disc is placing pressure on a nearby nerve, a discectomy can be performed to shave off or remove the portion of the disc that is placing pressure on the nerve
• Fusion: This procedure permanently joins two adjacent vertebrae into one solid bone, eliminating painful movement and providing stability at the involved levels. There are many options to obtain a minimally invasive fusion, so ask your surgeon which may be right for you.
• Laminectomy – Removal of a portion of the bone and surrounding ligament from the back of the spine which could be placing pressure on the nerves and causing stenosis.
• Foraminotomy – By widening the openings where the nerves leave the spinal canal, this procedure helps relieve the symptoms of nerve root compression.

Endoscopic Surgery Questions

What are the advantages of endoscopic surgery?

Sometimes referred to as ‘laser’ surgery, endoscopic spine surgery is a newer type of minimally invasive spine procedure offered today. During this type of surgery, a small camera is used. This allows for better and more accurate visualization of the areas being targeted. The major advantage of these procedures is that a very small area of normal tissue is disrupted during the surgery. As a result, most patients experience very little pain and have a minimal amount of blood-loss. In addition, this is almost always an outpatient procedure. We offer several different types of endoscopic procedures depending on the patients specific problem.

Physical Therapy Questions

Will I need to go to Physical Therapy after my surgery?

In the majority of surgeries we perform the only physical therapy needed is for transfers and progressive ambulation. In most cases, this is performed during a patients hospital stay and most people don’t require additional visits with a therapist. Occasionally, some patients may require physical therapy via a home-health agency – the decision for this is made at time of discharge. Following some lumbar procedures, some people benefit greatly from pool-therapy. This is usually evaluated and decided upon during post-operative office visits.

Many patients overlook the role of physical therapy prior to surgery. This often occurs as some people may have had a negative experience with physical therapy in the past. Ideally, pre-operative physical therapy should be targeted to strengthen and condition muscles that support and surround the spine. The stronger these muscles are prior to surgery, the quicker they will rebound afterward. Conversely, weaker muscles will generally require more time and conditioning to return to normal function.

Pain Questions

When do I need to see a doctor for my back or neck pain?

In most cases, back and neck pain will resolve on its own over time without the need for any intervention. The first line of treatment for most back pain is: over-the-counter anti-inflammatories, rest, and ice/heat application.

It may be time to contact your doctor if you experience any of the following:

• Pain after any trauma, such as a fall or car accident
• Difficulty with your balance, changes in your handwriting or the ability to perform tasks with your hands (i.e. buttoning a shirt)
• Weakness or numbness in your arms or legs
• Pain to your back or neck which is accompanied by fever or unexplained weight loss
• Loss of bladder or bowel control
• Severe, constant pain that does not change with activity
• Ongoing pain after attempting conservative care at home

What causes back pain?

Finding the source of back pain can be difficult due to the number of possible causes. Back pain may occur suddenly or be noticed more gradually. Pain that doesn’t go away on its own will often require further imaging or testing done by your doctor to help identify the cause. Common causes of back pain include:

• Muscle strain or ligament sprain – Muscles, tendons and ligaments around the spine can become damaged, stretched or torn.
• Arthritis – Often times the normal aging process of the spine due to inflammation and “wear and tear” can be a source of pain.
• Disc problems – The shock absorbing cushions which rest in between each bone of your back and neck can bulge or herniate out of place, putting pressure on a nerve, or simply degenerate over time.
• Spondylolisthesis – Often times due to degeneration or trauma, the bones in your back can become unstable. Spondylolisthesis is when one vertebra slips over the one either above or below it, and pain can result from the resultant instability or nerve compression.
• Spinal stenosis – If the opening of your spinal canal becomes too narrow, you may experience pain, numbness, tingling, weakness or fatigue from pressure on the spinal cord and nerves.
• Spinal deformity – An abnormal curvature in your spine, such as scoliosis, can cause pain. Similarly, abnormal alignment after previous back surgeries, or due to arthritis can result in a spinal deformity, such as a “flat back,” which can cause pain.

What type of doctor should I see for spine care?

The key component of who to trust for your spine care today is to seek someone who is Fellowship-trained in spine surgery. Some spine surgeons completed their initial training in neurosurgery, others in orthopedic surgery, but a special focus on spine surgery is imperative to provide the best care and to keep up with the latest innovations in spine surgery. The spine care team at most facilities includes a combination of spine surgeons, as well as other practitioners including: anesthesiologists, physiatrists, radiologists, rheumatologists, and occupational and physical therapists.

How will my back or neck pain be treated?

The first line for treating back or neck pain is always conservative care in the absence of a condition which requires emergent care (i.e. spinal cord injury, cauda equina, progressive cervical myelopathy). Conservative measures, such as activity modification, physical therapy, and medications, including nonsteroidal anti-inflammatories (NSAIDs) and muscle relaxers, should be attempted first. If the pain persists, your doctor may suggest interventional procedures such as epidural steroid injections to reduce inflammation, better understand the location of the pain generator and to provide some symptomatic relief.
Surgery is often the last line of treatment and should be used when all other treatment options have been attempted. Thankfully, many cases of spine surgery can now be performed using minimally invasive techniques, allowing for a quicker recovery, less immobilization, and less narcotic usage.

What is facet pain?