Frequently Asked Questions

If you can't find the answers to your questions on this page (or elsewhere on the website) we encourage you to write any questions down before visiting. Many questions of course get answered during the course of the consultation.

Surgery

This is a very difficult question to answer as everyone is different. And the phrase 'out of action' doesn't really make any sense. Minimally invasive surgery however is usually associated with very little "down time". Most patients are encouraged to walk the next day. Single level disc replacements at L5/S1 usually require an overnight admission, 6 weeks without driving and provided you can work without the need to drive a car, return to work 2-3 weeks later performing light duties. These patients return to exercise 6 weeks later and simply need to be careful and exercise common sense for 4-5 months while the prosthesis bonds.

On the other hand, complex revision surgery with chronic nerve damage requiring multiple approaches may take a year or more to recover from with time before that using walking aids.

No two patients or surgeries are the same. If you can gauge where you lie within these two extremes you will get an idea of your downtime. Generally, I advise patients to plan for the worst and hope for the best. Most patients tend to get their life back and be on the road to recovery 4-5 weeks post-op.

This is a very difficult questions to answer. Success means very different things to different people and circumstances. For example, success to a patient with impending paralysis may simply be avoidance of being confined to a wheelchair for the rest of their life. Success to most people means pain relief and restoration of normal activities. This is achieved usually in over 90% of patients who have disc replacements and successful fusions. Success rates drop off in patients who have complications of surgery, patients who have unrealistic expectations, patients who are dependent on strong painkillers, patients who are under the jurisdiction of workers compensation schemes or litigation, patients with osteoporosis or who are frail and medically unwell.

If surgery has been unsuccessful, we make a concerted effort to work out why and see if anything else can be done. Some people take longer to recover than others (for example if there is chronic nerve damage, or in revision surgery). First of all, it needs to be ascertained that surgery has indeed been unsuccessful -therefore a suitable amount of time has to pass, and the original goals of surgery need to be revisited. Often patients simply forget how bad they were to begin with, and so perceive surgery to be unsuccessful when some pain persists. If surgery has been unsuccessful then there are salvage procedures that whilst not ideal to offer hope such as spinal stimulators, radiofrequency treatments and help from pain management specialists.

In many cases spine surgery is performed in 2 stages a few days, or a week apart. The reasons are many and varied. Minimally invasive surgery is performed through small incisions with very little disruption to the tissues. The advantage is far greater success rates. But the disadvantage is that the surgeon relies on radiology and computer navigation to get the job done rather than direct vision. As a result, when we know that we have to use multiple approaches in a patient's surgical reconstruction we will often want to get a scan or assess the clinical result of the first approach, before proceeding to the second approach. Contrary to patient's beliefs 2 stage surgery is safer and involves less anaesthetics than performing the whole lot in one stage due to turn-around time between stages.

Other reasons are not necessarily medical – financially, patients are out-of-pocket less money with staged surgery. Medicare will only pay for single level disc replacement surgery so if you require two or more then these have to happen a minimum of 28 days apart in order to comply with Medicare billing legislation.

Spine surgery in the public hospital system is massively underfunded and tends to be reserved for those patients involved in trauma or who have tumours or malignancies (cancers). Patients sent by me to the public sector in 2009 are still waiting to be treated.

Pain medication and prescriptions

Yes, I can but if you require repeats or authority prescriptions for large amounts then these need to come from a single person who controls and monitors this which logically should be your GP. Extremely strict rules govern the prescribing of controlled drugs and harsh penalties exist for doctors who stray from these.

No. It is an offence for a doctor to prescribe medications for a patient without that patient being physically present.

Medico-Legal

Yes. This is an easy request however it must be made by your lawyer in writing and accompanied by a form which you sign which gives me your consent to release information about you to a third party. Requests by a patient for 'a legal report of my condition' cannot be entertained. Such a report, if it did exist, would have no legal value whatsoever and serve no purpose. A proper report constitutes a legal document which can be used in arbitration, and can be cross-examined and as such needs to be requested and delivered in a proper manner.

These are personal correspondences which also constitute the medical record of your consultation. Generally speaking, I have no problem with you having a copy of these – but they need to be provided to you via your GP so that he / she is also aware that you have them. Be extremely careful however with applying a layman's interpretation to a written medical opinion which you may not fully understand.

If you are seeing me for an IME then I am not your doctor. I am not allowed to like you or dislike you, I am not allowed to think your situation is fair or unfair. It is independent of subjection or emotion. Once your medico legal situation has been finalised however you are certainly welcome to come and see me as a patient.

I have no control over what WorkCover does with your case. Well over 90% of the time the closure of a WorkCover case is absolutely appropriate, and the angst lies simply in the misunderstanding of the patient over what exactly WorkCover is liable for.

No medical practitioner, in this day and age, is going to sign their name to a document which states you are cleared to do anything. To do so would be going directly against sage advice from our lawyers and indemnity insurers - and we are obliged to adhere to this advice. Doctors can advise you to refrain from something or not to do something, life lift heavy objects, or not work. Outside of advice not to do something, as sensible adults, you are by definition cleared to do whatever you please within the boundaries of common sense. If your employer wants to know specifics about your medical condition and specifics about what you can and cannot do in the workplace, they are welcome to write and ask specific questions. This request must be accompanied by a signed document from you allowing the release of your medical information to third parties.

Billing

Spine surgery shouldn't be expensive but large out of pocket gap payments exist for reasons that are not really under our control. Firstly, most spine surgery these days involves a number of small operations, using different incisions, performed under the same anaesthetic or on different days. Most patients do not know this but whenever a surgeon performs a second incision / surgery the rebate from Medicare drops to 50% and sometimes 25%. Surgeons are simply not able to work for 25% of a government rebate fee. Secondly the recent freeze on rebate fees for 4 years or more has led to a complete inability to not charge a gap payment.

'No Gap' policies are not what they seem. A similar trend occurred in the USA over a decade ago and the thousands of surgeons who subscribed to it rapidly found themselves with insurance companies telling what they could and couldn't to with their patients and essentially enslaved to bureaucrats. Private health care in Australia is still very much physician led and it needs to remain that way. I do in fact subscribe to these schemes on a very limited basis so that I can look after patients with complications without having to charge extra out of pocket expenses. Frequently health funds refuse to pay for services for 12 months or more which is another reason these schemes are poorly subscribed to.

Outside of 'extras', health funds only pay for services which occur as an inpatient in hospital. Therefore, there is no health fund rebate for clinic consultations, outpatient radiology procedures or physiotherapy for example. If you are having surgery then the health fund will pay for the theatre fees (often in excess of $15,000), implants (often reaching $40,000 or more for complex spine surgery), hotel fees of the hospital ($1000+ / night) and it pays 25% of the Medicare rebate fee for the surgery. Therefore, your health fund does in fact pay a large sum for your surgery - bills which you may never even see.

Dr Neil Cleaver

I have never been successfully sued for negligence or malpractice.

It varies but in 2016 I performed 180 disc replacements. About 70% lumbar and 30% cervical.