Frequently Asked Questions

1. What are the names of insurance companies you accept? Does the doctor accept Workers' Compensation patients?

The San Francisco Spine Center can bill any insurance company, including Workers' Compensation patients. Most HMO's and PPO's, however will require a referral from a primary care physician before they approve payment.

2. Does the doctor treat conservatively or is he only interested in performing surgery?

All patients are treated conservatively as long as possible except in cases where paralysis is imminent. A patient requires surgery when all conservative measures of treatment have failed and the patient's quality of life is unacceptable.

3. What is the difference between a CT scan and an MRI?

A CT scan is a computer generated x-ray picture of your spine. It is the most accurate for visualizing the bone. An MRI or magnetic resonance image produces no harmful radiation and is more accurate for visualizing discs, nerves and other soft tissues.

4. What is spondylolisthesis?

Spondylolisthesis is an acquired condition and, in some cases may be congenital. The problem is a slippage of the vertebrae (spine bone) over or across the disc which causes pain, deformity or nerve compression.

5. How many people suffering from back pain need surgery?

Eighty percent of Americans suffer from back pain, but only one in 10,000 actually needs surgery.

6. Why do 33% of back surgeries fail?

There are three main reasons or a "failed back surgery." They are:

1. Incorrect operation. This often occurs in disc surgery when a decompressive laminectomy or discectomy is performed. The most common problem in this surgery is incomplete disc removal. The surgeon often neglects to look behind the vertebral body to remove all of the disc. This can result in recurrent disc herniation.
2. Failure to stabilize. Spinal stabilization techniques should frequently be used with surgeries like scoliosis, recurrent disc herniation and spondylolisthesis.
3. Failure of fusion. When disc removal of the cervical (neck) spine is necessary, an iliac (pelvis bone) graft must always be used for a successful fusion.

7. What role does the surgeon play in a failed surgery?

Most failed back surgeries can be avoided, and are usually caused by a well meaning surgeon. The five main reasons for back surgery failure are:

1. Incorrect diagnosis.
2. Using inappropriate procedures.
3. Using overzealous procedures.
4. Failure to stabilize the unstable spine.
5. Failure of fusion.

8. What is Scheurmann's Disease?

Scheurmann's Disease is not really a disease at all. It refers to a developmental variation in the spine. It is characterized by wedge-shaped vertebrae, irregularities in the ends of the spinal bone called Schmorl's nodes, and premature wearing of the discs. It can sometimes lead to early disc herniation. It is usually not disabling, but can result in a stiff, achy spine.

9. Do I need a myelogram, discogram or CT Scan?

Ninety-five percent of the time an MRI is all that is visualize spinal pathology. In patients with scoliosis, prior surgery, or multiple defects where the doctor is unsure of the cause of the pain, the other tests are sometimes required. While the tests are accurate, they only make sense when they are compared with the history and physical examination.

10. Are pedicle screws still useful?

Pedicle screws and rods are tools that help stabilize and strengthen the spine. They are valuable tools in scoliosis, spondylolisthesis, or conditions that have resulted in displacement of the vertebrae. They are still the most reliable way of improving the likelihood that the spine will heal following spinal fusion.

11. What effect does scar tissue have?

Scar tissue is a necessary by product of any operation. Following surgery, it causes the spinal nerves to attach to the margins of the disc spaces, pulling, pinching, and irritating them. It is commonly believed this may be the cause of a failed back surgery but its factuality has never been substantiated.

12. I injured my back a few days ago, but now my leg is hurting more than my back. Could this be related to my back injury?

If you are between the ages of 25 and 50, and the pain continually radiates below your knee, you probably have an acute herniated disc. The pain can usually be handled by a brief period of rest, and in 2 or 3 weeks should go away.

13. My doctor says I have a low back strain. What does this mean?

Most low back strains are really arthritic pains that originate in the joints of the spine. As the intervertebral disc wears, the covering of the disc either stretches or tears. The disc annulus is richly innervated by nerve pain fibers which are irritated by prolonged sitting, standing bending or lifting. This results in reflexive muscle spasms and the feeling of a "muscular strain."

14. How do I tell if I have muscular pain or if the spine is affected?

If the pain starts after a weekend of strenuous sporting activity, or home improvement projects and goes away in three days the problem may be muscular. If the pain recurs over several months or if it takes at least 3 weeks to resolve and the pain usually originates in a spinal joint.

15. What is a herniated disc?

A displaced cartilage fragment that separates from the vertebral body and pinches a spinal nerve, which can cause pain that is localized or radiates down the leg.

16. What is the best exercise to keep your back fit?

Swimming. This sport engages almost all muscle groups. There is no stress on the joint muscles, and much less risk of injury compared to other sports. Swimming enhances and benefits the cardiovascular system.

17. What is a "chronic muscle strain?

There is no such thing. Most chronic muscle strains are actually degenerative or herniated discs. With a degenerative or herniated disc, the patient often experiences secondary muscle spasms. The chronic muscle strain is not a cause, but a result.

18. When do I need surgery?

A patient requires surgery when all conservative measures of treatment have failed, the pain is severe and disabling, there is a neurological patient's quality of life is unacceptable.

19. What is "spinal stenosis?"

It is a narrowing of the spinal canal. This condition causes a pain that radiates down both legs. The problem (and pain) is made worse by standing or walking. The symptoms are always relieved when the patient is sitting clown. This problem occurs most often in patients over 60 years of age.