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Your primary care doctor is one of the best resources you have to help you determine what your problem may be. We most commonly see patients who have been referred to us for consultation when other problems have been ruled out or when a spine problem has been identified. This is usually the most efficient way to proceed, as your doctor has most likely ordered an MRI which is a critical step in evaluating the spine. This saves significant time and makes your consultation much more effective.

We see patients who are self-referred. Some have had MRI’s performed already, some have not. When there has not been diagnostic imaging performed, the first consultation may result in no definite treatment being recommended until an MRI can be performed.

Patients prefer open MRI as there are less complaints of discomfort because of the enclosed space of the magnet. Surgeons prefer closed MRI because the image quality is superior. Unfortunately, a problem that compounds the poor image quality of open MRI is when large bodied patients are placed in the open magnets. This may make the patient more comfortable, but frequently results in poor quality images because of the strength of the magnetic field. The newer technology of the “short-bore” magnet gives the patient less feeling of being in an enclosed space but still yields excellent quality images. Given the option, a closed or short-bore magnet yields the best quality images, improving the accuracy of the diagnosis. An MRI gives physicians the ability to see the vertebrae, discs, spinal ligaments, the spinal cord and nerves, and gives information about the age of fractures and many other conditions.

When a patient has a pacemaker, a cerebral aneurysm clip, metallic foreign bodies in the eye, spinal cord stimulators and other types of implantable pain devices, or a recent sternotomy, they are not able to have an MRI. To investigate problems of the spinal canal, they then need an older test called a myelogram. A radiologist injects dye into the spinal canal and then obtains a CT scan to allow visualization of the available space around the structures in the spinal canal. A plain CT scan provides little usable information about the nervous structures of the spine. When investigating fractures of the spine, especially those caused by osteoporosis, a bone scan can be a useful substitute for an MRI. Patients who have orthopedic implants such as hip and knee replacements, rods, plates, and screws may have MRI’s without any concern. If there is any question, the radiologist can easily determine if a patient is able to have an MRI.

New patient appointments are scheduled for 30 minutes. Depending on the complexity of the problem it may be much longer. Consultations involving discussions of surgery are usually an hour. Simple problems, particularly those that are not caused by spine conditions, may be much shorter. As much time will be spent as is necessary to evaluate and explain your problem. Most people need to plan on at least 90 minutes for their office consultation.

You will be asked to provide a full medical history. This can be downloaded and completed before arriving for your consultation (see Patient Information). Our physician assistants and nurses will perform an evaluation, ask questions, and perform some parts of the examination. Doctor Spears will review all of this information and review all of your imaging studies. He will then discuss your problem with you, perform a neurologic and spine examination, and discuss your diagnosis and options. You will be able to see your imaging studies and models, and gain an understanding of what your problem is. We will make every effort to assure that you have as complete an understanding as possible of what the problem is and what options exist.

If you have had no studies performed, your first visit will most likely result in having to obtain an MRI and returning to complete the consultation. X-rays, particularly standing and motion films may be obtained to aid the decision making process. Sometimes nerve function tests such as EMG’s are ordered. Infrequently test to identify pain generators such as discograms are also considered.

Once the decision to proceed with surgery has been made, elective surgeries can frequently proceed within weeks. Certainly, urgencies are performed as soon as possible. Other health factors may interfere with a person’s ability to have a surgery quickly. When patients are on medications that thin their blood, they must stop taking these medications for a period of time to limit bleeding during surgery. Medications such as Plavix, Coumadin, aspirin, ibuprofen, naprosyn and other anti-inflammatory and arthritic medications must be stopped for varying amounts of time pre-operatively. Patients who have cardiac conditions may need a stress test and clearance from their cardiologist before having surgery.

It is Latin for “to free from oppression.” It is the motto of the United States Army Special Forces (“the Green Berets”). We chose this for several reasons. One reason is because it is very apt. Many of our patients tell us they feel they have been freed from a substantial burden when they return to see us after their surgery, now able to use their extremities without disabling pain. The other reason is in honor of Doctor Spears’ service in Special Forces. The skills and philosophy he learned in special operations and unconventional warfare he uses daily to evaluate and treat problems in an innovative way.