Christopher Duntsch MD PhD – Minimally Invasive Spine Surgeon

To find out more about Christopher Duntsch, go to www.texasmis.com for phone, email, address, and Texas Neurosurgical Institute Clinic Map – A Patient’s Perspective: Back and Neck Pain, Arm and Leg Pain, What to expect? From the onset of the problem, to its diagnosis and treatment. (screen down the page for the answers to these questions)


Do you have spine pain, or pain in your neck or back that radiates into your arms or legs?

Spine pain (Neck and / or back) pain is experienced by everyone at some point in their life and becomes more common as we age. The causes of neck and back pain are a true blend of genetics, biology, wear and tear disease, and /or trauma to the spine or nerve roots as they exit the spine.  When the nerve or nerve root is involved, the pain radiates from the spine (for example, from the neck into the shoulder, arm, and hand, or in the lumbar spine, into the hip, thigh, leg, and foot.  Pain in the neck or low back that is worse with prolonged sitting, standing, and walking, is typically due to arthritic degeneration and the associated anatomical changes of the spinal disc joints, or posteriorly, the facet joints at one or more spinal levels.  Pain in the spine only (isolated to the neck or back) and worse with activities or postures that are prolonged is generally referred to as mechanical back pain. Pain in the arms or legs that radiates from the back is typically due to compression of the nerves as they descend in the spinal canal, or as they exit the spine and enter the extremities.  Pain in the extremities is a sign of irritation of the descending nerve or exiting nerve root, typically due to compression from an anatomical defect (for example, congenital anatomical anomalies such as scoliosis, or spontaneous such as a bulging or ruptured disc compressing the nerve or nerve root).  Pain in the extremities due to nerve root irritation is referred to as a radiculopathy. Often one may experience both pain in the spine such as the neck or low back (axial pain of a mechanical nature), and pain that radiates into the extremities (radiculopathy).  This is because the various types of spine disease that effect the neck or back simultaneously causes bony spine and joint pain, and nerve root compression related to the changes in the spine that have occurred.  An accurate diagnosis of what type of pain a patient experiences is required to create and effective treatment plan.


When should you see a Neurosurgeon that specializes in minimally invasive spine surgery such as Dr. Christopher Duntsch?

Restricting one’s activities and taking precautions when lifting heavy objects can help prevent the occurrence or recurrence of back pain and extremity pain in many situations.  Most episodes of back and / or leg pain are short lived and amenable to simple home treatments (for example, rest, heat, ice, over the counter pain and inflamation medications, etc.). Generally speaking, if home treatments fail and the pain and / or associated symptoms persist or worsen, patients should see their primary care provider.  It is ok to proceed directly to a spine surgeon, but a primary care physician is qualified to treat back, neck, and extremity pain in it’s early stages, and to identify when more serious issues exist, and further can easily refer you to a spine neurosurgeon if appropriate or if the treatments he prescribe fail. The exception to note here is that if the pain is associated with severe numbness or weakness, changes in bowel or bladder, or severe debilitating pain, then the patient should be immediately referred to the neurosurgeon for expedited evaluation and treatment. Seeing a primary care provider first works better for the patient (i.e., some type of treatment and diagnosis can be gained quickly), and for the Neurosurgeon (insurance restrictions require that the neurosurgeon order the main study required for definitive diagnosis, the spinal MRI, if the patient has not first seen his primary care provider and had this ordered and done prior to his visit with the neurosurgeon).  Thus, if the primary care provider is seen first, he can order the imaging studies, so that they are ready and can be brought to the clinic visit.  Doing so turns two clinic visits with the neurosurgeon into one.  This is because if one proceeds directly to the neurosurgeon, he will need to also get an MRI, ordered by the neurosurgeon, after the visit, and return in the next few days to review the results and develop a definitive diagnosis and treatment plan together, the patient and the neurosurgeon as a team.  Dr. Christopher Duntsch will always see a patient that makes the time to come to his clinic, so either scenario is acceptable. However, the patient should always remember to bring his or her films with them.   Another point most physicians don’t communicate to their patients, the films (whether X-ray, CT, or MRI) need to be less than 6 months old to be considered reliable for diagnostic purposes.    The patient should also bring a detailed list of the medications being taken, and if he or she does not have one, simply bring the medications to the visit in a bag for the doctor to review. The standard of care with respect to initial imaging needed for a first clinic visit are X-rays (front to back and from a lateral aspect while standing, also known as weight bearing; and also with flexion forward and extension backwards, attempting to reach extremes ranges of motion of the spine in either direction), and an MRI of the affected area.  The primary care physician or the neurosurgeon and  his staff will assist will aspects of getting the imaging paid for by insurance, scheduled, and the resulting studies made available prior to the visit. In summary, home treatment is acceptable for less serious spine and extremity pain flare ups that is associated with a causal event such as a weekend doing heavy lifting and activities (gardening, landscaping, etc.).  The simple treatments mentioned above are often effective.  If the symptoms do not resolve with home treatments, worsen, or change, if the pain becomes intolerable, or if neurologic symptoms also develop such as numbness and weakness, then the patient should see the doctor immediately.


What should you expect from your first clinic visit with Dr. Duntsch and his spine team at Texas Neurosurgical Institute?

As discussed above, always bring your MRI and X-rays (should be less than 6 months old) of the affected area when you coming to the clinic for a visit with Dr. Duntsch.  Bring any other medical documentation you think would be helpful. When you see Dr. Duntsch in his clinic, expect to be seen right away, greeted with a smile, and treated with respect and empathy.  Every attempt will be made to expedite your visit with us. Please comes 30 minutes before your appointment if it is your first visit with Dr. Duntsch.  This will allow you to take your time filling out forms and being thoughtful about what pain and related symptoms you are experiencing. When you check in, you will be asked to fill out demographics and medical forms so that we know as much as possible about your current spine and extremity problems, and your past medical history.  We are very thorough here for your benefit, so please be patient and give as much information, and as detailed information, as possible. When you are done with your forms, you will brought to an exam room, and your vitals will be taken. Dr. Duntsch will review your imaging and then do his best to see you soon after you are brought back to the examining room. He will discuss your current problem with you, as well as inquire about your past medical history and medications. He will examine you and look for Neurologic signs and physical symptoms that correlate with the cause of the spine and extremity pain. The history of the pain and related symptoms, combined with the neurological exam, and the imaging studies, will all be used together to identify a cause and make definitive diagnosis. Once a cause is identified, a treatment plan will be made. Sometimes it will be necessary to order more imaging studies and / or other medical tests in order to best diagnose the cause of the problem.  This is rare though, and Dr. Duntsch can establish the diagnosis 95% of the time at the first visit.


How will you be treated by Dr. Duntsch for spine and nerve conditions that cause pain or other symptoms in the neck, back, arms, or legs?

Regardless if you are surgical candidate for direct fixation, you will first be treated with non-surgical conservative care.  The reason for this is historical. 40 years and hundreds of thousands of patients have been followed and it is clear that 90% of all patients first seen in the clinic will improve completely, or to a significant extent, with nonsurgical approaches. However, if the patient has not improved after a course of nonsurgical care, then the options for nonsurgical care become limited and surgery becomes the both the last resort and the best approach to fixing spine definitively. All reasonable nonsurgical therapies will given in stages and in a chronological manner to treat the problem and attempt to prevent the need for surgery.  One important note to make, there are two components to this process, and all three are required for effective treatment.  First, the patient must be compliant and follow the treatment plan exactly as dictated.  Second, the patient must be patient because time is a key factor in the healing process.  If the treatment goes on for 1 month, then the patient is seen by the doctor, only 20% will by improved. If the treatment goes on for 10 – 12 weeks, 80 – 90% will be improved.  Time is critical, thus, patience is a part of what is needed to get better with nonsurgical treatments.  If the pain or neurological dysfunction becomes worse, changes in nature, or becomes intolerable, the patient should abandon the treatment plan and come back to see Dr. Duntsch in clinic immediately. The first line of treatment includes medications, education, physical therapy, restriction of activities, bracing the back or neck, chiropractic care / accupuncture when indicated (primarily when the patient requests this), and other simple modalities such as heat, ice, and time.  The second line of treatment includes referral to a pain doctor for spinal nerve or facet joint blocks in the affected areas, and occasionally other treatments as indicated. This is very effective for some patients, but not always on the first try.  It often takes 2 – 3 procedures spaced in time to get the pain level under control. After a full course of treatment, if the patient strongly does not want surgery despite the fact it is indicated, and they have failed basic nonsurgical treatments, then Dr. Duntsch will continue to treat you with other types of nonsurgical treatments (i.e., TENS unit, traction, etc.). In other words, he is there to help you, not just to operate on a spinal problem.  Dr. Duntsch will not ever talk a patient into surgery no matter how indicated, nor take a patient to surgery who does not want to have surgery.  It is a team decision between the doctor and the patient.


Why can most patients can get better (decreased pain, increased function) without surgery? Why will Dr. Duntsch treat you nonsurgically in most cases, and use surgery as a last resort?

Most patients can get better without surgery. This has been studied by spine surgeons for decades. There are two reasons to avoid surgery if possible.  First, it is proven that nonsurgical care can make most patients better if not completely treated for their condition.  Second, all surgeries have risks.  Finally, surgery can spuriously and unavoidably lead to other spinal problems years or decades later in some.  Surgery is a last resort.  However, if a patient fails nonsurgical treatment and meets criteria listed below, surgery is usually the best path to take for treatment of a spinal condition.


When is spine surgery appropriate for treating your pain or other conditions such as numbness or weakness?

In Most cases, surgery is appropriate when the following criteria are met:

1) The natural history of the problem, the physical exam of the patient, and the imaging of the spine, all correlate with known neuroanatomical disease of the spine. In other words, there is good correlation from three directions.  Thus, a definitive diagnosis can be made with confidence.  In turn, an effective treatment plan can be made with confidence and intiated immediately. 2) The patient has attempted in a compliant manner all reccomended nonsurgical care, without improvement. 3) Dr. Duntsch believes he can effectively improve or completely treat the pain with surgical fixation. 4) The patient completely understands the diagnosis, the type of surgery, and the prognosis if surgery is avoided.  The patient completely understands the risks and benefits. The patient is medical fit for surgery, as determined by a medical doctor who performs a required medical clearance for surgery including lab work.  The patient’s health and the complexity of the surgery must be considered and balanced with the risks of the surgery to the patient. 5) The patient wants to have surgery.  This may be a personal choice, or the patient may be so debilitated that their quality of life and daily routine are completely disrupted.

Occasionally, a patient will present with a condition that is deemed urgent, or even emergent. In this particular situation, it will be important to take the patient to surgery immediately, or within a few days of the first visit. This is only done when one of the following criteria is met:

The pain is so intense the patient cannot function, and his or her quality of life is completely disrupted. The patient may have to be admitted 1-2 days before surgery to get adequate pain control and medical attention as indicated.  For example . . . The pain is associated with an emergent condition in which significant loss of function can occur unless the problem is addressed immediately with surgical fixation.  For example, syndromes and pathologies that are acute in onset and serious in their nature such as cauda equina syndrome, conus medullaris syndrome, spinal cord compression with myelopathy and loss of  neurologic function, and epidural compression from tumor or infection that suddenly causes the patient to deteriorate. (emergent) . . . or . . . The patient presents with spinal disease causing acute spinal cord or nerve compression that is progressively getting worse.  This type of spine-related presentation can cause loss of neurologic function over weeks and the loss will become permanent if it is not addressed surgically soon after it is diagnosed. (urgent)


What should you expect before your surgery, and during your hospital stay under Dr. Duntsch’s care?

The pre-operative process follows:Discussion of all aspects of the spinal disease, the surgery planned, and the expected recovery.  The two critical components of recovery are time and compliance with activities and medications.  Dr. Duntsch will treat the post-operative healing process as serious as the surgery itself. If you are not compliant, you risk failure of the surgery or recurrence of the problem requiring a second surgery. Listen to Dr. Duntsch!

Signing of a surgical consent, choosing a date for surgery, sometimes additional information is requested.

When indicated, medical clearance by your primary doctor or cardiologist is needed.  This includes all indicated labwork.

You will be asked to stop all blood thinners at least 7 – 14 days before surgery.

You will be asked to not eat or drink after midnight the day before your surgery.

For a typical surgical event, the following can be expected:

You will be asked to show up to the hospital at a certain time on the day of your surgery to be checked in.

Basic procedures are done prior to the surgery such as placing IV lines and starting medications.

Dr. Duntsch will come and see you in the pre-operative holding area and check that everything is in order. He will discuss everything with you one last time and give you an opportunity to ask last minute questions.

You will be brought the OR, and the surgical procedure will be performed.

After surgery, you will be brought to the postoperative area to be monitored and cared for until you are awake and deemed to be in good condition. Dr. Duntsch will locate your friends and family and update them as to how things went and when they can see you after recovery from anesthesia.

If you are going home the same day, you will be taken to the same day surgery area to be monitored and care for until you are deemed ready for discharge home. If you are staying for one or more days, you will be taken to your hospital room and cared for until it is time for you to go home.

If you have  serious medical condition, Dr. Duntsch will ask an internal medicine doctor to follow along with him to insure you medical needs are kept fine tuned and there are no issues.  Depending on the level of severity, Dr. Duntsch may ask you to spend the first night in the ICU simply for observation and safety’s sake.

Most surgeries are same day, or require an overnight stay.  The remainder are 2- 4 days.  Rarely does a surgery take longer than that unless the spinal condition and surgery are severe. In this situation, inpatient rehabilitation will be considered in the best interest of the patient.


What should you expect my recovery from minimally invasive spine surgery to be like in the first week, month, and year?

Regardless of the type of surgery, you will be asked to rigorously restrict your activities and not return immediately to work. I want you to give your surgery every possible advantage with respect to healing, and prevention of a recurrence of a spinal conditions (i.e., re-rupture of a spinal disc).

The recovery time and patient recovery experience depends on the type of problem and the type of surgery.  Simple surgeries recover quickly and if the surgery is done well, the patient is typically pain free or at least much improved.  Because Dr. Duntsch is a minimally invasive spine surgeon, the incisions are small (range 16mm – 22mm on average).  Thus, peri-operative pain is rarely a problem, rarely even mentioned by my patients.

If there is no need for instrumentation and/or fusion, you will see Dr. Duntsch or his staff at 7-10 days for a brief wound check, and then at one month for an overall evaluation of the success of the surgery.  Most patients are pain free and doing well at this time. After the one month visit, you will only need to see Dr. Duntsch if a new problem arises, or if you experience a recurrence of the original problem.  If you follow the instructions given during the recovery period, this is very rare.

If there is a need for instrumentation and/or fusion, you will see Dr. Duntsch or his staff at 7-10 days for a brief wound check, and then at one month for an overall evaluation of the success of the surgery. This visit will entail followup with X-rays of the surgical site to check the spine anatomical alignment, the position of the instrumentation, and to begin following the carefully prepared fusion.  See below for the additional visits that are required.


How often will you see Dr. Duntsch in the Texas Neurosurgical Institute Clinic after surgery?

For simple surgeries, you will be seen:

Once at 1 – 2 weeks to check your incision and to review how you are doing at that time.

At 1 month to insure all is well with your condition, and how effectively we have treated it.

For more complex surgeries that require fusion and instrumentation, you will be seen in follow up:

At 1 – 2 weeks to check your incision, and to review how you are doing at that time.

At 1 month with X-rays of your spine to follow the progress of your fusion, and to review how you are doing at that time.

At 3 months with X-rays of your spine to follow the progress of your fusion, and to review how you are doing at that time.

At 6 month with X-rays of your spine to follow the progress of your fusion, and to review how you are doing at that time.

At 12 months with X-rays of your spine to follow the progress of your fusion, and to review how you are doing at that time. If everything looks good, you will be released from the clinic and deemed to be effectively treated.


What should you do if neck, back, or extremity pain (or related symptoms) recur, or if new symptoms occur after minimally invasive spine surgery?

You should schedule a clinic visit with Dr. Duntsch if the problem recurs, or new problems occur. If the problem is severe pain, or a loss of  neurologic function, you should go to the emergency room and have the physician on staff contact Dr. Duntsch.