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A Comprehensive Spine Center Approach

Not every patient needs surgery!

A Comprehensive Spine Center Approach

At Florence Neurosurgery and Spine Center, we embrace a multidisciplinary approach to the care of our patients. Our spine care specialists include physicians and providers with expertise in neurosurgery, neurology, interventional pain management, sports medicine, non-operative spine care, and physical therapy.  Although many patients ultimately benefit from surgical interventions, most patients do not need surgery.

As we often tell our medical students, it is critical to understand the natural history of any disease that you treat. In other words, what happens if you do nothing? Most people with back and neck pain get better. Most patients with a disc herniation get better without surgery. The challenge of course is to reduce pain and suffering while waiting for the natural history to play out.

There are multiple interventions that reduce pain and suffering and accelerate recovery in patients with back and leg pain or neck and arm pain. Physical therapy is the mainstay of conservative management. Yet physical therapy is more than “back and neck exercises.” Physical Therapy involves multiple modalities that target pain generators including ultrasound, electrical stimulation, traction, iontophoresis, and dry needle therapy.

Non-narcotic medications are often helpful in the management of spinal disorders. Oral steroids, non-steroidal medications such as ibuprofen, muscle relaxants, and gabapentin are typical examples. Although narcotics may have a role in the management of acute post-operative pain, at Florence Neurosurgery and Spine Center we believe that these medications are only rarely indicated in the ongoing management of neck and back pain.

Interventional pain management offers many options that alleviates pain by targeting specific areas within the spine. Injections can target either nerves, muscles, or joints depending upon what is the likely pain generator. Ablative treatments such as radiofrequency lesioning and restorative treatments such as neuromodulation therapy (spinal cord stimulators) offer minimally invasive options for many patients.

Sometimes patients are “advertised” as one thing but actually have a very different problem. Shoulder pain, for example, can be a pinched nerve in the neck but also can be an issue with the shoulder itself.  Imaging, electrical studies, physical examination, and a good history are all critical components to accurately diagnosing the true cause of a patient’s symptoms.

Unfortunately, in many patients, low back pain is a chronic condition. Physical therapy, interventional pain management, and yes, sometimes surgery, are necessary in the management of acute, subacute and chronic low back pain. And yet, many patients are better served with other approaches.

A growing body of scientific literature suggests that mind–body exercise therapies may be helpful tools in managing patients with low back pain. As a part of a multidisciplinary approach to the treatment of chronic low back pain, Florence Neurosurgery and Spine offers supervised Yoga classes by a certified instructor. Yoga is a good alternative for many of our patients

Although surgery helps many patients, at Florence Neurosurgery and Spine Center our first goal is to improve our patients’ lives through non-operative means. But if surgery is necessary, minimally invasive approaches should be the first option!


© Florence Neurosurgery and Spine Center

Important Things to Know About Brain Tumors

Of the nearly 80,000 brain tumors diagnosed in the U.S. each year, approximately 32% are considered malignant

Important Things to Know About Brain Tumors

What is Brain Tumor?

Of the nearly 80,000 brain tumors diagnosed in the U.S. each year, approximately 32% are considered malignant – or cancerous. Overall, the chance that a person will develop a malignant tumor of the brain or spinal cord in his or her lifetime is less than 1%. Glioblastoma multiforme (GBM) is the deadliest type of brain cancer, accounting for 45% of all malignant brain tumors.

Primary brain cancer is rare.

A primary malignant brain tumor is a rare type of cancer accounting for only about 1.4% of all new cancer cases in the U.S. The most common brain tumors are known as secondary tumors, meaning they have metastasized, or spread, to the brain from other parts of the body such as the lungs, breasts, colon or prostate.

The cause of brain cancer is usually unknown.

Most people diagnosed with a primary brain tumor do not have any known risk factors. However, certain risk factors and genetic conditions have been shown to increase a person’s chances of developing one, including:

  • The risk of a brain tumor increases as you age.
  • People who have been exposed to ionizing radiation—such as radiation therapy used to treat cancer and radiation exposure caused by atomic bombs– have an increased risk of brain tumor.
  • Rare genetic disorders like Von Hippel-Lindau disease, Li-Fraumeni syndrome, and Neurofibromatosis (NF1 and NF2) may raise the risk of developing certain types of brain tumors. Otherwise, there is little evidence that brain cancer runs in families.

Typically brain tumors don’t have obvious symptoms.

Headaches that get worse over time are a symptom of many ailments including brain tumors. Other symptoms may include personality changes, eye weakness, nausea or vomiting, difficulty speaking or comprehending and short-term memory loss.

Even benign or non-cancerous tumors can be serious and life threatening. If you experience these symptoms, speak with your doctor right away.

Brain tumors can occur at any age.

Primary brain tumors—those that begin in the brain—can develop at any age, but they are most common in children and older adults. While brain tumors are one of the most common cancers occurring in children 0-14 years, the average age of diagnosis is 59 years. [iii]

Living with a Brain Tumor

There is always hope!

Living with a Brain Tumor

Perhaps the most difficult conversation for a Neurosurgeon is the one when he lets his patient know he or she has a brain tumor. Over the years, I have delivered this news too many times, and yet, for our patients, each time it is a brand new event.

The diagnosis of a brain tumor is a life-altering event. Ultimately, the brain is who we are. It is the seat of our soul and the keeper of our thoughts. It is what makes us fully human. No computer compares. No computer will ever replace it.

When a patient hears the words “brain tumor” the natural tendency is to think the worst. And yet, there is hope and there are choices for patients who develop a brain tumor.

The diagnosis of a brain tumor is extremely complex as there are many different types, with each one carrying sometimes radically different treatment options and survival rates. Whereas some tumors are literally “death sentences,” others are imminently curable and once removed, the patient can have a normal life expectancy.

There are two basic types of brain tumors: those that arise from the brain itself (primary tumors) and those that spread to the brain from elsewhere (metastatic tumors). Primary brain tumors can be highly malignant, benign, or somewhere in between.

Location is extremely important in brain tumors. Although some tumors may indeed be benign (no cancer cells present), they can still be life threatening based on their size and potential to damage adjacent normal brain.

One of the most common tumors that we see is a meningioma. A meningioma is a primary brain tumor that arises from cells that form the covering of the brain or “meninges.” These tumors can cause neurologic deficits such as weakness, visual loss, stroke, and even death. And yet with surgery they can sometimes be cured.

Metastatic brain tumors or tumors that spread to the brain from a different part of the body (such as the lung or breast) are extremely common and represent the most common type of brain tumor that we treat at the Florence Neurosurgery and Spine Center.

Although the exact incidence of metastatic brain tumors in the United States is uncertain, it is estimated to be between 150,000 and 170,000 people per year. There are also approximately 70,000 new cases of primary brain tumors diagnosed each year. All together, the annual incidence of brain tumors in the United States (metastatic and primary combined) may be as high as 240,000 persons per year—more than lung cancer, breast cancer, prostate cancer, or colon cancer.

The management of brain tumors can be quite complex and often requires a team approach involving neurosurgeons, medical oncologists, radiation oncologists, neurologists, medical physicians, and nurses.

Fortunately, we have many tools available in the management of brain tumors.  Through computer-assisted microsurgery we can remove many tumors while preserving normal brain function. Some tumors are not appropriate for open surgery and for these we sometimes treat with stereotactic radiosurgery—a procedure that precisely delivers high doses of radiation to a computer defined tumor target while sparing normal brain.

Over the last 20 years, a significant amount of information has been learned about the genetics of brain tumors. Already some brain tumors are being treated with targeted chemotherapy based on the specific genetic profile of the individual tumor. Although many advances have been made recently, even greater ones are sure to come during the next 20 years!


© Florence Neurosurgery and Spine Center 

Spinal Cord Injury

Think before you leap!

Spinal Cord Injury

September is National Spinal Cord Injury Awareness Month.

According to the National Spinal Cord Injury Statistical Center, roughly 300,000 Americans are living with a spinal cord injury! 80% are men. Motor vehicle accidents are the #1 cause followed by falls. Most 20 year-olds who suffer a cervical spinal cord injury are dead before the age of 60.

The estimated lifetime cost of caring for a 25-year-old with a cervical spinal cord injury is between $3.4 to $4.7million! This does not include the loss of work wages! It is estimated that the annual incidence of SCI, not including those who die at the scene of the accident, is approximately 40 cases per million populations in the U.S. or approximately 12,500 new cases each year, given the current population size of 313 million people in the U.S.

The number of people in the U.S. who are alive in 2014 who have SCI has been estimated to be approximately 276,000 persons, with a range from 240,000 to 337,000 persons.

The average age at injury has increased from 29 years during 1970s to 42 years since 2010. Approximately 80% of spinal cord injuries occur among males. Currently, about 23% of spinal cord injuries occur among African Americans, which is higher than the proportion of African Americans in the general population (12%).

Vehicle crashes are the leading cause of injury, followed by falls, acts of violence (primarily gunshot wounds), and sports.

Days hospitalized in the acute care unit after SCI have declined from 24 days in the 1970s to 11 days since 2010. Substantial downward trends are also noted for days in the rehabilitation unit (from 98 to 36 days). The most frequent neurologic category is incomplete tetraplegia followed by incomplete paraplegia, complete paraplegia, and complete tetraplegia. Less than 1% of persons experienced complete neurologic recovery by hospital discharge.

Former South Carolina Governor Haley proclaimed September 23 as “Falls Prevention Day.” Falls are the second most common cause of SCI.

According to the proclamation falls are “a common cause of death among the older population, with two out of 10 admissions to trauma centers attributed to patients aged 65 and over with fall-related injuries.”

The proclamation continues: “older adults can reduce their risk of falling by exercising, knowing the side effects of their medications, having their vision checked, wearing proper shoes, and improving the lighting both inside and outside their homes.”

Older adults are at high risk for complications from falls. Spinal cord injury, spinal fractures, and subdural hematoma are common injuries seen in this age group and are very much life threatening. Many falls can be prevented by recognizing physical limitations, using assistive devices as necessary, avoiding excessive alcohol intake, and by not engaging in “fall risky” activities!

Have fun but be safe!


© Florence Neurosurgery and Spine Center

Stereotactic Radiosurgery: surgical precision with no incision

Stereotactic Radiosurgery (SRS) is a highly sophisticated procedure performed by neurosurgeons...

Stereotactic Radiosurgery: surgical precision with no incision

Stereotactic Radiosurgery (SRS) is a highly sophisticated procedure performed by neurosurgeons, radiation oncologists and radiation physicists utilizing 3-D computerized imaging to target and deliver a high dose of radiation to an affected area. Through robotic control of both the radiation source and the treatment table, converging radiation beams are focused on a single target. By delivering the radiation from various directions and angles, normal tissue is spared while obtaining sub-millimeter accuracy.


Stereotactic Radiosurgery requires a multidisciplinary approach that involves neurosurgeons teaming with radiation oncologists, radiation physicists, medical oncologists, and neuro-radiologists to determine the best approach for each individual patient.


Stereotactic Radiosurgery requires no incision but delivers “surgical” precision. Common indications for SRS are brain tumors, including metastatic brain tumors, meningiomas, and acoustic neuromas; spinal tumors; arteriovenous vascular malformations (AVM’S); and Trigeminal Neuralgia. In 2003, the Florence Neurosurgery and Spine Center began offering Stereotactic Radiosurgery for its patients. Since 2014, our neurosurgeons have utilized the LINAC-based SRS (True Beam) system at McLeod Regional Medical Center.


© Florence Neurosurgery and Spine Center

Subdural Hematoma

As we age we certainly are not as agile and athletic as in our youth. Seniors by and large are more likely to lose their balance and fall, striking their head.

Subdural Hematoma

I am often asked what are the most common problems that a Neurosurgeon sees in the Emergency Room. Given that Neurosurgeons see such a wide spectrum of patients with many different diagnoses, I thought the readers of Golden Life might be interested in one of the most common Neurosurgical emergencies that affects senior citizens: Subdural Hematoma.

The covering of the brain is called the dura. Blood clots can form between this covering (the dura) and the brain. We call this type of blood clot a “subdural hematoma.” Seniors are particularly susceptible to forming a subdural hematoma for several reasons.

As we age we certainly are not as agile and athletic as in our youth. Seniors by and large are more likely to lose their balance and fall, striking their head. Head trauma is the most common cause of subdural hematoma. In the elderly even incidental trauma can lead to a subdural hematoma.

Because heart disease, peripheral artery disease, and stroke are so common, many older people are on blood thinners such as Coumadin, Plavix, and Aspirin. Although these medicines save lives, they unfortunately can increase the severity of bleeding after even minor head trauma, making a subdural hematoma even worse.

A well, our brains normally will decrease in size slightly as we age. Sometimes shrinkage or atrophy of the brain is a sign of dementia. More often it is just the normal aging of the brain and not associated with loss of cognitive ability. With atrophy, however, the space between the brain and its covering (the subdural space) increases in size.

There are small veins normally found within the subdural space that can become stretched as the brain atrophies with age. With head trauma these veins can tear and cause bleeding, leading to an acute subdural hematoma. If this hematoma becomes large enough it causes pressure on the brain. This can lead to confusion, weakness, even death.

Sometimes head trauma can cause these veins to tear but lead to a smaller hemorrhage or cause the injured vein to leak slowly over time. Or a larger hemorrhage may not completely dissolve and as the blood products break down over several weeks or even months, more fluid can collect over the surface of the brain. We call this a chronic subdural hematoma.

Patients with a chronic subdural hematoma often present with a progressive change in their mental capacities with confusion, loss of memory, difficulty concentrating or loss of other routine cognitive abilities. Many times patients with chronic subdural hematomas can have difficulty with their balance or even weakness on one side of their bodies. Other potential symptoms include difficulty with speech, headache, drowsiness, and seizures. If left untreated, a chronic subdural hematoma can cause death.

Since the symptoms of chronic subdural can include a slow loss of mental functions, patients with chronic subdural hematomas can sometimes falsely be labeled as having dementia or Alzheimer’s disease. Some patients with chronic subdural hematomas do not even remember hitting their heads. That is why it is so important for any patient with a change in mental status to undergo either a CT scan or MRI of the brain.

Many times a subdural hematoma will need surgery. If caught in time, it can be removed quite successfully and patients can return to most normal activities.

So seniors-- stay active but be safe. And wear your helmet when riding a bicycle around the neighborhood!


© Florence Neurosurgery and Spine Center

The Secret of the Care of the Patient

Caring for the Patient!

The Secret of the Care of the Patient

As true today as when Dr. Francis Peabody first wrote his famous 1927 essay, at Florence Neurosurgery and Spine Center, we believe strongly that “the secret of the care of the patient is in caring for the patient.” Medicine and healthcare change almost on a daily basis, with new technology, new medications, and new approaches. Yet this fundamental principal of good medicine remains.

It is an enormous responsibility that a physician accepts, when a patient places his trust in his doctor. But more so, it is a humbling privilege that requires an unyielding commitment to what is best for the patient in front of you. Numerous external pressures confront the modern physician. Unfunded government mandates, insurance companies, hospital bureaucracies, malpractice claims, unreasonable expectations, an internet filled with “half-way facts,” and a world that accepts one marginal study’s results as “evidence-based medicine.” Yet, when face-to-face with a patient, doctors must do their best to make the right decision—to do what is best for the patient in front of them.

We are often asked by patients confronting difficult decisions “what would you do doctor if it were your spouse? If it were your child? If it were your mother?” These are easy questions for most physicians, as there are no separate standards. There are no secret medicines or interventions brought out for the “important” patient. Given the same set of circumstances, the same clinical presentation, the same physical findings, the recommendations would be the same—be it for the homeless man, the drug abuser, the executive, or the local minister. 

That is not to say that physicians do not err or that other opinions may not be valid. Empathy and compassion, however, must be the driving force in physician decision-making.

A successful organization should be able to understand and articulate its underlying mission. At Florence Neurosurgery and Spine Center, we encourage our physicians, providers, nurses, technicians, and staff to periodically review our mission statement as we hope that it will inform and motivate them during their daily work lives:

“We pledge to our patients that we will place their needs first and foremost as we help them to confront potentially complex and even life threatening neurosurgical disease processes. We are committed to maintaining our own continuing education as well as offering state of the art neurosurgical techniques. We will work along side our medical colleagues, always advocating for our patients, hoping to improve the quality of their lives…”

At Florence Neurosurgery and Spine Center we embrace Dr. Peabody’s advice given so long ago, that “the secret of the care of the patient is in caring for the patient.”

© Florence Neurosurgery and Spine Center

The Snap, Crackle, Pops of Aging and Spine Health

Pain can be abrupt from an injury, or it can develop slowly over time due to age-related changes of the spine.

The Snap, Crackle, Pops of Aging and Spine Health

About 80% of adults experience low back pain at some point in their lifetime. Both men and women are affected equally. Pain can be abrupt from an injury, or it can develop slowly over time due to age-related changes of the spine.

What are the causes?

The majority of back pain in seniors is mechanical and related to the normal wear and tear on the joints disc and bones of the spinal column. Patients can experience muscle sprain/strain and decrease in core muscles strength of the abdominal and spine muscles from deconditioning as they age. The bones (vertebrae) can lose their density from osteoporosis and be at higher risk for fracture and compression. The disc or cushion shock absorbers between the vertebrae degenerate/ dehydrate and lose their height. With wear and tear there can be changes in spine curvature (scoliosis/kyphosis). There is formation of bone spurs, arthritis and degeneration of normal joint capsules. These changes can cause pinching of the central spinal canal or smaller foramina where the nerves exit the spinal canal. With this, individuals may experience pain down the leg/legs, numbness in the leg or weaknesses, hence the "snap, crackle, pops".

Other medical conditions that may present as back pain include infections of the bones, disc or abdominal/pelvic areas. Tumors or tumors that spread (metastatic) to the spinal space, although less likely, are still a possibility. Abdominal aneurysms and kidney stones are some other possibilities.

Most causes of acute back pain are short-lived and self-limiting. They may require a few days of rest or decrease in level of activity, ice, gentle stretching and possibly over-the-counter medications or anti-inflammatory type medications.

If any red flags exist such as history of cancer, signs of infection, or neurologic deficit such as weakness, numbness or changes in bladder/bowel function a work-up may need to be expedited sooner.

If a patients pain is chronic, or in other words, greater than three months, recurrent, or unrelieved with conservation treatment further testing to identify the cause and possible treatments is often necessary.

What are some tests that may be ordered?

•possibly lab test if concerned of infection, inflammation, arthritis and some genetic markers (if family history ankylosis of spine)

•x-ray to look at bone alignment or for fracture

•CT-computer tomography of spine to evaluate soft tissues and disc not seen on x-ray

•CT myelogram-CT with contrast injected in spinal fluid to look for narrowing/compression on spinal canal or nerve root of spine

•MRI-magnetic resonance imaging used to create a computer-generated image to get a better look at soft tissue structures such as muscles, tendons, vessels, disc tears/ruptures and to evaluate for infections.

•Bone scan - may be used to detect and monitor infection, fracture, or disorder of bone

•EMG/NCV - electro diagnostic study of the muscles and nerves

What can I do?

Just like a yard or house that has not been maintained or has been neglected - a body that is out of shape or deconditioned will need work and maintenance.

•Start SLOW a plan of low-impact exercise such as speed walking, swimming or stationary biking working up to 30 minutes daily can increase muscle strength and flexibility

•Yoga can help stretch and strengthen muscle and improve posture

•Aerobic exercises are good to maintain disc health

•Core strengthening exercises focus to improve strength of abdominal and spinal muscles

•Eat healthy and drink plenty of fluids

•Discuss with your physician need for bone density evaluation (postmenopausal females <65 with risk factors and all women >65 - men may also need testing)

•Get appropriate amount of sleep - sleeping on a firmer mattress may help. Sleeping on side with knees bent may help patient with pinched nerves (radiculopathy) or spinal stenosis get comfortable

•STOP SMOKING - smoking reduces blood flow to the lower spine and contributes to disc degeneration, osteoporosis and delays healing process

•DON’T get discouraged. It is better to start off slow and be dedicated to an exercise program ... than to over do it or be a weekend warrior.

Where do I start?

Florence Neurosurgery and Spine Center offers a comprehensive evaluation and individualized treatment plan of spine disorders. In addition, most of the above test are available in a comfortable office base setting to expedite your care and path to recovery.

Yoga for Low Back Pain

Low back pain is the leading cause of work-related disability in the United States!

Yoga for Low Back Pain

Low back pain remains a major health problem in the United States. It is a leading cause of Emergency Department visits, timed missed from work, and disability. In individuals younger than 45 years, it is the number one cause of work-related disability. For all ages, it is the second most common cause of temporary disability. It is also one of the leading diagnoses in health care expenditures.

The economic impact of low back and neck pain is huge. According to a study published in the Journal of the American Medical Association, “low back and neck pain” was the 3rdhighest health related spending category for 2013 (behind Diabetes and Ischemic Heart Disease) at $87.6 billion.

Over 80% of individuals develop acute low back pain in their lifetime with about 5% developing chronic low back pain. According to the CDC, each year roughly 12-14% of the adult population will visit their doctor with a complaint of low back pain.  Nearly 30% will experience low back pain at some point in any given 3-month time period!

There are certain “red flags,” however, in acute low back pain that should warrant timely evaluation. Among theses are radiating leg pain, motor weakness, bowel or bladder dysfunction, onset associated with trauma, onset after recent “blood infection,” and a history of cancer. Although low back pain may have discrete causes that need immediate surgical interventions, sometimes it becomes a chronic disease.

Successful management of patients with chronic low back pain includes lifestyle modifications. Better nutrition, tobacco cessation, and exercise are all important features of any back pain treatment or prevention program. 

As a part of a multidisciplinary approach to the management of chronic low back pain, the Florence Neurosurgery and Spine Center offers supervised yoga classes by a certified instructor. Mind–body exercise therapies such as yoga may be helpful tools in managing patients with chronic, non-specific low back pain.

Yoga is a well known and accepted discipline in many health and fitness programs. Over the last 10 years published studies have suggested that yoga may reduce back pain and improve functional outcomes in some patients. Other studies have suggested that “mindfulness” practices may lead to quantifiable positive changes in brain function as seen on MRI and fMRI scanning.

At the Florence Neurosurgery and Spine Center, we believe that patients with low back pain should be approached holistically. Not every patient needs surgery. Not every patient needs an injection. Not every patient needs an MRI. By providing physician and provider expertise in multiple disciplines, we hope to better serve our patients with low back pain.


© Florence Neurosurgery and Spine Center


1204 E. Cheves Street, Florence, SC 29506

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