Spine procedures and services, organized by what they do

Procedure categories

Synergy’s procedure menu sorts into four broad categories. Endoscopic spine surgery — decompression of compressed nerves through small portals, without fusion. Image-guided interventional procedures — diagnostic blocks, epidural injections, radiofrequency rhizotomy. COOLIEF cooled radiofrequency — for joint pain (knee, hip, shoulder) and spine-mediated pain. Diagnostic procedures — selective nerve root blocks, facet blocks, SI joint injections.

The right procedure for any patient depends on what’s causing the pain. Most patients arriving at the practice undergo a careful workup before any treatment is recommended — including MRI review, sometimes diagnostic blocks, and clinical examination correlating with imaging.

Endoscopic spine surgery

The core procedure category at Synergy. Full-endoscopic technique uses an incision less than ⅓ inch, continuous saline irrigation for visibility, and small instruments to remove offending disc material or decompress narrowed canals.

Specific procedures: endoscopic discectomy, transforaminal endoscopic discectomy, interlaminar endoscopic decompression, endoscopic foraminotomy, lumbar endoscopic surgery, cervical endoscopic surgery, thoracic endoscopic surgery, percutaneous discectomy, awake spine surgery, revision spine surgery.

COOLIEF cooled radiofrequency

COOLIEF uses cooled radiofrequency to create larger, more uniform nerve lesions than standard RFA — interrupting pain transmission from joints and certain spine-mediated sources for 6-18 months per treatment, repeatable when symptoms return.

Specific applications: COOLIEF knee (genicular nerves), COOLIEF hip, COOLIEF shoulder, COOLIEF for back pain (medial branch), COOLIEF SI joint (lateral branch).

Diagnostic & image-guided procedures

Before any therapeutic procedure, the source of pain has to be identified accurately. Diagnostic blocks anesthetize specific structures to confirm them as pain sources. These have both diagnostic value (identifying the source) and sometimes therapeutic value (extended relief from accompanying corticosteroid).

Specific procedures: diagnostic nerve block, epidural steroid injection, facet joint injection, SI joint injection, medial branch block, endoscopic rhizotomy, spinal cord stimulation evaluation.

Where each procedure fits

Procedure selection isn’t arbitrary. It follows from the diagnosis. A herniated disc compressing a nerve root → endoscopic discectomy. Confirmed facet-mediated axial pain → radiofrequency rhizotomy. SI joint pain confirmed by diagnostic injection → COOLIEF lateral branch ablation. Central canal stenosis without instability → endoscopic decompression.

The conditions index at /conditions/ maps the other direction — from condition to appropriate procedure. The two indexes work together.

Written bySteven Lockhart, Healthcare Marketing Group

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

Endoscopic spine procedures

The core surgical services are full-endoscopic spine procedures — performed through incisions less than ⅓ inch, under local anesthesia with sedation, outpatient. Most common: endoscopic discectomy for herniated discs, endoscopic decompression for stenosis, endoscopic foraminotomy, transforaminal endoscopic discectomy, and interlaminar endoscopic decompression. Anatomical-level approaches available for cervical, lumbar, and (selectively) thoracic spine. Philosophy: decompression before fusion when appropriate — see /no-fusion-promise/.

Interventional pain procedures

Beyond endoscopic surgery, the practice offers interventional pain procedures for patients who aren’t surgical candidates or for whom less invasive options are appropriate first-line: epidural steroid injections, facet joint injections, facet rhizotomy, endoscopic rhizotomy, diagnostic nerve blocks. Dr. McMillan’s University of Pennsylvania IPM fellowship informs the interventional side.

COOLIEF cooled radiofrequency procedures

The practice offers COOLIEF cooled radiofrequency ablation for joint and spine pain where conservative care has been inadequate but surgical replacement isn’t appropriate. FDA-cleared. Procedure-specific pages: knee osteoarthritis, hip pain, shoulder pain, back pain, SI joint. Pricing at /coolief-cost/.

What the practice does NOT do

The practice does not perform spinal fusion procedures. Patients whose anatomy genuinely requires fusion receive referral guidance to qualified fusion surgeons. Candor is structural — see /no-fusion-promise/. The practice also does not perform total joint replacement (knee, hip, shoulder); for end-stage joint disease, orthopedic referral is appropriate.

How to think about which procedure applies to your situation

Patients researching spine procedures often encounter a bewildering catalog of options — laminectomy, laminotomy, discectomy, microdiscectomy, endoscopic discectomy, foraminotomy, facetectomy, fusion (with many subtypes), disc replacement, and various minimally invasive variations. Understanding the differences is easier when the procedures are organized by what problem they solve rather than by their technical names. Three broad categories cover most spine surgical work: (1) removing tissue that’s compressing nerves (decompression), (2) removing damaged disc material (discectomy), and (3) stabilizing vertebrae (fusion). Most spine procedures fit within one or more of these categories.

Decompression procedures address the problem of nerves being compressed by surrounding tissue — most commonly overgrown bone from arthritis, thickened ligaments, or narrowed foramina from disc height loss. The clinical presentation is typically radicular pain, numbness, weakness, or (for central canal stenosis) neurogenic claudication. Endoscopic decompression accomplishes the same clinical goal as open decompression but through a smaller incision with less surrounding tissue disruption. See /endoscopic-decompression-stenosis/ for the primary decompression procedure detail.

Discectomy procedures address the problem of herniated disc material compressing nerve roots. The clinical presentation is typically acute radicular pain following a specific injury or gradual onset. Endoscopic discectomy accomplishes the same clinical goal as microdiscectomy (which is the current standard for open discectomy) but through a smaller incision. See /endoscopic-discectomy/ for the primary discectomy procedure detail. Specific approaches include transforaminal and interlaminar depending on anatomy.

Fusion procedures address the problem of vertebral instability — vertebrae that slip, shift, or move abnormally under normal loading. The practice does not perform fusion procedures; patients with genuine fusion indications receive referral to qualified fusion surgeons. The clinical judgment of whether a specific case needs fusion or decompression comes down to imaging findings (presence of instability, slip grade, alignment) and physical examination — see /no-fusion-promise/ for the practice’s approach to that judgment. For pain conditions that don’t cleanly fit these categories — chronic axial back pain without clear structural cause, complex regional pain syndromes, failed prior surgery — the interventional pain toolkit (injections, rhizotomy, SCS evaluation) becomes relevant.

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:

• Conditions Hub — details, indications, and process context relevant to the topic above.
• Endoscopic Spine Surgery Hub — details, indications, and process context relevant to the topic above.
• COOLIEF Hub — details, indications, and process context relevant to the topic above.
• Our Philosophy — details, indications, and process context relevant to the topic above.
• The Evidence — details, indications, and process context relevant to the topic above.
• Transparent Pricing — 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.
• FDA — 510(k) Device Database — 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/.