Process
How it works, step by step
First MRI submission to post-operative follow-up. The actual sequence patients experience, with realistic time estimates at each step.
Step 1 — Submit your MRI for free review
The process starts with the free MRI review. Patients send a copy of recent MRI imaging by mail or upload it through a secure portal. Dr. McMillan personally reviews the imaging and a brief clinical history.
Time required: 15-20 minutes to gather imaging and complete the brief intake form. Review turnaround: typically within several business days. There’s no charge and no obligation; the goal is to determine whether you might be a candidate before you invest further time or travel.
Step 2 — Phone consultation
If the MRI review suggests you might be a candidate for one of the procedures Synergy offers, the next step is a phone consultation. This is a substantive conversation: review of your symptoms, the imaging findings, what procedure might be appropriate, and what the typical experience looks like.
Time required: typically 30-45 minutes. The consultation includes time for your questions and an honest assessment of options. If a Synergy procedure isn’t the right answer for your situation, that’s what you’ll be told.
Step 3 — Schedule in-person consultation and procedure
For appropriate candidates who want to proceed, the next step is an in-person consultation followed by the procedure. Out-of-town patients typically combine consultation and procedure into a single travel trip — see the 3-day plan for the typical cadence.
The consultation fee is $250, credited toward the procedure if you proceed. Procedure pricing is the published bundled rate for the specific procedure planned — $15,000 for lumbar endoscopic, $16,000 for cervical, $6,000 for percutaneous discectomy, and individual pricing for COOLIEF procedures.
Step 4 — Day of procedure
The procedure day begins with check-in and final pre-procedure preparation. The procedure itself is performed under local anesthesia with light sedation. Most full-endoscopic procedures take approximately one hour. The incision is less than ⅓ inch.
Recovery room time is typically 30-60 minutes; total time at the facility is usually 3-5 hours. Same-day discharge is standard. You’ll need a companion to drive you to your lodging or home (you can’t drive yourself the same day due to the sedation).
Step 5 — Early recovery and follow-up
Most patients are walking within hours of the procedure and notice meaningful symptom improvement within 2-5 days. Pain reduction develops over the first 1-2 weeks as the previously compressed nerve recovers. Heavier activity progresses over the following weeks.
Follow-up is typically a combination of in-person (if you’re local) or remote (phone, video, secure messaging) appointments. Imaging follow-up at typical intervals is coordinated with local providers for out-of-town patients. The bundled procedure price includes routine post-operative follow-up within the standard period.
Step 1: Free MRI review (before any travel or financial commitment)
Every patient relationship begins the same way: the free MRI review. Submit imaging through the secure online portal or by mail using the process at /mri-review-by-mail/. Dr. McMillan personally reviews each submission. The review identifies whether imaging supports endoscopic intervention, what procedure is appropriate, and approximate bundled price. Turnaround 3-5 business days. No charge, no obligation.
Step 2: Phone consultation (free, 30-45 minutes)
If the MRI review identifies you as a candidate, the next step is a phone consultation with Dr. McMillan covering symptoms in detail, the specific procedure recommended, expected outcomes, recovery timeline, and full pricing. Patients are encouraged to bring questions — particularly comparing to fusion or open surgery alternatives. No charge. For patients pursuing a second opinion after a fusion recommendation elsewhere, this is where the comparison conversation gets concrete.
Step 3: In-person visit (1-3 days for most patients)
For patients who decide to proceed, the in-person visit combines pre-operative evaluation, procedure, and post-operative follow-up. Out-of-town patients typically follow the 3-day plan — arrival evening before, in-person consultation and pre-op day 1, procedure day 2, post-op evaluation and departure day 3. Procedure takes about an hour, performed outpatient under local anesthesia with sedation.
Step 4: Recovery and follow-up
Most patients are walking within hours of the procedure and notice meaningful relief within 2-5 days. Office workers typically return to work 1-2 weeks; manual labor 4-6 weeks. Routine follow-up is included in the bundled price and conducted by phone, video, or secure messaging for out-of-town patients. Imaging follow-up, if needed, is coordinated with local providers. Complications (rare) are addressed remotely when possible.
What to expect if you’re a candidate versus not
The clinical outcomes of the MRI review process fall into three broad categories, and understanding which category applies to you shapes the next steps. Category 1: Clear candidate for a specific procedure. Your imaging shows pathology that endoscopic surgery can address, your symptoms match the imaging findings, and the specific procedure being recommended has a strong evidence base for your specific pathology. This is the most common outcome for patients whose imaging shows single-level lumbar herniated disc with radiculopathy, single-level lumbar stenosis with neurogenic claudication, or foraminal stenosis with unilateral radiculopathy. Next step is the phone consultation and, if you decide to proceed, scheduling the in-person visit.
Category 2: Not a candidate for endoscopic surgery — fusion or alternative recommended. Your imaging shows pathology that requires fusion (significant instability, severe spondylolisthesis, scoliotic curve progression) or a different intervention entirely (spinal cord stimulator, intrathecal therapy, non-spinal source of symptoms). The review response will typically include referral guidance — often to specific fusion surgeons the practice knows and trusts, or to appropriate subspecialists. This outcome is more common than patients expect because many patients arrive assuming endoscopic surgery is universally applicable; it isn’t, and the review honestly identifies who benefits from it and who doesn’t.
Category 3: Diagnostic ambiguity — additional workup recommended before surgical commitment. Your imaging shows pathology but the connection between the imaging findings and your symptoms isn’t clear. Common examples include multi-level degenerative changes where the pain-generating structure isn’t obvious, cases where diagnostic injections would clarify which structure is contributing to symptoms, or cases where updated imaging is needed because the existing imaging is old or of poor quality. The review response identifies what additional workup would resolve the diagnostic question — often this involves diagnostic discography, diagnostic nerve blocks, or repeat imaging.
For all three categories, the practice’s response is written and specific — not a generic “please schedule a consultation” message. Patients in Category 1 have clear direction for scheduling; patients in Category 2 have specific referral guidance; patients in Category 3 have specific diagnostic recommendations. The honesty about which category applies is what makes the review clinically useful rather than just a marketing intake step. Full pricing context for Category 1 patients is at /transparent-spine-surgery-pricing/.
Further reading and authoritative sources
The pages linked below cover related topics in more detail. For patients who prefer independent, non-practice sources, the external references at the end of the list provide authoritative verification of clinical facts, procedural information, and regulatory context. This practice’s clinical statements are traceable to the peer-reviewed literature and professional-society guidelines listed here.
Related pages on this site:
- Free MRI Review — details, indications, and process context relevant to the topic above.
- 3-Day Plan — details, indications, and process context relevant to the topic above.
- Out-of-Town Patients — details, indications, and process context relevant to the topic above.
- MRI Review by Mail — details, indications, and process context relevant to the topic above.
- Medical Travel Cost — details, indications, and process context relevant to the topic above.
- Practice Location — details, indications, and process context relevant to the topic above.
Independent authoritative sources:
- ACR Appropriateness Criteria — authoritative independent source for verification and further reading.
- NASS Patient Resources — authoritative independent source for verification and further reading.
For patients whose questions extend beyond the material covered here, the direct path forward is the free MRI review for candidacy-specific questions or a phone call to (864) 886-9888 for process or logistics questions. The practice’s broader clinical philosophy — including the reasoning behind the no-fusion-first orientation and the single-surgeon model — is documented at /our-philosophy/.
Frequently asked
How long does the whole process take?
From first MRI submission to procedure day is typically 4-8 weeks depending on scheduling. The procedure itself takes about an hour; total facility time is 3-5 hours. For candidacy assessment specific to your imaging, the free MRI review is the practical starting point.
Can the whole process be done remotely?
MRI review, phone consultation, and most follow-up can be remote. The procedure itself requires in-person presence. For step-by-step process context, see /how-it-works/.
What if I’m not a candidate?
You’ll be told that clearly. If the issue isn’t appropriate for the procedures we offer, we’ll explain why and suggest where to look next. Verifiable credentials and background are at /credentials-and-training/.
Do I need to stop my medications before the procedure?
Specific medication guidance depends on what you’re taking. The pre-procedure instructions cover this in detail; certain blood thinners and anti-inflammatories need to be paused beforehand. For candidacy assessment specific to your imaging, the free MRI review is the practical starting point.
How soon can I fly home after the procedure?
Typically the day after the procedure at the earliest, often 2 days after. The standard is at least one night locally before flying. For candidacy assessment specific to your imaging, the free MRI review is the practical starting point.
What’s the typical out-of-pocket cost?
Self-pay patients pay the bundled procedure price. Insured patients face plan-specific out-of-pocket exposure that varies; the office can help estimate. For step-by-step process context, see /how-it-works/.
