FAQs (frequently asked questions) about Neck
and Spine Surgery
1. Does Dr. Schiffer perform all types of
Yes. Dr. Schiffer performs:
(CED) for cervical herniated/protruded disc problems.
(ACD) for extensive osteophytes (bone spurs) with or without disc
Anterior Cervical Fusion
(ACF) for an unstable cervical spine.
Lumbar Endoscopic Discectomy and Thermal
Annuloplasty (LED/TA) for lumbar herniated/protruded disc with or without annular
tears or degenerative disc disease.
(MD) for sequestered free disc fragments and/or bone spurs in the
2. Why do other surgeons want to perform only
disc fusions and not endoscopic discectomy?
Until mid 80's, fusion was considered the common solution for herniated
discs. Ironically, most surgeons still believe in that theory. Medicine
has made such advancement in the past 20 years and endoscopic discectomy
is a great example of that progress. Endoscopic discectomy requires
considerable training and experience, which most surgeons are yet
3. Why doesn't Dr. Schiffer use a laser?
Dr. Schiffer performs his endoscopic discectomies by suctioning
only the herniated/ protruded part of the disc, leaving the rest
of the disc intact. He does not see any special benefits from
using laser. Moreover, all lasers create heat, which can cause
severe pain and damage the nerve root. For this reason, most
cervical laser surgeries are performed under general anesthesia,
which is an additional unnecessary risk.
When are Lumbar Endoscopic Discectomy (LED) and Microdiscectomy
Lumbar Endoscopic Discectomy (LED) is recommended to treat
herniated/protruded lumbar discs with or without annular tears
and degenerative disc disease. This procedure is performed endoscopically
with a small probe, under local anesthesia and there is no incision.
Dr. Schiffer often combines the LED procedure with Thermal Annuloplasty
procedure. Microdiscectomy is recommended to treat sequestered
free fragments and bone spurs in the lumbar region. The surgery is
performed using a microscope, under general anesthesia through
a small incision.
5. When are Cervical Endoscopic Discectomy (CED) and Anterior
Cervical Discectomy (ACD) recommended?
Cervical Endoscopic Discectomy (CED) is recommended to treat herniated/protruded
cervical discs. It is performed endoscopically under local anesthesia,
using a small probe. CED can also be performed on cervical herniated
discs that are extruded or compressing the spinal cord. Anterior
Cervical Discectomy (ACD) is recommended to treat extensive osteophytes
(bone spurs) with or without disc protrusion. This surgery is performed
using a microscope, with a small incision, under general anesthesia.
Bone fusion is not necessary.
6. How do you handle multiple disc problems?
Both cervical and lumbar endoscopic discectomies can be performed
at multiple disc levels to treat herniated/protruded discs. If a
patient has a herniated /protruded disc at one level and also osteophytes
(bone spurs) at another disc level, both these problematic discs
can be treated by doing a combination surgery of an endoscopic discectomy
and an open discectomy at the same time. These combination surgeries
can even be performed at more than two disc levels. Dr. Schiffer
has performed many combination surgeries at multiple disc levels
in both the cervical and lumbar areas. These combination disc surgery
at multiple levels have reduced the cost of surgeries tremendously.
7. Is a patient with prior spine surgery a candidate for
an endoscopic discectomy?
Patients with prior surgery can still undergo an endoscopic discectomy.
However, the only definite contraindication would be a prior fusion
at the same disc level.
8. What are the long-term results of Cervical Endoscopic Discectomy (CED)?
In our eight years of experience of the CED
(Cervical Endoscopic Discectomy) and 14 years of experience with the LED
(Lumbar Endoscopic Discectomy), the long-term results are excellent.
When is disc fusion indicated?
Disc Fusion is recommended only when the patient has an unstable cervical
or lumbar spine, that can be diagnosed by flexion and extension
views of the spine.
What is main long-term complication of a disc fusion?
There is significant evidence in the medical literature that a disc fusion
changes the weight bearing dynamics of the spine and stresses the
discs above and below the fused level. In time, these adjacent discs
are more susceptible to herniation and degeneration. Because of
these negative aspects, Dr. Schiffer strongly opposes disc fusion
unless the patient has an unstable cervical or lumbar spine.
11. Do patients need pre-operative tests?
We do require patients to undergo some pre-operative tests in their
local area and these tests need to be done at least 10 days prior
12. How long do out-of-state patients need to stay in California?
Patients scheduled for an endoscopic discectomy are requested to
stay in California for three days. They will be seen for a consultation
and surgery discussion on the first day, surgery will be performed
on the second day, and they can return home on the third day after
a post-operative visit with the doctor. Patients with open discectomies
are requested to stay for at least two days post-operatively.
13. How about post-op care?
Post operative care for endoscopic discectomy is minimal.
Physical therapy will be recommended in patients' local area. Dr.
Schiffer will stay in touch with patients via telephone and e-mail.
14. Do all insurance companies cover Dr. Schiffer's procedures?
Most insurance companies cover endoscopic discectomies and other procedures. Dr.
Schiffer is not a contracted provider for any insurance company. Most
PPO and POS plans would allow you to be treated by Dr. Schiffer
as an out-of-network or non-contracted provider. Our office staff
will be pleased to help you with the process of getting the surgery authorized
by your insurance company. Unfortunately, HMO plans usually do not
allow patients to be treated by a non-contracted provider.