Case Study: How Multidisciplinary Collaboration Solved a Patient’s Back Pain

When 35-year-old woman came to us for help with migraines, she also mentioned she was experiencing back pain. The patient dismissed this as part of post-partum recovery, but our neurology ARNP noted it and took action – kicking off a comprehensive care process that started conservatively and led to a minimally invasive discectomy that completely alleviated her pain. This patient’s experience illustrates how the Eastside Neuroscience Institute (ENI) brings together experts from Overlake Medical Center and EvergreenHealth to quickly work across disciplines and offer a broad range of interventions, under one roof.

“We work to provide each patient with a detailed understanding of what’s causing neck and/or back symptoms and the different treatment options available,” says Brian Dial, MD, an orthopedic surgeon who addresses complex spinal deformities and is fellowship trained in pediatric and adult spinal deformities. “Then we use shared decision-making to decide on the best course of treatment. Ideally, we’ll select the least invasive intervention that allows patients to regain their lifestyle.”

When this patient’s back pain persisted, our ARNP ordered an MRI that revealed a disc herniation. The patient then saw one of our neurosurgery-trained spine surgeons, Jonathan Choi, MD, within a week.

“We talked through all the potential treatment options and their pros and cons, and I educated her on how a healthy diet and appropriate exercise could potentially make a big difference,” Dr. Choi says. “We decided on a conservative approach and I referred to one of our physiatrists, Seth Swank, DO.”

Dr. Swank is an interventional pain physician whose fellowship training emphasized non-opioid pain management. His close collaboration with Dr. Choi and others at NSI illustrates our goal of evaluating each patient as a team, via case conferences that bring together experts in several disciplines to develop tailored treatment plans.

“One benefit of being a multidisciplinary center is that we have many different treatments and non-surgical approaches at our disposal, so we can match patients with the approach that fits their goals,” Dr. Choi says.

Outside of our center, the patient completed physical therapy, massage therapy and saw a chiropractor. She also modified her diet. Unfortunately, the pain continued. The patient consulted Dr. Swank and decided to have us give her an epidural steroid injection.

When the pain was still present after a few weeks, she elected to pursue surgery with Dr. Choi, who is part of the Eastside Neuroscience Institute surgical team that specializes in minimally invasive approaches to spine surgery.

“Using a minimally invasive approach reduces retraction that can damage muscle and surrounding tissue, it decreases the risk of infection and excess blood loss, and patients typically have shorter recoveries with less pain than traditional surgery,” Dr. Choi says.

The patient underwent a right L4-5 and left L5-S1 minimally invasive discectomy in February 2022. Four weeks later, her back pain was completely gone and she was back to all of her normal activities – including caring for her new baby.

“We’re ecstatic that she had a good outcome,” Dr. Choi says, “and her case is a perfect example of how we do everything we can to work together and help each patient find the approach that’s right for them.”