Our philosophy, five principles that drive every decision

1. The smallest operation that addresses the problem

Spine surgery has trended toward larger procedures over the past several decades — partly because techniques and instrumentation made them possible, partly because reimbursement structures rewarded them, partly because patient expectations followed surgical capability. Fusion rates increased substantially even for conditions where decompression alone was historically sufficient.

Our principle: the smallest operation that addresses the specific anatomical problem is generally the right answer. For a single disc herniation compressing a nerve, that’s discectomy — not fusion. For focal foraminal stenosis, that’s foraminotomy — not multilevel decompression with instrumentation. For confirmed facet pain, that’s rhizotomy — not a fusion construct. Bigger isn’t better; appropriate is better.

2. Transparent pricing

Healthcare’s traditional billing model creates financial uncertainty during medical decision-making. Patients facing surgery often don’t know what their procedure will actually cost until weeks afterward, when bills from facility, anesthesia, surgeon, and ancillary services arrive separately.

Our principle: pricing should be specific and disclosed before scheduling. The 2026 rates are published: $15,000 lumbar endoscopic, $16,000 cervical endoscopic, $6,000 percutaneous discectomy, $3,000 COOLIEF knee, $4,000 COOLIEF hip, $3,000 COOLIEF shoulder. The bundle includes surgeon, facility, anesthesia, and routine follow-up. Patients can plan financially because the number is known.

3. Single-surgeon practice

Endoscopic spine technique has a real learning curve. Volume correlates with outcomes; the relationship is well-established in the surgical literature. A practice with multiple surgeons rotating through divides volume across providers, reducing each surgeon’s case load below the threshold where outcomes stabilize.

Our principle: single-surgeon practice. Dr. McMillan performs every procedure at Synergy personally. This isn’t a marketing claim — it’s a structural choice with consequences. The trade-off is scheduling capacity: there are limits to how many procedures one surgeon can perform per week. We accept that constraint because the alternative is dilution of surgical experience.

4. Evidence-driven candidacy

Not every patient is appropriate for endoscopic decompression. Anatomy varies; pathology varies; sometimes a different approach is genuinely better; sometimes no surgery is the right answer. A practice committed to a specific technique can drift toward applying it more broadly than evidence supports.

Our principle: candidacy is established by MRI review and clinical correlation before scheduling. Patients who aren’t good candidates are told so directly, not steered into a procedure that won’t help them. The free MRI review by mail is partly logistics, partly a screening step — patients learn whether they’re candidates before booking travel.

5. Honest second opinions

Many patients arrive at Synergy after being told fusion is the only option elsewhere. Sometimes that’s correct; sometimes it isn’t. Our role in those conversations is to give patients the most accurate possible picture of their options, including options we don’t offer ourselves.

Our principle: second opinions are given candidly. If endoscopic decompression isn’t appropriate for your situation, we’ll tell you. If a different surgeon or different technique is the better fit, we’ll suggest it. The goal isn’t to convert every consultation into a surgical case — it’s to give patients accurate information they can use to make the right decision for themselves.

Written bySteven Lockhart, Healthcare Marketing Group

Medically reviewed byMarion R. McMillan, MD, Interventional Pain Medicine & Endoscopic Spine Surgery

Decompression before fusion — the philosophical core

The defining commitment at Synergy Spine Center is that spinal fusion should be reserved for patients with genuine indications — typically significant instability, slippage beyond a threshold, or deformity — rather than reflexively recommended for stenosis or herniated disc that targeted decompression can address. This isn’t a fringe position. NASS clinical guidelines explicitly distinguish between conditions requiring fusion and conditions that can be addressed by decompression alone. The explicit policy is at /no-fusion-promise/.

The single-surgeon model

Spine surgery literature consistently demonstrates volume-outcome relationships at the individual operator level. The practice operates as a single-surgeon model because of this finding: Dr. McMillan personally performs every endoscopic procedure and reviews every MRI. No fellows, no junior associates performing primary surgical work. Structural choice, not marketing. Credentials at /credentials-and-training/.

Transparent pricing as ethical practice

The U.S. healthcare system permits — arguably encourages — opaque pricing where patients receive multiple bills from multiple providers without prior visibility into total cost. The practice publishes its 2026 procedural rates openly at /spine-surgery-cost-transparent-pricing/ because the alternative — quoting an estimate and letting patients discover the actual number through invoices — is incompatible with informed consent. The federal No Surprises Act codifies similar principles for emergency care; this practice extends the principle to elective spine surgery.

Candidacy before commitment

The free MRI review exists because the alternative — patients traveling cross-country before knowing whether they’re candidates — wastes patient time and money. The review screens candidacy in advance, delivers written assessment, and recommends specific procedures or alternative referrals before any travel commitment. Patients who aren’t candidates are told directly, often with referral guidance. This is screening, not sales.

How the philosophy shapes daily clinical decisions

The gap between philosophical commitment and daily clinical practice is where medical practices either establish or lose credibility. At Synergy, the practical expression of the philosophy shows up in specific decisions: which patients get told they’re not candidates and referred elsewhere, which patients get scheduled for procedures, and how pricing is quoted. Patients who arrive expecting a specific procedure sometimes receive a different recommendation — a patient hoping for endoscopic decompression may be told their imaging actually shows pathology that fusion would address better, and they’re referred out. Patients who arrive skeptical of surgery sometimes get told that conservative care alone is unlikely to resolve their pathology and that endoscopic intervention is the appropriate step.

The candor extends to unfavorable answers. Not every patient benefits from the procedures the practice offers. Some patients have pathology that endoscopic surgery cannot address — for example, significant spondylolisthesis with instability, severe deformity, or pathology in anatomically inaccessible locations. Some patients have comorbidities that make elective spine surgery risky enough that continued conservative care is the better path. Some patients have symptom patterns that don’t fit their imaging findings well, which usually signals that additional diagnostic workup is needed before surgical commitment. In each case, the practice’s response is honest disclosure rather than proceeding with a procedure that may not help.

The transparent pricing at /spine-surgery-cost-transparent-pricing/ is the philosophy applied to the financial side. The bundled prices published there are what patients pay — not “starting at” quotes that get supplemented by facility fees, anesthesia fees, or implant charges billed separately. The number you see is the number you owe. Patients who receive quotes from other practices that seem substantially lower should ask directly what’s included versus what will be billed separately by other providers; the practice’s cash vs. insurance comparison covers this in detail.

The single-surgeon model, the transparent pricing, the candid candidacy assessment, and the no-fusion-first orientation are all expressions of the same underlying idea: the practice’s incentives should align with the patient’s outcomes, not with volume, throughput, or revenue optimization. This is easier said than done in U.S. healthcare — most practice structures create at least some misalignment. Making the alignment structural rather than aspirational is what the practice attempts through the specific choices documented here and at /dr-marion-mcmillan/.

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:

• About Dr. McMillan — details, indications, and process context relevant to the topic above.
• Credentials & Training — details, indications, and process context relevant to the topic above.
• The Evidence — details, indications, and process context relevant to the topic above.
• Our Philosophy — details, indications, and process context relevant to the topic above.
• The No-Fusion Promise — details, indications, and process context relevant to the topic above.
• Patient Stories — details, indications, and process context relevant to the topic above.

Independent authoritative sources:

• NASS — North American Spine Society — authoritative independent source for verification and further reading.
• CMS — No Surprises Act — 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/.