What to Expect
What happens when you come see us?
“My goal is to get patients back to doing things they love and living the pain-free lifestyles they desire.”
Patient Care Philosophy
Patients always ask me, “Do I need spine surgery?” Usually (not always), the answer is NO. Most people WANT surgery to get back to living the lifestyle they want.
If the main issue is pain, the first goal is diagnosis. What is causing the pain?
To figure this out, it all begins with the patient visit. We listen to your story. Where is the pain? When does it occur? What makes it better or worse? When did it start?
Then, we focus on the physical exam. Is there any weakness? Are the reflexes normal? Is there tenderness anywhere?
We look at all the data and order appropriate imaging, such as MRI, CT, and dynamic x-rays (standing and bending forward/backward to see if anything shifts). We may order a nerve study (EMG).
Once a diagnosis is suspected, we try to fix it conservatively, without surgery. Depending on the issue, we may try physical therapy, medications (nerve pills, muscle relaxants, anti-inflammatories), or injections by a interventional pain doctor. If that is not enough, we discuss all the options, and come up with a plan together.
Principles of Care
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We are no longer in the “authoritarian” Age of Medicine when doctors told patients what they needed and gave them ultimatums. This is a team effort!
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Example 1: Two patients may have the same exact problem (lumbar spondylolisthesis), but one wants to fix only the leg pain, and the other wants to fix the back AND leg pain. This may mean different surgeries for each patient.
Example 2: A patient with significant scoliosis (curvature of the back) may only want their leg pain (radiculopathy) fixed because of a herniated disc. We can perform the discectomy (remove the herniated disc) and address the scoliosis later if desired.
Example 3: A patient with significant scoliosis (curvature of the back) may have back pain, but the back pain may actually be due to sacroiliac (SI) joint dysfunction, and not due to scoliosis. The patient’s story, physical exam, and response to injections will help clarify, and the treatment will be significantly different for the SI pain as compared to the scoliosis correction.
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We will always encourage patients do complete and exhaust ALL methods of conservative measures prior to discussing surgical options. This included medications (muscle relaxants, nerve medications, anti-inflammatories), physical/occupational therapy, and injections. MOST of our patients get better with this and end up NOT needing surgery!
Surgery is reserved for patients who have pain despite trying conservative measures, or those who have weakness or concerning symptoms (such as balance or hand dexterity issues).
In patients with risk factors (e.g., smoker, osteoporosis or weak bones), it is better to wait, address those factors, and make surgery safer with less risk of complications.
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This can help educate you, push you toward a decision, and will confirm whether you do (or don’t) like your surgeon. That relationship is important!
A perfectly executed surgery, done for the wrong reasons or in the wrong patients, will not help. This is partially why there is a “bad reputation” for spine surgery in the community and why there are “failed back” surgeries. Patients need the CORRECT diagnosis, APPROPRIATE surgery, executed with surgeon SKILL to MAXIMIZE results.
Pre-operative Conservative Therapy
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Not just a band-aid!
Arm/leg pain, consider epidural steroid injection (this injection goes by the nerves).
Axial Neck/back pain: consider medial branch blocks / facet blocks / ablations (this usually consists of “test shots” which may only last a few hours; that is still success if it gives you pain relief! Then you become a candidate for the nerve radiofrequency ablation (small nerves in the bone are burned).
Vertebrogenic back pain: a new type of pain management intervention is basivertebral nerve ablation (Intracept) which work great for certain patients with “modic endplate changes” (the bones have to have swelling visible on imaging).
SI injection: the sacro-iliac (SI) joint is often a cause of low back pain. This shot can be both diagnostic (helps determine if that is your source of pain) and therapeutic (makes you feel better).
Hip / bursitis injection: Often times pain radiating into the hips, thighs, or groin is because of bursitis (inflammation of the hip joint) or hip issues. This shot can be both diagnostic (helps determine if that is your source of pain) and therapeutic (makes you feel better).
Trigger point injections: injections into the muscles.
Just because one injection does not work, DO NOT GIVE UP! Maybe another injection should be tried in a different location.
In my opinoin, there is no great scientific evidence for PRP/stem cell injections or disc replacement “gels” for the spine (at least for now). HOWEVER, that does not mean that OTHER injections do not work.
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Not just a band-aid! Often times, the CORRECT therapy will fix your pain. For herniated discs or pinching of the nerves, we often recommend physical therapy WITH TRACTION or DECOMPRESSION THERAPY (non surgical decompression).
PT should be directed at the problem. PT for the neck is different than PT for the back which is different than PT for the SI joints which is different than PT for balance/gait (walking).
If PT does not help, it WILL still make you stronger for surgery. Patient's who do “pre-hab” do better after surgery. Plus, many insurances require you try therapy prior to approving surgery.
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Anti-inflammatory = (acetaminophen (tylenol); ibuprofen (Alleve, Advil); naproxen; meloxicam (Mobic)
Nerve pills for nerve pain = gabapentin; pregabalin (Lyrica)
Muscle relaxants for neck/back pain = methocarbamol (Robaxin); cyclobenzaprine (Flexeril); tizanidine (Zanaflex); baclofen
Steroid pack = Medrol dose pack; prednisone
Surgery
Focused on
1) Safety
2) Minimal-Invasiveness
3) Motion-Preservation (fusion avoidance)
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This entails certain techniques and procedures to limit the extent of injury to the normal tissues, while maximizing the results achieved. The advantages are:
Less pain
Limit normal tissue and muscle disruption
Decreased blood loss
Decrease risk of infection
Decrease length of stay (LOS) in hospital or ability to do surgery as outpatient
Improved healing and faster recovery
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If placing screws, thoracic/lumbar screws are generally placed with a “navigation” system much like the GPS in your car. This makes screw placement much safer. An intra-operative CT is done (for example, with an “O-Arm), transferred to the navigation system (e.g, Stealth Navigation), and hardware (e.g., screws) is placed with the navigation system.
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In select cases, there is a special “neuro-monitoring” team present in the surgery that places needles into your arms/legs to monitor the nerves and spinal cord during surgery for additional safety.
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A “bone knife” that allows for safer, more efficient, bone decompressions with less blood loss
Post-Operative
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Started between 2-12 weeks postoperatively (sooner if surgery was a disc replacement or decompression without fusion).
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X-rays usually at each visit if any instrumentation was placed.
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For fusions, you may get placed in a collar or bone stimulator to promote bone healing, especially if you have weak bones (osteoporosis)
Post-Operative Discharge Instructions:
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No! Unlike what happens at Academic Institutions, all surgeries are performed by Dr. Katsevman, including skin closure.
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This is a complicated question and requires a complicated, PERSONALIZED response. There is a difference between technical success (post-operative x-rays look good) and clinical success (long term, successful pain relief).
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YES! This is the most rewarding part of it…happy patients!
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YES! We prefer in person visits as they make the experience more intimate, but we are happy to meet you via a Telemedicine visit.
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YES! We are happy to see you in person (it is an excuse to visit beautiful Naples…) or via a Telemedicine visit.
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Unfortunately, not yet. Hopefully coming 2025.
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Hopefully you give us the chance to help you, whether it be through conservative (non-surgical) treatments or via surgery. But to see what other patients have thought, please scroll down to see patient reviews and testimonials (or click the “Reviews” tab).
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