Webinar: Laminectomy vs. Discectomy: Options for Back Pain

If your back pain is caused by pressure on a disc somewhere in your spine, a minimally invasive procedure such as a laminectomy or discectomy can be very effective treatment options. Join ONS Neurosurgeon, Dr. Amory Fiore, as he explains the difference between the two surgeries and what will determine if one of them is right for you.  Q &  A. Free.

Please register.

The Low Down on Low Back Pain


Did you know that 80 percent of Americans experience low back pain at some point in their lifetime? According to neurosurgeon Dr. Scott Simon of Orthopedic and Neurosurgery Specialists in Blog sizeGreenwich and Stamford, the majority of low back pain is due to a lower back muscle and ligament strain or sprain.

“This type of low back pain usually occurs as muscles tighten after exercise or other exertions,” he said, adding that stress has also been shown to make people more susceptible to episodic low back pain. Avoiding sudden lifting away from your body and stretching before or after exercise can often help prevent pain.

In most cases, back pain from strains or sprains lasts two to five days. It is best treated with heat and anti-inflammatory medication such as Naprosyn or ibuprofen. In the vast majority of cases, the pain subsides on its own without the need for additional treatment. Even as the pain dissipates, however, Dr. Simon recommends easing back into exercise. “Re-injury can occur if the muscles and ligaments are still healing,” he said.

Despite the claims of manufacturers, there is no conrete evidence supporting the use of a product to prevent or treat back pain.  “The best mattresses, pillows or chairs are the ones that are most comfortable according to the needs and prefences of the individual,” Dr. Simon explained.

Those who experience back pain that lasts longer than a week or produces leg pain, weakness, numbness or tingling sensations may have a more serious problem and should seek medical attention. Pain that radiates down one or both legs may be due to nerve irritation or pinching from either a disc herniation or arthritis. In the majority of these conditions, patients can be treated with physical therapy

Anyone should see a doctor immediately if the low back pain is a result of trauma or if the pain is accompanied by any of the following symptoms:

  • Fever and chills

  • Significant leg weakness

  • Sudden bowel and/or bladder incontinence

  • Difficulty passing urine

  • Severe continuous abdominal pain

Finishing First Following Spine Surgery


Amanda Miller has been running the 5-mile Jim Fixx Memorial Day Run in downtown Greenwich for as long as she can remember.  “That race is my annual barometer. It tells me where I am with Amanda Miller Race 3 webmy running and it kicks off my summer running season,” explained the 50 year old real estate agent and mother of three.  This year’s run was particularly triumphant.  Amanda ranked first in her age group with a 39:46 minute finish and 11th among women runners of all ages.  Her triumph, though, was the fact that she could run the race at all.  A herniated disc and subsequent back surgery in 2015 could have kept her on the sidelines indefinitely.

Amanda is married to ONS orthopedist and shoulder surgeon, Seth Miller, MD, so she didn’t have to look very far to find one of the top spine surgeons in the state.  “I give all the credit to my doctor, Paul Apostolides.  He gave me confidence that I’d be able to run again,” she said. Six months after surgery, Amanda was back on the road.

Amanda has had a lifelong passion for running distances, competing with herself to run faster or further with each race. In the fall of 2014, she achieved a personal goal by running in the New York City Marathon.  However, in many ways this year’s Memorial Day race was a sweeter accomplishment.  “By finishing the race in less than 40 minutes, I am running at nearly the same pace I was before the surgery,” she said. “I’ve always known that ONS is among the best practices in the tri-state area because of how consistently high the doctors are in the rankings, but now I’ve lived through it myself. I’m so grateful.”

ONS Physicians Open State-of-the-Art Ambulatory Surgery Center


The Stamford ASC has recently received Connecticut State Department of Health approval for license and is now open for physicians to treat patients. Stamford ASC specializes in musculoskeletal surgeries and interventional pain management. The center includes two surgical suites built specifically for orthopedic and neurosurgical procedures, equipped with the latest arthroscopic and computer-assisted technology. The facility also has a procedure room for interventional pain management, a comfortable waiting room, and pre-operative and post-operative areas designed for utmost safety, comfort and efficiency. The technologically advanced surgery center offers patients access to the same arthroscopic and open surgery options found in a hospital setting but in a smaller, more comfortable environment.
Entrance 2 (2)

The warm surroundings of the center and emphasis on caring, individualized attention minimizes the stress often associated with surgery. Patients are released within hours of their procedure so they may complete their recovery in the comfort of home. Covered parking and a ground level entrance help make the patient experience as easy and convenient as possible.
“The Stamford ASC is the result of several years of research and planning, which began when ONS partners with a shared mission set out to build an industry-leading surgical care facility,” said Mark Camel, M.D., one of the Stamford ASC partners.

Formed by 14 experienced and respected orthopedic surgeons and neurosurgeons affiliated with Orthopaedic and Neurosurgery Specialists (ONS) in Greenwich and Stamford CT, the Stamford ASC reflects the standard of excellence that patients have come to expect from surgeons at ONS. “In the current healthcare environment, patients are looking for a more personalized surgery experience that is first and foremost, safe and efficient,” said Dr. James Cunningham, Medical Director of Stamford ASC. “This center will provide service that meets, if not exceeds, the most stringent Government safety requirements and infection controls.” The center was surveyed and approved by the Connecticut State Department of Health earlier this month.

“High quality outpatient facilities such as Stamford ASC best position physicians for healthcare industry challenges by combining cost efficiency with cutting edge technology and a new kind of patient experience,” said Dr. Cunningham. “I fully expect that the Stamford ASC will set the standard for efficient, cost-effective and patient-focused care in the region.”

Read the local press coverage in Greenwich Time and on the Daily Voice

ONS Sports Medicine Specialists and Orthopedic Surgeons awarded 2nd place at The American Orthopaedic Society for Sports Medicine Meeting for “Incidence of Culture Positive Propionibacterium Acnes in Shoulder Arthroscopy”


The American Orthopaedic Society for Sports Medicine (AOSSM) was founded primarily as a forum for research and education for orthopedic surgeons, physicians and health care professionals in the field of sports medicine. Each year the AOSSM holds a conference to highlight areas of recent research, surgical techniques and to debate and share clinical insights about hot topics in the field of sports medicine. Physicians are recognized and awarded for their efforts in research and presentations about sports medicine conditions.

At the annual AOSSM meeting held in Seattle, Washington this July 10th-13th, ONS orthopedic surgeons Timothy Greene, MD, Katie Vadasdi, MD, director of the ONS Women’s Sports Medicine Center and Paul Sethi, MD, President of the ONS Foundation for Clinical Research and Education, were awarded 2nd place for research presented on “Incidence of Culture Positive Propionibacterium Acnes in Shoulder Arthroscopy.” This research is best described in a statement below from Dr. Paul Sethi:

“As the field of shoulder surgery and, particularly, shoulder replacement grows, the risk of developing shoulder infection increases. When treated imperfectly, infection may cause devastating complications. Our goal is to help develop a universal measure to absolutely minimize post-surgical infection. Reducing complications adds value to patient experience and avoids the costly road of infection eradication. The bacterium (Proprionibacter Acnes) most commonly attributed to shoulder infection is a very unusual organism. Until recently, it was not properly recognized because it was so difficult to identify.

Now that one of the greatest bacterial offenders (in the shoulder) has been more clearly identified, we are looking for ways to prevent it from infecting patients. In our last study we took over three hundred cultures and studied them. After careful analysis, we were able to identify when (during surgery) patients are most susceptible to this bacterial infection and were able to determine just how frequently this bacteria is present. Now that we know when this bacterium may gain its access to patients, we are developing ways to attack it at the patient’s point of vulnerability.”

Paul Sethi, MD
Paul Sethi, MD
Katie Vadasdi, MD
Katie Vadasdi, MD
Timothy Greene, MD
Timothy Greene, MD

Sethi PM, Greene T, Vadasdi K, Miller S.  Incidence of P. Acnes Culture after Primary Shoulder Arthroscopy.  AOSSM Annual Meeting. Seattle, WA. July 2014

Posters are judged by the AOSSM Education Program Committee. With just three poster awards available, we congratulate our physicians on their research and 2nd place award.

ONS Foundation Awarded 2nd Place in AOSSM Poster Contest
ONS Foundation Awarded 2nd Place in AOSSM Poster Contest

For more information on the AOSSM Annual Meeting, please click here: http://www.sportsmed.org/Education/Meetings/Annual_Meeting_2014/2014_Annual_Meeting/


Orthopaedic and Neurosurgery Specialists PC (ONS) is an advanced multi-specialty orthopedic and neurosurgery practice in Greenwich, CT. ONS physicians provide expertise in sports medicine, minimally invasive orthopaedic, spine and brain surgery, joint replacement and trauma. For more information, please visit www.onsmd.com.



Looks like more snow is in the forecast, we have some skiing tips for you!

skierThe knee is the most vulnerable body part for any athlete, including skiers. Downhill skiing produces large amounts of torque on the knee, challenging the integrity of ligaments and tendons. Whether from a fall or overuse, the most common injuries in skiers are tears to the MCL (Medial Collateral Ligament) or ACL (Anterior Cruciate Ligament), two important structures that give our knee stability.  When a skier is thrown off balance, his skis will sometimes shoot out in front of him, creating extra torque on the knees and damaging our stabilizing structures.

Both novice and experienced skiers are at risk of hurting their knees. We frequently see novice skiers hurt themselves when they do not know how to turn, stop or fall properly. Taking lessons and working with an instructor goes a long way in preventing knee injuries for beginner skiers. Experienced skiers frequently take risks and assume that they can manage faster speeds on any slope.  Many injuries, whether you are a beginner or an experienced skier, are related to weather conditions. It is important to realize that as visibility and surface conditions deteriorate, the slope or trail level goes up. In poor visibility or icy conditions, a beginner trail becomes an intermediate trail, and an intermediate slope becomes advanced slope. Keep injury prevention in mind, if the conditions are difficult, ski down a level.

A second reason injuries occur is fatigue. Most skiers’ bodies are not accustomed to exercising 6-8 straight hours. In addition, many skiers push their bodies to take advantage of the whole day, even when they start to feel tired and stiff.  For this reason, injuries tend to happen at the end of the day.

Having the knowledge of what places skiers at a higher risk for knee injuries, we are passing on recommendations about how to stay safe on the slopes.  Both beginners and experienced skiers can benefit from these tips!

  1. Start a conditioning program a few months before your first ski trip. Leg strengthening, flexibility and balance are important aspects of an adequate ski conditioning program.
  2. Ski with good technique. Maintain your balance and control, keep your hips above your knees, keep your arms forward, and maintain a safe speed.
  3. Learn how to fall correctly: keep your legs together, keep your chin to your chest and your arms up and forward.
  4. Pay attention to weather conditions and remember to ski down a level if conditions deteriorate.
  5. Listen to your body. If you start to feel pain or stiffness upon exiting the lift chair, then you should probably make that run your last. Head to the lodge and enjoy a warm drink by the fire.

Good luck and stay warm!

If you become injured, while skiing, remember, ONS sports medicine physicians are trained at the top universities and hospitals in the country and have expertise in the latest treatments for sports-related injuries in high-performance and recreational athletes.

Orthopaedic and Neurosurgery Specialists, PC (ONS) physicians provide expertise in the full spectrum of musculoskeletal conditions and injuries, sports medicine, minimally invasive orthopedic, spine and brain surgery, joint replacement and trauma. The main office is located at 6 Greenwich Office Park on Valley Road, Greenwich, CT. For more information, visit https://onsmd.com/ or call 203.869.1145.


Wide variety of spinal disorders treated at the ONS Spine Center

The large majority of people in the United States will have some type of spinal disorder but most will recover completely with nonsurgical treatments. The first line of treatment after a full evaluation should be conservative measures like physical therapy, medications, injections or even acupuncture. If a patient does not improve using conservative treatments, spinal surgery may be an option.

The ONS Spine Center is made up of a team of highly-skilled and experienced neurosurgeons who specialize in the full spectrum of non-operative spine treatments and operative spine treatments. From diagnostic imaging to physical therapy to therapeutic spinal injections to the most advanced surgical techniques including Minimally Invasive Spine Surgery, our Spine Center offers premier and comprehensive spine care.

“Does Laser Spine Surgery Work?”


…a question often asked by our patients.

Here’s the answer:

Spine surgery is typically done to relieve pain and other symptoms by decreasing pressure on a compressed nerve or by stabilizing the spine.  In the case of a herniated or ruptured disc, a discectomy may be done to remove the damaged portion of a disc in the spine; or a laminectomy may be done to remove bone spurs or other spinal growths. In cases where the spine is unstable, a spinal fusion can be performed to secure together two or more of the vertebral bones so that they “fuse” together.  These surgeries are now often performed using minimally invasive techniques that minimize damage to the surrounding tissue and allow for a faster recovery with much less blood loss. Laser spine surgery is often promoted as being minimally or even noninvasive and risk-free.  However, these laser spine procedures do require incisions and the laser itself can result in serious complications.

Laser spine surgery has never been studied in a controlled clinical trial to determine its effectiveness. Marketing pitches for spine surgery performed with a laser often make bold promises of pain relief for chronic neck and back pain and a quick return to normal life; sometimes in a matter of days. What is often not clear from marketing hype, is that laser spine surgery does actually involve surgery.  An incision is required to allow access to the spine.  A focused beam of light (laser) is then used only to remove the soft tissues over the spine.   Bone and ligament are then removed in order to free the nerve from compression using small instruments.  The laser in laser spine surgery actually plays a very minor role.

Lasers are certainly not new technology.  Lasers have been available for use in medicine since 1973.  However, they have not been widely adopted as a tool to be used in spinal surgery.  The fact is that most neurosurgeons do not use or recommend the use of lasers for spine surgery because there are no clear benefits and there are other well-established and documented studies proving the effectiveness of more modern and established spine surgery techniques.

The Importance of a Proper Diagnosis

It is important to have a proper diagnosis of your problem before deciding to undergo spine surgery.  Most cases of back and neck pain are muscular in origin and do not require or benefit from surgery. Unless severe pain or muscle weakness is making walking or performing daily activities extremely difficult, surgery is rarely the first line of treatment. Anti-inflammatory medication, physical therapy and exercise, lifestyle changes and other noninvasive treatment modalities such as therapeutic massage are often successful at resolving back and neck pain.

If conservative treatments fail to reduce back pain, then surgery may be necessary, depending on your diagnosis. For example, if you have a herniated disk with leg or arm pain as a major symptom that hasn’t been relieved with other treatments, discectomy may be appropriate. If surgery is recommended, get a clear explanation of your diagnosis and how the surgery will help relieve your symptoms.

Traditional spine surgery has been tested in numerous clinical trials.  The vast majority of patient who undergo discectomy for treatment of a herniated disc experienced relief from pain and other symptoms.  In elderly patients diagnosed with spinal stenosis, laminectomy is also a highly effectively procedure. Very few neurosurgeons regard laser spine surgery as a viable alternative to conventional spine surgery techniques. ONS neurosurgeons do not use or recommend laser spine surgery.

Mayo Clinic Opinion on Laser Spine Surgery


In the News!

ONS Collaborates with Greenwich Hospital in Joint Venture
Greenwich Time, June 7, 2011

Orthopedic surgeon and sports medicine specialist Dr. Paul Sethi at the Orthopedic and Neurosurgery Center on Holly Hill Lane in Greenwich, CT
Orthopaedic surgeon and hand specialist Dr. John Crowe of ONS in Greenwich.


Orthopaedic and Neurosurgical Center of Greenwich now Operational

ONS and Greenwich Hospital collaborate in surgical joint venture

Greenwich Hospital and Orthopaedic & Neurosurgery Specialists, PC (ONS) recently announced a joint ven­ture agreement that will enhance access and improve the quality of orthopedic and neurosurgical care for area residents. Beginning this month, ONS surgeons are performing same-day surgical procedures, one day a week, at the Leona M. and Harry B. Helmsley Ambulatory Surgical Center at 55 Holly Hill Lane, Greenwich. The Center will operate under the name, Orthopaedic and Neurosurgical Center of Greenwich, LLC.

”We are very excited about our new relationship with the hospital,” said ONS President Dr. John Crowe.

“ONS and Greenwich Hospital are at the forefront of the evolution of healthcare. Across the country, physician groups and hospitals are combining their resources to provide more convenient and better care for patients. The partnership with Greenwich Hospital in the Ambulatory Surgery Center will provide patients with the benefits of the latest surgical technology and the convenience of a same-day center.”

The Orthopaedic and Neuro­surgery Center expects to perform 1,200 ambulatory procedures during its first year of operation.

The Ambulatory Surgery Center has four operating rooms equipped with the most advanced technology.

“The partnership with Greenwich Hospital in the Ambulatory Surgery Center will provide patients with the benefits of the latest surgical technology and the convenience of a same-day center.”

According to President and CEO Frank A. Corvino, “the ONS surgeons are very highly respected through­out our region. Over the last 15 years, the hospital has steadily enhanced its reputation as a center of excellence for orthopedic surgery and neurosurgery. This is a great opportunity to provide an improved, more efficient, high-quality service for our communities.”

The advantages of an ambulatory surgery center include lower costs for patients, and convenience.  Less “red tape” is required as compared to the admissions process at most hospitals. Patients also like being able to leave the center and return home more quickly.
Of major importance to surgeons is the greater efficiency of the ambulatory center which offers more control over procedures and standards.

The Ambulatory Surgery Center is comprised of four operating rooms that are equipped with the most advanced technology, including high-definition video cameras for arthroscopic procedures, state-of-the-art surgical equipment, and a full-service sterile processing facility. In the post-operative area, there are ten beds and a central nursing station. The facility is optimized for the highly-skilled staff to provide personalized patient care in an attractive, comfortable atmosphere designed to put patients at ease.

Dr. Crowe noted that the most common surgical cases that will be moved from the hospital to the Ambulatory Surgical Center include shoulder and knee arthroscopies, ACL reconstruction, and foot, hand and minimally invasive spine procedures.

The shift of orthopedic and neurosurgical ambulatory patients to the Center one day a week will open up additional operating room slots for surgeons seeking to perform inpatient procedures at the hospital.

Neurosurgeon to discuss Neck Pain and Treatments at Greenwich Hospital-May 18

Neck injury can be the result of a car accident, sports activity or a fall. Neck pain may also be caused by abnormalities in muscles, ligaments and nerves as well as conditions of the bones and joints such as arthritis or disc degeneration.

Dr. Amory Fiore

In fact, about two thirds of people will experience neck pain at some point in time. On Wednesday, May 18, at 7 p.m. Board-certified neurosurgeon Amory Fiore, MD of ONS (Orthopaedic and Neurosurgery Specialists) and Greenwich Hospital will present a talk on neck pain and conditions of the cervical spine in the Hyde Room at Greenwich Hospital. Dr. Fiore will discuss common causes of neck pain as well as the most effective conservative and surgical treatments. Admission is Free. To register, call Greenwich Hospital at 203-863-4277 or 888-305-9253.

Dr. Fiore graduated medical school at the College of Physicians and Surgeons at Columbia University in New York. He did his residency at The Neurological Institute of New York at Columbia University and did Fellowship training in Spine Surgery at the Emory Clinic in Atlanta, Georgia. He is Board Certified by the American Board of Neurological Surgery.

Pain in the Neck? Hear Board certified Neurosurgeon Amory Fiore, MD discuss neck pain and treatments

On Tuesday, February 1, at 6 p.m. Board-certified Neurosurgeon Amory Fiore, MD of ONS(Orthopaedic and Neurosurgery Specialists) and Greenwich Hospital will present a talk on neck pain and spinal conditions of the neck in the Noble Conference Center at Greenwich Hospital. Car accidents, sports activity and falls may cause injury to the neck.  Neck pain may also result from abnormalities in muscles, ligaments and nerves, and conditions of the bones and joints such as arthritis. Dr. Fiore will discuss common causes of neck pain as well as conservative and surgical treatments. Admission is Free. To register, call Greenwich Hospital at 203-863-4277 or 888-305-9253.

Pain in the Neck?

Date: Tuesday, February 1, at 6 p.m.
Where: Greenwich Hospital, Noble Conference Center

Admission is Free.

Spine Surgery Seminar at Greenwich Hospital – Tonight

Neurosurgeon Scott Simon, MD will speak on Minimally Invasive Spine Surgery

Minimally Invasive Spine Surgery (MISS) – What makes it better than open surgery?

On Wednesday, March 31 from 6:30 p.m. to 8 p.m., the ONS Foundation for Clinical Research and Education will present a talk at Greenwich Hospital on Why Minimally Invasive Spine Surgery (MISS) is better than open surgery? Continue reading “Spine Surgery Seminar at Greenwich Hospital – Tonight”