Please call 310.574.0400 to be speak with a new patient coordinator at DISC.

Please remember to bring your insurance card and picture ID to your appointment, as well as any imaging studies or new tests/procedure results. Please arrive 10-15 minutes before your scheduled appointment time to ensure all paperwork is completed, we endeavor to have our patients in the exam room at the scheduled appointment time. If your doctor is running behind schedule, we will let you know as soon as we can, to give you the opportunity to reschedule. DISC provides 10% parking validation. Please be prepared to pay for parking if you plan to park in the lot. Street parking is also available.

You will be required to pay your insurance co pay at the time of the appointment. For cash pay patients, you may pay by cash, credit card (depending on your physician, most, but not all accept credit cards) or check at the time of check-in. If imaging studies are needed at the time of your consult, you may be expected to pay Mink Radiology at the time of service, depending on your insurance.

Please ask your pharmacy to request your prescription renewal via fax. Each office has a designated fax number. Please call the office at 310-574-0400 to get the correct fax number.

Please contact medical records, a release must be on file. Please fill out and contact if you had films taken at Mink Radiology 310-305-4500 or Marina del Rey, 310-358-2100.

Please have your treating therapist contact our office at 310-574-0400 or have your treating therapist fax the request to your doctor’s fax. Each office has a designated fax number. Please call the office at 310-574-0400 to get the correct fax number.

Please call your doctor as staff cannot give out information until it has been reviewed by the doctor and discussed with the patient.

To schedule surgery, please call 310-574-0400 and ask to speak to your physician’s surgery scheduler.

Each physician’s office uses a different billing company for their professional services; please speak to your doctor’s assistant to facilitate if the need arises for you to discuss the doctor’s professional billing. Our Surgery Center billing can be reached at 310-574-0449

If you have questions that you would like answered by your physician, please call 310-574-0400 and speak to your physician’s assistant. Your message will be communicated to your physician during his or her next office hours, or sooner if urgent. If you need to speak to a doctor regarding an urgent issue after the office has closed, your call will be transferred to the answering service and a physician will be contacted. If you have a true medical emergency, please call 911 or arrange immediate transportation to the emergency room.

In general cervical fusion causes decreases range of motion by a bout 5 degrees in flexion. The impact on rotation and side-to-side movement is not significant as majority of cervical fusion procedures avoid the first two vertebrae. The most commonly fused levels, cervical levels five-six and six-seven, have a relatively minor impact on day-to day activities. Of course, fusion should only be considered after other non-surgical measures have been tried and failed. Overall, there is some support in the literature for adjacent segment degeneration. In other words, increased stiffness at the level of the fusion can lead to accelerate the degenerative changes in the neighboring levels. The rate of degeneration is very low, quoted at about 2- 3% chance per year.

The are three kinds of grafts that are in general use for spinal fusion operations: Autograft bone (usually harvested from the hip), Allograft bone (processed bone from cadaveric source), and Synthetic graft (Aka PEEK). The choice of the graft material used in your surgery is highly individualized and depends on several factors, such as, your age, smoking history, osteoporosis, and your preference. For example, some patients prefer their own bone, while others don’t want to suffer from hip pain from the harvest procedure. While others are concerned about disease transmission with allografts. Overall, all three grafting material produce high degree of fusion with reliable and lasting results. Consult your surgeon for more details.

Single level anterior cervical fusion general does not result in any appreciable loss of motion. The most common levels for surgical intervention and fusion are the C5-C6, and C6-C7 levels. These levels contribute to a minor percentage of motion. Patient’s with degenerative cervical disc disease in fact report better neck movement and less pain, since the fusion removes the offending degenerated painful disc.

Although all patients will have a degree of pain and discomfort after surgery, use of minimally invasive procedures and elimination of hip graft harvest from most of the anterior cervical procedures have significantly reduced postoperative pain and discomfort. Anterior cervical procedures are performed through a muscle-sparring technique with minimal blood loss. Most one and two level cervical fusion patients are in hospital for only an over-night stay.

By design, anterior cervical discectomy and fusion removes the offending degenerated disc while removing bone spurs or herniated disc that cause nerve compression and arm pain. A great number of patients experience good to excellent outcomes as far as their radicular symptoms (i.e. arm weakness, numbness and tingling). To a lesser degree do we see total resolution of neck pain. Postoperative physical therapy and neck muscle strengthening play central role in postoperative recuperation of patients.

Neck fusion, like any other surgery, carries the risks of infection, bleeding, and general anesthesia. If you are in good general health and pass your pre-operative physical, these general risks are very low. Specific risks related to the anterior cervical discectomy and fusion are related to damage in the structures of the neck, such as, the carotid and vertebral artery injury causing a stroke, vagus nerve injury causing vocal cord paralysis, vocal, esophageal injury, spinal cord and nerve root injury and cerebrospinal fluid leakage. Chances of serious and life-threatening complications are extremely low with a reported rate 1-3%. At DISC we are blessed with an even lower rate of such complications. Please talk to your surgeon for more details.

Indications for neck support and immobilization after surgery depend on several factors, such as, the number of levels fused, history of osteoporosis, smoking, and other pre-existing medical conditions that can impact the fusion rate. In an otherwise healthy patient who has undergone a one-level uncomplicated surgery with plate and screw supplementation, need for hard collar immobilization is obviated.

If your surgeon has not prescribed a postoperative cervical collar, you can start driving in about four to five days. It is not recommended to drive with the neck collar as it limits your ability to turn your neck. Once your surgeon has cleared you from wearing the collar, he/she will advise you regarding driving and resuming regular activities. Additionally, we ask you not to drive if you are still taking narcotic pain medication, or other medication that can impair your judgment.

In the medical world, conservative treatment is usually any treatment that is not invasive or surgical. That means, nothing is inserted into your body and no surgery is performed.

In the case of treating a neck injury, conservative treatment could mean physiotherapy, medications, exercise, heat/cold treatments, or bracing to keep your neck steady.

Unless it is urgent that surgery be done, as can be in some cases, conservative treatment is usually among the first options.

The problem of chronic low back pain (LBP) is faced by many people each day. Finding a way to manage it is the goal of many research studies. Taking a look at studies done all over the world has shown us that many different therapies combined together may make the difference.

That’s what is referred to as a multidisciplinary approach. It starts with intensive physical exercises along with behavioral therapy. Cognitive and behavioral therapy helps patients change the way they think about and respond to pain.

Instruction to help educate patients is essential. Improving skills for coping psychologically and emotionally is also included. The goal is to increase function and activity even if pain levels don’t change. Many patients want to get back to work. This may be possible with work-related and vocational training.

Studies show that people seem to do better when they get instruction and education to help explain their back pain there may be neurological/orthopedic spinal surgeons, physical medicine and rehabilitation specialists, chiropractic/soft tissue care, pain management physicians along with alternative practitioners of acupuncture and oriental medicine on the team.

At DISC we provide this multidisciplinary approach offering a wide range of therapies which may help improve your pain and increase your functional abilities.

When conservative measures fail with spinal stenosis, surgery may be the next step. Stenosis refers to a narrowing of the spinal canal. Congenital narrowing, combined with degenerative changes that come with aging, often bring on painful symptoms.
Conservative care is always the first line of treatment. Rest, antiinflammatory drugs, and steroid injections often work well. But when nonoperative care doesn’t change the symptoms, then decompressive surgery is considered.

In this operation, a portion of the bone around the spinal cord is removed. This takes the pressure off the spinal cord or spinal nerves. But sometimes the neural structures were pinched long enough and hard enough before surgery that there is some loss in sensory and/or motor control.

This may be temporary or permanent. Nerve tissue can heal but it’s a very slow process. Time can help resolve these final symptoms without further surgery. In some cases, a rehab program may also be beneficial.

Spinal stenosis is no respecter of persons as the old expression goes. It is a degenerative condition of the spine brought on by aging, not activity.

Stenosis refers to a narrowing of the spinal canal and openings for the spinal nerves. Changes in the bones, soft tissues, and joints contribute to stenosis.

For example, the broad band of ligament that runs down the spine called the ligamentum flavum (LF) starts to thicken. It can even get pinched between the vertebral bones causing additional pain.

The vertebral bodies start to weaken and compress. The discs thin out and lose their soft flexibility. The vertebrae and joints start to move closer together. Bone spurs form around the joints. The joints may become misshapen and lose their normal ability to slide and glide. The joints may no longer fit together and move smoothly. This adds to the problem.

Some people are born with a narrow spinal canal. This is not a problem during the younger years. But with the changes described here, the spinal opening is gradually closed off. Pressure on the spinal cord or spinal nerves causes back and/or leg pain.

Without knowing exactly what the problem is and the type of surgery your doctor is proposing, it’s not possible to get specific. However, most surgeries do have the same types of issues. First, how bad is your pain? Is it affecting your lifestyle? Have you tried various pain relieving medications and/or physiotherapy, or other treatments? Has it affected your ability to move around or control your bladder or bowels? These are some things to consider.
You will need to weigh the potential benefit of surgery against the potential complications. Like most surgeries, there is a chance of infection, bleeding, or blood clots. And, of course, there is always the chance that the surgery is not successful.

This is something you must discuss with your doctor before you make any decisions.

It can be confusing when you hear different terms being used for the same

thing. Bulging, slipped and herniated disks are all the same thing. Other names used are: compressed, prolapsed, and ruptured disks.
Your backbone is made up of small bones called vertebrae. There is a gel-like substance between the disks that cushion them and keep them in place. Sometimes, a back injury results in a disk moving and pressing on a nerve. That’s what causes the pain.

Drop foot (sometimes called foot drop) is caused by pressure on the spinal nerve root as it leaves the spinal cord. A bulging disc or other degenerative disorder of the lumbar spine can have this effect.

Nerve impairment can result in muscle weakness. When the L5 nerve is affected, motor loss of the tibialis anterior muscle can occur. The tibialis anterior is the muscle along the front of the lower leg. It pulls the foot up toward the face. Weakness of this muscle results in the toes dragging along the floor as the foot and leg move forward.

Surgery to remove pressure from the nerve can prevent this problem from happening. For those patients who don’t have the surgery soon enough, drop foot can be permanent. The sooner surgery is done, the better your chances are for full recovery.

In a recent study from Japan, researchers found that more than half the patients did recover function. Only about one-third had a complete recovery. These patients were younger, had greater strength of the tibialis anterior muscle before surgery, and a shorter duration of symptoms.

You have a much better chance of recovery with the surgery than without. Talk to your surgeon about what to expect. Motor recovery can be a slow process taking up to two full years for complete return of strength.

The most likely diagnosis is ulnar nerve entrapment of the elbow or wrist. Clinical examination and electrodiagnostic testing are necessary to make the diagnosis. Depending on the severity, surgery may be necessary. Weakness is not always correctible, so a prompt evaluation by a hand specialist is recommended.

I see this more and more frequently. Overuse of the fingers and thumb while using a Blackberry can lead to problems in the hand or wrist. The most common problem is that with similar symptoms to you: de Quervain’s tendonitis of the wrist, also called “Blackberry Thumb”. The first treatment would be to rest the hand by stopping the use of your Blackberry which is usually not practical. A steroid injection and a splint are very effective.If conservative treatment fails, surgery may be necessary and is usually a quick recovery. Please consult a hand specialist for a thorough evaluation.

This sounds like a classic case of carpal tunnel syndrome or a pinched nerve at the wrist. Symptoms start with numbness and tingling in the thumb, index, middle and ring fingers and advance to loss of feeling and weakness in the hand. The first treatment involves the use of wrist splints and modifying one’s work if repetitive in nature. Additional treatment may consist of a cortisone injection. If symptoms persist, surgery is highly effective.

The most likely cause is a ganglion cyst on the back of the wrist that buckles when the wrist is extended leading to increased pain. A careful examination will most likely reveal a tender cyst at the wrist. After an MRI to assess the wrist ligaments and cartilage, surgery is highly successful and can be performed with the assistance of minimally invasive wrist arthroscopy.

This is one of the most common injuries to the elbow and is frequently a result of repetitive forceful gripping. The muscle origin that attaches at the outside of the elbow and extends the wrist develops small tears that has difficulty healing. The tear fills in with inflamed tissue known as lateral epicondylitis, “tennis elbow”. Conservative treatment usually prevails: rest, tennis elbow band, anti-inflammatory medication, and a cortisone injection. While surgery is a last resort, it is highly effective.

This is a common wrist injury due to a torquing injury leading to a tear of the trianglular fibrocartilage complex (TFCC). An MR-arthrogram will most likely reveal a tear of the TFCC. It is also important to assess additional ligamentous damage. Following advanced arthroscopic surgery a full recovery usually occurs with a return to the pre-injury level of sporting activities.

Trigger finger is one of the most common hand problems. Due to frequent finger use, inflammation develops forming a knot on the flexor tendon. This becomes caught on a band in the palm when flexing the finger leading to triggering. A cortisone injection may provide long term relief of symptoms. If not, a surgical release under a local anesthetic is an easy cure.

A physiatrist is a medical doctor in the specialty of physical medicine and rehabilitation. Physiatrists go through a four year residency period after medical school and are board certified.

Physiatrists are doctors of function. They treat various diagnoses, including orthopedic and neurological disorders. Physiatrists are not surgeons and use a variety of non-surgical treatment, such as physical therapy, medications, injections, and complimentary techniques to treat symptoms and ultimately increase function and improve quality of life.

In my opinion, specific brands of mattresses are over-rated. The most important factor in purchasing a mattress is having a firm, supportive mattress. Most reputable stores will give a trial period to use the mattress and this is helpful to see if this particular type of mattress works for you. In addition, if pain wakes you at night or you wake up stiff and uncomfortable in the morning, the position you sleep in may be a factor. Sleeping on your stomach or back is more likely to produce discomfort because the spine is in a relatives arched position which can inflame the joints of the spine. Sleeping on your side with a pillow between the legs puts the spine in a much more biomechanically correct position and makes pain less likely.

In most cases, no, but it is important to get evaluated by a physician before engaging in rigorous activity if you are concerned. Most of the time, the pain is just inflammation and as long as it is understood that certain activities may cause discomfort, they can be performed and treated with medication and/or heat/ice.

After it is understood what is causing the pain and a diagnosis has been made, the symptoms can be treated. The best long-term treatment is exercise and strengthening of certain muscle groups to avoid stress on the affected area. It is important to perform exercises everyday to get ongoing results. Medications and injections may be used on a short-term basis to manage the symptoms until a long-term program is obtained.

Exercising is not just going to the gym everyday for 2 hours at a time. It can also consist of a stretching and strengthening program focusing on certain muscle groups that last 15-20 minutes. This should be a daily routine that can be incorporated anytime throughout the day—I usually tell people to do the exercises first thing in the morning because then they are over and done with and they can get on with their day. If they go to the gym, Pilates, yoga, etc. then that is icing on the cake, however, the simple stretching program should be part of the daily routine.

Physical therapy is a helpful treatment to manage symptoms, but it is not a cure. I use therapy as an educational process to learn an exercise program and proper body mechanics. Once the exercises are learned, they can be incorporated into your daily routine. Even if pain is not completely relieved after therapy, it does not mean that therapy is a failure. Therapy is considered successful if the patients are educated and then it is up to the person to make therapy a success by incorporating the practices learned in therapy.

An EMG is a test to evaluate nerve function. It is comprised of two portions: nerve conduction studies which use little electrical impulses to see if the nerve is conducting the message properly, and the needle examination which uses a little pin to test nerve-muscle communication. The test can tell where the nerve is pinched and if there is damage or healing going on. It cannot, however, tell the cause of pain—only if the nerve is functioning properly or not.

In combination with the appropriate treatment program, glucosamine and other supplements such as fish oil can be useful adjuncts to pain relief. They are generally safe and can be effective; however, they may take up to 3 months of continuous usage before efficacy can be fully assessed.

At first pain has the purpose of warning the person. It protects us from further injury or harm. The body is saying, “Stop whatever you are doing — it hurts.” Escape is the next step: get away from whatever is causing the pain. This is also a protective mechanism.

Expressions of pain (facial or verbal cues) are a way to seek help. They also have the effect of causing empathy on the part of others. Our own distress in seeing someone in pain motivates us to help or assist that person. Pain helps the sufferer get the care he or she needs.

If the pain signals are not turned off early on, they can get stuck. Someone with chronic pain that doesn’t go away may not have anything wrong biologically. The pain system has set up a circuit or loop that can’t get turned off. The natural purpose for pain has been overridden.

In some people there may be a psychologic or emotional need for pain. This type of pain is called a behavioral response. The traditional medical model of treatment may not help this person. Until we learn how to stop chronic pain, treatment has become a management issue. We help the patient do more within the confines of their pain. Pain may be reduced but not eliminated.

It’s clear that some people cope with pain using endurance strategies. They increase rather than decrease their exercise and activity. If this describes you, you may not benefit from a rehab program that focuses on increasing your physical fitness. That type of program would just overload your muscles even more.
You may need a specialized program. The therapist will assess you for specific disabling activities or changes in activity pattern that you may not even be aware of. The therapist may be able to help you learn better ways to move that won’t load your spine as much.

And it’s possible there are ways to modulate your pain so that you can continue doing what you want to do activity-wise with less pain and/or discomfort. Chronic pain has a way of changing how your body moves and perceives movement. Based on this fact, you may be at increased risk for future injury.

The therapist can help you regain normal proprioception (sense of joint position) and kinesthesia (awareness of movement). If there is a movement impairment of any kind, the therapist can guide you through specific exercises and patterns of movement to restore full and normal motion.

Although pain and depression are two completely different things, they can be connected very closely. When someone experiences chronic pain, they can find themselves not doing many of the activities they enjoy doing, or they may not do them as well as they used to. Chronic pain can keep them from going out to social activities, or spending time with family and friends. Just moving around the home or concentrating on a favorite television show may become difficult.

When someone is used to being active, but the pain keeps them from participating, they can become frustrated or angry at themselves. This can lead to sadness, or depression. We then begin to see a cycle. As someone gets more depressed, they are less likely to try harder to do things, and the cycle continues.

OxyContin (also known as Oxycodone) is a schedule II opioid pain reliever. That means it’s a drug that can only be obtained from a doctor by prescription. It was first brought onto the market in 1996 so it is a relatively new drug.

OxyContin is a highly effective pain reliever used by millions of chronic pain patients. Unfortunately it does have a down side with long-term use because it is morphine-based and can be addictive. Morphine-based drugs bring pain relief but also a sense of euphoria and pleasure that can lead to abuse and addiction.

Long-term use of OxyContin leads first to tolerance. This means you must take larger amounts over time to get the same pain relieving (or euphoric) effects. Tolerance is not the same thing as addiction.

The next step is physical or psychologic dependence. Dependence means that without this drug, the body starts to go into withdrawal symptoms. The person is considered addicted when the drug is needed for the person to function normally and when withdrawal symptoms occur if the drug is stopped.

Talk to your doctor about your concerns. Find out how to manage your dosage to get the maximum benefit with the minimum amount of risk.

Chronic back pain can be very difficult to evaluate and treat. There are many things we still don’t know about pain, what causes pain, and how to stop it. In many ways, the nervous system in charge of perceiving pain and sending pain messages remains a complex mystery.

Many pain clinics use a management approach to chronic back pain. The combined efforts of the doctor, psychologist, physical therapist, nutritonist, and others are used to find the best program of intervention and management for each patient.

If you haven’t been working with a team of pain experts, that may be your next step. You may live in an area where a pain clinic has not been developed yet. As a consumer, you may have to put together your own team.

Instead of the physician coordinating all of the services, you would have that role. It will be up to you to communicate with each individual member on the team.

There are many traditional and complementary techniques available now for pain management. On the traditional side, medications are often the first-line of treatment. They range from mild analgesics to powerful narcotics.

From a less traditional approach, there is acupuncture, hypnosis, massage, relaxation therapy, and biofeedback to name just a few. It may take a while to find the right one or the right combination to get maximum benefit, but it can be done.

There isn’t an easy or simple answer to the question of complex regional pain syndrome (CRPS). Scientists are conducting many studies to sort out all the variables and factors that go into a condition like this. So far there isn’t agreement about the mechanism of cause.
It may be that nerve damage after an accident or injury occurs setting off this extreme response. Some doctors and scientists think the central mechanisms of the nervous system are triggered by the injury. Their signals get mixed up and reorganized in a chaotic way.

For now it seems that there’ isn’t a single one-way to explain what went wrong. Once the underlying pathology is discovered treatment will be able to address the cause instead of just the effects (symptoms).

Sciatica or pain in the low back, buttock, and down the leg is caused by irritation of the sciatic nerve in the lower extremity. It usually only affects one side.
Steroid injection into the epidural space around the spinal nerve can give pain relief. There is some debate about whether or not the results are short-term or long-lasting.

Routine use of epidural steroid injections is not advised. Usually only one to three injections are given. The patient should be informed that these injections may not improve function. They may end up having surgery anyway.

Epidural steroid injections are considered safe. There are a few possible complications. Headache is the most common but doesn’t last more than a few days.

Pain specialists advise patients to keep a pain log. Frequency, intensity, location, and duration of pain are recorded before and after the injection. The pain can be rated each day on a scale from zero (no pain) to 10 (most pain).

Even though this is a subjective measure, it can help you decide if you are getting pain relief, how much, and how long it’s lasting. With repeated injections, you should see continued improvement that lasts and pain doesn’t come back.

The sciatic nerve runs from your lower back, down through the buttock to the leg, on both the left and right sides. Sciatica isn’t really a disorder itself, but a symptom of a problem, like the back pain you describe. If you have a slipped disk that is pressing down on a sciatic nerve root, this can cause the pain that you are feeling lower down.
There are several treatments that may help relieve sciatic pain, but since the pain is a symptom, before doing anything you should see your doctor. It’s not safe to assume that it’s your old back injury that is causing this problem because it could be something new. Some of the stretching exercises that work wonderfully well for some people can actually make it worse for others, depending on the cause.

Once your doctor has confirmed the reason for the pain, you might be treated through medications for pain and/or inflammation, physical therapy, back bracing, or even surgery.

Researchers don’t quite understand how acupuncture works, but there are several theories. One theory is that the introduction of the needles releases chemicals and endorphins that help manage the pain, while another theory says that the needles affect a patient’s pain threshold. However it works, the Chinese belief is that the body’s health is a balance of two forces, the yin and the yang.
If the forces are not in balance, as would happen with illness or accident, this must be fixed and acupuncture is able to fix this.

The acupuncturist locates various points that are believed to be responsible for certain areas of the body and by inserting the acupuncture needles into these points, balance is achieved.

It’s true that quality of life does suffer when a person is faced with chronic pain. Depression can be a natural response to the downward spiral of pain, deconditioning, loss of function, and more pain. But studies show over and over that certain personality types are more likely to become depressed after an injury or problem with back pain.
Some researchers have linked this response to patients who are more likely to catastrophize an event in their lives. This means they blow it out of proportion. Pain and other symptoms escalate and don’t respond to treatment with medications, injections, exercise, or rest. Results don’t improve with physical therapy or even surgery.

A recent study from the University of Texas (Arlington) used a personality inventory called the MMPI to test almost 1,500 patients with chronic occupational spinal disorders (COSDs). Almost two-thirds had some type of personality disorder. Half had a significant depressive or anxiety disorder. Only seven per cent were in the normal profile (NP) category.

If you tested positive for depression, you may benefit from medical treatment for this condition. Ignoring depression won’t make it go away and will almost certainly keep you in the downward spiral mentioned. Starting a course of anti-depressants along with an exercise program could be the start to restored function and improved quality of life.

There are two sides to every coin. Whereas depression has become a very common disorder, especially in older adults, anti-depressants aren’t always the quick and easy answer.
On the other hand, depression is known to cause joint and/or muscle aches and pains. An antidepressant is certainly less invasive than surgery to correct the problem. And if the X-rays show a mild case, then other conservative measures might be helpful.

Besides antidepressants, nonsteroidal antiinflammatory drugs (NSAIDs) may be helpful. Physical therapy to improve posture and spinal alignment may also help. Sometimes a local injection of steroids gives patients long-lasting pain relief.

Surgery is the most successful treatment for moderate to severe cases. But if there is a mental disorder of any type, surgery isn’t likely to make a big difference.