1. How can you help me when others cannot?
Since we use minimally invasive techniques, we can solve problems that are more difficult to resolve with conventional surgery. Scar tissue is less, trauma is less, and therefore we can usually solve the problem without making things worse. Also, our techniques are so advanced that we can resolve problems related to disc, bone or scar tissue. Even though over 50% of our patients have had prior spinal surgeries and are considered "spinal surgery failures", our techniques have resolved the majority of the pain in most of these people, according to our patient satisfaction surveys and research.
2. I have spinal stenosis; can I be helped?
Yes, our techniques work very well for spinal stenosis and other disorders that relate to nerves impinged by bone or disc. We can remove small amounts of disk and bone that are impinging upon the spinal cord. The removal of this bone and soft tissue is under direct observation to assure that the nerve impingement is resolved. You are awake during the procedure and can alert us to whether the problem is resolved or not.
3. What are my costs for your procedures?
MicroSpine is constantly trying to work to help you the patient receive the best care at a reasonable price. After years of research to prove our techniques effective, insurance companies have approved our services. we accept many major insurance plans (You can help us get on your insurance plan by contacting your insurance carrier and requesting that they consider contracting with MicroSpine). If your insurance is not covered then we offer a global fee package that includes almost every expense and thus limits your cost per surgery. Click the link below for more information about specific insurance companies.
4. I have "scar tissue" causing pain; can I be helped.
Yes, we actually attempt to manually remove scar tissue via our minimally invasive techniques. We have been able to resolve nerve entrapment pain due to scarring from infection, prior surgery, etc. Often, the problem referred to as arachnoiditis or scar tissue is really a combination of scar tissue and residual nerve root compression. Scar tissue tends to act like a "space occupying lesion" and thus compresses the nerve in an already tight spinal canal. Once the foraminal canal is opened and the scar tissue is reduced, the pain will generally dissipate.
5. Why Should I utilize MicroSpine for my endoscopic surgery?
Our physicians only perform endoscopic spinal surgery and have performed over 7000 such surgeries. We perform endoscopic surgeries that many others cannot and we are very honest about what we think we can and cannot treat. Not many M.D.'s perform true minimally invasive spinal surgery and even fewer have the years of experience that MicroSpine has. We don't give false hope but real hope and real answers. We are not perfect but we will utilize all of our experience to try to resolve your pain. Our staff will be with you from start to finish. Although you may have to wait a little for our services, always remember that a good surgeon is busy, a questionable surgeon can get you in right away.
6. It sounds too good to be true; can I really get the results you claim?
Often people say if it sounds too good to be true, then it is. Well this is the exception to that rule. We're not miracle workers, but by using modern science and new techniques we can perform procedures that some would call a "miracle". Considering that most of our patients have had prior spinal surgery and we still get good to excellent results in over half of them would be considered by many spine surgeons as amazing. Especially since many of our patients have been "written off" as "not treatable" and thus told to live with their pain. We have performed thousands of these procedures, and our research has shown similar or better outcomes when compared to conventional surgery.
7. What are your results?
Obviously it depends on your problem, if you have had prior surgery, and the amount of nerve damage you have had. For patients who have never had spinal surgery, the results are similar to conventional surgery but with fewer complications or down time. Thus, about 70 to 80% of our patients get what they term as "good to excellent" relief. This compares to conventional surgery where most get 50 to 70% "good to excellent" results. Cervical problems generally have a better success rate than lumbar problems and patients without prior spinal surgeries usually have a better success rate than those with prior surgeries.
8. Why are you located in DeFuniak Springs?
Many people ask this question and the honest truth is the following:
When Doctors Mork and Haufe left their previous group to venture out on their own they didn't have the resources to open a large center. Both doctors also wanted to avoid taking "call" and working late hours which occurs at most hospitals. They also wanted to live in Florida (since this is where they are licensed) and near the beach. They needed their own operating room and some space in the hospital to get started. It was hard finding such a location, but the small town of DeFuniak Springs could accommodate all of these needs. Also, DeFuniak Springs had a surgery center that had been vacated by the collapse of a major healthcare company. This surgery center was in the doctors' minds as a excellent place to expand to.
9. Why is MicroSpine unique?
MicroSpine represents the future of spinal surgery. Everything we do is minimally invasive and with the belief that leaving your spine in a condition that is as close to natural is the best solution for spinal problems. We are unique in that no one treats every aspect of the spine minimally invasively. We are the only center in the World that is dedicated to every aspect of minimally invasive spinal surgery. The way we diagnose, manage and treat people is unique and our results show this. We never rush you and in fact there are times that we may spend hours trying to correctly diagnose your problems. The patients who come to us are often complicated and we realize that each patient needs special treatment.
10. What are the risks and complications of your endoscopic surgery?
Endoscopic spine surgery is very safe and complications are low. The most common complication is infection and this is usually discitis and related to disc surgeries. The incidence of discitis is similar to conventional surgery and is around 2%. Other risks include nerve damage, bleeding, tissue damage, Dural headaches, etc. but these are very rare. Bleeding is usually less than 100 cc's and thus is minimal. We never utilize transfusion systems. Nonetheless, as with any surgery, complications are possible and we will gladly discuss your concerns with you.
11. What type of anesthesia is used for these procedures?
The anesthetic medications place the patient in a comfortable, yet awake state. This allows you to communicate with the surgeon as the procedure is commencing. When your pain has been resolved, then we can be sure we have taken care of the problem. Also, having the patient awake makes the procedure safer. There are less risks from a sedation-type anesthesia than will a general anesthetic, and there are less risks of nerve injury. But don't worry about being awake! We have performed thousands of these procedures, and over 95% of the patients say "it was a piece of cake" being awake.
12. Why don't more physicians learn this new technology.
First of all, this is very sophisticated surgery. Many surgeons would have trouble learning how to perform these procedures. It is almost like fixing a car through the muffler, the surgeon has to rely on scopes and cameras to guide him. Secondly, there are a lot of incentives for surgeons to install hardware such as cages, rods, and artificial discs. Also not many M.D.'s in the world perform these types of procedures, and therefore, there aren't many physicians to learn from. Thirdly, many doctors get fixed in how they treat patients. It is easier for them to treat patients with techniques that they learned in residency training, than to take the effort and risks of learning new techniques. Just as the knee scope surgeries that are common today were once taboo, so will spinal surgery change but it will take time.
13. What is "So Bad" about conventional or open surgery?
The biggest problem with conventional surgery is that it is too much surgery for most problems that occur in the spine. Large incisions mean more scar tissue and scar tissue can become a problem 6-12 months later and your pain may return. Also, with conventional surgery you are under general anesthesia and it is only after you awaken that one can be assured that the pain had been properly treated. Thus, you may awaken from surgery and still have pain. With our procedures you are awake and you will tell us if the pain is gone at the end of the surgery. Also, recovery time is much quicker and pain is much less than with conventional surgery.
14. Why haven't I heard about these procedures on TV or radio?
MicroSpine has personally been invited and seen on non-advertised television programming. Unfortunately, television often focuses on dramatic surgeries (such as body make-over's) and not those where there isn't much to be seen such as those through a 1/2 inch portal. Thus, some media shows have been done on the subject but most of these are on public broadcasting channels or cable since it would be hard to get advertisers to pay for a show where patients don't act or look twenty years younger.
15. My doctor says he's performs this kind of surgery. Why should I go to you
First of all, we specialize in minimally invasive spinal surgery and nothing else. Minimally invasive surgery has been defined as surgery that is performed via a 1 inch incision or less. This means that the portal can't be greater than around 15 mm in size. Many doctors call a 3 inch incision as minimally invasive but this is compared to a foot long incision. Thus, ask your physician as to whether he truly does this kind of surgery. If he says that he performs percutaneous discectomy, IDET (Intradiscal electro coagulation therapy, ELF procedures, or hemi-laminectomies, then he is only bordering on the fringes of doing what we perform. We also perform these procedures but also many others. Our techniques are performed in holes the size of your finger (1/4 to 1/2 of an inch) that are measured in millimeters, not multiple inches.
16. What do I have to do to get an evaluation and do I need to go to your center?
Often we can give you an "preliminary evaluation" without even seeing you! Just contact us and we will be glad to evaluate your MRI reports, Free of Charge! Just make sure it is a fairly recent MRI (within one year or so, and after any other surgeries or injuries). We can give you a reasonable idea of whether you are a surgical candidate or not, but we cannot tell you what exactly needs to be done to solve your problem since this would require a complete evaluation by our physicians, but at least you can get some information about what options you have and whether or not we believe that we may be able to help you. Expect about one week for your MRI reports to be reviewed and then a response to be made.
17. How many procedures will I require to solve my pain problem?
Since our work is so minimally invasive, we can only focus on one area of the spine at a time. Many individuals only have one nerve being compressed and therefore only require one surgery. Others may have extensive hardware or scoliosis that may require more work. Thus the answer to your problem is very specific to you. Nonetheless, Most of all our patients will only require one procedure and we will not operate unless we believe the probability of improvement is significant.
18. How long will I have to stay at your facility when I come for surgery?
We require that you remain within 50 miles for the day of surgery. You may be in the area for around 5 to 7 days and half this time is for preoperative purposes and the remainder is for postoperative reasons. This is so we can be available if there are any problems that need to be addressed. Rarely, do problems occur, but if they do, such as bleeding, they usually occur right away. Obviously, it is easier to rectify the problem if you're nearby versus if you're 3000 miles away. Rarely, will we make exceptions to this requirement because it is for your benefit and safety.
19. Can I have my initial evaluation and then surgery, without having to make an extra trip?
Yes, we have many patients from around the world, and this is a frequent concern. We will book your initial evaluation and then two or more days later your surgery. This is a guaranteed surgical date, and thus a deposit may be required to hold this time slot. If, after your initial evaluation, we feel you are not a surgical candidate or your health is not optimized, then your deposit will be gladly returned. Nonetheless, many patients utilize this scenario to avoid repeat travels to our facility.
20. I have hardware; can you help me?
Possibly, depending on the situation, we can endoscopically work around the hardware to rectify your problem. With certain types of hardware we can remove a piece or entire side of the hardware to open up the neural canal. It is truly dependant on the situation and each case is evaluated independently. Thus, we must evaluate you first prior to determining exactly what we can offer you.
21. I have scoliosis; can I be helped?
Probably, we have had great success with scoliosis through our endoscopic techniques, and we don't require a fusion. We simply decompress the area that is impinging upon the nerve. We cannot straighten the spine, but we often can relieve the pain associated with the curvature.
22. What are my limitations after surgery?
Generally, we don't want you to perform any excessive bending or heavy lifting (greater than 10 lbs.) for about three to six weeks after the surgery. We encourage a gradual return to normal activities over this period of time. Often, many individuals who have desk type jobs can return to work within a week. We do stress to patients to "take it easy" for about a month to let the spine heal. But after this period we do expect you to return to your normal lifestyle.
23. My doctor wants to perform IDET, Epiduroscopy or Myeloscopy; is this the same type of procedure?
Absolutely not! First of all, IDET has a very, very poor track record. According to the manufacturer's own data (which is often the most positive data), IDET only improves pain by 2 to 3 points on a 0 to 10 pain scale. Thus, if your pain is a 10 over 10 (which many patients are), you could only expect a decrease to an 8 over 10. This only represents a 20% improvement and is barely significant. In fact, many of the original researchers in IDET no longer perform IDET because of the overall poor results. As for Myeloscopy (or Epiduroscopy), few physicians perform this anymore and most insurance companies wont pay for it. Results with Myeloscopy are not any better than just performing an epidural steroid injection. Therefore, in our opinion, both IDET and Myeloscopy will gradually fall out of use by pain physicians as soon as patients and insurance companies realize they are mostly ineffective.
24. How long will I have to wait to have surgery?
Generally, MicroSpine is "booked" ahead for both evaluations and surgeries, but openings do occur. Usually, we can get you in for surgery within a month or two. We always stress to potential patients that good doctors are busy while questionable doctors are not and can usually get you in for surgery right away.
25. Can you resolve spinal arthritis?
Yes, We can treat spinal arthritis permanently in most cases. Most Rhizotomy procedures that pain management doctors perform offer only 3 to 6 months of relief while our procedure appears to be permanent in most people.
26. What special needs should I arrange for prior to my surgery?
You need someone to drive you to your hotel after surgery and any injections. Under no exceptions can you drive the day of surgery or whenever you are being sedated. You should bring enough clothing and health supplies for up to two weeks. Bring your medications with you. If you live further than 50 minutes (one hour) from the facility (which many of our patients do), we require that you stay in a local hotel for the day of surgery. In some cases, we can arrange a local assistance company to assist you if you don't have anyone to bring with you but these arrangements need to be done in advance.
27. I belong to a HMO, will you become a provider of my plan?
Unfortunately, the answer is no. We are contracting with more carriers as a PPO provider and we suggest that you contact your insurance company and ask them to contract with us if we are not listed as a provider. We do except Medicare but there are some items or doctors that may not be covered by the current Medicare system and you need to check with us about current costs for Medicare patients.
28. Can you treat disc related pain?
Disc related pain is one of the hardest problems to resolve. Nonetheless, we offer several treatments options that can resolve disc related pain without a fusion or clunky metal artificial disc. Techniques such as endoscopic discectomies and percutaneous discectomies offer success rates similar to fusions or artificial discs but without the metal and complications. We also offer several state of the art injection therapies that attempt to resolve disc related pain with high success rates as well.
29. What is Nucleotomy?
This is a procedure which some surgeons utilize to "decompress" the disc. It involves inserting a tube into the disc and aspirating the contents of the disc. The problem with this technique is that it doesn't decompress the disc significantly. Therefore, most doctors utilize discectomy procedures which are more advanced and actually remove the fragment and decompress the disc about 10%. People may get relief with Nucleotomy or it may only be short lived, but it is a viable technique especially for back pain when a simple discectomy cannot be done. Nonetheless, an endoscopic or percutaneous discectomy is probably superior to a Nucleotomy and the risks are no different.
30. What physical therapy requirements will I have?
MicroSpine's goals are not only faster resolution of pain disorders but only reductions in costs. Thus, we have noted that many patients require little to no physical therapy postoperatively. Some people do require rehabilitation but most do not. We suggest a gradual return to normal activities over a few weeks and then progressing after that.
31. What are the disadvantages of your procedures?
Obviously our website stresses the advantages of our MicroSpine techniques, but what about the disadvantages. There is really only one disadvantage, since we are working through such a small portal, we can only address one problem area at a time. Therefore, if you have spinal stenosis at two levels, we would have to perform two procedures. People often ask why we cannot perform multiple levels at the same time. This is impossible because each level takes about two hours and there is a limit to how long people can tolerate being awake on an operating table. Nonetheless, it is important to remember that you will be up and about the same day. Most people say that the discomfort of having multiple procedures is minimal compared to one conventional procedure. Also, Most of our patients only require one procedure. As for risks associated with our surgeries, they are generally similar as with conventional surgery.
32. What defines MicroSpine surgeries or minimally invasive spine surgery?
MicroSpine surgery or minimally invasive spine surgery has been defined as surgery that involves an incision of less than one inch. Any spinal surgery with an incision of greater than an inch is conventional surgery by this definition. Thus ask if your surgeon can perform microspine surgery and whether the incision will be less than an inch. There is a huge difference between a 1/2 inch incision and a three inch incision.
33. I have had prior surgery, can you help me?
Yes, In fact about 50% of our patients have had prior surgery. Our success rates with prior surgery range from 50% to 70% good to excellent results. We are among the very few who are capable of treating scoliosis, spondylolisthesis, or spinal stenosis endoscopically. Others want to use pumps and stimulators to mask the pain, we want to solve the pain.
34. How does Microspine surgery compare with fusions, conventional laminectomies and the artificial disc?
Results of all spinal surgery are similar in success rates. Fusions and conventional laminectomies offer 50 to 70% success rates while the artificial disc is around 67% success rates (per a recent study, although studies by the manufacturer reports success rates in the 80% range). Our surgeries are around 70% successful. Thus, the success rates are very similar but the recovery time, incision size and postoperative pain are greater with non-Microspine techniques.
35. What do success rates for surgery really mean?
For the patient this is often very confusing. Success rates mean that the operation was successful with a good to excellent result. Good to excellent results imply that the patients problem was either resolved or significantly improved upon. Thus when a surgeon tells you to expect a 70% success rate this means that 7 out of ten people end up with a good to excellent result. Now for the downside. with every surgery there is the possibility of NOT having a good to excellent result. This is the remaining number and may imply that the pain is unchanged or that you are worse off than before. Thus, if 70% of the patients get good to excellent results, 30% will get poor to negative results. Thus, out of ten people, 7 will be improved or cured and 3 will be unchanged or worse. Many physicians don't tell you that you may be worse off after the surgery, but there is a significant amount of people who suffer from failed spine surgery syndrome. Conventional spine surgery has a 60 to 70% success rate and our procedures have similar or better success rates. The big issue here is that our procedures have a similar or better success rate than conventional surgery and very rarely do we have any patients actually worse off after surgery. This is due to the small amount of tissues removed. No surgery is perfect, but there are definite advantages to different surgeries and every patient needs to be aware of them.
36. I have been told I have arachnoiditis or scar tissue, can I be helped?
Yes, we can remove the scar tissue piece by piece to free the nerve. Also excessive bone and disc may be removed to give more flexibility to the nerves and thus reduce pain since the pain is generally from a combination of the scar tissue with residual bone impingement. Procedures such as epiduralysis, Racz procedures and epiduroscopy generally have not be proven to be any more beneficial than an epidural steroid injection but doctors perform them because they are trying to help you. The solution is to free up the nerve and provide more flexibility to the surrounding tissues by decompressing the remaining bone and that is what our procedures aim to do.
37. What medications should I avoid prior to surgery?
We recommend that medications such as aspirin and other anti-inflammatory drugs be stopped 10 to 14 days prior to surgery. These medications result in increased bleeding. Coumadin, Warfarin, etc. are blood thinners and should be stopped 3 to 5 days prior to surgery. Plavix should be stopped 7 to 10 days prior to surgery. We also recommend that Vitamin A and E be stopped as well. Other medication should be taken with a sip of water (a sip, not a gulp or a whole glass!). If you have any questions, do not hesitate to ask us.
38. Are your procedures similar to the ELF procedure? (endoscopic laser foraminoplasty)
The name sounds the same but the procedure is different. ELF procedures utilize a holmium laser (similar to our laser) to make very small chips in the bone of the foramen to attempt to decompress the nerves. This sounds great but in reality it doesn't work very well. These lasers only remove small amounts of bone and have the risk of burning the nerves if the stenosis is too tight. There haven't been any good reports on the success of this procedure except from the individual and company that is trying to sell the product. We actually remove enough bone to totally decompress the entire foramen from the spinal cord outward, not just chip away a little bone. It may seem like a semantic lesson, but even though the names sound similar, the procedures are quite different. Our concern with the ELF procedure is that the amount of bone removed is negligible and thus the problem will remain or return within a short period of time.
39. Who can treat spinal problems better? A neurosurgeon or an orthopedic surgeon?
There really is no good answer to this since both sides will say they are better at treating spinal problems. The real answer is that the better individual is the surgeon who has more experience in treating spinal disorders with a well known reputation of good results. Both orthopedic surgeons and neurosurgeons regularly treat spine problems but many only treat them occasionally. The neurosurgeon who mostly deals with brain problems and the orthopedic surgeon who mostly deals with shoulders and knees are probably not the best choice for your back related problems. Experience and reputation are the key. Ask them how many similar surgeries they have performed and what is their success rate, not the success rate listed in medical journals. Don't be afraid to ask questions.
40. Are there any Board Certifications relating to microspine surgeries?
The answer to this question is: Currently No. There are several organizations that offer pseudo-board status but they are not recognized and in their current state they probably never will be recognized. A M.D. physician can only claim to be board certified when they are a member of a board that is recognized by the government. There are many organizations that call themselves "boards" but they are not recognized at the state level and thus are not official. It is often illegal for a doctor to claim he is board certified unless the board has state approval.
41. What is a laminoforaminoplasty?
A laminoforaminoplasty means literally an alteration of the lamina and the foramen. This means that the lamina and foraminal canal are altered so that as the nerve root leaves the spinal cord there is no impingement of the nerve. The lamina is the bone on the back of the spinal cord and the foraminal canal is the hole through which the spinal nerves exit the spinal cord. Enough bone is removed to create a window that will prevent any further impingement of the nerve. We do have an educational site on this website with multiple pictures.
42. What is meant by endoscopic hardware removal?
When we remove hardware endoscopically our main objective is to alleviate any pain that the hardware may be causing by pinching nerves. Only part of the hardware is removed and this is performed via a 1/2 inch portal (the portal may be up to 3/4 of an inch if the screws are that large). Special cutting tools are used to slice through the hardware and to cut it to a size that will allow it to be removed through the small portal. Removal of hardware is on a case to case basis and thus we must evaluate your situation before we can conclude whether we can endoscopically remove the hardware.
43. What is an endoscopic discectomy?
An endoscopic discectomy is a relatively common and simple procedure that many physicians around the world perform. It involves the removal of a portion of the disc to rectify both back and leg pain. The amount of disc removed is approximately 10% of the total of the disc itself and therefore it is really a partial discectomy. A discectomy is substantially different from a Nucleotomy in that the latter only aspirates or at the most removes a very small amount of material and thus a discectomy is considered a more advanced technique.
47. Is Microsurgery the same as minimally invasive surgery?
Although the names sound similar they are in fact two totally different things. One of our physicians was very surprised when a surgeon that he was working with years ago made a 3 inch incision in the neck for what was termed "cervical spine microsurgery". When he questioned the surgeon about the description of the surgery, her response was," it is microsurgery because I am using the microscope." The reality is that with microsurgery the size of the operation is unimportant, it simply implies that at some point during the procedure a microscope was used and thus the surgeon could bill for the use of the microscope. These are not little microscopes, a surgical microscope is about 6 feet high and weighs a ton. This is one of the reasons we are pushing new terms such as Microspine surgery, endoscopic spine surgery and minimally invasive spinal surgery which are more descriptive but still not perfect. Nonetheless, the literature has defined minimally invasive spinal surgery as having an incision of less than one inch.
50. The big question: Can you cure everyone?
Of course not. We are only human and we try to be very honest and upfront about what we can and cannot do. We will not give you false information or hope. We are constantly booked in advance and we are never "searching" for patients. People come to us because they have heard of us and our good results. Thus, unlike some other doctors, we will not push you into surgery if we do not believe we can help you. We will tell you upfront what we think we can fix and what we probably cannot. Nonetheless, we are very proud of our accomplishments and we are proud of our success rates and that is incredible considering that over half of our patients have had prior failed spinal surgeries and have been considered untreatable. Is everyone satisfied with our services? Of course not. If 80% of people have great success then the other 20% have less than perfect results and are probably unhappy. We try our best with what modern science can offer. No spine surgery is perfect but we believe ours is close.