FAQ
Q. Am i a candidate for minimally invasive spine surgery?
A. On your first visit you will have your images (MRI, CT, X-Rays, etc) reviewed by Dr. Miller and his staff. Please bring any images you have of your spine with you to your visit. We may order new imaging depending on how old the images are, the results of your neurological examination, and our review of your medical history. After a comprehensive evaluation we will discuss with you treatment options- including Minimally Invasive Spine Surgery if you are a candidate.
Q. What exactly is minimally invasive spine surgery?
A. Minimally Invasive Spine (MIS) surgery is the term for the specialized surgical approaches and equipment used to reach the spinal column and associated nerves while causing the least amount of destructive tissue damage. This means much smaller incisions (often only an inch or two) than traditional “open” spine surgery, less blood loss, less pain, and a quicker recovery. This may include the uses of small tubular retractors or even the insertion of a tiny endoscope. Only 10% of all spine surgeons are trained in these MIS techniques but simply being trained in them does not make a surgeon a specialist in this type of surgery. Dr. Miller has done thousands of these minimally invasive procedures using the latest in state-of-the-art technology in his practice and is truly an expert in these techniques- which sets him apart from every other spine surgeon in Alaska. However, not every surgery is best performed using MIS surgery. Your surgery plan will be as individualized as you are.
Minimally Invasive Spine Surgery (MISS) vs. traditional Open spine surgery incision size comparisons. MISS incisions are much smaller, have less bleeding, tissue damage and pain, and heal quicker than conventional spine surgery
Q. I don’t know if I need spine surgery, are there other options?
A. Dr. Miller and his team will present you with treatment options, including surgery if indicated. Sometimes a patient is better suited to try, or continue trying, conservative therapy such as physical therapy, massage therapy, chiropractic care, accupuncture, pain alleviating spinal injections, or other modalities. Apex Neurosurgery has an extensive network of providers we work with throughout Alaska to help you and will provide referrals when necessary to take care of you the way you deserve.
Q. How long will I be out of work after my surgery?
A. Every patient and every surgery is unique. We will discuss general ranges of time off of your work or school, or training for your sport and recovery guidelines which will be reviewed in detail and provided as a handout during your surgical counseling appointment- as well as at each post-operative visit. Patients recovering from Minimally Invasive Surgery (MIS) report faster return to work with less pain and less muscle loss than older, open techniques still used by most surgeons. Almost all of Dr. Miller’s patients have same-day surgery and usually are home within a few hours after surgery and back to work within a few days to a few weeks.
Outpatient spine surgery will have you back home at home a few hours after your surgery
Q. I have had multiple back surgeries by other doctors, why am in still in pain?
A. Neurosurgery is the most specialized surgical specialty of them all and not all surgeons are trained alike, and not all conditions respond the same to surgery. Dr. Miller is an expert in treating “Failed Back Syndrome”, a condition where the patient has undergone multiple spine surgeries and despite this has continued pain or neurological injury. These are often the most complex of all surgeries as they often involve the undoing or “fixing” of a prior surgery and then additional surgery on top of that.
Q. Dr. MIller is a Neurosurgeon, but is there a difference between orthopedic spine doctors and neurosurgeons?
A. Yes. Both neurosurgeons and orthopedic spine surgeons work on the spine but the training route is very different. All neurosurgeons have a 6 or 7 years residency- and focuses on the surgical treatment of the brain, spinal cord and peripheral nervous system. All neurosurgeons are trained as spine surgeons and may practice spine surgery after residency. Some neurosurgeons, like Dr. Miller, also complete further training with a fellowship.
Whereas orthopedic surgeons complete a 5 year general orthopedic residency which would focus on the treatment of injuries and fractures of all the limbs and joints and may or may not include any spine training at all and then must complete a 1 year fellowship in spine surgery in order to be allowed to practice spine surgery. Dr. Miller has completed both a Neurosurgical residency focused on spine surgery plus an advanced Orthopedic fellowship in complex spine surgery giving him the best of both worlds and a unique training pedigree. He specializes in minimally invasive spine (MIS) surgery and uses specialized equipment such as tiny tubular retractors and endoscopic spine surgery.
Q. I’ve heard about Laser spine surgery? Does Dr. Miller use lasers?
A. No. Unfortunately the idea of using lasers to treat medical conditions sounds very futuristic and attractive. This marketing gimmick, pioneered by the Laser Spine Institute, LLC (which had centers all over the country but after a series of lawsuits are now bankrupt) - offered unproven “Laser” surgeries that were usually performed by pain doctors- not surgeons- or used bait and switch tactics where patients would travel across the country to have a “laser” surgery but instead a conventional surgery was performed. There are only a few very specific uses of lasers in neurosurgery, usually to dissect out certain tumors using a specific type of laser frequency. No Neurosurgical or Orthopedic Spine association or professional organization recommends any type of laser spine surgery for disc herniations or degenerative conditions and these surgeries have never been tested in controlled scientific studies against conventional surgery. Be wary of any spine clinic that advertises the term “Laser”. Dr. Miller uses only evidence-based medicine tested and proven procedures that are the least invasive spinal surgery currently available.
The current North American Spine Society (NASS) recommendations are that “Laser spine surgery in the cervical or lumbar spine is NOT indicated at this time. Due to lack of high-quality clinical trials concerning laser spine surgery with the cervical or lumbar spine, it cannot be endorsed as an adjunct to open, minimally invasive or percutaneous surgical techniques”.
Q. Do you accept my insurance?
A. Apex Neurosurgery accepts almost all private insurances, such as Blue Cross, Blue Shield, MODA, AETNA, most Workers Comp, United Health Care, Alaska Union Insurances (International Brotherhood of Electrical Workers - 1547 Local Union, Nea Alaska, Teamsters Local 959, Alaska State Employees Association Local 52 (AFSCME Local 52), and American Federation of Teachers - 4900 Alaska Public Employees Association, etc.) as well as many federal payors. Please call or email us to inquire about your specific insurance concerns.
