Frequently Asked Questions

Your first visit

Do I need a referral?

No. You can start by telling us your story through the online intake, or by calling the office. Some insurance plans require a referral for the visit to be covered, so check with your plan.

What should I bring?

Any X-rays, MRI, or CT scans you have had, on a disc or through a patient portal, with the written reports. A list of your medicines. A note of what you have already tried: therapy, injections, medicines, chiropractic care. Your questions, written down.

Will I get an MRI at the first visit?

Usually not, and usually you do not need one. For most neck and back pain, I can tell what is going on from your story and your exam, and X-rays taken standing up are often more useful than an MRI. I order an MRI when the result would change the plan: when a nerve is involved and we are considering an injection or surgery, when there are warning signs, or when symptoms have not improved after a reasonable course of treatment.

My MRI report sounds terrible. Should I be worried?

Probably not. MRI reports describe everything they see, and most adults over 40 have "degenerative" changes, bulging discs, and some narrowing that cause no symptoms at all. What matters is whether a finding on the picture matches your symptoms and your exam. I read your images with you and tell you which findings matter and which are just you getting older, like gray hair.

Non-surgical care

Does everyone need physical therapy first?

Most people with neck or back pain, sciatica, or stenosis should complete a real course of therapy before anyone talks about surgery, because most get better with it. The exceptions are a nerve that is losing strength, a nerve emergency, and a few conditions where the structure of the spine, not the symptoms, decides. Therapy should be active, with a program you do at home, not just heat and massage.

Do injections cure anything?

No, but they can be very useful. An epidural steroid injection calms an inflamed nerve, which can give you the window you need to get better with therapy and time. The relief lasts weeks to months. I limit how many you have in a year, because steroids have side effects, and if you keep needing them, that is information.

What about chiropractic care, acupuncture, or massage?

They can help neck and back pain and are reasonable to try for pain without nerve symptoms. I ask you to avoid forceful neck manipulation if you have a pinched nerve, instability, or spinal cord pressure, and to tell your chiropractor about any spine diagnosis you have.

Should I rest or stay active?

Stay active. Bed rest beyond a day or two makes back pain worse. Walking is the one treatment nearly everyone can do, and it is the most useful.

Deciding about surgery

How do I know if I need surgery?

Three situations: a nerve emergency, which is rare; weakness or spinal cord pressure that is getting worse; and pain or disability that has not improved with a proper course of non-surgical care and that matches a problem surgery can fix. If you do not fit one of those, I will tell you that surgery is not the answer, even if you came hoping for a fix.

Will you tell me if I don't need surgery?

Yes. Most people I see do not need an operation, and I would rather send you out with a clear plan than carry you through visits that go nowhere. If something changes later, you come back.

What is the smallest operation that would fix my problem?

That is exactly the question I ask myself. The answer depends on whether the problem is a nerve being pinched (which needs a decompression), a worn disc causing pain (which may suit a disc replacement), an unstable or slipped level (which needs a fusion), or a curve. I match the size of the operation to the actual problem.

Is "minimally invasive" always better?

No. It is better when it accomplishes the same thing through a smaller path. Endoscopic and tubular techniques are excellent for the right problems, and I use them whenever they fit. Some problems need a bigger operation to be fixed well, and doing a small operation for a big problem leaves you with the problem.

Disc replacement, endoscopy, and fusion

Am I a candidate for disc replacement?

Often, if the pain comes from one or two worn discs, the facet joints behind them are not badly arthritic, your bones are strong, and the spine is stable. Age, bone density, prior surgery, and the shape of the spine all matter. My disc replacement overview has a candidate list, and the decision is made with your imaging in front of us.

What is endoscopic spine surgery?

Surgery done through an incision about the size of a dime, using a camera the width of a pencil. It is used for herniated discs, stenosis, pinched nerves in the neck, thoracic discs, and facet pain. The relief is the same as with open surgery; the recovery is easier. My endoscopic spine surgery page has animations of each procedure.

Why would you recommend a fusion if you prefer motion-preserving surgery?

Because sometimes the spine needs to be held still: a vertebra has slipped, the level is unstable, there is a large curve, or a previous surgery has failed. In those situations a fusion is the operation that works, and a motion-preserving operation would fail. Fusion is reserved for only when it is truly needed, and when it is needed, I do it well.

Will a fusion leave me stiff?

Fusing one or two levels in the low back or neck removes a small share of the spine's total motion, and most people do not notice it in daily life. Longer fusions do limit bending, which is one reason I choose levels carefully and prefer tethering or selective fusions in growing patients.

Recovery

How long until I can drive, work, and exercise?

It depends on the operation. As a rule: driving once you are off opioid pain medicine and can turn comfortably, often one to four weeks. Desk work in one to six weeks. Physical work and sports from four weeks (decompression) to three months or more (fusion). Each of my post-op playbooks gives the timeline for your surgery.

Will my numbness go away?

Pain usually improves quickly after a nerve is freed. Numbness and tingling recover more slowly, over weeks to months, and numbness that was present for a long time before surgery may not fully recover. Weakness that was present before surgery can take up to six months to improve.

What can I do to make a fusion heal?

No nicotine in any form, no anti-inflammatory medicines until I clear them, walking every day, good nutrition with enough protein, vitamin D, and calcium, and keeping your blood sugar controlled. Those five things matter more than anything else.

Do I need a brace after surgery?

Usually not. Modern screw fixation holds the spine well, and braces weaken the muscles that should be doing the work. I use a brace for specific situations, such as weak bone or certain fractures, and I will tell you if yours is one.

Children and teens

My child was told they have scoliosis. Is it an emergency?

No. Scoliosis is common, usually painless, and most children only need to be watched. The two numbers that matter are the size of the curve and how much growing is left. Bring the X-ray or the report, and we will put both numbers in front of you at the first visit.

Does bracing work?

Yes, when it is worn. A rigid brace worn 13 to 18 hours a day lowers the chance that a moderate curve will reach the surgical range. It does not reverse a curve. The exception is a young child, where early bracing or casting sometimes improves the curve itself.

Is there an alternative to fusion for my teenager?

For a child who is still growing with a flexible curve in the right range, vertebral body tethering can correct the curve while keeping the spine flexible. For some children with two curves, a hybrid of a thoracic fusion and a lumbar tether keeps the low back moving. Fusion remains the proven operation for larger and stiffer curves. I perform all of these, and I will tell you honestly which fits your child.

Can my child play sports after scoliosis surgery?

Yes. After tethering, most sports resume at six weeks. After fusion, non-contact sports at about three months and contact sports at about six months once the fusion is forming. Playing college or professional sports after a fusion is common.

The practical side

Do you take my insurance?

The office checks your benefits before your visit and tells you what to expect. Some procedures, especially disc replacement and endoscopic surgery, need prior authorization, which we handle.

Can I get a second opinion?

Please do, if it would help you decide. Bring your imaging and your other surgeon's plan. I will tell you whether I agree and why, and I will not be offended if you choose a different path.

How do I reach the office after hours?

For an emergency, call 911 or go to the nearest emergency room. For urgent problems after surgery, call the office number; the answering service reaches the doctor on call. Medication refills are handled during office hours only, so call a few days before you run low.

Do you see patients in languages other than English?

Yes. Interpreters are arranged for visits, the online intake is available in several languages, and the patient guides on this site are written in English, Spanish, Chinese, Portuguese, and Korean.

These answers are general. Your own situation may differ, and what we discuss in clinic always comes first.