Q: When is surgery necessary for patients with spine problems?
A: The majority of conditions that cause neck and back pain tend to have a good prognosis and resolve without major intervention. Because of this, the treatment of most spinal conditions usually follows a pathway that starts with the least invasive and time-consuming options and progresses from there to the more advanced and invasive therapies. After a thorough evaluation, many conditions are treated simply with mild rest and activity limitation. Analgesic medications including anti-inflammatory and muscle relaxing medications are often utilized during this stage. The next step in treatment usually involves a program of formalized physical therapy. If these initial treatments are not effective and patients find their symptoms very bothersome, additional workup with imaging studies such as an MRI scan is usually performed. Some patients with persistent symptoms can benefit from spinal injections such as epidural steroid injections. Other second-line medications are also considered at this stage.

Q: Is minimally invasive spine surgery safe?
A: The goal of all spine surgery is safety and effectiveness. In our practice, minimally invasive techniques are only utilized when it does not compromise these critical goals. For marketing reasons, many surgeons and non-surgeons are using “minimally invasive” techniques that have limited track records and may place patients at increased risk. Our practice prides itself on fully educating patients about their condition and treatment options. One needs to be cautious about marketing campaigns for surgery focusing around seductive words like “laser” and “percutaneous.” When these techniques are a good option, we will let you know. When they are not, we will give you an honest answer.

Q: What is the difference between a herniated disc and a bulging disc?
A: Bulging and herniated discs represent degrees of disc injury on a spectrum. To oversimplify, a disc is shaped like a jelly donut. When the outer part of the donut has a weakness, it can bulge like a flat tire. If the outer part of the disc tears, the disc material can displace outward. This is called a disc herniation. Other words for this are disc extrusion, protrusion, prolapse, and rupture. All discs eventually show signs of aging and degenerations. Non-spine specialists tend to call almost all disc problems a “herniated disc.” Determining what exactly you are dealing with requires a careful review of your MRI scan. In our practice, we make it a priority to review your imaging studies with you so that everyone is on the same page with regards to treatment options.

Q: What is multi-level spondylitis?
A: Multi-level Spondylitis is a group of inflammatory diseases that typically affect the vertebrae, facet joints, and spinal structures, and can lead to chronic pain and discomfort. Spondylitis treatment options include exercises, physical therapy, medications, physical modalities such as heat, electrical stimulation, ultrasound, epidural cortisone injections, brace immobilization, and in severe cases, spinal surgery.

Q: Do you accept insurance?
A: At The New Jersey Spine Specialists, Drs. Drzala and Reiter work with a wide range of insurance carriers for those patients who have out-of-network benefits. Please call us at 908.608.9619 to speak with one of our experienced patient advocates with any questions you may have regarding your insurance benefits.Our doctors also work with many workers’ compensation carriers and most auto insurance companies as well. Please reach out to one of our patient advocates at 908.608.9619 to see if our doctors participate with your policy. Our patient advocate will then contact your adjuster in order to determine if an appointment can be made. Drs. Reiter and Drzala DO NOT participate with Medicaid or Medicare. Dr. Hullinger is in-network with most insurance carriers. She accepts most Blue Cross Blue Shield and commercial insurance plans with the following exceptions: Advance EPO, Anthem BCBS, Aetna (no EPO), AmeriHealth (no EPO), Cigna, Great West, Health Republic NJ, Medicare, Oxford, QualCare, Tricare, and United Healthcare. Some of these may have tiers or limitations, so please contact the office first to confirm coverage eligibility at 908 376 1530. Of note, Dr. Hullinger DOES NOT participate with MagnaCare, United Healthcare Medicare Complete HMO, BCBS Advance EPO, Humana. Dr. Hullinger DOES NOT participate with Medicaid. Regardless of the doctor you see, a financial hardship program is available to those patients that meet the program’s qualifications.

Q: What type of care will be needed after surgery?
A: With state of the art surgical techniques, nearly all of our patients are able to get out of bed either the same day as surgery or the next morning. Any surgical pain will be carefully controlled with medications. Postsurgical rehabilitation will be coordinated by our office and usually begins 1-2 weeks after surgery.

Q: Do I need to wear a brace after surgery?
A: For non-fusion spinal surgery, a brace is almost never necessary. For fusion procedures, newer and more rigid internal fixation techniques have significantly decreased the need for postoperative braces. The determination as to whether a brace is required is based on multiple factors that will be discussed prior to your surgery.

Q: What can I do to avoid surgery?
A: The best things that one can do to avoid spinal surgery are to stay physically fit. This includes a program of aerobic conditioning and some core muscle strengthening. Avoiding smoking and obesity is also helpful. Unfortunately, some people are genetically predisposed to spinal disc disorders despite following the above recommendations.

Q: Will I be in pain after my surgery?
A: Drs. Reiter and Drzala both feel strongly that surgical pain should be well controlled. This starts with the use of long acting systemic and local anesthetics placed during the procedure. Pain control following surgery requires a careful balance of short and long acting pain killers, anti-inflammatory medications, and careful mobilization. Managing pain is a dynamic process in which the patient and doctor work as a team to achieve their goals.

Q: How long is the recovery time and when will I be able to resume normal activities?
A: Each spinal condition and procedure has a different time frame for when patients are allowed to resume normal activities. We work hard to use techniques that are the least invasive so that disruption of one’s life is minimized.

Q: Will I need physical therapy after spinal surgery?
A: Most patients receive physical therapy following surgery. This is done to help regain spinal range of motion and strength that is lost during the period of disability prior to surgery as well as from the procedure itself.

Q: What is the recovery time for a Sacroiliac Joint Fusion?
A: The time to fully recover from a sacroiliac fusion varies from patient to patient, but most patients have recovered fully from this minimally invasive surgery within six months. For the first 6 weeks after the sacroiliitis treatment, it’s recommended to protect weight bearing on the surgical side with the use of crutches or a walker. After that, patients are typically enrolled in a course of physical therapy under the guidance of a certified physical therapist. Physical therapy will include more passive measures for the first few weeks followed by a more active rehabilitative exercise program. Passive postoperative treatments that your therapist may choose to use include heat, ice, electrical stimulation, ultrasound, and massage. As your condition improves and you regain your strength, you will begin an active strengthening exercise program, which will allow you to increase your level of function. As your doctor and your therapist feel that you have been properly rehabilitated, you will be able to resume normal activities. Your doctor and physical therapist will be valuable contacts during your recovery and will help guide you and adjust your level of activity as necessary during this time. Ultimately, the goal is to resume a normal level of function with minimal discomfort.

Q: Do you offer help for patients with Failed Back Surgery Syndrome?
A: New Jersey Spine Specialists treatment starts with properly diagnosing the cause of the continuing or new symptoms. Post-operative MRI and/or CT scans often play an important role in assessing the underlying spinal problem. Persistent symptoms of pain and discomfort following spinal surgery can have a variety of common causes. Read more about Failed Back Syndrome and optional treatment.

Q: Do you offer help for patients with Failed Back Surgery Syndrome?
A: New Jersey Spine Specialists treatment starts with properly diagnosing the cause of the continuing or new symptoms. Post-operative MRI and/or CT scans often play an important role in assessing the underlying spinal problem. Persistent symptoms of pain and discomfort following spinal surgery can have a variety of common causes. Read more about Failed Back Syndrome and optional treatment.

Q:Can I benefit from laser spine surgery?
A: Laser spine institutes argue that laser spine surgery is more efficient, effective and gentle than traditional minimally invasive spine procedures. Laser spine institutes claim it causes a decrease in blood loss and scarring, and reduces the recovery time. However, lasers can generate harmful, excessive heat, which can be damaging to the sensitive nerves in the spine. Laser spine institutes aggressively market the term laser spine surgery because it sounds futuristic and appeals to patient. In reality, minimally invasive spine surgery can be performed as effectively, and more effectively, without a laser.

Q:Is ACDF considered major surgery?
A: ACDF is an abbreviation of the term, Anterior Cervical Discectomy and Fusion. In this surgical procedure, a herniated or slipped disc in the neck is removed and the cervical spine is then fused where the disc was removed. This operation is performed in appropriately selected patients who typically are experiencing disabling neck and/or arm pain. Many of these individuals may also experience numbness and weakness in their upper extremities as well. The pain, numbness, and weakness is most commonly due to herniated or slipped discs in the neck but can also be due to Cervical Stenosis or Degenerative Disc Disease. ACDF surgery is often recommended by Spine surgeons to those patients with persistent neck and arm pain, numbness, and/or weakness where nonoperative treatment options have failed to supply acceptable and sustained relief of their pain. These less-intensive options include physical therapy, home exercises, rest and activity modification, medications, and possibly even cervical epidural steroid injections. The ACDF surgical procedure is performed under general anesthesia. A small transverse incision is made on the front of your neck near your throat to carry out this surgery. Your spine surgeon will then remove the problematic disc or discs. Next, a bone graft or a spacer device with graft material will be inserted into the emptied disc space to fuse the bones above and below the disc to each other. Oftentimes, a small metallic plate and screws will be implanted to further strengthen the spine at these levels. This will effectively stabilize the spine and will prevent these bones from collapsing, which can also cause pain. Following the ACDF surgery, over time, the body will incorporate the graft material, which will consolidate and will knit one bone to the other to form a solid fusion. Although most individuals consider ACDF to be major surgery, it is a surgical procedure that is performed frequently and very safely in the proper hands. Most patients can be discharged and return home the same day as their surgical procedure. To achieve the best possible outcome, it is prudent for individuals to seek out consultation and treatment with Board-certified spinal surgeons, who have expertise in performing this surgery.

Q: Is ACDF a high-risk surgery?
A:Although most individuals consider ACDF to be high-risk surgery, it is a surgical procedure that is performed frequently and very safely in the proper hands. Over 132,000 ACDF procedures are performed nationally in the United States each year, and many of these patients are successfully discharged and return home the same day as their surgical procedure. During this surgery, your spinal surgeon will make a small incision on the front of your neck near your throat, through which the cervical discectomy and fusion will be performed. This relatively minimally invasive approach is inherently less disruptive to the soft tissues and allows for quicker recovery. ACDF surgery at one level typically lasts approximately one hour, with most patients returning home the same day. To achieve the best possible outcome, it is prudent for individuals to seek out consultation and treatment with Board-certified spinal surgeons, who have expertise in performing this surgery.

Q: How long does it take to fully recover from ACDF surgery?
A: The recovery process for ACDF surgery varies widely amongst patients. Immediately after your ACDF surgery, to help mitigate post-surgical pain, spine surgeons often prescribe opioid pain medications, skeletal muscle relaxants, and/or nerve pain medications. Non-steroidal anti-inflammatory pain medications like ibuprofen may be used in certain instances but generally are not recommended, as these can slow the fusion healing process. Your spine surgeon may prescribe a hard cervical collar for you to wear while you are recovering from your ACDF surgery, possibly up to 4 to 6 weeks (about 1 and a half months). If this cervical brace is prescribed, ultimately your surgeon would decide for exactly how long you would be required to wear it. During recovery, patients should avoid contact sports or other strenuous activities that may impede recovery from this surgery A one-level ACDF, or a surgical fusion at one disc level only, will often be stable appropriately 4 to 8 weeks from the date of the surgery. The time to achieve a solid fusion radiographically can take much longer, oftentimes many months, however in most cases, this will not prevent a patient from returning from a full and normal level of activity much sooner. The newly fused bone will continue to grow stronger with the passage of time. During the post-operative period, your spine surgeon will obtain x-rays periodically to assess the fusion status. Once the fusion appears stable, which may be earlier than 8 weeks, your spine surgeon may recommend a course of physical therapy for you, but most times that is not necessary. Generally, most patients who have undergone ACDF surgery at one level can return to normal activities at 12 weeks from the date of their surgery. Ultimately, however, the decision when to return to a full and normal level of activity will be made by your spine surgeon.

Q: Is Cervical Disc Replacement a major surgery?
A: Board-certified spine surgeons consider Cervical Disc Replacement a major surgery. With the latest surgical techniques and years of experience, the surgery can often be performed as an outpatient. If appropriate, some patients can go home the same day and if overnight stay is required, most can go home the following day. This procedure is common, with about 132,000 Cervical Disc Replacement surgeries performed each year nationwide. With age, the intervertebral discs of the spine slowly become damaged due to wear and tear. When left untreated, the damaged intervertebral discs can lead to disc bulges or herniations and can develop bone spurs over time. Disc herniations with or without bone spurs can take up space in the spinal canal resulting in numbness/tingling, weakness, and/or pain. Therefore, a Cervical Disc Replacement effectively removes the damaged disc in the neck region of the spine, replacing it with an artificial disc to restore movement. After completing the procedure, patients will return home with detailed instructions and recommendations on a balanced diet and lifestyle for optimum recovery.

Q: How painful is a Cervical Disc Replacement?
A: Spinal surgeons perform Cervical Disc Replacements under general anesthesia. Lasting several hours, patients will not feel any pain or discomfort during the procedure. The NJSS team seeks to deliver a positive experience, so our team will deploy multimodal approach with medications and other techniques to minimize pain and improve the whole experience. Some discomfort after cervical disc replacement surgery is normal and usually quickly improves; and great care is undertaken to provide appropriate level of pain control after the surgery, so the patients feel as comfortable as possible during the recovery period.

Q: How long does it take to recover from Cervical Disc Replacement surgery?
A: While recovery time varies between each patient, most patients will complete their initial recovery process at around 6 weeks. During the first two weeks after the cervical disc replacement, the NJSS team recommends taking it easy to avoid flare ups. Furthermore, patients should avoid vigorous activities, sports, and excessive exercises during the initial recovery period. Factors that inhibit recovery time include smoking, diabetes, and age. After the two-week mark, patients can start to return to their daily activities.

Q: Is Cervical Fusion a major surgery?
A: Yes! With nearly 137,000 procedures performed each year, Cervical fusion is a major surgery that stabilizes the spine and prevents neurological injury. Unstable cervical spondylolisthesis, cervical herniated disc, spinal stenosis, kyphosis, and unstable arthritis are all conditions where a cervical fusion is performed. Moreover, the NJSS team can deploy several surgical methods to achieve a fusion, such as an anterior approach or a posterior approach. Surgeons typically recommend posterior cervical fusion surgery for cases requiring fusion at more than 3 levels, and some cases of kyphosis and tumors. While cervical fusion is a major surgery, New Jersey Spine Specialists have qualified experts with many years of highly specialized experience, routinely performing these procedures. Upon completing the surgery, patients usually will have minimal pain or stiffness during the recovery period.

Q: Can you move your neck after Cervical Fusion surgery?
A: Yes, you can! While you may experience increased soreness or stiffness in your neck after the surgery, cervical fusion at one or two levels, does not significantly reduce neck flexibility. Cervical fusion stiffens the neck only at the location of the vertebrae where it is fused, but the other levels usually will compensate, and overall range of motion usually does not change significantly.

Q: Are there permanent restrictions after Cervical Fusion surgery?
A: No. Cervical fusions stiffens the area where vertebra was fused together. The other levels usually compensate with motion and most patients do not notice any significant decrease in range of motion or function of the spine. Following Cervical Fusion surgery, the NJSS team will ask you to adhere to instructions during the recovery period designed to improve patient’s overall outcome. It also gives patients the best chance to return to their regular lives and achieve their goals of improved function and symptoms. As a reminder, post-surgical recovery is different and unique to each patient, which is why our team always delivers a tailored individualized recovery plan. In general, after the initial recovery period, the goal is not to have any permanent restrictions, so patients can go back to their lives and family and get back to the activities they like to do as soon as possible.

Q: What areas and locations do you serve?
A: New Jersey Spine Specialists have two spine centers in Northern New Jersey. Dr Reiter has an office in Summit, Dr Drzala has an office in Summit and Montclair New Jersey, and Dr Hullinger has office in both Summit and Montclair. This allows us to be conveniently located to our patients, who come in from all over the Northern New Jersey, and New York tri-state area. We routinely see patients from Livingston, Morristown, Hackensack, Bernardsville, Basking Ridge, Berkeley Heights, New Providence, Summit, Short Hills, Warren, Bloomfield, Westfield, Millburn, Maplewood, Millburn, Watchung, Union, Glen Ridge, Bloomfield, Nutley, Mountainside, Florham Park, and Mountain Lakes as we are convenient to get to from Union, Morris, Essex, Middlesex, and Somerset counties. Through telehelath services, we can also see and treat patients without having to come visit the office. With a staff of nationally recognized spine experts and the best spine surgeons in NJ we also draw patients from all over the United States, and even internationally.

Q: Do you offer back pain management treatment?
A: Between physical therapy, over-the-counter anti-inflammatory medication, and epidural steroid injections, New Jersey Spine Specialists are experts at non-surgical management of spinal disorders. We also offer epidural injections. Epidural injections help pain management by reducing inflammation in the affected area. An epidural steroid injection refers to a powerful anti-inflammatory medicine administered directly outside of your spinal cord. This minimally invasive procedure can help manage pain in the neck, arm, back and leg regions.