Click on the questions below to see answers:
General Office Visit
The length of each individual visit will depend on the nature of your problem, the number of questions which you have and the number of studies which you bring us to review. In our practice, we strive to answer all of the questions you have before leaving your room. For this reason, we frequently will have delays in our clinic. The disadvantage for you is this might require a wait. However, the advantage is your questions will be answered when you get to see Dr. Taylor and he will not leave the room until your questions have been answered. If you have additional questions regarding this, please contact my nurse, Lori Burke, to further discuss the nature of your problem prior to your visit.
Yes. Patients may be seen for out-of-network care.
Please contact my office if additional questions arise regarding this issue.
Dr. Taylor accepts most insurance plans. Please contact the office for further details.
Attention Medicare Patients – Read the Opt Out Letter
Conditions:
- Cervical spine disorders
- Degenerative disc disease
- Degenerative spinal conditions
- Herniated disc
- Lumbar spine disorders
- Myelopathy
- Osteoarthritis
- Sciatica
- Spinal stenosis
- Spondylolisthesis
- Trauma
Treatments
- Discectomy
- Lower back surgery
- Microdiscectomy
- Minimally invasive surgery
- Neck surgery
- Spinal fusion
We offer cervical total disc replacement. We are members of the Prestige FDA trial. We offer lumbar total disc replacement. We are a site for the Maverick FDA trial. We also have access to the Link Charite and the PRODISC. We offer intraspinous process distractors, a DIAM FDA trial, Wallace trial, and X-STOP. We offer dynamic posterior stabilization, Dynesys, PEEK rods, Laminoplasty, minimally invasive procedures including discectomy and fusion surgery.
Yes. Dr. Taylor will see cases involved in litigation. If you have additional questions regarding this, please contact his office. This is a frequent and significant portion of his present practice.
If you have a PPO, you do not need a referral. If you have a HMO, you will need to obtain a referral.
Dr. Taylor will prescribe pain medications to patients during their postoperative state. However, we will not prescribe narcotic medications to patients prior to surgery. If patients require strong narcotic medication, we ask that you involve care of a pain specialist or your primary care physician.
You may call Lori Burke at (314) 294-4578 between the hours of 8:30AM-4:00PM, Monday-Friday or call Town & Country Crossing Orthopedics at (636) 227-8226.
No prescription refills will be filled over the weekends or holidays.
Please call our office for further information.
Yes. The doctor requires a MRI performed within the last year.
No. The doctor needs to examine the films to provide an accurate diagnosis
Workman’s Compensation
Yes. Dr. Taylor will manage patients with work related injuries. Dr. Taylor understands that these are very complex situations that frequently require communication with both employers as well as attorneys. Please present any additional questions regarding this to Dr. Taylor’s team.
Dr. Taylor and his spine team understand the unique challenges presented by industrial injuries and illnesses. It is critical in these circumstances that accurate, early diagnosis and treatment of spinal injuries be implemented and that the injured parties return to work as soon as possible taking into consideration their medical conditions. While it is also critical that the employers and insurance carriers be appraised of the treatment program, prognosis and overall status of the involved party. Dr. Taylor will work closely with both the patient and the employer to ensure that the appropriate work restrictions and duty assignments are prescribed. In our practice, we exhaust non-operative care providing cost containment and consider surgical interventional a last resort after non-operative measures fail. We also will provide information regarding work injury prevention to help patients maintain proper body mechanics and to promote post-injury rehabilitation.
SERVICES:
- Board certified orthopaedic spine surgeon
- Independent Medical Evaluations
- Medical legal/second opinion consultations
- Timely written reports to meet the requested legal requirements (these to be provided upon request).
Spine Related Problems
Degenerative disc disease simply means arthritic changes. All people who live beyond adolescence will develop degenerative disc disease. In some patients, this results in symptoms. However, most people who develop degenerative disc disease do not need surgery. In rare circumstances where the arthritic process results in nerve compression or loss of muscle function is surgery considered. Under normal circumstances, we encourage non-operative treatment including physical therapy, medications and behavior modification to include weight loss and cessation (discontinuing) of nicotine abuse. Surgery is only indicated for intractable pain and/or progressive neurologic deficits. Before ever considering surgery, you should exhaust all non-operative treatments and consider surgery a last resort.
Spinal stenosis is a process in which the arthritic process narrows the space available for the spinal nerves. When we are born, we have a certain shape of our spinal canal. As arthritis develops, this shape will change. In some individuals, mild arthritic changes will result in significant compression of the nerve. This can cause symptoms in either the arms and hands if the stenosis occurs in the neck, or it can cause symptoms in the legs and feet. Most people with spinal stenosis do not need surgery and can live a normal life. However, there are a small population of patients who develop severe symptoms related to spinal stenosis. In these circumstances, we encourage activity modification, medications and frequently injections of steroid medications. If these non-operative treatments fail, then surgery can be performed to make the canal bigger by removing the bone that is compressing the nerves. In certain circumstances, we have to also fuse the spine if there is evidence of instability prior to surgery or during surgery after the decompression. We recommend fusion in patients with instability because we feel that removing a portion of the bone to decompress the spine in the setting of instability may result in greater instability and postoperative pain. The recovery period for a decompressive procedure depends on the patient’s preoperative medical health to include both their pulmonary function, cardiac function and general health status. Patients who have multiple medical problems typically will require significant medical treatments to optimize their medical condition prior to surgery. The recovery period from a standard decompressive procedure can be 3-6 months. However, if a fusion is also needed, the recovery period will be greater.
Most people will suffer back pain during their lifetime. Eight out of 10 people develop back pain at some point in their life and it is a leading cause of missed work or lost work days second only to the common cold. Unfortunately many patients who are out of work because of back problems for a significant period of time will never return to work. This is related to both the physical injury as well as to the social and psychological issues related to job related injury and time away from work. Clearly the best solution is prevention. For this reason, we encourage patients to maintain good aerobic physical conditioning, keep their body weight ideal for their height, avoid the use of nicotine products and maintain healthy back ergonomics during their work environment.
Pseudoarthrosis occurs when an attempt has been made to grow two bones together or fuse the bones. Instead of bone growing completely between the two bones, a fibrous tissue develops resulting in motion. If this motion or failure to fuse causes pain, there are options to fix it. However, we often suggest that you attempt to live with this with activity modification, exercises and behavioral modification. If these non-operative attempts fail, fixing this type of problem will involve a risky, revision surgical procedure with an attempt to grow the bones together frequently requiring the use of metal screws and rods. This may require that we operate from both sides of the spine, both an anterior/posterior surgery using bone grafts which may or may not come from your pelvis. This surgery is extremely risky and for this reason we encourage you to exhaust non-operative treatment before considering surgery for pseudoarthrosis.
Scar tissue also referred to as arachnoiditis is an inflammatory process which occurs around the spinal cord and nerve roots. Normally the spinal cord is surrounded by fluid. This fluid is called cerebrospinal fluid. Symptoms of arachnoiditis or inflammation of the membrane around the nerves can include chronic pain and chronic disability. This is a very difficult problem to treat. Most patients will have these problems for life. Fortunately this an extremely rare problem and we encourage non-operative treatments for this type of pathology.
There a number of known risk factors related to the development of back and spine pathologies. If you have a history of back problems in either your family or in your personal history, you are at increased risk for spine problems. Increased age is also associated with a risk of spinal problems and overall poor health is associated with development of spinal problems. If you are in poor physical condition and live a sedentary lifestyle, you are at increased risk of developing spinal problems. As well, if you have a poor workplace environment with low levels of co-workers support and poor job dissatisfaction, you are at increased risk for developing problems with your spine. Smoking and the use of nicotine products increases your risks of spinal problems. A history of psychological issues related to anxiety or depression or other forms of psychological distress are also associated with back problems. Pregnancy is a risk factor for back problems and this increases with the number of vaginal deliveries. Obesity, and being in poor physical shape, are extreme risk factors for back problems. Exposure to vibration, particularly prolonged driving, and exposure to a self-perceived physically demanding work environment are all risk factors for back problems.
Unfortunately the diagnosis of chronic pain syndrome is in our opinion a wastebasket diagnosis in which many problems are lumped together. We would encourage you to be evaluated by a pain specialist who might be able to give you further guidance regarding the particular pain generators which could more directly be treated by non-operative interventions. In our practice, we do not provide narcotic medications for chronic long-term problems and limit our use of narcotics to postoperative patients during the first 6-8 weeks after surgery. For this reason, we ask that you consult an anesthesiologist interested in chronic pain therapy, and only if a pain generator is identified should you ever consider fixing this problem with a surgical intervention.
When spinal surgery is performed through the back of the spine, the patient is forced to lie on their belly during the operation. We have special tables which were developed specifically for patients who are lying in the prone position or with their belly face down. There is a ten-fold increase risk of eye injury with prone spinal surgery. This can be due to corneal injury, ischemic optic neuropathy, and cortical blindness. These types of eye problems can often result in permanent blindness. The risk of this type of complication is thought to be less than or equal to 1% of the spinal cases. Some of the causes include pressure on the eye, as well as blood flow issues related to hypoperfusion or poor blood flow. In our practice, we ask that the patient’s blood pressure be monitored throughout the procedure and kept as close as possible to the patient’s normal blood pressure or mean blood pressure. We frequently will use a Cell-Saver device to reinfuse or give the patient’s back any blood loss during the operation. As well, we make every attempt to insure that surgical times are less than eight hours when at all possible. The risk factors that increase the chance of visual problems after surgery include obesity, hypertension, calcified vessels, or atherosclerosis, glaucoma, and diabetes. When we perform a procedure, we place the patient in the prone position avoiding undue pressure on the eye. We use a specialized foam face rest and headrest to avoid any undue pressure on the eye. We will place the bed in a modest head up position to prevent or decrease facial swelling, and we ask that the mean arterial pressure be maintained around your bareline blood pressure.
Please note that this is a list of more commonly occurring complications that are listed in the literature in relation to spinal procedures.
- Dural tear. The spinal nerves are covered by a dense tissue. This tissue can thin during certain pathologies. As well, it can be injured during surgery resulting in leakage of the cerebral spinal fluid that lives around the spinal nerves. The risk of this complication increases during re-operations or revision surgeries. Incidental durotomy is considered a benign occurrence and typically does not negatively affect the overall course of a person’s health care.
- Surgery can be performed at the wrong level. This complication is avoided by obtaining adequate radiographs. However certain factors can increase the risk of wrong level surgery including body habitus and revision surgery.
- Vascular and visceral injury. Large blood vessels can be damaged during spinal surgery. As well, injuries can occur involving the bowel, the ureter which is the tube that runs from the kidney to the bladder, the bladder, and other visceral organs such as the pancreas and/or liver.
- Another complication is a syndrome called cauda equina syndrome. This is a very rare occurrence; however it has very severe consequences.
- Other complications include new neurologic deficits resulting from manipulation of the neural elements, retained surgical items such as sponges and/or instruments, and rarely visual loss which is thought to be due to perioperative ischemic optic neuropathy. This is a very rare condition where patients suffer vision loss after spine surgery. This occurs more commonly in surgeries that require patients to lie on their belly during the operation.
Spine Procedures
A spinal fusion is a process in which two bones are grown together using either bone and/or metal. If metal is used, it is a temporary function to hold the bone still as the bone actually grows between the two bones. The entire fusion process can take up to two years and the recovery from this surgery for that reason can take up to two years. If you smoke cigarettes or if you have poor bone quality, poor nutrition quality and if you are taking certain medications, your success with fusion will be decreased.
What are your thoughts on disc replacement? Fifty years ago patients with arthritic hips and knees underwent a fusion procedure. Today hip or knee fusions are procedures which surgeons rarely perform. Hip and knee replacement surgery allows motion retaining implants which allow improved function. Presently the standard of care for back problems is a spinal fusion. However, motion retaining spinal implants are now being evaluated in the United States. The first device to receive FDA approval in the United States is the Charité device provided by DePuy Spine. This device is a combination of two metal plates and a plastic insert which are sandwiched together. Studies performed on the LINK Charité found that this device provided pain relief similar to a spinal fusion. In selective patients, disc replacement may be an option for your spinal problem. Another device which we are investigating is the Maverick artificial disc provided by Medtronic Sofamor Danek. In addition there are disc replacement devices under investigation for the cervical spine or neck. These include the PRESTIGE disc as well as other companies who are developing disc replacement for the neck. It is important for the patient to be well educated regarding the investigational nature of these devices. This is critical to avoid over utilization of these new techniques which in some circumstances are as yet unproven. If you have further questions regarding disc replacement and the ability to have a disc replacement in our practice, please discuss this with us during your visit.
During microdiscectomy a small incision is made and an operating microscope or magnifying glasses are used to remove the portion of a disc that is herniated and is pressing on a nerve. During this procedure, only the damaged extruded portion of the disc is removed. The majority of the degenerative disc is not removed, therefore, some of the symptoms related to this disc (back pain) will persists. There are risks involved with this surgery. One of which is that you can re-herniate a disc after the procedure. This occurs in up to 20% of patients who have disc operations. For this reason, we ask that you remain somewhat sedentary for the first two weeks after surgery and not return to vigorous activity for 3-4 months after a brief period of rehabilitation.
Discography is a controversial procedure. However, in our practice, we do feel it plays a role. The technique is performed by a specialist in spinal procedures who will place medicines into the disc to investigate the shape of the disc as well as determine if the disc is a concordant pain generator, “the cause of your back pain.” As medicine is injected into the disc, the patient will be asked to describe the sensation. In most circumstances, this injection is painless or is described as pressure. If, however, this injection reproduces the same discomfort as the patient’s primary complaint, in other words, the symptoms that are bringing them to the doctor, in our opinion, it identifies that disc as an area that might be improved with surgical treatment.
Hardware removal or removal of screws and or rods or metal cages from the spine can be performed after nine months to a year after surgery if the radiographs (x-rays) show evidence of bone fusion. Once the bone has fused, this metal instrumentation is no longer necessary. Unfortunately removing metal hardware or instrumentation does not guarantee improvement in symptoms. In rare circumstances, patients are symptomatic over prominent hardware, however, this is rarely the case. For this reason, we do not encourage hardware removal on a routine basis. However, once all other potential sources of pain are ruled out (eliminated), hardware removal and exploration of a fusion to evaluate pseudoarthrosis may be a last resort after exhausting all non-operative treatment options.
In my opinion, pedicle screws are effective treatments for certain spinal pathologies. We routinely use these devices and feel that they are safe in the hands of (Spine Fellowship trained) surgeons adequately trained for the use of these devices. In our opinion, pedicle instrumentation is the standard of care for spinal surgery for certain spinal problems such as instability, deformity, tumors and trauma. If you feel strongly about the use of pedicle screws or, do not want instrumentation utilized in your case, discuss these issues with your surgeon.