The Spine Center is a center of excellence. A COE is a specially designed organization made up of multidisciplinary spine specialists who provide the complete range of care of the spine often in a vertically integrated fashion. There is a strong emphasis on nonsurgical conservative care of the spine with surgery as a final option. COEs are committed to high-quality, cost-effective, patient-centric care. They perform extensive outcomes tracking and have complex treatment protocols to ensure the highest level of care of the spine. Our COE specializes in the care of the spine. A center that only specializes in spine care can provide a much higher, comprehensive, and specialized level of care with the potential for much better outcomes. We employ neurosurgical and orthopedic spine specialists, physical therapists, and nonsurgical care specialists in our COE.

No, you can call our office anytime for an appointment. We may, however, recommend that you see a nonsurgeon first, as most cases of back or neck pain will result in nonsurgical care. For example, you may see a physical therapist first and undergo physical therapy which may help relieve the pain enough to restore you to normal living and avoid surgery altogether.

Your surgeon is specially trained to perform surgery on your spine. Training is completed over many years, including medical school and residency. Fellowship training is an additional year of specialized training in the spine after the completion of a residency. Board certification verifies that your surgeon is committed to continuing education and maintaining current surgical standards, knowledge, and expertise and is held to the highest standards of performance. Certification and/or fellowship training sets the surgeon apart from others in the field of spine surgery.

We try to ensure that all patients who want an appointment with us get helped as soon as possible. We accept self-referrals and physician referrals which means that you can call us directly to make an appointment, or you can have your healthcare provider call us to set it up. Call us at (605) 341-1414. If you have a specific healthcare provider you would like to see, please let our schedulers know that up front. If not, we will schedule you with the first available one. In some cases, you will be scheduled with one of our physician assistants or a nurse practitioner. They are advanced practice providers who are specialty-trained in the spine and will provide exceptional initial care to you. We also accept walk-in patients Monday through Friday from 8:00 a.m. to 5:00 p.m. If you have insurance, we encourage you to bring your information and insurance card. Also, please bring your driver's license, a list of your medications, and any recent imaging of your spine.

We can usually get you in to see one of our spine providers within a few days. Our advanced practice providers may be able to see you sooner than our surgeons, and if your condition warrants it, you may be able to have to see the surgeon sooner.

These signs are also called "red flags" and indicate a serious problem that requires immediate attention and care. These can include:

• Sudden significant arm or leg weakness.
• Sudden loss of bowel and bladder control. This could be a sign of cauda equina syndrome. This is a true emergency that requires immediate evaluation possibly in an emergency department.
• A history of trauma, fever, unexplained weight loss, a history of cancer, long-term steroid use, and drug abuse.
• Intense localized pain.

The decision to consider back surgery should always come if your back or neck pain continues to be persistent and disabling after you’ve tried all nonsurgical or conservative options. The only exception would be for acute injury or a serious spine condition. You and your spine surgeon should make the decision together. Your surgeon will perform a comprehensive evaluation of your condition and may get imaging studies to help determine the problem, then your surgeon will sit down and discuss the options for surgery, a description of the surgery, the risks and benefits, and your recovery period. You are encouraged to participate in this decision-making by asking questions and doing your own independent research.

Yes, our goal at the Spine Center is to get you back to being healthy without the need for surgery. Surgery should usually only be considered when all other options have been exhausted. Nonsurgical care of the spine is the first step in getting back to being healthy. There are many options other than surgery that you can try. First, a healthy active lifestyle is the most important defense to prevent the need for surgery. Some other first steps in nonsurgical treatments can include physical therapy, acupuncture, acupressure and massage therapy, aquatic/water therapy, nutrition/lifestyle changes, cupping, osteopathic manipulation, and chiropractic treatment. If those treatments alone are not enough, then other treatments can include injections, spinal cord stimulators, nerve blocks, or rhizotomy procedures. Finally, anti-inflammatory drugs like aspirin, ibuprofen, and acetaminophen can provide short-term relief for the pain. Prescription painkillers can be highly addictive and should only be used for short periods and under the strict guidance of a pain specialist. If all of this doesn’t provide relief, then you may be a candidate for spine surgery. We have excellent spine surgeons who can evaluate your condition and discuss your surgical options with you.

It is common knowledge that smoking is bad for your overall health. Smoking may decrease your bone density which increases the risk of osteoporosis. Smoking impairs your blood flow and deprives your spine of nutrients and the oxygen it needs to stay strong and healthy. It also can decrease your physical activity due to deoxygenated blood and damage done to your lungs. Your weakened cardiovascular system can cause walking to become difficult and painful, reducing your activity levels. Finally, smoking can keep you from healing after surgery as well as increase the development of blood clots and infections during recovery. We can help you quit smoking. We have resources that we can connect you with that can help, just ask. Some helpful hints for quitting or resisting the urge to smoke include:

• Nicotine replacement therapy.
• Avoid triggers situations where you typically feel the urge to smoke.
• Try to delay the urge like going to a smoke-free public zone.
• Chew sugarless gum.
• Don't have "just one."
• Get some physical activity to distract you from the urge.
• Practice relaxation techniques.
• Ask for help from family members, friends, or a support group.
• Go online for support.
• Remind yourself daily of the benefits of not smoking.

Prevention is your best strategy for avoiding back or neck pain. Everyone has an episode of temporary back pain from time to time. Maintaining a healthy physical condition is key to avoiding long-term back pain. Some basic practices that you can follow include:

• Stretching before and after strenuous activity.
• Strengthening your core muscles via targeted exercises including aerobics, flexion, and extension stretches.
• Using good posture at all times while both sitting and standing. Ensure that you use proper ergonomic movements at all times. For example, when using a computer, be sure to have the keyboard and mouse adjusted for your physique.
• Do not sit for long periods without frequent breaks to get up and move around.
• Maintaining a healthy weight.
• Don't smoke or chew tobacco.
• Don't try to lift objects that are too heavy. When lifting, use your legs more than your back.
• Avoiding excessive amounts of alcohol.
• Practicing stress reduction techniques daily.
• Keeping hydrated. Drink plenty of water.
• Eating healthy. Stay away from processed food and sugars.
• Getting plenty of sleep. Sleep on a medium to firm mattress.
• Staying active, like walking every day for at least 10 – 30 minutes.

Depending on the circumstances you may need to get imaging, like an MRI or CT scan, performed before your appointment. In cases of "red flag" conditions, like weakness, bowel and bladder dysfunction, a fracture, or cancer, our healthcare provider may need an image to make the appropriate diagnosis. In other cases, our advance practice providers can see you, make the evaluation, and order conservative care for you without the need for imaging.

Physical therapy is one of the most commonly recommended treatments for back or neck pain. Physical therapy can provide relief without surgery in many cases. Your physician will refer you to a therapist who is specially trained in this type of care who will use a combination of active and passive therapy to assist you in decreasing your pain and increasing physical function. Passive therapy includes things like heat or ice packs, ultrasound, or TENS units. Active therapy includes things like stretching, lumbar stabilization, or other exercises to strengthen the back, core muscle strengthening, and low-impact aerobic conditioning.

As you age, your spine, like many other parts of your body, starts to degenerate. Spinal discs lose water, degenerate, and become compressed, adding pressure to the joints and narrowing the spinal canal. By age 35, approximately 30% of people will show evidence of disc degeneration. By age 50, more than 90% of people will show evidence of some disc degeneration. Cartilage fades away causing spinal arthritis resulting in the low back and radiating leg pain. Osteoporosis weakens the bone structures and may cause fractures in the spine. The best defense against this is a healthy lifestyle, healthy diet, and lots of exercise or physical activity.

No, bed rest as a part of treating back pain has a limited role in healing sore backs. It should only be done in very small doses. An extended period of bed rest isn’t helpful for moderate back strain at any stage of therapy. Muscles lose conditioning and tone with too much bed rest possibly resulting in issues such as constipation or blood clots in your legs. Depression, malaise, and physical weakness are common among people confined to bed.

Minimally invasive spine surgery is a type of surgery on your spine that uses smaller incisions than standard surgery. The goal of MISS is to give you an equal outcome as open surgery but with less pain, fewer complications, and a shorter recovery period. MISS uses special imaging tools to aid in navigating the area of your surgery, and a special surgical device called a tubular retractor to assist in performing the surgery. This stiff tube-shaped surgical tool allows the surgeon to use a much smaller incision. The surgeon uses the tool to create a tunnel to access the damaged area of the spine, gently pushing aside muscle rather than cutting it. Surgeons can use MISS for lumbar discectomy, laminectomy, and spinal fusion.

Vertebral compression fractures occur when the vertebral body in the spine collapses, leading to severe pain, deformity, and loss of height. The fractures most commonly occur in the thoracic spine and are often associated with a condition called osteoporosis. Other common causes are car accidents, sports injuries, or a hard fall. Finally, metastatic tumors can be a cause in patients younger than 55. Symptoms include a sudden onset of back pain, pain intensity increasing while standing or walking, and limited mobility. Most of the time it is treated conservatively with over-the-counter pain medication, bracing, muscle relaxants, or medications for nerve/bone pain. Opioids should only be used for a short period of time for acute pain. There are a few minimally invasive procedures that sometimes may help, including vertebroplasty or kyphoplasty. There is also a relatively new procedure called spine jack that is providing good results for patients.

Degenerative disc disease is a condition in which natural, age-related wear-and-tear on a spinal disc causes pain, instability, or other symptoms. Spinal discs are like shock absorbers between the vertebrae, bones, or your spine. They help your back stay flexible so you can bend and twist. The discs are made up of a soft inner core (nucleus) and a tough outer wall (annulus). Your discs are mostly made of water and when you are born, they are soft and supportive. As you get older, these discs can dry and get thinner. They lose their ability to cushion or absorb shocks to your spine. They can also crack from the stress of everyday movements or minor injuries over the years. These tiny tears can cause the nerves to become painful. Symptoms can include a sharp or constant pain in your back or neck. Other signs may include pain that comes and goes, feels worse when you bend, lift, or twist, or gets better when you change positions or lie down.

Spinal discs are jellylike cushions (discs) that sit between the individual vertebrae that stack up to make your spine. A spinal disc has a soft, jellylike center (nucleus) encased in a tougher, rubbery exterior (annulus). A herniated (also called ruptured or slipped) disc occurs when some of the nuclei push out through a tear in the annulus. Symptoms may include arm or leg pain, numbness or tingling, and weakness. In some cases, your surgeon will perform a discectomy to remove some of the herniated material, if conservative treatments do not produce relief.

Your body constantly breaks down and replaces bone. Osteoporosis occurs when the new bone creation doesn’t keep up with the loss of old bone. Osteoporosis causes bones to become weak and brittle. A fall or mild stresses, such as bending or coughing, can cause a fracture to your spine. Osteoporosis most commonly affects older women who are past menopause. Symptoms include back pain caused by a fractured or collapsed vertebra, loss of height, a stooped posture, and bones that breaks easily. Risk factors for osteoporosis include your age, race, sex, family history, hormone levels, dietary factors, steroid use, and other medical conditions. Prevention includes adding plenty of protein to your diet, keeping excess weight off, supplementing calcium and vitamin D intake, and exercising. You should consult your healthcare provider before embarking on any of the prevention items listed above.

Pain caused by these two conditions may feel similar or even identical however they are caused by quite different reasons. Sciatica is typically caused by a herniated lumbar disc, stenosis, bone spur, or spinal instability that irritates the spinal nerves or sciatic nerve sending pain, numbness, tingling, or weakness down the back of your leg. Sacroiliitis or sacroiliac joint dysfunction is caused by trauma or degeneration of the sacroiliac (SI) joint. The SI joint is where your iliac (pelvis) bone connects to the sacrum (lower spine above the tailbone). Treatment for these two conditions is different. Your healthcare provider will evaluate you to determine the exact cause of your pain.

Spinal stenosis occurs when your spinal canal or vertebral foramen narrows causing back and/or leg pain. The spinal canal is a tunnel formed by your vertebrae that your spinal cord runs through. The vertebral foramen is a narrow opening between your vertebrae where nerves exit the spinal cord to your muscles. Stenosis is commonly caused by aging, and wear and tear related to osteoarthritis. In severe cases, your surgeon will recommend surgery to create additional space for the spinal cord or nerves. Common symptoms include weakness, numbness or tingling in the hand, arm, foot, or leg, neck or back pain, and problems with walking and balance.