we also have a large number of younger, more athletic types with rup-
tured discs or injuries from motor vehicle accidents.
The largest group of patients is made up of people who are frustrat-
ed by their limitations. They used to play tennis and golf, but find they
can't anymore. They used to take trips or visit their kids, but now, if
they drive long distances, they spend the whole weekend in bed
because their backs hurt so badly. Comorbidities are the one signifi-
cant inhibiting factor, but as long as our team is confident that we can
manage and educate a given patient, we can handle a broad range.
We've had patients in their 90s who've been highly motivated and
who've done very well.
Of course, surgery isn't the first option. Our surgical patients are
people who've tried anti-inflammatories, or other approaches, like chi-
ropractics or acupuncture. It's when those things fail that we'll look at
X-rays and MRIs and discuss findings and options. Keep in mind, how-
ever, that payers are steering volume to high-value programs and
requiring conservative management before surgical consultation for
low back pain.
A patient may have an epidural, may have physical therapy or may
go straight to surgery. It depends on the pathology. Once they've had
surgery, it's usually about 6 weeks before they can start physical ther-
apy, but they're usually back at work very quickly. It's amazing how
much spine surgery has progressed in the last 20 years. Incisions are
smaller, and with microscopes and very fine instruments, tissue dis-
ruption is minimal and recovery is fast. Most importantly, it's giving
people back the lifestyles they want.
OSM
6 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • N O V E M B E R 2 0 1 7
Dr. Bray (lsotoodeh@discmdgroup.com) is the founder and CEO of the
Diagnostic and Interventional Surgical Center (DISC) in Marina del Rey,
Calif., and DISC Surgery Center at Newport Beach, Calif. Ms. Reiter (kreit-
er@discmdgroup.com) is the administrator.
