PHYSICIAN-LED SPINE EVALUATION · DALLAS & PLANO
Back and Neck Pain
You may be a surgical candidate and still deserve a careful evaluation of whether surgery is the best next step.
Back pain rarely comes from a single structure. A thoughtful evaluation connects your symptoms, examination, movement, and imaging before recommending surgery or a nonsurgical treatment plan.
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​The spine is one connected structure. Dr. Westergaard treats it that way. Cervical, thoracic, lumbar and sacroiliac along with the peripheral joints that share the load. Each target is approached under the imaging that suits it: fluoroscopy with contrast confirmation for deep spinal structures and nerve roots, ultrasound for tendons, ligaments and superficial joints. Placement is verified before biologic is delivered, not inferred afterward.
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​Double board-certified physician, fellowship-trained in interventional spine and joint procedures under Gabor Racz, MD, a pioneer of the field.
ONE PATIENT’S EXPERIENCE
Back pain was taking over her life. Here’s her story nine months later.
One patient’s reported experience. Results vary; this outcome is not a guarantee of pain relief or avoiding surgery.
Explore other patient experiences. Individual results vary.
CLARITY BEFORE AN IRREVERSIBLE DECISION
Your MRI Is Important. It Is Not the Entire Story.
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MRI findings such as disc degeneration, bulges, stenosis, or arthritis may be clinically meaningful—but similar findings can also appear in people without disabling pain. Read when back surgery may be appropriate.​
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A responsible decision asks whether the image matches your pain pattern, neurologic exam, function, and response to prior care. Imaging is necessary. It is not the entire story.
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Cervical (Neck) Pain
Evaluation begins with your symptoms, neck and shoulder movement, strength, sensation, and reflexes. Dr. Deborah Westergaard reviews relevant imaging to assess discs, facet joints, nerve roots, ligaments, and supporting muscles. Pain traveling into an arm may involve a nerve in the neck, but an examination helps distinguish it from shoulder or peripheral nerve problems.
Possible care may include targeted rehabilitation, activity changes, medication review, or selected image-guided procedures. Orthobiologic treatment is considered only when the diagnosis, anatomy, and evidence support it. The imaging method is chosen for the target, with fluoroscopy and contrast for appropriate deep spinal procedures.
Surgical review may be needed for significant nerve or spinal cord compression. New or worsening weakness, hand clumsiness, or difficulty walking needs prompt medical evaluation. No procedure can guarantee that surgery will be avoided.
Thoracic (Mid-Back) Pain
Evaluation considers the mid-back, ribs, movement, and neurologic examination. Dr. Westergaard reviews relevant imaging when appropriate and considers whether symptoms may arise from discs, facet or rib joints, ligaments, or supporting muscles. Mid-back pain can also have causes outside the spine, so the diagnosis comes before a procedure.
Possible care may include rehabilitation, posture and activity changes, medication review, or selected image-guided procedures. Any orthobiologic option depends on the identified target, clinical findings, and evidence. Dr. Westergaard discusses expected benefits, risks, alternatives, and costs before recommending treatment.
Surgical or urgent medical review may be needed for fracture, infection, spinal cord compression, or progressive weakness. New loss of bladder or bowel control, or back pain with chest pain or trouble breathing, requires emergency evaluation.
Lumbar (Low Back) Pain
Evaluation considers your lower back, hips, leg symptoms, movement, strength, sensation, and reflexes. Dr. Westergaard reviews relevant imaging and assesses how discs, facet joints, sacroiliac joints, nerve roots, ligaments, and stabilizing muscles may contribute. Pain traveling into the buttock or leg may involve a lumbar nerve, but hip and other conditions can cause similar symptoms.
Possible care may include targeted rehabilitation, activity changes, medication review, or selected image-guided procedures. Orthobiologic options, including platelet-based procedures, are considered when the diagnosis, anatomy, and evidence support their use. Fluoroscopy with contrast is used for appropriate deep spinal targets. Benefits, risks, alternatives, and costs are discussed before treatment; results vary.
Surgical review may be appropriate for significant nerve compression, instability, or persistent disabling symptoms. New or worsening leg weakness needs prompt assessment. New urinary retention, loss of bladder or bowel control, or numbness in the saddle area requires emergency evaluation.
A COMPLETE EVALUATION
What Should Be Reviewed Before Back or Neck Surgery?
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The goal is to identify the probable pain generator and determine whether the proposed operation addresses it. This functional spinal unit evaluation considers the discs, facet joints, SI joints, nerves, ligaments, and stabilizing muscles together.
â—† Your pain pattern, neurologic symptoms, limitations, and personal goals
â—† A focused examination of strength, sensation, reflexes, motion, and stability
â—† Review of MRI and X-rays in the context of the clinical examination
â—† Possible contributions from discs, facet joints, sacroiliac joints, nerves, ligaments, and stabilizing muscles
â—† What prior treatments did, or did not, clarify about the source of pain
â—† Whether urgent surgical findings or progressive neurologic deficits are present
NOT ONE TREATMENT FOR EVERY SPINE
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Possible Nonsurgical Treatment Pathways
Targeted Rehabilitation
Movement, strength, load management, posture, and stabilization may be addressed through an individualized rehabilitation plan.
Diagnostic & Image-Guided Care
When appropriate, targeted diagnostic or therapeutic procedures may help clarify and address a specific pain generator. Read why image guidance matters for spine procedures.
Regenerative Options
Platelet lysate epidurals, bone marrow concentrate, PPP multifidus injections, and prolotherapy may be considered when the diagnosis, anatomy, and treatment target support their use.
No nonsurgical procedure is appropriate for every patient, and regenerative procedures should not be represented as reliably reversing advanced structural disease. Individual outcomes vary.
How does the pain source guide treatment?
Dr. Westergaard connects your symptoms, examination and imaging before selecting a treatment target. A disc procedure, facet injection, SI-joint injection and epidural approach address different structures.
Disc-related pain
A degenerative disc on MRI does not by itself establish the source of pain. The evaluation considers whether the disc findings fit your symptoms and whether any proposed disc-directed procedure is appropriate.
Facet-joint pain
The small joints behind the vertebrae can contribute to neck or back pain. Examination and selected diagnostic procedures may help determine whether a facet-directed treatment belongs in your plan.
Sacroiliac-joint pain
The SI joints connect the sacrum and pelvis. Assessment considers these joints alongside the lumbar spine and hips; an SI-joint target is distinct from a disc or epidural target.
Nerve-related symptoms
Pain traveling into an arm or leg may involve an irritated or compressed nerve. An epidural approach targets the area around spinal nerves. Significant compression or progressive neurologic deficits may require surgical assessment.
Any orthobiologic recommendation depends on the evidence for that specific diagnosis and target. Benefits, risks, alternatives, recovery and costs are discussed individually; evidence for knee treatment does not establish effectiveness in the spine. Learn more about spinal injection targets from AAOS.
BEFORE ANY PROCEDURE IS SCHEDULED
Treatment costs and coverage
Treatment plans are individualized. Cost depends on the structures involved and what your evaluation shows, so we do not publish fixed procedure prices.
You will receive a clear cost estimate before any procedure is scheduled. Nothing is booked until you have reviewed the estimate. Your evaluation is billed separately.
Orthobiologic procedures are generally not covered by traditional insurance. Regenexx employer benefits may cover eligible treatment, depending on your plan. Staff can help you identify questions to ask, but coverage is not guaranteed.
CareCredit financing is available, subject to credit approval.
Call (214) 750-6200 or read our payment and benefits FAQs before booking.
WHEN SURGERY MAY BE APPROPRIATE
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When Is Back or Neck Surgery the Better Choice?
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Surgery may be the more predictable option when neurologic deficits are progressing, the spine is unstable, or symptoms remain disabling after reasonable nonsurgical care. Emergencies such as cauda equina syndrome, infection, fracture, or tumor require prompt surgical evaluation. A second opinion should create clarity. It should not postpone necessary surgery.
A responsible evaluation has to be willing to recommend an operation. Fusion, decompression, or another procedure may be the sound next step for some people. The work of this visit is to match the plan to the problem, not to delay care that should not wait.
SIGNS THAT REQUIRE PROMPT CARE
Surgery may be the more appropriate option when there is progressive weakness, loss of bowel or bladder control, cauda equina syndrome, spinal instability, fracture, infection, tumor, severe neurologic compression, or disabling symptoms that remain unacceptable despite reasonable nonsurgical care.
The purpose of a second opinion is clarity - not delaying necessary surgery.
Fusion, decompression, or another procedure may be the sound next step for some people.
EDUCATIONAL VIDEOS
Understand Your Spine Before You Decide
When Surgery May Not Be the First Move
Why Your MRI May Not Tell the Full Story
When Back Surgery Truly Makes Sense
A Responsible Evaluation Must Be Willing to Recommend Surgery
PHYSICIAN-LED CARE
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Meet Deborah Westergaard, M.D.
Deborah Westergaard, MD completed an ACGME-accredited Pain Medicine fellowship at Texas Tech University and is double board-certified in Anesthesiology and Pain Medicine. In practice since 1989, she brings deep experience in anesthesiology and image-guided procedures to the evaluation and treatment of spine and joint pain. When nonsurgical treatment is appropriate, she performs these procedures herself.
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She earned her medical degree from LSU School of Medicine and completed anesthesiology training at UT Southwestern Medical Center. Her role is to explain the findings, define realistic expectations, and identify which patients are reasonable candidates for nonsurgical spine care and which are better served by surgical consultation.
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Read more about Dr. Westergaard. Individual patients describe their visits in the patient Reviews.
REGENEXX NETWORK AFFILIATION
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What Does Regenexx Affiliation Mean for Spine Care?
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Dr. Westergaard is a Regenexx-affiliated physician. Regenexx maintains standardized protocols for bone marrow concentrate and platelet procedures, along with a proprietary laboratory process performed on site rather than with a bedside centrifuge. Affiliated physicians are trained and credentialed in these protocols. Suitability for spine-related conditions still depends on diagnosis, examination, imaging, and goals.
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The network maintains a patient outcomes registry that supports ongoing published research in orthobiologics. A registry is not a guarantee of benefit for any one person. Details of Regenexx orthopedics at this practice, and additional reading on the practice blog, are available if you want protocol-level context before a visit.
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Frequently Asked Questions About Back Surgery Alternatives
Can back surgery always be avoided?
What are alternatives to lumbar fusion?
Can regenerative procedures repair a severely damaged spine?
What are the benefits of image-guided spine care?
Is a second opinion reasonable before back surgery?
What non-surgical spine care is available in Dallas?
How do I book a spine consultation in Plano?
EVIDENCE-INFORMED DECISION-MAKING
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Where Can You Read Independent Information About Back Pain?
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Independent organizations publish patient-facing information about back pain, spine conditions, surgery, and regenerative medicine claims. Reviewing a trusted source can help you prepare better questions for a consultation. These links are educational. They are not a diagnosis and they do not determine whether any treatment at Regen Experts is appropriate for you.
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American Academy of Orthopaedic Surgeons (OrthoInfo): Low Back Pain
North American Spine Society: Know Your Back
U.S. FDA: Important Patient and Consumer Information About Regenerative Medicine Therapies
MOVE FORWARD WITH CLARITY
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How Do You Request a Precision Spine Consultation?
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If back pain is limiting work, travel, or sleep, a physician-led review can help you understand whether surgery is the next step or whether other options remain reasonable. Patients seen in Dallas near Preston Center, and in Plano, often come from across North Dallas, including McKinney and Frisco. Request a careful review of your symptoms, examination, and imaging.
The next step is a conversation, not a predetermined procedure. Start from Regen Experts, review services, or contact the Dallas and Plano offices.
Educational information only. A consultation is required to determine whether any treatment is medically appropriate. Outcomes vary.
COSTS & COVERAGE
What will treatment cost?
Your evaluation is billed separately. Procedure costs depend on the treatment plan, so we provide an individualized estimate before scheduling.
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​Orthobiologic procedures are generally not covered by traditional insurance. Regenexx employer benefits may cover eligible treatment, depending on your plan. CareCredit is available, subject to credit approval.