FOR PATIENTS

FOR PATIENTS

New & Existing Patient Information

If you have more questions or do not see the information you need please let us know!

We make every effort to work with patients’ insurance companies; however, responsibility for your bills rests with you alone. Before treatment, check with your insurance company to verify authorization and to determine whether you need a referral. Usually, new patients must be referred to see us by a qualified health care provider (medical doctor, nurse practitioner, physician assistant or chiropractor). If your insurance representative says you do not need a referral, please bring us either: a copy of the insurance policy that states referrals are unnecessary the name and phone number of the representative and the date of your conversation. Dr. Spence is a provider for Medicare and most major and minor insurance plans. Your insurance company may also require you to pay a co-payment at the time of your appointment. Co-payments are due when services are rendered. We work hard to see all patients in need of neurosurgical consultation regardless of financial status and insurance coverage. Anything not covered by insurance will be your responsibility. If necessary, our billing company can meet with patients to establish payment plans. Payment plans should be arranged in advance. If you lack insurance or cannot afford medical care, please let us know right away. Depending on your ability to pay, we can help you get reduced-cost or free care, possibly through referral to the appropriate hospital-based clinic. If you have any questions regarding which insurance plans we accept or any patient billing concerns, please call us at 405-455-3393. Questions regarding your coverage and benefits should be directed to your employer or insurance company.

X-rays

X-rays provide excellent detail of bones because they consists mainly of minerals which block xray beams. However, soft tissue such as discs and nerve roots do not have such minerals, so an x-ray does not capture an image of these structures. Therefore, xrays are not useful for the diagnosis of disc herniations. They give useful information about the alignment of the spine. Many different angles of xrays may be necessary to fully diagnose a disorder including but not limited to AP, Lateral, Flexion, extension or scoliosis views.

Magnetic Resonance Imaging (MRI scan)

The most useful imaging study available for the diagnosis of the majority of brain, spine, and spinal cord problem. MRI scans provide highly detailed images of non bony anatomy.

No radiation is used to perform an MRI scan, and they may safely be done on pregnant women. However, patients with certain implants such as a pacemaker, spinal stimulator should not have an MRI scan because the magnetic field will cause the device to malfunction.

Computerized Tomography (CT scan)

A CT scan is a highly detailed x-ray that can provide images of the body in different views. Like an x-ray, a CT scan works by shooting an x-ray beam through the body. Next, a computer is used to reformat the image into cross sections of the spine. Like xrays, they provide excellent bony detail, and are useful for evaluating fractures and other bony lesions. They do provide useful information about some soft tissue lesions, such as very dense tumors.

Computerized Tomography (CT scan) with Myelogram

A myelogram consists obtaining xrays of a region of the spine after injecting a radiographically opaque dye (dye that can be seen on x-rays) into the sac around the nerve roots. When combined with a myelogram, a CT scan provides for excellent nerve detail. The myelogram adds additional risk to the CT scan( such as a spinal headache) but provides substantial information about the spinal cord, spinal canal and nerve roots as well as any lesions that may narrow the spinal canal. First the myelogram is performed by a radiologist then the CT scan is obtained.

Discogram

A discogram is a test that can help to determine if back pain is coming from the discs. Discograms are also performed to assist in preoperative planning for candidates for a lumbar spinal fusion.

The discographer places a needle into the center of the disc through an area in the patient’s back. Radiographic dye is then injected into the disc, and if injecting the dye recreates the patient’s normal pain (concordant), it is then inferred that the specific disc is the source of pain for the patient. If the pain is unlike their normal pain (discordant) it can be inferred that even though the disc may look degenerated on an MRI scan, it is in fact not the source of the patient’s pain. The test itself is painful, but the patient needs to be awake and aware in order to tell the discographer what kind of pain is generated by the injection.

Bone scan with Spect Imaging

A bone scan is performed by injecting a small amount of radioactive marker into an intravenous line (IV). Three hours later, the patient is placed through a scanner and the radioactive marker will be concentrated in any region where there is high bone turnover.

A bone scan is sometimes performed to rule out an inflammatory process, or infection. It is also useful for diagnosing fractures not seen on an x-ray. It can also be used to determine if a compression fracture of the vertebral body is old or new, as an old fracture will not light up and a new one will.

Electromyography (EMG)/ Nerve Conduction Study (NCV)

An EMG/NCV is sometimes recommended to assess the electrical activity of nerves in the arms or legs. Compression or chronic irritation of a nerve will slow electrical conduction along that nerve. This can also result in changes affecting the muscle supplied by that nerve. By placing small needles into various muscles, these changes can be detected by EMG. Application of a small current can show slowing in NCV. They are used to diagnose nerve entraptment such as carpal tunnel syndrome, neuropathy and radiculopathy.

Please make sure to read, print, fill out and submit to Dr. Spence’s office, by mail or in person.

Read instructions and click link below to download this PDF file.

DOWNLOAD FORM HERE

What is Self-Referral Screening?

New patient appointments are scheduled by referral from a physician to Dr. Caple A. Spence, MD. Otherwise, patients who wish to refer themselves are required to undergo a Self-Referral Screening to determine if they will receive an appointment with Dr. Spence,
which is free of charge.

How does the screening process work?

In order to be screened, you must have had an MRI or CT myelogram or CT scan of the symptomatic region of your spine (or brain) within the past 12 months. You must submit the required material (see the checklist below) to Dr. Spence’s office by mail or in person. Dr. Spence will personally review the material you have submitted, for no charge. He will use the available information to determine if he can be effective in further evaluation and treatment. Within a few days, you will be notified by phone about whether you have been accepted for an appointment. If you have not heard from his office within one week, you may call us to check on the status of your screening.

Self-Referral Screening Checklist

The following material should be submitted to Dr. Spence’s office, by mail or in person:

MRI or CT images: These can be submitted on a CD (preferable) or on printed film. These will not be mailed back to you. If you are not accepted for an appointment, you will be given one month to pick up the films in person.
Written radiologist report of the studies you bring.
Completed Self-Referral Questionnaire (download above)
Signed acknowledgement of the Terms and Conditions of Self-Referral Screening (download above)
If your materials are incomplete, the screening process cannot be completed!!

Please make sure to print, read, fill out and bring with you all of the following forms to your appointment.

DOWNLOAD FORMS HERE

Your health care provider needs to make a referral first. Once an appointment is arranged you will be called by our scheduling staff. We will reconfirm the appointment shortly before your appointment and advise you of all the important documents to bring with you.

What to Bring to the Appointment

  • A form of identification (Drivers license)
  • Physician referral forms if required by insurance
  • Pertinent information about your medical and surgical history (may bring additional records or studies done pertaining to the affected area, including old films.)
  • Your insurance card
  • Co-Payment if applicable
  • Plain X-rays, of involved area, within six months: A/P and Lateral
  • Closed MRI, of involved area, within six months. May have CT Myelogram if patient has a pacemaker or is otherwise unable to have MRI. (An open MRI is generally not optimal for surgical decision making

What to expect during your appointment
Generally, our offices are open from 8:00 a.m. to 5:00 p.m. Monday through Friday, except for holidays and weekends. Dr. Spence sets aside some days for office visits and other days for surgeries.
After checking in at the front desk with the required information {link to stuff to bring}, a careful history will be obtained in reference to your complaints and a physical exam will be performed. You will be shown your various diagnostic tests and their meaning. A lively discussion of the next steps will be encouraged along with answering any of your questions. We will help you arrive at a solution that fits your needs. We will help make arrangements to facilitate your appointments and scheduling.

We will spend all of the necessary time to understand your issues, discuss your test results and answer all of your questions. Since the amount of time necessary to accomplish this is variable, please be courteous if we are delayed. We will make every effort to run on time, but each person is important to us.

Due to the fact that we provide Emergency care to those with life threatening illnesses, even after you have confirmed your appointment, Dr. Spence may be called away. Rarely, your appointment may have to be rescheduled as a result. We regret the inconvenience to you but hope you’ll understand our desire to help patients when they need us the most. If Dr. Spence leaves for an emergency, he may see you after a delay. Alternatively, we may have to reschedule your appointment. We make every effort to see rescheduled patients as soon as possible.

After explaining all of your symptoms, giving your history, reviewing your physical exam and diagnostic studies, a diagnosis will be arrived at. For every diagnosis, there are a number of general options that are possible.  Some options are more appropriate than others.  If non-surgical options are the most reasonable for your situation, we will be happy to recommend that course of action and facilitate the necessary appointments.   Surgery can be risky and difficult, but sometimes after careful consideration, it’s clearly the best option. Other times, alternatives to surgery are the wisest choice.

Learning to ask the right questions — and getting the right answers — is vital to helping you decide whether or not surgery is right for you. Being a responsible health care consumer starts with getting involved in decisions about your health. That way, you’re more likely to feel calm and confident about whatever course of treatment you choose.

DECIDING WHICH OPTION IS BEST

So how do you decide about surgery? The first step is to find out whether the surgery being recommended  is emergent, urgent, or elective.

Emergent  Surgery

When surgery is needed to save a person’s life (such as to remove or decompress a large brain tumor with swelling or hematoma causing coma) or must be done immediately to prevent permanent disability (such as to decompress an injured spinal cord, or repair a fractured spine), it is considered emergent. That means there is little or no choice but to have the operation or risk serious consequence to a person’s future health.  There is usually little to no time to explore other options and surgery is performed within minutes to hours of diagnosis. Fortunately, few surgical procedures are truly emergent.

Urgent  Surgery

When performing surgery prevents the occurrence of, or progression of serious dysfunction it is considered urgent.  These circumstances may allow for plans to be made, schedules to be adjusted while preparations for surgery is made.  Preparations may include medical clearance or further preoperative testing.  These procedures are performed within days of diagnosis.

Elective Surgery

Most surgical procedures involve some degree of choice for the patient. In some cases, alternatives to surgery exist, such as medications, interventional procedures or other ways of dealing with the problem. In other cases, surgery may be the only option for correcting a particular problem, but the symptoms don’t merit the risk of surgery. For example, many people with radiculopathy have no weakness and only intermittent pain.

Surgery is appropriate when it is needed to:

  • Relieve or prevent pain
  • Restore or preserve normal function
  • Correct a deformity
  • Save or prolong your life

Even if surgery is appropriate, it may not be the only choice of treatment. It’s always best to investigate all other options before choosing surgery.

If you feel anxious or nervous, take a friend or relative along for moral support. Then assess the information and decide what you want to do.  It is usually appropriate to come to a decision after the appointment is over and you have had a chance to consider the information you were given during the visit.  Make sure it’s your own decision. Don’t let yourself be pressured into having surgery.


ASKING FOR A SECOND OPINION

Getting more information can help when you’re deciding about surgery. One way to do this is to get a second opinion, also called a “review of treatment”.  A second opinion can help you make a more informed decision. Some health plans require second opinions before they will cover certain procedures, but others may not cover it. Check with your health insurance to learn whether a second opinion is covered.

You might feel uncomfortable asking for a second opinion, but most doctors today are used to this and are very cooperative. A doctor who responds with anger or refuses to cooperate with such a request may not have your best interests at heart. Dr. Spence frequently performs second opinions for patients and other surgeons.  Likewise, he would be glad to recommend other physicians or surgeons in the area and nationally.

 

QUESTIONS TO ASK BEFORE SURGERY

  • Why is this surgery recommended?
  • How will this procedure help my condition?
  • What are the benefits?
  • What other treatment options are available?
  • What will happen if I don’t have the surgery?
  • Is no treatment an option?

Name and Procedure

  • What’s the operation called?
  • What will be done?
  • How is it performed?
  • How long will it take?
  • How serious is it?
  • What’s the typical recovery period?
  • How long will I be unable to care for myself?
  • When can I return to work and my normal activities?


Timing

  • How soon should I have the surgery?
  • How soon must I make a decision?
  • What will happen if I postpone the operation?


Risks/complications

  • What are the risks involved?
  • What percentage of patients die from this procedure?
  • What complications may occur?
  • Which complications are common for my age and state of health?


Experience

  • How often do you perform this procedure?
  • How often is this surgery done at your hospital?


Cost

  • What will be covered by my health plan?


Except in certain emergencies, we must get your informed consent before performing a procedure such as surgery. In doing so, we will explain the risks and benefits of the procedure, alternative treatments, and the likely outcomes of not having the procedure.  A form will be used to reinforce information given orally and to document that consent was given. If you do not understand any part of the consent form, do not sign it until we have addressed your concerns.

If you are admitted to the Hospital, a neurosurgery team headed by Dr. Spence, will care for you. Other team members typically include nurse practitioners, nurses, physical therapists, case managers, and consulting physicians among others.

Before Surgery

Prior to going back to the operating room, you will be prepared for surgery including answering questions about your current medical condition, meeting your anesthesiologist, and operating room staff that will be helping during your operation.  Feel free to ask any remaining questions you may have to these team members.  This is a good time to ask questions and make requests of your anesthesiologist concerning pain control, nausea and other issues you may have. The region of your body where your surgery will take place will also be identified and marked during this time period.

Due to a number of factors that are not under our control, the time of your procedure may vary from what you may have expected.  Some operations take longer than expected. Some operations may be canceled just before surgery for a number of reasons. Some team members may need to complete a task prior to committing their entire attention to your care. As a result of these possibilities, you may elect to adjust to the schedule accordingly, or you may elect to reschedule your procedure.  Feel free to discuss these issues with your pre-operative staff.  Dr. Spence may or may not be available to help in this decision making process as he may be dedicating all of his attention to another patient during their operation.

 

During Surgery

During your procedure, the team will be focusing their activity on you.  Everyone has a very particular role that they know well and perform daily.  Your nurse will update available family members at particular intervals.  We DO NOT accept questions from family members DURING the procedure, as this is disruptive to the process.  Remember that each operation represents a series of issues that are dealt with until the procedure is over.  Some issues may require more or less time than anticipated, thereby extending or shortening the total operative time.  It is important that family members understand this so they do not become worried by the length of the procedure.

 

After Surgery

When your procedure has ended, your anesthesiologist will control your waking up, and immediate post operative pain control. You will be transported to the recovery room.  While you are recovering there, Dr. Spence will discuss the pertinent Intraoperative events with your family according to your wishes.  He will also answer their questions at that time.

After a brief recovery period, you will be taken to your room where you will receive your postoperative care. Team members will make rounds each day. Dr. Spence will review your care each day. All critical decisions about your treatment will be made by him.  Team members will address questions about your care and, at your request, communicate with your family. 

Responsibility for your care rests with Dr. Spence, who visits patients after surgery according to his schedule.

 

Being Discharged

Once you have been medically stable, tolerating a regular diet, with good pain control and you are able to be active, you may be ready to be discharged.  The decision to be discharged is made by you, Dr. Spence, and other team members.  You will be given prescriptions appropriate for you and discharge instructions.  These instructions are also available on this site. Feel free to ask any questions you may have, realizing that you can call for questions at any time after you leave the hospital.

When You Go Home

Follow-up care plays a crucial role in your recovery. You will leave the hospital with a set of instructions. Please call our office within one business day to make or confirm your follow-up visit and to discuss follow-up care, which may include suture removal.

Each follow-up visit will be tailored to your individual needs. Please contact our office any time after your surgery if questions or concerns arise.

 

Questions or Concerns Between Office Visits

Patients often forget to ask questions during office visits or think of new ones later. If that happens to you, call us. Unless your concerns are urgent, please phone during office hours.

When a secretary or receptionist takes your call, be aware that he or she may not be able to answer clinical questions, and will forward your message to the appropriate practitioner. A nurse or Dr. Spence will return calls about medical matters, typically within one business day. Some questions, though, require a review of tests and records as well as discussions among team members. In those cases, we may ask you to call back or await a call from us the next business day. Sometimes we will ask you to schedule an office visit.

Patients who have concerns outside office hours may call 405-455-3393, and let the operator know your name and that you are a patient of Dr. Spence. Explain if you have had surgery and when. Thereafter you will be transferred to a member of the neurosurgery team, or they will return your call since someone is available around-the-clock.

 

Prescription Renewals & Controlled Substance Prescriptions

Please view here for all information on Prescription Renewals & Controlled Substance Prescriptions.

 

Emergencies

If you need emergency care outside normal office hours, call 911 or go directly to the nearest hospital emergency department.

Surgical Instructions: 
Anterior Lumbar Interbody Fusion- DOWNLOAD

Discharge Instructions:

Brain Surgery- DOWNLOAD

Cervical (Neck) Surgery- DOWNLOAD

Anterior Lumbar Interbody Fusion- DOWNLOAD

Lumbar Laminectomy- DOWNLOAD

Ulnar Nerve- DOWNLOAD

Carpal Tunnel Release- DOWNLOAD

Educational Information

Dr. Spence believes in educating patients on their diagnosis and procedure. If you have any questions, please let us know! 

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is the result of the median nerve and tendons in the carpal tunnel, the narrow area between bone and ligaments in the wrist, undergoing increased pressure rather than an issue with the nerve itself. The pressure could be due to arthritis, thyroid disease, or damage to the wrist. Common symptoms include burning, tingling, or numbness in the palm of the hand.

Ulnar Nerve Entrapment

The ulnar nerve is one of the arm’s major nerves and is part of the brachial plexus system. As the ulnar nerve runs the entire length of the arm, there are many places it could be compressed or irritated. The entrapment is most common near or in the elbow, normally on the inner part of the elbow, or in the wrist. Symptoms often include numbness of the arm or a weak grip.

Educational Information

Dr. Spence believes in educating patients on their diagnosis and procedure. If you have any questions, please let us know! 

Biopsies are used to remove a small piece of nerve or a tumor for examination. Typically a biopsy is performed by creating a small incision for the removal of the samples. The samples are then examined to determine the presence or extent of any diseases.
Surgery is the most commonly used method to remove tumors. Depending on the situation a biopsy may be necessary to examine the tumor and determine the treatment necessary such as radiation or chemotherapy. After surgery a follow up is necessary along with plenty of rest.

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